Search

Background This pilot study examined intraoperative instructional techniques during “takeovers,” defined as the act of an attending taking control of a case from a resident. This work describes what happens during takeovers and identifies possible reasons for takeovers. Methods Intraoperative audio-video recordings during 25 laparoscopic inguinal hernia repair procedures were collected. Participants included 2 postgraduate year–5 residents and 5 attendings. Postoperative evaluation forms were completed by attendings. Coding schemes for takeovers during hernia reduction and mesh placement steps were developed using conventional and directed content analysis in an iterative process by study team members, including individuals with expertise in education, surgery, and surgical education. Results Takeovers occurred in 72% of cases. Frequency of takeovers was not related to case difficulty or differences in resident technical skill levels, nor did they decrease over the duration of the 2-month rotation. Takeovers most commonly occurred when a resident struggled to progress the case. They also occurred when anatomy was unclear or when the attending wanted to teach a specific skill. Differences were identified among attendings regarding frequency of takeovers. The majority of takeover behaviors were directed at instructing residents; however, attendings’ teaching techniques did not vary by resident. Conclusion Attending teaching habits appear to be independent of resident skills and depend on the attending’s teaching style rather than residents’ learning needs. Findings highlight the need for faculty development to help surgical educators learn how to tailor instruction to individual trainees. Additionally, future research is needed to establish the effectiveness of instruction through takeovers in the operating room.

Background Interest is growing in simulation-based continuing medical education courses for practicing surgeons. However, little research has explored the instruction employed during these courses. This study examines instruction practices used during an annual simulation-based continuing medical education course. Methods Audio–video data were collected from surgeon instructors (n = 12) who taught a simulated laparoscopic hernia repair continuing medical education course across 2 years. Surgeon learners (n = 58) were grouped by their self-reported laparoscopic and hernia repair experience. Instructors’ transcribed dialogue was automatically coded for 5 types of responses to the following questions: anecdotes, confirming, correcting, guidance, and what not to do. Differences in these responses were measured against the progress of the simulations and across learners with different experience levels. Postcourse interviews with instructors were conducted for additional qualitative validation. Results Performing t tests of instructor responses revealed that they were significantly more likely to answer in forms coded as anecdotes when responding to relative experts and in forms coded as what not to do when responding to novices. Linear regressions of each code against normalized progressions of each simulation revealed a significant relationship between progression through a simulation and frequency of the what not to do code for less-experienced learners. Postcourse interviews revealed that instructors continuously assess participants throughout a session and modify their teaching strategies. Conclusion Instructors significantly modified the focus of their teaching as a function both of their learners’ self-reported experience levels, their assessment of learner needs, and learner progression through the training sessions.