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Metacognition plays an important role in the professional development and growth of surgical educators. This work presents the development and pilot of the MAISE (Metacognitive Awareness Inventory for Surgical Educators). The MAISE is a novel tool for surgeons who are teaching residents in workplace-based learning environments and provides a framework for surgeons to consider their roles as educators and prompt reflection on potential areas for self-improvement.The MAISE was developed for the surgical context by a general surgery resident by revising 2 existing validated instruments designed to measure metacognitive processes related to teaching. The first version of the MAISE consisted of 35 statements designed to measure 7 subdimensions of metacognition (factors). A principal components analysis with a varimax rotation was conducted, and factor loadings greater than 0.4 were used to assign items to factors.The initial version of the MAISE was piloted by recruiting participants via email and social media platforms (Facebook and Twitter).Thirty participants who identified as attending surgeons with resident teaching responsibilities completed the initial version of the MAISE.Twenty-four of the 35 original items were included in the final version of the MAISE, which includes 5 factors. Final factors were determined based on item loadings. When items loaded on more than one factor, interpretability was used to decide which factor to which an item was assigned. Some factors were excluded due to lack of interpretability. This model explained 85% of the variance in the data.MAISE is a valid tool for assessing metacognition among surgical educators. Improving surgeons' metacognition of their teaching practices may advance the surgical field by promoting reflection on teaching processes and areas for growth. This will help surgical educators develop their teaching practices and to employ and model effective teaching with trainees.

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.

Background Given their variegated backgrounds, surgeons taking continuing medical education (CME) courses possess different learning needs. This study examines the relationship between surgeons’ levels of experience and the questions they asked in a simulation-based CME course. Methods We analyzed transcribed audio-video data collected from surgeons participating in a simulated laparoscopic hernia repair CME course and identified four types of questions learners posed to their instructors. Linear regressions compared how often these questions were asked versus self-reported operative experience. Results Both Requesting Guidance and Requesting Confirmation were inversely proportional to experience, whereas Asking About a Specific Case was directly proportional to experience. Requesting Instructor Preference exhibited no significant correlation with experience. Conclusion Practicing surgeons with relatively less experience tend to ask for confirmation and guidance, whereas those with greater experience tend to focus on specific hypothetical scenarios. This data can be used to tailor instruction based on learners’ self-reported experience level.