title: Teaching communication and supporting autonomy with a team-based operative simulator.
abstract: BACKGROUND
  Changing residency structure emphasizes the need for formal instruction on team leadership and intraoperative teaching skills. A high fidelity, multi-learner surgical simulation may offer opportunities for senior learners (SLs) to learn these skills while teaching technical skills to junior learners (JLs).
  
  
  METHODS
  We designed and optimized a low-cost inguinal hernia model that paired JLs and SLs as an operative team. This was tested in 3 pilot simulations. Participants' feedback was analyzed using qualitative methods.
  
  
  RESULTS
  JL feedback to SLs included the themes "guiding and instructing" and "allowing autonomy." Senior Learner feedback to JLs focused on "mechanics," "knowledge," and "perspective/flow." Both groups focused on "communication" and "professionalism."
  
  
  CONCLUSIONS
  A multi-learner simulation can successfully meet the technical learning needs of JLs and the teaching and communication learning needs of SLs. This model of resident-driven simulation may illustrate future opportunities for operative simulation.
authors.affiliation: Department of Surgery, ​Oregon Health and Science University, Mail Code L611, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. Electronic address: cookmac@ohsu.edu.
authors.forename: Mackenzie R
authors.initials: MR
authors.lastname: Cook
authors.affiliation: Department of Surgery, ​Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Shanley B
authors.initials: SB
authors.lastname: Deal
authors.affiliation: Department of Surgery, ​Oregon Health and Science University, Mail Code L611, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Scott
authors.affiliation: Department of Surgery, ​Oregon Health and Science University, Mail Code L611, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Alexis M
authors.initials: AM
authors.lastname: Moren
authors.affiliation: Department of Surgery, ​Oregon Health and Science University, Mail Code L611, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Laszlo N
authors.initials: LN
authors.lastname: Kiraly
mesh_terms: D002983:Clinical Competence; D003142:Communication; D003198:Computer Simulation; D005240:Feasibility Studies; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D013514:Surgical Procedures, Operative / Q000193:education*; D013663:Teaching / Q000458:organization & administration*
keywords: Inguinal hernia; Surgical education; Surgical simulation; Team training