Exploring the surgical residents' experience of teaching and learning process in the operating room: A grounded theory study

The Impact of Interactions with Nonsurgical Staff on the Surgical Resident Experience in the Nonoperative Clinical Learning Environment: A Qualitative Study

OBJECTIVE

Residents interact, collaborate with, and learn from nurses, advanced practice providers, and physicians in multiple specialties. Both positive and negative experiences in the clinical workspace can affect residents' well-being, their ability to learn, and their development into effective, independent physicians. The aim of this study is to evaluate the general surgery resident experience in the nonsurgical clinical learning environment to identify how interactions outside of the operating room affect resident well-being and their ability to learn. We hypothesize that surgical resident experience is impacted by nonoperative interactions with nonsurgical faculty and staff.

METHODS

Qualitative semi-structured interviews of 6 residents were performed to understand the impact of resident interactions with nonsurgical staff on their learning experience. Interviews were conducted virtually, transcribed verbatim, and de-identified. Two team members independently reviewed and coded interviews using thematic coding. Codes were then audited, and themes were identified.

RESULTS

Three major themes were identified, all of which highlighted the significance of resident interactions with other services. Communication barriers limit successful and positive resident experiences, with residents especially highlighting communication over the phone as a source of negative experiences. Preconceived perceptions of surgeons from others can lead to negative interactions. Finally, conflicting specialty goals and cultures can lead to challenges in resident training.

CONCLUSION

The surgical resident experience in the nonsurgical clinical learning environment is an integral part of resident training. The interactions outside of their surgical training environment play a role in well-being and their training experience. Improving communication skills across departments and a better-developed understanding of interdepartmental goals and cultures can lead to an improved training experience for general surgery residents.

The Surgical Education Checklist as an Adjunct to Training in the Operating Theatre: The Surgeons' Experience

BACKGROUND

An important aspect of surgical training occurs within the operating theatre. However, access to learning opportunities in this environment has been compromised by issues including reduced working hours and the COVID pandemic. Every training opportunity that does exist, therefore, needs to be maximized. The Surgical Education Checklist (SEC) is a tool that has been designed with the ambition of improving the quality and consistency of education-focused discussions in the operating theatre. The aim of this research was to explore the lived experience of surgeons who have used the SEC in practice.

METHODOLOGY

Phenomenological methodology, using purposive sampling, was employed. Seven semi-structured interviews were conducted via Zoom with participants, all of whom were consultant surgeons who had used the SEC. Reflective thematic analysis was used to identify key themes.

RESULTS

Four key themes were generated: the checklist formalizes the intuitive, the trainee-trainer relationship is central to the experience, preoperative discussion improves learning, and routine feedback is ideal but difficult.

DISCUSSION

Introducing the SEC to the operating theatre may improve the quality and consistency of education-focused discussions, such as preoperative goal setting and postoperative feedback, by providing structure for these conversations as well as a prompt to have the discussion at all. The trainee-trainer relationship is at the core of these behaviors. Trainers acknowledge the uncertainty that can impede trainees and that a tool such as this may help enable trainees to be more assertive regarding their educational needs and become more confident in the eyes of the trainer. If the SEC were widely implemented, it may help standardize good practice so that all surgeons, not just the natural educators, can deliver this for their trainees and provide trainees with a tool to help them be assertive about their training needs.

Examining the Applicability of Surgical Coaching Rules for Resident Autonomy in Non-teaching Hospitals

INTRODUCTION

This retrospective study aims to analyze the impact of standardized rules for teaching in university hospitals on surgical resident autonomy and patient safety, as measured by patient outcomes, and also examines the learning curves for residents and their impact on patient outcomes in a non-teaching hospital.

METHODS

The data for the study was collected retrospectively from medical records of 2000 adult patients who went through surgical procedures from January 2020 to December 2022. Participants were categorized into two groups based on the supervision level provided by attending surgeons and residents. Appropriate statistical methods were used to analyze the data.

RESULTS

It was observed that operative times of cases handled by both attending and resident surgeons were less than those handled by residents alone. On the other hand, the former group had a significantly higher burden of comorbidities and higher rate of perioperative complications than the latter. These results have important implications for the training of medical residents and the overall delivery of healthcare services in university hospitals.

CONCLUSION

The findings will also help towards better understanding of the effectiveness of these rules and their potential for improving the quality of care provided by residents in these settings.

Becoming a neurosurgeon in France: A qualitative study from the trainees' perspective

Introduction

The training of neurosurgeons is evolving in a world of socio-professional changes, including the technological revolution, administrative pressure on stakeholders, reduced working hours, geographical heterogeneity, generational changes, to name but a few.

Research question

This qualitative study aimed to explore experiences and feedback of French neurosurgical trainees concerning their training.

Material and methods

The grounded theory approach was used with 23 neurosurgical trainees' interviews. Inclusion was continued until data saturation. Six researchers (an anthropologist, a psychiatrist, and four neurosurgeons) thematically and independently analyzed data collected through anonymized interviews.

Results

Data analysis identified three superordinate themes: (1) The Trainee-Senior Dyad, where the respondents describe a similar bipolarity between trainees and faculty (trainees oscillating between those who fit into the system and those who are more reluctant to accept hierarchy, faculty using an ideal pedagogy while others refuse to help or invest in training); (2) The difficulty to learn (describing pressure exercised on trainees that can alter their motivation and degrade their training, including the impact of administrative tasks); (3) A pedagogy of empowerment (trainee' feelings about the pertinent pedagogy in the OR, ideal sequence to progress, progressive empowerment especially during the shifts, and stress of envisioning themselves as a senior neurosurgeon).

Discussion and conclusion

Respondents emphasize the heterogeneity of their training both intra- and inter-university-hospital. Their critical analysis, as well as the formalization of their stress to become autonomous seniors, can be an important link with the reforms and optimizations currently being carried out to improve and standardize the training of young French neurosurgeons.

Explanation of the professional development process of general surgery residents in the operating rooms: A situational analysis

INTRODUCTION

Numerous factors and elements are effective in the professional development of any field of study, including the educational structure, the individual characteristics of learners, and the educational atmosphere prevalent in the educational environment. Understanding each of these factors and elements and the relationships among them can guide educational system administrators in the direction of professional development. Surgical residents' professional development is no exception to this rule. As a consequence, the present research sought to explain and suggest a model for surgical assistant professional growth in Iranian operating rooms.

METHODS

The present research was a grounded theory study based on a post-positivist approach, in which data analysis was performed using Clark's situational analysis methodology by drawing three maps, situational map, social worlds/arenas map, and positional map.

RESULTS

In the presence of human and non-human factors, cultural, political, historical, and social components, the ordered situational map demonstrated the complexity of the operating room learning environment. The social worlds/arenas map confirmed the existence of several communities of practice wherein surgical residents were present with different power roles, and the positional map showed role of the educational level in the acquisition of the competence in the professional development pathway. Finally, the Triple Helix model of professional development was extracted, which has three components: psychological identity, social identity, and surgical competency.

CONCLUSION

The surgical residents' professional development in operating rooms occurs due to the acquisition of surgical competency along with the growth of individuals and socialization. As a result, all factors and components impacting the residents' competence development process in this learning environment must be identified and their linkages clarified.