Maintaining operative efficiency while allowing sufficient time for residents to learn
Surgical residents desire independent operating experience but recognize that attendings have a responsibility to keep cases as short as possible. We analyzed video and interviews of attending surgeons related to more than 400 moments in which the resident was the primary operator. We examined these...
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Veröffentlicht in: | The American journal of surgery 2019-07, Vol.218 (1), p.211-217 |
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creator | Sutkin, Gary Littleton, Eliza B. Kanter, Steven L. |
description | Surgical residents desire independent operating experience but recognize that attendings have a responsibility to keep cases as short as possible.
We analyzed video and interviews of attending surgeons related to more than 400 moments in which the resident was the primary operator. We examined these moments for themes related to timing and pace.
Our surgeons encouraged the residents to speed up when patient safety could be jeopardized by the case moving too slowly. In contrast, they encouraged the residents to slow down when performing a crucial step or granting independence. Attending surgeons encouraged speed through economical language, by substituting physical actions for words, and through the use of Intelligent Cooperation. Conversely, they encouraged slowing down via just-in-time mini-lectures and by questioning the trainee.
We present recommendations for safe teaching in the operating room while simultaneously maintaining overall surgical flow. Teaching residents to operate quickly can save time and is likely based on an automaticity in teaching. Slowing a resident down is vital for trainee skill development and patient safety.
•When teaching, maintain tight control over the pace of the case and safety of the patient.•Encourage residents to slow down when performing a crucial step or granting independence.•Encourage speed with economical language, substituting physical actions, and Intelligent Cooperation.•Slow down via just-in-time mini-lectures and by questioning the trainee.•We present an overall strategy for efficient, safe surgical teaching. |
doi_str_mv | 10.1016/j.amjsurg.2018.11.035 |
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We analyzed video and interviews of attending surgeons related to more than 400 moments in which the resident was the primary operator. We examined these moments for themes related to timing and pace.
Our surgeons encouraged the residents to speed up when patient safety could be jeopardized by the case moving too slowly. In contrast, they encouraged the residents to slow down when performing a crucial step or granting independence. Attending surgeons encouraged speed through economical language, by substituting physical actions for words, and through the use of Intelligent Cooperation. Conversely, they encouraged slowing down via just-in-time mini-lectures and by questioning the trainee.
We present recommendations for safe teaching in the operating room while simultaneously maintaining overall surgical flow. Teaching residents to operate quickly can save time and is likely based on an automaticity in teaching. Slowing a resident down is vital for trainee skill development and patient safety.
•When teaching, maintain tight control over the pace of the case and safety of the patient.•Encourage residents to slow down when performing a crucial step or granting independence.•Encourage speed with economical language, substituting physical actions, and Intelligent Cooperation.•Slow down via just-in-time mini-lectures and by questioning the trainee.•We present an overall strategy for efficient, safe surgical teaching.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2018.11.035</identifier><identifier>PMID: 30522695</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Automation ; Clinical Competence ; Cooperation ; Education, Medical, Graduate - methods ; Efficiency ; General Surgery - education ; Humans ; Internship and Residency ; Interviews ; Medical personnel ; Operating Rooms ; Pace ; Patient safety ; Qualitative research ; Safety ; Surgeons ; Surgeons - education ; Surgery ; Surgical outcomes ; Surgical teaching ; Teaching ; Videotape</subject><ispartof>The American journal of surgery, 2019-07, Vol.218 (1), p.211-217</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><rights>2018. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-3a17333ec01fc9bad5fe672d19495cadeebad1b8efc7e2d58e6859379f7d30773</citedby><cites>FETCH-LOGICAL-c393t-3a17333ec01fc9bad5fe672d19495cadeebad1b8efc7e2d58e6859379f7d30773</cites><orcidid>0000-0003-2772-1548 ; 0000-0002-0436-1503</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2239147827?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000,64390,64392,64394,72474</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30522695$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sutkin, Gary</creatorcontrib><creatorcontrib>Littleton, Eliza B.</creatorcontrib><creatorcontrib>Kanter, Steven L.</creatorcontrib><title>Maintaining operative efficiency while allowing sufficient time for residents to learn</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Surgical residents desire independent operating experience but recognize that attendings have a responsibility to keep cases as short as possible.
We analyzed video and interviews of attending surgeons related to more than 400 moments in which the resident was the primary operator. We examined these moments for themes related to timing and pace.
Our surgeons encouraged the residents to speed up when patient safety could be jeopardized by the case moving too slowly. In contrast, they encouraged the residents to slow down when performing a crucial step or granting independence. Attending surgeons encouraged speed through economical language, by substituting physical actions for words, and through the use of Intelligent Cooperation. Conversely, they encouraged slowing down via just-in-time mini-lectures and by questioning the trainee.
We present recommendations for safe teaching in the operating room while simultaneously maintaining overall surgical flow. Teaching residents to operate quickly can save time and is likely based on an automaticity in teaching. Slowing a resident down is vital for trainee skill development and patient safety.
•When teaching, maintain tight control over the pace of the case and safety of the patient.•Encourage residents to slow down when performing a crucial step or granting independence.•Encourage speed with economical language, substituting physical actions, and Intelligent Cooperation.•Slow down via just-in-time mini-lectures and by questioning the trainee.•We present an overall strategy for efficient, safe surgical teaching.</description><subject>Automation</subject><subject>Clinical Competence</subject><subject>Cooperation</subject><subject>Education, Medical, Graduate - methods</subject><subject>Efficiency</subject><subject>General Surgery - education</subject><subject>Humans</subject><subject>Internship and Residency</subject><subject>Interviews</subject><subject>Medical personnel</subject><subject>Operating Rooms</subject><subject>Pace</subject><subject>Patient safety</subject><subject>Qualitative research</subject><subject>Safety</subject><subject>Surgeons</subject><subject>Surgeons - education</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Surgical teaching</subject><subject>Teaching</subject><subject>Videotape</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkE1v1DAQhi1ERZfCTwBF4sIlwWOvY_uEUMWXVNRL4Wp57XFxlMSLnbTqv6-XXThw4WCNPPPMa-sh5BXQDij074bOTkNZ823HKKgOoKNcPCEbUFK3oBR_SjaUUtbqHug5eV7KUK8AW_6MnHMqGOu12JAf32ycl3rifNukPWa7xDtsMIToIs7uobn_GUds7Dim-wNT1tNoaZY4YRNSbjKW6GunNEtqRrR5fkHOgh0LvjzVC_L908ebyy_t1fXnr5cfrlrHNV9abkFyztFRCE7vrBcBe8k86K0WznrE2oOdwuAkMi8U9kpoLnWQnlMp-QV5e8zd5_RrxbKYKRaH42hnTGsxDIRQWgnFKvrmH3RIa57r7wxjXMNWKnYIFEfK5VRKxmD2OU42Pxig5iDeDOYk3hzEGwBTxde916f0dTeh_7v1x3QF3h8BrDruImZTfgtGHzO6xfgU__PEI17kmDU</recordid><startdate>201907</startdate><enddate>201907</enddate><creator>Sutkin, Gary</creator><creator>Littleton, Eliza B.</creator><creator>Kanter, Steven L.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2772-1548</orcidid><orcidid>https://orcid.org/0000-0002-0436-1503</orcidid></search><sort><creationdate>201907</creationdate><title>Maintaining operative efficiency while allowing sufficient time for residents to learn</title><author>Sutkin, Gary ; Littleton, Eliza B. ; Kanter, Steven L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c393t-3a17333ec01fc9bad5fe672d19495cadeebad1b8efc7e2d58e6859379f7d30773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Automation</topic><topic>Clinical Competence</topic><topic>Cooperation</topic><topic>Education, Medical, Graduate - methods</topic><topic>Efficiency</topic><topic>General Surgery - education</topic><topic>Humans</topic><topic>Internship and Residency</topic><topic>Interviews</topic><topic>Medical personnel</topic><topic>Operating Rooms</topic><topic>Pace</topic><topic>Patient safety</topic><topic>Qualitative research</topic><topic>Safety</topic><topic>Surgeons</topic><topic>Surgeons - education</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Surgical teaching</topic><topic>Teaching</topic><topic>Videotape</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sutkin, Gary</creatorcontrib><creatorcontrib>Littleton, Eliza B.</creatorcontrib><creatorcontrib>Kanter, Steven L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sutkin, Gary</au><au>Littleton, Eliza B.</au><au>Kanter, Steven L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Maintaining operative efficiency while allowing sufficient time for residents to learn</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2019-07</date><risdate>2019</risdate><volume>218</volume><issue>1</issue><spage>211</spage><epage>217</epage><pages>211-217</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><abstract>Surgical residents desire independent operating experience but recognize that attendings have a responsibility to keep cases as short as possible.
We analyzed video and interviews of attending surgeons related to more than 400 moments in which the resident was the primary operator. We examined these moments for themes related to timing and pace.
Our surgeons encouraged the residents to speed up when patient safety could be jeopardized by the case moving too slowly. In contrast, they encouraged the residents to slow down when performing a crucial step or granting independence. Attending surgeons encouraged speed through economical language, by substituting physical actions for words, and through the use of Intelligent Cooperation. Conversely, they encouraged slowing down via just-in-time mini-lectures and by questioning the trainee.
We present recommendations for safe teaching in the operating room while simultaneously maintaining overall surgical flow. Teaching residents to operate quickly can save time and is likely based on an automaticity in teaching. Slowing a resident down is vital for trainee skill development and patient safety.
•When teaching, maintain tight control over the pace of the case and safety of the patient.•Encourage residents to slow down when performing a crucial step or granting independence.•Encourage speed with economical language, substituting physical actions, and Intelligent Cooperation.•Slow down via just-in-time mini-lectures and by questioning the trainee.•We present an overall strategy for efficient, safe surgical teaching.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30522695</pmid><doi>10.1016/j.amjsurg.2018.11.035</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-2772-1548</orcidid><orcidid>https://orcid.org/0000-0002-0436-1503</orcidid></addata></record> |
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subjects | Automation Clinical Competence Cooperation Education, Medical, Graduate - methods Efficiency General Surgery - education Humans Internship and Residency Interviews Medical personnel Operating Rooms Pace Patient safety Qualitative research Safety Surgeons Surgeons - education Surgery Surgical outcomes Surgical teaching Teaching Videotape |
title | Maintaining operative efficiency while allowing sufficient time for residents to learn |
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