Association for Academic Surgery (AAS)

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Best Practices in Resident Teaching

Last week, AAS President-Elect Justin Dimick posed a question to the AAS Twitter Community:

The question was posed after several faculty (@jdimick1, @AmaliaCochranMD, @DHBBaylorMed) discussed “Best Practices” for intraoperative teaching and quickly reached the conclusion that these practices are largely unknown. The twitter conversation had a number of interesting responses and several consistent themes emerged from the residents:

1. Feedback!

Several residents requested feedback, and more importantly honest feedback. Some residents felt coddled at times in the OR, too often told that they are doing “great” with little meaningful critique or guidance. Dr. Tom Varghese (@TomVargheseJr) noted that his department even has a formal teaching curriculum on how to give and receive feedback effectively.

Further discussion revealed some key best practices for giving and receiving feedback. It needs to be timely (@LVSelbs says within 15 minutes, or else “everyone forgets the nitty gritty specifics, which is needed for discussion”). It needs to be honest, with both good elements and things to work on (@ShihTerry). It needs to be given early in an attending’s interactions with the residents (e.g. the first week of a rotation), with follow-up later to identify areas of progress (@minervies – “Note improvement over time”).

2. Focused learning goals

A focused preoperative briefing, combined with postoperative feedback has been used in formal interventions aimed at improving intraoperative teaching (Anderson CI, Gupta RN, Larson JR, et al. Impact of objectively assessing surgeons’ teaching on effective perioperative instructional behaviors. JAMA Surg. 2013 Oct;148(10):915-22). From the perspective of several of our resident responders, setting goals and expectations in advance helps guide the teaching efforts intraoperatively. It also contributes significantly to the ability to give appropriate feedback, since you can debrief how well you progressed towards your previously stated goals.

3. Autonomy and the chance to struggle

Every resident remembers the first case, big or small, that he or she completed truly independently. It’s a marker of progress that stands out in time. It is also, from my experience at least, truly terrifying. Struggling without a safety net makes you think more about the consequences of each move you make. This opportunity for independent practice is, from the perspective of a resident, a critical stage in development. From the faculty’s perspective, it is one of the most difficult to allow. @AmirGhaferi, in a discussion offline, expressed that this has been very hard as a junior faculty—to balance your patients’ expectations (and their safety!) with providing appropriate autonomy.

4. Have patience:
Last but not least, have patience with us as we try to learn, and remember:

Please join in the conversation and leave us your best teaching pearls on twitter (@AcademicSurgery) and in the comments section below!

Education Resources:

If you have other helpful links for educators, please share them as well!

Christopher Scally

Christopher Scally, MD is a fifth year General Surgery resident at the University of Michigan, currently pursuing a post-doctoral research fellowship under the mentorship of Justin Dimick, John Birkmeyer, and Sandra Wong. He has a passion for surgery education, as well as in Health Policy and the cost of healthcare.

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