title: From novice to master surgeon: improving feedback with a descriptive approach to intraoperative assessment.
abstract: BACKGROUND
  A developmental and descriptive approach to assessing trainee intraoperative performance was explored.
  
  
  METHODS
  Semistructured interviews with 20 surgeon educators were recorded, transcribed, deidentified, and analyzed using a grounded theory approach to identify emergent themes. Two researchers independently coded the transcripts. Emergent themes were also compared to existing theories of skill acquisition.
  
  
  RESULTS
  Surgeon educators characterized intraoperative surgical performance as an integrated practice of multiple skill categories and included anticipating, planning for contingencies, monitoring progress, self-efficacy, and "working knowledge." Comments concerning progression through stages, broadly characterized as "technician," "anatomist," "anticipator," "strategist," and "executive," formed a narrative about each stage of development.
  
  
  CONCLUSIONS
  The developmental trajectory with narrative, descriptive profiles of surgeons working toward mastery provide a standardized vocabulary for communicating feedback, while fostering reflection on trainee progress. Viewing surgical performance as integrated practice rather than the conglomerate of isolated skills enhances authentic assessment.
authors.affiliation: Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA, 94143-0470, USA. Electronic address: Emily.Huang2@ucsf.edu.
authors.forename: Emily
authors.initials: E
authors.lastname: Huang
authors.affiliation: Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA, 94143-0470, USA.
authors.forename: Susannah M
authors.initials: SM
authors.lastname: Wyles
authors.affiliation: Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA, 94143-0470, USA.
authors.forename: Hueylan
authors.initials: H
authors.lastname: Chern
authors.affiliation: Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA, 94143-0470, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Kim
authors.affiliation: Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Sullivan
mesh_terms: D000046:Academic Medical Centers; D002140:California; D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D000068156:Formative Feedback; D066296:Grounded Theory; D006801:Humans; D007396:Internship and Residency; D007407:Interviews as Topic; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D033262:Narration; D036301:Qualitative Research; D066231:Surgeons / Q000193:education*
keywords: Assessment; Feedback; Intraoperative development; Skill; Surgical education; Teaching