title: How surgical mentors teach: a classification of in vivo teaching behaviors part 2: physical teaching guidance.
abstract: OBJECTIVE
  To study surgical teaching captured on film and analyze it at a fine level of detail to categorize physical teaching behaviors.
  
  
  METHODS
  We describe live, filmed, intraoperative nonverbal exchanges between surgical attending physicians and their trainees (residents and fellows). From the films, we chose key teaching moments and transcribed participants' utterances, actions, and gestures. In follow-up interviews, attending physicians and trainees watched videos of their teaching case and answered open-ended questions about their teaching methods. Using a grounded theory approach, we examined the videos and interviews for what might be construed as a teaching behavior and refined the physical teaching categories through constant comparison.
  
  
  METHODS
  We filmed 5 cases in the operating suite of a university teaching hospital that provides gynecologic surgical care.
  
  
  METHODS
  We included 5 attending gynecologic surgeons, 3 fellows, and 5 residents for this study.
  
  
  RESULTS
  More than 6 hours of film and 3 hours of interviews were transcribed, and more than 250 physical teaching motions were captured. Attending surgeons relied on actions and gestures, sometimes wordlessly, to achieve pedagogical and surgical goals simultaneously. Physical teaching included attending physician-initiated actions that required immediate corollary actions from the trainee, gestures to illustrate a step or indicate which instrument to be used next, supporting or retracting tissues, repositioning the trainee's instruments, and placement of the attending physicians' hands on the trainees' hands to guide them. Attending physicians often voiced surprise at the range of their own teaching behaviors captured on film. Interrater reliability was high using the Cohen κ, which was 0.76 for the physical categories.
  
  
  CONCLUSIONS
  Physical guidance is essential in educating a surgical trainee, may be tacit, and is not always accompanied by speech. Awareness of teaching behaviors may encourage deliberate teaching and reflection on how to innovate pedagogy for the teaching operating room.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, Pittsburgh, Pennsylvania. Electronic address: gsutkin@magee.edu.
authors.forename: Gary
authors.initials: G
authors.lastname: Sutkin
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Eliza B
authors.initials: EB
authors.lastname: Littleton
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Kanter
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003142:Communication; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007398:Interpersonal Relations; D008297:Male; D008505:Medical Staff, Hospital; D008611:Mentors / Q000523:psychology*; D009873:Operating Rooms; D012494:Sampling Studies; D066231:Surgeons / Q000193:education / Q000523:psychology*; D013663:Teaching / Q000145:classification*; D014481:United States; D014741:Video Recording
keywords: Interpersonal and Communication Skills; Patient Care; Systems-Based Practice; attending physicians; fellow physician; medical education; resident physician; surgical education; video recording