Presentation is loading. Please wait.

Presentation is loading. Please wait.

Perspectives On Intraoperative Teaching: Divergence and Convergence Between Learner and Teacher Charles M. Vollmer, Jr., MD Lori R. Newman, M.Ed Grace.

Similar presentations


Presentation on theme: "Perspectives On Intraoperative Teaching: Divergence and Convergence Between Learner and Teacher Charles M. Vollmer, Jr., MD Lori R. Newman, M.Ed Grace."— Presentation transcript:

1 Perspectives On Intraoperative Teaching: Divergence and Convergence Between Learner and Teacher Charles M. Vollmer, Jr., MD Lori R. Newman, M.Ed Grace Huang, M.D. Julie Irish, Ph.D. James Hurst, MD Karen D. Horvath, MD BETH ISRAEL DEACONESS MEDICAL CENTER A member of CAREGROUP APDS Meeting, Boston, MA, March 25, 2011

2 We have nothing to disclose

3 Evolution of Surgical Education The Craft of Surgery

4 Evolution of Surgical Education Virtual Learning

5 10,000 Hours What’s happening here?

6 The MisMatch Pugh CM, J Surg Ed, 2007 Area of knowledgeResidentsFaculty Instrument use/selection111 Selection of suture material212 Operative field exposure37 Patient Positioning49 Sequence of Procedures55 Procedure Choices64 Postoperative care78 Follow-up procedures810 Patient Selection96 Anatomy102 Patient Outcomes113 Natural History of the Disease121

7 Adult Learning Principles Are self-directed learners and problem solvers. Bring a foundation of prior learning and life experiences that must be recognized and utilized. Seek feedback on their performance. Transfer new learning to future experiences. Are motivated by the process of metacognition. Reznick RK, Am J Surg, 1993 Residents (Adults): Andragogy - Malcolm Knowles

8 Is there a process of teaching in the operating room? How frequently are adult- learning principles employed?

9 Methods Simultaneous, parallel survey to: Faculty (N=59) and Residents (N=60) 5 institutions affiliated with BIDMC Prior needs assessment, literature review, external input sought Answers based solely on teaching in the intraoperative or procedural setting April - June 2009

10 Survey Design General demographics Quantitative questions (n=38) Teaching strategies themed on ALPs, some habits Frequency (1 = “never use” to 5 = “always use”) Ranking of preferred techniques General effectiveness of teaching Open-ended questions 1)“In your opinion, what other techniques define effective operative teaching?” 2) “Describe techniques you feel the faculty could improve” 3) “List three major impediments to teaching in the OR.” Iterative pattern qualitative analysis

11 Quantitative Questions Operating room learning environment (n=11) Preoperative teaching and assessment (n=6) Intraoperative teaching (n=16) Postoperative debriefing (n=5) “I encourage residents to verbalize their thought processes.” “The faculty encourage you to verbalize your thought processes.” 4 Domains

12 Attending Demographics Mean years as an attending 17 (1-43) Academic rank  Instructor - 31%  Assistant Professor – 39%  Associate Professor – 19%  Full Professor – 11% Full time academic appointment 83% % Teaching Effort – 50% (21-40% of their time) Teaching awards – 60%, mean = 1.5 (0-8) Formal medical education training obtained N=5 Responses: Residents 77%, Faculty 63%

13 Results  “Ask which specific skills the learner wants to practice/perform in the operation”  “Criticize learner if expectations are not met”  “Allow learner to operate alone”  “Take over the operation if learner does not keep pace”  “Refer to previous experiences”  “Refer to, or provide, illustrations” Disagreement on 32/38 strategies Agreement on: Only 4 rated higher by residents – Negative connotations

14 Results Most frequently employed strategy Faculty “Set and communicate high standards” Mean =4.6 Residents “Demonstrate technical consistency” Mean = 4.0

15 Results Most frequently employed strategy Faculty “Set and communicate high standards” Mean =4.6 Residents “Demonstrate technical consistency” Mean = 4.0 Least frequently employed strategy Both “Ask learner for suggestions on how you might improve your teaching” Mean = 1.5, 1.9

16 Subgroup Analyses Junior (PGY1-2) vs. Senior (PGY3-5) Residents “Provide spontaneous presentations relevant to the case” Junior vs. Senior Academic Rank “Allow learner to perform critical technical steps” “Allow learner to operate alone” (1.8 vs. 2.7) Experienced vs. Less Experienced Faculty “Allow learner to perform critical technical steps” “Provide immediate feedback to the learner” “Demonstrate technical consistency”

17 Valued Strategies - I Learning Environment Residents Faculty #1 Allow for graduated learner autonomy (59%) Allow for graduated learner autonomy (39%) #2 Create a supportive learning environment (24%) Set and communicate high standards (36%)

18 Valued Strategies - II Preoperative Assessment ResidentsFaculty #1 Ask learner to describe sequential “steps” of the operation (61%) Discuss case preoperatively with learner (75%) #2 Discuss case preoperatively with learner (48%) Discuss potential operative pitfalls with learner (53%)

19 Valued Strategies - III Intraoperative Teaching ResidentsFaculty #1 Allow learner to perform critical technical steps (52%) Provide immediate feedback to learner (39%) #2 Provide immediate feedback to learner (39%) Demonstrate technical steps for learner (33%)

20 Valued Strategies - IV Postoperative Debriefing ResidentsFaculty #1 Provide specific examples of what learner needs to improve (85%) Provide specific examples of what learner needs to improve (81%) #2 Provide specific examples of what learner did well (44%) Provide specific examples of what learner did well (69%)

21 OR Teaching Effectiveness FacultyResidents Very Poor02% Poor3%17% Average23%39% Good49%30% Very Good27%11%

22 OR Teaching Effectiveness FacultyResidents Very Poor02% Poor3%17% Average23%39% Good49%30% Very Good27%11%

23 Qualitative Analysis Communication issues (n=59) Time considerations (n=55) Work and learning environment (n=51) Teacher engagement (n=36) Patience/Tolerance (n=35) Autonomy (n=33) Feedback (n=31) Learner preparedness (n=31) Patient advocacy/Legal considerations (n=23) 9 Themes Emerge

24 Qualitative Analysis Resident Quotes: “Fear of judgment if not technically perfect or asking good questions.” “External demands on attendings for cases to be finished quickly – clinic, meetings, rounds, subsequent cases, home demands.” Faculty Quotes: “Residents being distracted by pages from the floor, or as the consult resident.” “Systematically, good teaching isn’t something that will happen without a department-wide dedication to making it a priority.” Work and Learning Environment

25 Conclusions Teaching techniques based on Adult Learning Principles are in play in the OR…. to various degrees Resident and faculty perceptions of the frequency of their use are disparate. While faculty seem to value most of these strategies, they overestimate their actual use. Qualitative analysis yields common themes which provide a foundation for educational process improvements.

26 Opportunities Multi-institutional, national assessment Dissect teaching of various surgical skill-sets  Open  Laparoscopic Assess best teaching practices along the continuum of surgical education  Fellows  Students Development of peer-review instruments

27 Acknowledgments Dr. Richard Bell (American Board of Surgery) Dr. Paul Greig ( University of Toronto) Dr. Karen Horvath (University of Washington)

28 Perspectives On Intraoperative Teaching: Divergence and Convergence Between Learner and Teacher Charles M. Vollmer, Jr., MD Lori R. Newman, M.Ed Grace Huang, M.D. Julie Irish, Ph.D. James Hurst, MD Karen D. Horvath, MD BETH ISRAEL DEACONESS MEDICAL CENTER A member of CAREGROUP APDS Meeting, Boston, MA, March 25, 2011


Download ppt "Perspectives On Intraoperative Teaching: Divergence and Convergence Between Learner and Teacher Charles M. Vollmer, Jr., MD Lori R. Newman, M.Ed Grace."

Similar presentations


Ads by Google