How Surgical Mentors Teach: A Classification of In Vivo Teaching Behaviors Part 1: Verbal Teaching Guidance

Objectives To illuminate surgical teaching at a fine level of detail by filming intraoperative communication between surgical attending physicians and trainees and provide a naturalistic categorization and analysis of verbal teaching behaviors. Design Live, intraoperative verbal exchanges between su...

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Veröffentlicht in:Journal of surgical education 2015-03, Vol.72 (2), p.243-250
Hauptverfasser: Sutkin, Gary, MD, Littleton, Eliza B., PhD, Kanter, Steven L., MD
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container_title Journal of surgical education
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creator Sutkin, Gary, MD
Littleton, Eliza B., PhD
Kanter, Steven L., MD
description Objectives To illuminate surgical teaching at a fine level of detail by filming intraoperative communication between surgical attending physicians and trainees and provide a naturalistic categorization and analysis of verbal teaching behaviors. Design Live, intraoperative verbal exchanges between surgical attending physicians and their trainees (residents and fellows) were filmed, and key verbal teaching moments were transcribed. In follow-up interviews, attending physicians and trainees watched video clips of their teaching case and answered open-ended questions about their surgical teaching methods. Using a grounded theory approach, we examined the videos and interviews for what might be construed as a teaching behavior and refined verbal teaching categories through constant comparison. Setting We filmed 5 cases in the operating suite of a university teaching hospital that provides gynecologic surgical care. Participants We included 5 attending gynecologic surgeons, 3 fellows, and 5 residents for this study. Results More than 6 hours of film, 3 hours of interviews, and more than 400 verbal teaching utterances from our participating attending surgeons were transcribed. We found that attending surgeons used unique types of verbal guidance to describe relevant anatomy, explain the rationale behind a specific surgical action, command the trainee to perform the next step, reference a specific aspect of the surgery, and provide an indirect verbal construct. Attending physicians prefixed speech with polite terms and used terse language, colorful verbal analogies, and sometimes humor. Our participants denied a significant Hawthorne effect. Interrater reliability was high using Cohen κ with 0.77 for the verbal categories. Conclusions Our categorization of live intraoperative verbal teaching can provide a measurable, replicable basis for studying how spoken guidance can lead to the best intraoperative learning. Because surgical teaching occurs on a microscopic level, film review is important when analyzing intraoperative teaching behaviors.
doi_str_mv 10.1016/j.jsurg.2014.10.003
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Design Live, intraoperative verbal exchanges between surgical attending physicians and their trainees (residents and fellows) were filmed, and key verbal teaching moments were transcribed. In follow-up interviews, attending physicians and trainees watched video clips of their teaching case and answered open-ended questions about their surgical teaching methods. Using a grounded theory approach, we examined the videos and interviews for what might be construed as a teaching behavior and refined verbal teaching categories through constant comparison. Setting We filmed 5 cases in the operating suite of a university teaching hospital that provides gynecologic surgical care. Participants We included 5 attending gynecologic surgeons, 3 fellows, and 5 residents for this study. Results More than 6 hours of film, 3 hours of interviews, and more than 400 verbal teaching utterances from our participating attending surgeons were transcribed. We found that attending surgeons used unique types of verbal guidance to describe relevant anatomy, explain the rationale behind a specific surgical action, command the trainee to perform the next step, reference a specific aspect of the surgery, and provide an indirect verbal construct. Attending physicians prefixed speech with polite terms and used terse language, colorful verbal analogies, and sometimes humor. Our participants denied a significant Hawthorne effect. Interrater reliability was high using Cohen κ with 0.77 for the verbal categories. Conclusions Our categorization of live intraoperative verbal teaching can provide a measurable, replicable basis for studying how spoken guidance can lead to the best intraoperative learning. Because surgical teaching occurs on a microscopic level, film review is important when analyzing intraoperative teaching behaviors.</description><identifier>ISSN: 1931-7204</identifier><identifier>EISSN: 1878-7452</identifier><identifier>DOI: 10.1016/j.jsurg.2014.10.003</identifier><identifier>PMID: 25456208</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>attending physicians ; Clinical Competence ; Curriculum ; Education, Medical, Graduate - methods ; fellow physician ; Female ; Gynecology - education ; Helping Behavior ; Hospitals, Teaching ; Humans ; Interdisciplinary Communication ; Internship and Residency - methods ; Male ; medical education ; Mentors ; Missouri ; Observer Variation ; Operating Rooms ; resident physician ; Surgery ; surgical education ; Teaching</subject><ispartof>Journal of surgical education, 2015-03, Vol.72 (2), p.243-250</ispartof><rights>Association of Program Directors in Surgery</rights><rights>2014 Association of Program Directors in Surgery</rights><rights>Copyright © 2014 Association of Program Directors in Surgery. 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Design Live, intraoperative verbal exchanges between surgical attending physicians and their trainees (residents and fellows) were filmed, and key verbal teaching moments were transcribed. In follow-up interviews, attending physicians and trainees watched video clips of their teaching case and answered open-ended questions about their surgical teaching methods. Using a grounded theory approach, we examined the videos and interviews for what might be construed as a teaching behavior and refined verbal teaching categories through constant comparison. Setting We filmed 5 cases in the operating suite of a university teaching hospital that provides gynecologic surgical care. Participants We included 5 attending gynecologic surgeons, 3 fellows, and 5 residents for this study. Results More than 6 hours of film, 3 hours of interviews, and more than 400 verbal teaching utterances from our participating attending surgeons were transcribed. We found that attending surgeons used unique types of verbal guidance to describe relevant anatomy, explain the rationale behind a specific surgical action, command the trainee to perform the next step, reference a specific aspect of the surgery, and provide an indirect verbal construct. Attending physicians prefixed speech with polite terms and used terse language, colorful verbal analogies, and sometimes humor. Our participants denied a significant Hawthorne effect. Interrater reliability was high using Cohen κ with 0.77 for the verbal categories. Conclusions Our categorization of live intraoperative verbal teaching can provide a measurable, replicable basis for studying how spoken guidance can lead to the best intraoperative learning. 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subjects attending physicians
Clinical Competence
Curriculum
Education, Medical, Graduate - methods
fellow physician
Female
Gynecology - education
Helping Behavior
Hospitals, Teaching
Humans
Interdisciplinary Communication
Internship and Residency - methods
Male
medical education
Mentors
Missouri
Observer Variation
Operating Rooms
resident physician
Surgery
surgical education
Teaching
title How Surgical Mentors Teach: A Classification of In Vivo Teaching Behaviors Part 1: Verbal Teaching Guidance
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