Teaching on the run: teaching skills for surgical trainees

The role of trainees as clinical teachers of medical students in psychiatry

OBJECTIVE

To consider the role of specialty trainees as clinical teachers of medical students in psychiatry.

METHOD

We discuss the role of specialty trainees as teachers and approaches to improving their skills and capacity, giving examples from the local and international literature and our own experience as psychiatry medical educators.

RESULTS

Good clinical teaching is crucial for medical students' learning but sharp increases in numbers combined with economic and workforce pressures have stretched capacity. Specialty trainees do much of the medical student teaching during their clinical placements but infrequently receive instruction on how to teach. The two common approaches to increasing capacity are, first, establishing education rotations for individual trainees and, second, providing workshops to improve trainees' confidence and skill. Psychiatry trainees surveyed in New South Wales welcomed the role of teacher and the opportunity to improve their teaching capacity. Further support from supervisors, health services and medical schools is needed to assist trainees in their teaching role.

CONCLUSION

The role that trainees play as clinical teachers should be acknowledged and supported. Further development of research and scholarship in medical education is needed to determine how best to teach trainees to teach.

Back to the bedside: the 8-year evolution of a resident-as-teacher rotation

BACKGROUND

Teaching our residents to teach is a vital responsibility of Emergency Medicine (EM) residency programs. As emergency department (ED) overcrowding may limit the ability of attending physicians to provide bedside instruction, senior residents are increasingly asked to assume this role for more junior trainees. Unfortunately, a recent survey suggests that only 55% of all residencies provide instruction in effective teaching methods. Without modeling from attending physicians, many residents struggle with this responsibility.

OBJECTIVES

We introduced a "Resident-as-Teacher" curriculum in 2002 as a means to address a decline in bedside instruction and provide our senior residents with a background in effective teaching methods.

DISCUSSION

Here, we describe the evolution of this resident-as-teacher rotation, outline its current structure, cite potential pitfalls and solutions, and discuss the unique addition of a teach-the-teacher curriculum.

CONCLUSION

A resident-as-teacher rotation has evolved into a meaningful addition to our senior residents' training, fostering their growth as educators and addressing our need for bedside instruction.

The teaching of surgery in the undergraduate curriculum. Part II--Importance and recommendations for change

In the past decade, the teaching of surgery in the undergraduate curriculum has undergone considerable changes in quantity, mode and method of delivery. This is a result of the radical reforms of higher education, the health service and the undergraduate medical curriculum. The changes are complex and require us to ask the questions: how important is the teaching of surgery in the modern medical undergraduate curriculum and is there a need for change? We aim to tackle these questions and propose practical action which medical schools can take to ensure that they deliver effective surgical teaching within the modern medical curriculum and health service.

Potential errors and their prevention in operating room teamwork as experienced by Finnish, British and American nurses

This study describes how the potential sources of errors and error prevention in operating room (OR) teams are experienced by Finnish, American and British nurses. The data were collected by interviews and analysed using a qualitative content analysis. Results consisted of categories demanding teamwork practice, shared responsibility in teams and organized teamwork. The demanding practice category included fear of errors, turnover in teams, overtime work and emotional distress as potential factors leading to errors in OR teamwork. Shared responsibility emphasized how the familiar teams, safety control and formal documentation of errors prevented errors. At the organizational level, the prevention of errors required scheduling of work, good management, competency and a reasonable physical environment. In order to improve safety in OR teams, recognition should be given to the balance of error-making and learning from them. More effective ways in reporting incidents should be adopted and overall reporting systems should be developed in Finnish OR teams.

Learning about teamwork in operating room clinical placement

The aim of nursing students' operating room (OR) clinical practice is to gain experience of the perioperative nursing process and to develop skills related to the practice within OR teams in a variety of situations. However, it has previously been problematic to get enough practical experience within OR teams because of the general urgency, e.g. rapid turnover and flow of emergency cases, and preceptors' multiple responsibilities related to their simultaneous need to work as team members. This study describes how Finnish, British and American nursing students (n = 30) experienced learning about teamwork during their OR placement period. The critical incident technique was used for data collection, and data were analysed using a descriptive phenomenological method. Three types of teamwork emerged based on the students' perceptions: functional manifestation of OR teamwork, gaining OR team membership and technical orientation of OR teamwork. The findings are discussed in relation to OR practice, education and research on ways to improve teamwork while maintaining a satisfactory OR learning context and stimulating interest in perioperative nursing.

The in-house education of clinical clerks in surgery and the role of housestaff

BACKGROUND

While on surgical rotations, clinical clerks spend more time on the ward and in the emergency department than in any other location. Consequently, their in-house experience is of great importance to their education-yet the teaching processes in these settings have never been fully explored. Unlike the structured pre-clerkship years, the exact breakdown of a clerk's hospital-based education is difficult to elucidate. To effectively evaluate a clerkship curriculum, it is essential to know what clerks are being taught outside of seminars, how that teaching occurs, and by whom. This study proposes a methodology by which a surgical clerkship curriculum can be evaluated.

METHODS

For the purpose of the study, surgery clerks carried written and audio logs of their informal teaching encounters during one on-call period (30 hours). These included who taught them, where, by what methods, for how long, and what prompted the teaching. A survey of similar variables was administered to all clerks who rotated through general surgery over 4 months and to all general surgery residents.

RESULTS

Four clerks returned completed logs (100% response rate), and 17 clerks (85% response) and 15 residents (100% response) were surveyed. Audiotaped and written logs were similar, demonstrating good recall. Students recorded an average of 11 teaching encounters (range 3 to 20) per 30 hour period, lasting a total of 73 minutes (range 17 to 178) and each 6.7 +/- 14 minutes long. Both logs and surveys identified most teaching as unsolicited, done mostly by junior and chief residents, focused chiefly on diagnosis and using a Socratic style. Most teaching occurred in the operating room, yet its occurrence was unpredictable; in surveys the emergency room and clinic settings were perceived as more important. Staff surgeons contributed 27% of the logged encounters yet were perceived in surveys as the least contributors. Residents' and clerks' perceptions of teaching were similar except for residents overvaluing the amount of senior teaching (P = 0.04). The resident level correlated significantly with the comfort of teaching (r = 0.618, P = 0.04). Senior residents encouraged more problem-solving, whereas juniors favored minilectures. Only one resident had received formal teaching instruction.

CONCLUSIONS

Informal teaching of surgery clerks is variable and occurs through multiple short encounters in many settings and by various trainees. Efforts to improve the teaching process should focus on providing formal teaching instruction early in residency, specifically geared toward short encounters in flexible settings. Both the operating room as a learning environment and staff surgeons as informal teachers must be intentionally integrated into the teaching process.

Students' evaluation of surgical seminars in a teaching hospital

AIM

To evaluate the surgical seminars given for medical students at Auckland University and factors affecting them, so as to define areas for improvement.

METHODS

A confidential questionnaire was completed by fourth-year medical students for each surgical seminar they attended during an academic year. The seminars were repeated four times during the year. The questionnaire consisted of five statements relating to whether the seminar was stimulating, problem- oriented, patient-centred, evidence-based and interactive. The students rated each statement on a 7-point scale.

RESULTS

556 questionnaires evaluating 28 clinical teachers were collected. A generalized linear model showed that the clinical teachers (F=4.16, P = 0.0001), the attachment (F=4.39, P=0.005) and the interaction between the seniority and institute (F=6.38, P=0.019) had a significant effect on the rating of the seminars. University consultants and hospital registrars had the highest overall least-squares mean, followed by hospital consultants, while university lecturers had the lowest overall least-squares mean (5.56, 5.4, 5.18, and 4.36, respectively). Ratings for problem-oriented approach improved over the studied period, while ratings of evidence-based and patient-centred approaches remained lower. University consultants and hospital registrars had the best patient-centred approach compared with hospital consultants and university lecturers (least-squares means 5.52, 5.4, 5.01, 4.18, respectively). Hospital registrars showed the best interactive ability ratings (least-squares mean 5.51) while university lecturers had the least stimulating seminars (least-squares mean 4.46).

CONCLUSIONS

Surgical seminars which were introduced to cover surgical topics had acceptable ratings in each of the teaching domains, although there is a need for improvement in the patient-centred and evidence-based approaches.