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17 How to Teach Technical and Judgment Skills Eectively from Outside the Operating Room (Including…
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Table 17.1 Zwisch proposed model for Teaching and Assessment in the operating room (level designated based on
supervision provided for the majority of the key portions of the case)
173
Developmental Trajectories
Trainees should be progressively developing
technical skill and judgment simultaneously over
the course of their training. Faculty development
and resident education using organized developmental frameworks can build a common vision
among all shareholders in a training program.
These frameworks guide assessment, feedback,
and goals for deliberate practice. Huang et al.
described ve stages of development with associated narrative descriptions to enhance feedback
and tracking of progress for trainees [8]. For a
given procedure or as part of a global assessment,
a resident may be designated as Technician,
Anatomist, Anticipator, Strategist, or Executive
(Table17.2).
Similarly, the ACGME Surgery Milestones
may be a useful tool for developing a shared
understanding of an anticipated developmental
trajectory and providing descriptive formative
feedback (Fig.17.2a, b, and c). The milestones
for “Performance of Procedures,” “Technical
Skills,” and “Anatomy” each include overlapping elements of technical skill and judgment.
For the ACGME milestones, it is important to
note that Level 4 is designated as the residency
graduation target [9]. Programs hoping to assess
resident progress in a more granular fashion
may utilize the Operative Performance Rating
System (OPRS) forms, initially developed at
Southern Illinois University [10]. These forms
include procedure- specic and global operative
performance items. Completed forms can be utilized to provide specic formative feedback to
trainees, and aggregate form data may provide
useful information for understanding training
gaps on a program level. The forms are currently a mandatory component of qualication
by residents for American Board of Surgery
(ABS) certication, and free links to the forms
and a user’s manual are available on the ABS
website at the following link: https://www.
absurgery.org/default.jsp?certgsqe_resassess.
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Table 17.2 Descriptive assessment tool for intraoperative performance
E. W. Riddle and C. E. Haisch
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Patient Care 2: Intra-Operative Patient Care – Performance of Procedures
175
Level 1
Demonstrates basic
skills (e.g., knot tying,
suturing)
Level 2Level 3Level 4Level 5
Performs bedside
procedures (e.g., central
line, chest tube)
Performs common
operations (e.g., hernia,
cholecystectomy,
appendectomy)
Teaches basic skills to
medical students and
junior residents
Teaches bedside
operations to junior
residents
Comments:
Patient Care 3: Intra-Operative Patient Care – Te chnical Skills
Level 1
Demonstrates limited
tissue-handling skills
Requires prompting to
identify appropriate
tissue plane
Moves forward in the
operation only with active
direction
Level 2Level 3Level 4Level 5
Inconsistently
demonstrates careful
tissue handling
Identifies appropriate
plane but requires
redirection to maintain
dissection in the optimal
tissue plane
Moves forward in the
operation but requires
prompting to complete the
operation
Consistently
demonstrates careful
tissue handling
Visualizes tissue plane,
identifies and dissects
relevant normal anatomy
Moves fluidly through the
course of the operation
and anticipates next steps
Performs complex
operations (e.g., low
anterior resection,
paraesophegeal hernia,
abdominal wall
reconstruction)
Teaches common
operations to junior
residents
Not Yet Completed Level 1
Not Yet Rotated
Adapts tissue handling
based on tissue quality
Visualizes tissue plane,
identifies and dissects
relevant abnormal
anatomy
Adapts to unexpected
findings and events
during the course of the
operation
Performs uncommon
complex operations (e.g.,
Whipple, esophagectomy)
Teaches complex
operations to junior
residents
Identifies innovative
operative techniques,
instrumentation, operative
approaches, or significant
improvement in
established techniques
Comments:
Not Yet Completed Level 1
Not Yet Rotated
Medical Knowledge 2: Anatomy
Level 1
Identifies normal
anatomy (e.g., inguinal
canal) during common
operations
Articulates the steps of
common operations
Comments:
Level 2Level 3Level 4Level 5
Identifies variations in
anatomy (e.g., bile duct
anatomic variations)
during common
operations
Articulates the
implications of varying
anatomy on the steps of
common operations
Identifies normal anatomy
(e.g., gastric blood
supply) during complex
operations
Articulates the steps of
complex operations
Identifies variations in
anatomy (e.g., replaced
right hepatic artery)
during complex
operations
Articulates the
implications of varying
anatomy on the steps of
complex operations
Not Yet Completed Level 1
Not Yet Rotated
Develops simulation
models for teaching
anatomy and operations
Leads anatomy instruction
for students and coresidents
Fig. 17.2 (a) ACGME surgery milestones - Performance of Procedures. (b) ACGME surgery milestones - Technical
Skills. (c) ACGME surgery milestones - Anatomy
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E. W. Riddle and C. E. Haisch
Conferences
Formal conferences are an important forum for
teaching technical skills and judgment.
Conference content will most commonly align
with the cognitive phase of skill development,
though it may be combined with psychomotor
practice when paired with hands-on simulation
activities. The necessity of teaching conferences
as a component of surgical education is reected
in explicit requirements for training programs
accredited by the ACGME.The ACGME requires
“a course or a structured series of lectures that
ensures education in the basic and clinical sciences fundamental to surgery…regular organized
clinical teaching, such as grand rounds, ward
rounds, and clinical conferences” and “a weekly
morbidity and mortality or quality improvement
conference.” [11] Visiting or partnering surgeons
may provide a signicant boost to a training program by increasing the educational value of
existing conferences and implementing new,
education- focused conference formats.
At sites that have little or no prior experience
with formal educational conferences, a rst step
may be identifying existing clinical conferences
or routine meetings and adding a dedicated educational element. Many clinical facilities hold a
daily sign-out meeting, morbidity and mortality
or other quality conference, and surgical planning meetings. Below, we highlight ways that
these conferences may add increased educational
value as well as suggesting other conference formats that may be implemented toward the goal of
teaching technical skills and judgment outside
the operating room.
Morning Report
Many institutions hold a daily morning meeting
to sign out overnight admissions and organize the
clinical service for the day. Depending on the size
of the institution and organization of the surgery
department(s), this meeting may include all surgeons at the institution or only those divisions or
surgeons who consistently receive acute overnight admissions. This type of conference has
been shown to have a major educational potential
[12], which can be optimized in several ways:
– Provide a consistent structure to the confer-
ence, and template the presentations.
– Select a dedicated “teaching case” at each
meeting.
– Protect the educational time for trainees, and
strongly recommend or require trainee and
faculty attendance.
– Encourage and model Socratic questioning.
– Ensure resources are available to review and
focus teaching around clinical data (i.e., abil-
ity to review radiology, clinical photos, labo-
ratory values, etc.).
– When possible, review relevant literature, and
provide follow-up on cases presented at prior
conferences.
Morbidity andMortality
Morbidity and mortality (M&M) conference is an
essential forum for peer review, individual and
institutional accountability, quality improvement,
professional identity development, and education.
M&M conferences vary in their specic structure
across institutions. However, most M&M conferences include presentations by trainees with an
emphasis on trainee education and surgical quality
improvement. Generally, a key focus of the conference is discussion of changes in technique,
judgment, or systems- based factors that could
have averted an adverse outcome or that could prevent future adverse outcomes. The M&M conference is particularly well-suited for discussions of
surgical judgment, especially when the conference
is well attended by faculty who engage in frank
discussions of the presented complications and
deaths. Factors that have been proposed to improve
the educational value of morbidity and mortality
conferences include [13–15]:
– Consistent attendance by trainees and faculty
surgeons.
– Designated conference moderator.
– Predetermined teaching point(s) for each case.
– Templated presentation format.
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– Listing of complications using a dened sys-
tem like Clavien-Dindo or National Surgical
Quality Improvement Project (NSQIP).
Case Conference/Public Mock Oral
Examination
Case conferences provide an opportunity to discuss surgical technique and judgment in cases
that do not come under review at M&M.Programs
may choose to emphasize “bread and butter”
cases, rare diseases, interesting techniques, or a
combination of these and more. Many programs
that hold this type of conference will review one
or two cases in a 1-hour conference. Frequently,
residents prepare and present the cases, though
faculty may also present. Ideally, most cases are
pulled from clinical practice at the local site. A
visiting surgeon may choose to present a case
from their home institution to highlight surgical
pathology or treatments that are rare or rarely
implemented at the local site. The educational
value of these conferences depends on the participation of experienced surgical faculty members to moderate the discussion and ensure
teaching points are accurate. In many settings,
the case will be worked through in an extended
“boards style” questioning, often starting with
the most junior learners for the basics of the history and physical exam and working up to senior
trainees to discuss the intraoperative decisionmaking. The questioning may be formalized as a
public mock oral examination. Harbor-UCLA
Medical Center reported implementation of a
series of six public mock oral board examinations
each year, administered by the program director
to senior residents in front of an audience of faculty, junior residents, and students. Examinees
and the audience reported high satisfaction with
the conference format, and the program reported
improved pass rates on the oral board exams [16].
Surgical Planning Conference
Surgical indications and planning conferences
provide a valuable opportunity to assess and
develop trainees’ judgment. Depending on the
local context and surgical volume, these conferences may be held as often as daily, typically in
the evening to review the next day’s cases, or as
infrequently as weekly or biweekly to review
particularly complex cases. This conference format serves an administrative purpose as well,
providing an opportunity to organize personnel
and resources for scheduled cases. Typically,
trainees prepare the case presentations, often
using a template to maintain efciency and
ensure all critical information is reviewed. As
noted in the paper by St. Martin, Moulton, and
colleagues [5], a surgical planning conference is
an ideal setting for faculty to probe the trainees’
understanding of anticipated slowing-down
moments. The preoperative discussion then scaffolds an intraoperative focus on key points in surgical judgment for that procedure.
Grand Rounds/Didactic Conference
Grand rounds and didactic conferences constitute
the core of formal education for most surgical
residency programs. These conferences may
include discussions of technique and judgment
among other important topics relating to the basic
sciences and clinical practice of surgery. Often
these conferences are conducted in a formal lecture format. While the lecture may be informative, it is unlikely to facilitate assessment or
in-depth discussion of trainees’ judgment.
However, these conferences do provide an opportunity for trainees to encounter expert-level judgment and descriptions of expert technique. This is
critical for the cognitive phase of procedural
training and, especially for more senior trainees,
may prompt development of more advanced
learning objectives for technique and judgment in
the operating room. Practically, grand rounds and
didactic lectures are among the easiest formats to
share virtually between remote partner sites and
may be low-hanging fruit for educational
collaboration.
Each conference format can clearly empha-
size judgment and thought processes, which are
crucial to surgical care. Traditionally, these con-
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ferences have been held in person. However, the
travel and in-person gathering restrictions
imposed by the COVID-19 pandemic forced
most groups, from individual surgical training
programs to international societies, into virtual
formats. After an adjustment period, the virtual
conferences proved efcacious in maintaining
their clinical and educational functions. In many
cases, groups saw increased attendance and
reached attendees at more sites using the virtual
format than the previous in-person format. The
virtual format provided the added benet of the
option of recording the sessions for asynchronous viewing. As the world reaches a new normal, many programs are transitioning to hybrid
in-person and virtual conferences to capture the
benets of each. The technology and experience
of virtual conferencing that arose from the pandemic can be applied moving forward to facilitate educational opportunities between remote
partners and for sites that previously had no
access to these valuable conferences.
Simulation
Simulation presents a valuable opportunity for
teaching technical skills and, in some cases, judgment, outside the operating room. Chapter 15
describes establishing simulation events.
Ongoing opportunities to practice in a simulated
setting are important for surgical trainees. Ideally,
this is deliberate practice, a concept dened by
Ericsson and colleagues that requires motivated
learners, clear objectives, focused and repetitive
practice, objective training goals, and specic
feedback [17]. A visiting or remote partner surgeon may help guide the development of local
simulation opportunities and actively teach trainees in person or virtually.
Specic simulation needs and opportunities
may vary signicantly between groups of trainees and clinical sites. Technical skills simulation
ranges from basic knot tying and suturing to virtual reality endovascular and robotic procedures.
The educational needs assessment should inform
efforts in simulation. A valuable resource to
guide the development of simulation capacity
and augment simulation teaching with multimedia is the American College of Surgeons/
Association for Program Directors in Surgery
(ACS/APDS) Surgery Resident Skills
Curriculum. This curriculum is available online
(https://www.facs.org/for- medical- professionals/
education/programs/acs- apds- surgery- residentskills- curriculum/) at no cost to faculty and resi-
dents, though it is necessary to register for the
program. The curriculum is divided into three
phases. Phase 1 includes 16 modules focused on
basic surgical skills. Phase 2 includes 15 modules
focused on more advanced surgical skills. Phase
3 includes ten modules focused on teamwork and
communication. Each module includes a faculty
guide to setting up the simulation activity, and
many modules include multimedia photo and
video guides that trainees can reference to guide
their ongoing practice.
Virtual engagement in simulation activities
has been shown to be successful. Remote videoconference instruction has been shown to effectively augment trainees’ practicing of basic
knot-tying skills [18]. A collaboration between
institutions in Canada and Botswana described
“telesimulation” for intraosseus line insertion
and laparoscopic skills [19, 20]. The telesimulation setup involved preparing a room at each
location with the simulation model and two cameras attached to a laptop. One camera at each site
was trained on the simulation model, while the
other camera showed the person using the model.
The two video feeds were transmitted to two
screens in each location along with an audio feed
via Skype, allowing the trainee and instructor to
see and hear each other and view the movements
on the simulation model in real time. In the laparoscopic skills telesimulation trial, 16 participants in Botswana were provided with a
Fundamentals of Laparoscopic Surgery (FLS)
DVD and access to a standard FLS simulator. All
participants were instructed to practice the FLS
skills for 2hours per week. In addition, half the
participants received 15 minutes per week of
telesimulation mentoring from an instructor in
Canada. At the conclusion of the 8-week trial,
two surgeons from Canada traveled to Botswana
to administer ofcial FLS certication skills
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exams to participants. The participants in the
telesimulation group had higher scores in every
FLS task compared to the self-practice group,
and eight of eight surgeons in the telesimulation
group earned overall passing FLS skills scores,
compared to only three of eight in the self-practice group. This setup may be adapted for simulation across a wide range of technical skills.
Notably, equipment for simulation, especially commercially available items, may be
quite expensive. Basic technical skills, such as
knot tying and suturing, can be taught with relatively little equipment. Expired suture or other
consumables that can no longer be used for
patients should be reserved for simulation.
Expensive synthetic skin substitutes are not
necessary to practice suturing—pig skin,
chicken skin, or banana peels will sufce, and
at least one of these is available in most locales.
Even for laparoscopy, a wide range of low-cost
simulators have been described for practicing
basic skills [21]. For sites with a challenge to
allocate even a few basic instruments for technical skills simulation, exploring opportunities
at national or regional simulation centers may
be productive. Finally, partner sites with welldeveloped simulation centers and curriculum
may develop a focused simulation experience
as part of any trainee exchange trips with partner programs.
Video-Based Teaching
Video-based teaching has been successfully
implemented in surgical training across a wide
range of specialties and settings [22]. Advances
in video technology and proliferation of endoscopic procedures have made video-based teaching increasingly available and valuable in surgical
training. Cameras may be comfortably headmounted, incorporated in the surgical lights, or
mounted in the operating room. Videos from
cameras or endoscopes may be recorded for
future viewing or live-streamed. These video
resources provide an excellent opportunity for
teaching skills and judgment outside the operating room.
Live-streaming of video allows a surgeon to
replicate a “show and tell” approach to intraoperative teaching with a remote audience. When
technical capabilities and time zones allow, this
may be a very effective method of teaching intraoperative judgment and demonstrating technical
skills. Live-streaming may especially be useful to
teach cases that are rare at a partner site or when
local teaching faculty is limited. Another promising technology is telementoring, where a remote
surgeon views a live-streamed operation and provides commentary and direction in real time.
Initially, this approach was primarily utilized in
laparoscopic surgery with various platforms that
allowed the remote surgeon to provide guidance
and even make marks on the screen at the operative site [23]. More recently, telementoring systems have been developed that enable remote
guidance and annotation on the surgical eld in
open operations via a tablet suspended over the
operation [24] or through an augmented-reality
headset that captures the operating surgeon’s
view and projects markings onto smart glasses
[25]. The technical requirements and costs of
these systems are variable, and programs would
need to make an independent determination of
their utility at a given site. Additionally, telementoring may introduce complicated questions
about legal and ethical responsibility depending
on the relative capabilities of the local and remote
surgeons. However, the technology is promising
as part of a training system and in settings where
local surgeons may have no feasible options to
transfer a patient.
Increasingly, video-based resources are being
used as routine tools for education and preoperative preparation by trainees and surgeons in practice. A 2017 study found that 98.6% of
respondents from a group of surgical faculty and
trainees had used video to prepare for surgery
[26]. A signicantly higher percentage of trainees reported using videos as their preferred
method of case preparation and used videos signicantly more often compared to surgeons in
practice. Trainees were more likely to use
YouTube, SCORE, and WebSurg videos, while
surgeons in practice were more likely to use videos from society webpages or commercially
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available videos. Finally, younger surgeons most
valued didactic illustrations and narration in a
video, while older surgeons most valued technical skill. Though this was a single-site study, it
does raise important considerations for videobased teaching. Trainees are likely to use videos
for case preparation and likely to seek videos
from open access sites. Programs interested in
optimizing video-based teaching may consider
curating recommended videos or producing their
own videos for resident review to ensure content
is consistent with local technique, equipment,
and standard of care.
In the postoperative setting, video-based
coaching has proven benecial for surgical trainees and for surgeons in practice [27]. This
approach can improve technical skills and judgment as a complimentary tool for surgical training, surgical performance, and quality
improvement. Surgical coaching has specically
been highlighted as a potentially valuable tool for
continuous performance improvement and collaboration with surgeons in LMICs, helping to
build surgical capacity and quality [28]. Hu and
colleagues described a video-based coaching
intervention for surgical trainees [29]. In their
study, senior residents (post-graduate year 4 or 5)
were video-recorded performing an open operation with their faculty supervisor. The video captured the operative eld and operating room. The
resident and faculty coach had a subsequent
coaching session utilizing the video between 0
and 43 days after the procedure. The coaches
received an instructional pamphlet on “Coaching
Residents,” but no other specic guidance was
provided for the coaching session. The coaching
sessions were audio-recorded, and researchers
compared teaching in the operating room to
teaching in the coaching session. Faculty surgeons made more teaching points per time in the
coaching session than in the operating room.
Teaching in the coaching sessions was also found
to be more resident-centered, more focused on
reection and critical thinking by the resident,
and more in-depth. Finally, the content of the
coaching session complemented the intraoperative teaching, with signicantly more focus on
intraoperative decision-making and failure to
progress in the coaching session and signicantly
more focus on progress through the case and
anatomy in the operating room.
The Wisconsin Surgical Coaching Program
was developed as a statewide initiative for surgeons in practice [30]. This program paired participating surgeons with peer-nominated surgeons
who received special training in coaching techniques. Coaches were trained in a 4-hour in-person session supplemented with a coaching
manual and instructional videos. Coaching sessions were 1hour in length and included review
of a video- recorded operation by the coachee.
The activities of the session included goal setting, collaborative video analysis, feedback, and
action planning, with a focus on technical, cognitive, interpersonal, and stress management skills.
Coaches and coachees were satised with their
participation, though no long-term outcome data
has been collected to date.
Video is a valuable resource with many possible applications in surgical training. The specic uses of video at a given site will depend on
local needs, technological capacity, and ethical or
legal limitations on use of intraoperative video.
Where feasible, video-based teaching can overcome barriers of time and distance to facilitate
effective teaching in technical skills and operative judgment.
Independent Study
Independent study is a necessary component of
surgical training. The effectiveness of most training opportunities, whether in the operating room,
simulation, or conferences, relies on adequate
preparation by the trainee. Local, visiting, and
remote faculty may facilitate effective independent study by thoughtfully recommending
resources to trainees and mentoring trainees as
they develop lifelong learning skills. The lifelong
learning strategies are critically important, as
they will enable program graduates to efciently
and effectively assimilate new knowledge and
techniques that will arise throughout their careers.
In fact, one of the 18 ACGME Surgery Milestones,
“Reective Practice and Commitment to Personal
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Growth,” focuses on the developing surgeon’s
ability to design and implement an individual
learning plan.
Ideally, recommended independent study
materials will reference current evidence and
technology but should also be relevant in the
local context. The surgical and educational needs
assessment should inform the provision and
development of educational resources. In any setting, a library of at least a few current editions of
surgical textbooks provides an excellent resource
for trainees to develop foundational knowledge
of surgical science, management, and technique.
At sites with reliable Internet access and sufcient technology (computers, tablets, smartphones), a wide range of subscription and
open-access educational materials are available.
The Surgical Council on Resident Education
(SCORE) online portal, available at surgicalcore.
org, includes hundreds of modules with learning
objectives, detailed content, linked textbook and
video references, and self-assessment via discussion questions and multiple-choice quizzes. The
content covers a wide range of topics related to
general surgery and fellowship-level content for
some subspecialties, including pediatric surgery,
surgical critical care, surgical oncology, and vascular surgery. Notably, SCORE merged with the
American Board of Surgery in 2019, and the
SCORE curriculum is now aligned with the content of the American Board of Surgery Qualifying
Exam. Access to the SCORE program is available through a yearly subscription. Programs pay
a $500 (USD) annual license fee and $175 for
each trainee as of 2022. The annual program
license fee includes accounts for the program
director, program coordinator, and ve faculty or
administrative personnel. The program account
includes the ability to create and manage assignments for trainees to tailor the curriculum to local
program needs. The SCORE curriculum outlines
and proposed weekly topic schedule for “This
Week in Score” are available at https://surgical-
core.org/public/curriculum. The curriculum out-
lines and weekly topic schedule may be a valuable
reference for faculty and trainees even at programs that cannot or choose not to subscribe to
the full content.
Another commercial program is Decker
Surgery, which offers continuously updated
online curricular materials for surgery residents
through the Surgery Weekly Curriculum™, intraining and board exam preparation materials,
continuing medical education (CME) and maintenance of certication (MOC) opportunities,
and a teaching slide library. Decker also offers a
program designed for medical students called
Step into Surgery (SiS). Decker’s programs are
available through individual, program, or institutional subscriptions at varying costs. More information is available at https://www.deckerip.com/
products/surgery/.
The College of Surgeons of East, Central and
Southern Africa (COSECSA) has developed an
online learning platform for its members. School
for Surgeons (www.schoolforsurgeons.net) is
available to all COSECSA trainees, members,
and fellows. Available content includes mandatory case studies and Surgery in Africa Journal
Club modules for candidates. Through a collaboration with the Royal College of Surgeons in
Ireland, the website links to several surgical and
medical journals and textbooks. The website also
has a focused section for surgical trainers with
faculty development resources. Finally, the website hosts the Surgical Foundations in Basic
Science curriculum, which was successfully
introduced in January 2020 [31]. The curriculum
is designed for independent study by trainees as
preparation for ipped-classroom tutorial sessions with surgical faculty.
Increasingly, surgical societies are providing
free online educational materials. Trainees can be
directed to these materials for self-study if they
have sufcient technological resources. Most
North American societies publish their online
materials in English, and visiting faculty must
consider the relevance of materials that are not in
the primary language of local trainees and faculty. Examples of free, online surgical society
resources include:
– The Society of American Gastrointestinal and
Endoscopic Surgeons (SAGES) has published
the didactic content for their Fundamentals of
Laparoscopic Surgery™ (FLS), Fundamentals
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of Endoscopic Surgery™ (FES), Fundamental
Use of Surgical Energy™ (FUSE), and Safe
Cholecystectomy programs online at fesdi-
dactic.org. These programs are available to
anyone who registers with a valid email
address and are published in English, French,
Spanish, and Chinese.
– The American Society of Colon and Rectal
Surgeons (ASCRS) has several resources
available through its website. For trainees,
they have developed the ASCRS Trainee Boot
Camp video series (https://fascrs.org/
healthcare- providers/for- residents/colorectalsurgery- boot- camp) covering basic topics in
colorectal surgical practice. Their Core
Subject Update covers 24 core subjects in a
rotating 4-yearcycle. The recorded presentations by selected experts are available for
viewing at https://fascrs.org/healthcare-
providers/education/core- subjects.
Podcasts
Podcasts are an increasingly popular medium of
entertainment and education [32]. Podcasts are
audio-only recordings, typically available for
free, and often listened to on mobile devices,
though they are available on laptop and desktop
computers as well. Access requires a compatible
device and at least intermittent Internet access—
most podcast episodes are available for download
and thus do not require continuous Internet
access.
The rst surgery-focused podcast to gain popularity was Behind the Knife (behindtheknife.
org), created in 2015 by a group of residents at
Madigan Army Medical Center. Behind the Knife
now has almost 500 episodes with a wide range
of topics and formats including focused review of
surgical diseases, interviews with leaders in their
eld, journal clubs and literature updates, and
preparation for in-training and board exams. In
2018, an independent, bimonthly podcast focused
on vascular surgery was developed. That podcast,
Audible Bleeding, remains active and is supported by the Society for Vascular Surgery. More
recently, many surgical societies have developed
and published their own podcasts including the
Society for Surgery of the Alimentary Tract
(SSAT Soundbites), Society of American
Gastrointestinal and Endoscopic Surgeons
(SAGES Stories), Society of Surgical Oncology
(SurgOnc Today & Speaking of SurgOnc),
Society of Thoracic Surgeons (Surgical Hot
Topics), and the Americas Hepato-PancreatoBiliary Association (The AHPBA Podcast and
The AHPBA Podcast—Latin America).
Podcasts can be a valuable tool for independent study by individual trainees or assigned to a
group of residents for asynchronous education.
Ideally, podcast recommendations are curated by
a surgical faculty to optimize impact. The recommender should review the materials and consult
the results of the local educational needs assessment or work collaboratively with local faculty
and trainees to ensure the podcasts are contextually relevant and level appropriate for the assigned
audience. Podcasts may be especially useful for
education in surgical judgment, as many available episodes include experts discussing their
approach to common and challenging surgical
problems.
Conclusion
Teaching technical skill and judgment is the core
of surgical training. Certainly, skill and judgment
are primarily attained through experience in the
operating room. Yet valuable opportunities exist
to teach skills and judgment outside the operating
room, augmenting and accelerating the trainee’s
progress toward independence. Visiting surgeons
and remote partners may have limited opportunities to teach trainees in the operating room for a
variety of reasons. However, these surgeons may
still contribute signicantly to the training of surgeons at partner sites. Conferences, simulation,
video-based teaching, and coaching all provide
rich opportunities for surgeons to supercharge the
cognitive phase of procedural training and provide feedback that is necessary for effective
deliberate practice in the psychomotor phase.
Соседние файлы в папке @xirurgi_2025