Effective Perioperative Instructional Behavior
Original Investigation Research
Too Many Excuses for Not Teaching in the Operating Room and One Simple Solution Faculty Feedback P. J. Schenarts, MD; Kristin Flowers, MD
Surgical residents are performing fewer operations.1 Both surgical trainees2 and program directors3 are concerned about graduating residents’ readiness to enter practice and ability to perform procedures independently after completing residency. As a result, the importance of effective intraoperative teaching is coming into greater focus. While declining resident duty hours are frequently cited as the etiology of these concerns, this explanation alone is too simplistic. There are other significant obstacles that disrupt intraoperative resident education. The unstructured operative experience; intolerance of errors; the realities of the finanRelated article page 915 cial landscape; and the everpresent push for greater efficiency all have a significant negative impact on education. Finally, there has also been a fundamental disruption in the sequence of resident training, with assignments frequently based on coverage needs rather than the educational benefit to the trainee. As a result, junior residents are fre-
quently assigned to complex operations for which they are illprepared and from which they reap little educational benefit. While these obstacles are real, they do not relieve the faculty of their educational obligation. The focus of this article by Anderson et al4 on improving faculty performance is an important contribution to the literature. The current educational model requires faculty surgeons with little formal training in the art of teaching to assume the bulk of responsibility for surgical education. Focusing on the perioperative briefing and debriefing periods, the most important finding was that simply providing feedback data to faculty without any other intervention resulted in a 250% improvement. In the era of limited resources, this approach could be easily applied to all types of clinical training at essentially no cost. The final phase of this study, which required the residents to actively seek feedback, proves that creating an educational culture is achievable; a follow-up study to confirm the sustainability of these findings would strengthen this assertion.
Conflict of Interest Disclosures: None reported.
Author Affiliation: Department of Surgery, University of Nebraska, College of Medicine, Omaha (Schenarts, Flowers).
Corresponding Author: P. J. Schenarts, MD, Department of Surgery, University of Nebraska, College of Medicine, 983280 Nebraska Medical Center, Omaha, NE 68198-3280 (paul.schenarts @unmc.edu). Published Online: August 14, 2013. doi:10.1001/jamasurg.2013.2154.
1. Fairfax LM, Christmas AB, Green JM, Miles WS, Sing RF. Operative experience in the era of duty hour restrictions: is broad-based general surgery training coming to an end? Am Surg. 2010;76(6):578-582. 2. Yeo H, Viola K, Berg D, et al. Attitudes, training experiences, and professional expectations of US general surgery residents: a national survey. JAMA. 2009;302(12):1301-1308.
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3. Bell RH Jr, Biester TW, Tabuenca A, et al. Operative experience of residents in US general surgery programs: a gap between expectation and experience. Ann Surg. 2009;249(5):719-724. 4. Anderson CI, Gupta RN, Larson JR, et al. Association between surgeons’ teaching and effective perioperative instructional behavior [published online August 14, 2013]. JAMA Surg. doi:10.1001/jamasurg.2013.2144.
JAMA Surgery October 2013 Volume 148, Number 10