Exploring the Content of Intraoperative Teaching.
BACKGROUND
Much teaching to surgical residents takes place in the operating room (OR). The explicit content of what is taught in the OR, however, has not previously been described. This study investigated the content of what is taught in the OR, specifically during laparoscopic cholecystectomies (LCs), for which a cognitive task analysis (CTA), explicitly delineating individual steps, was available in the literature.


METHODS
A checklist of necessary technical and decision-making steps to be executed during performance of LCs, anchored in the previously published CTA, was developed. A convenience sample of LCs was identified over a 12-month period from February 2011 to February 2012. Using the checklist, a trained observer recorded explicit teaching that occurred regarding these steps during each observed case. All observations were tallied and analyzed.


RESULTS
In all, 51 LCs were observed; 14 surgery attendings and 33 residents participated in the observed cases. Of 1042 observable teaching points, only 560 (53.7%) were observed during the study period. As a proportion of all observable steps, technical steps were observed more frequently, 377 (67.3%), than decision-making steps, 183 (32.7%). Also when focusing on technical and decision-making steps alone, technical steps were taught more frequently (60.9% vs 43.3%).


CONCLUSIONS
Only approximately half of all possible observable teaching steps were explicitly taught during LCs in this study. Technical steps were more frequently taught than decision-making steps. These findings may have important implications: a better understanding of the content of intraoperative teaching would allow educators to steer residents' preoperative preparation, modulate intraoperative instruction by members of the surgical faculty, and guide residents to the most appropriate teaching venues.
Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: lpernar@partners.org.
Luise I M
LI
Pernar
Center for Experiential Learning, University of Rochester Medical Center, Rochester, New York.
Sarah E
SE
Peyre
Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Rian M
RM
Hasson
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
Stuart
S
Lipsitz
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
Katherine
K
Corso
Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Stanley W
SW
Ashley
Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
Elizabeth M
EM
Breen
D017081:Cholecystectomy, Laparoscopic / Q000193:education*; D013502:General Surgery / Q000193:education*; D007396:Internship and Residency / Q000379:methods*; D007432:Intraoperative Period
Interpersonal and Communication Skills; Medical Knowledge; Patient Care; cholecystectomy; communication; operating room; residents; teaching