Residents Think in the "Now" and Supervisors Think Ahead in the Operating Room. A Survey Study About Task Perception of Residents and Supervising Surgeons

Patrick Nieboer; Fokie Cnossen; Martin Stevens; Mike Huiskes; Sjoerd K Bulstra; Debbie Adc Jaarsma

doi:10.1016/j.jsurg.2020.06.010

Residents Think in the "Now" and Supervisors Think Ahead in the Operating Room. A Survey Study About Task Perception of Residents and Supervising Surgeons

J Surg Educ. 2021 Jan-Feb;78(1):104-112. doi: 10.1016/j.jsurg.2020.06.010. Epub 2020 Jul 2.

Authors

Patrick Nieboer¹, Fokie Cnossen², Martin Stevens³, Mike Huiskes⁴, Sjoerd K Bulstra³, Debbie Adc Jaarsma⁵

Affiliations

¹ Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: p.nieboer01@umcg.nl.
² Department of Artificial Intelligence, Bernouilli Institute of Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, the Netherlands.
³ Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands.
⁴ Center for Language and Cognition, University of Groningen, Groningen, the Netherlands.
⁵ Center for Research and Innovation in Medical Education, University Medical Center Groningen, Groningen, the Netherlands.

PMID: 32624449
DOI: 10.1016/j.jsurg.2020.06.010

Abstract

Objective: Progressive autonomous task performance is the cornerstone of teaching residents in the operating room, where they are entrusted with autonomy when they meet their supervisors' preferences. To optimize the teaching, supervisors need to be aware of how residents experience parts of the procedure. This study provides insight into how supervisors and residents perceive different tasks of a single surgical procedure.

Design: In this qualitative survey study a cognitive task analysis (CTA) of supervisors and residents for the 47 tasks of an uncemented total hip arthroplasty was executed. Both groups rated the level of attention they would assign to each task and were asked to explain attention scores of 4 or 5.

Setting: University Medical Centre Groningen (the Netherlands) and its 5 affiliated teaching hospitals.

Participants: Seventeen supervising surgeons and 21 residents.

Results: Normal attention (median attention score 3) was assigned by supervisors to 34 tasks (72.3%) and by residents to 35 tasks (74.5 %). Supervisors rated 12 tasks (25.6%) and residents 9 tasks (19.1%) with a median attention score of 4. In general, supervisors associated high attention with patient outcome and prevention of complications, while residents associated high attention with "effort."

Conclusions: Supervisors and residents assigned attention to tasks for different reasons. Supervisors think ahead and emphasize patient outcome and prevention of complications when they indicate high attention, while residents think in the "now" and raise attention to execute the tasks themselves. The results of this study allow residents and supervisors to anticipate preferences: residents are able to appreciate why supervisors increase attention to specific tasks, and supervisors obtain information on which tasks require individual guidance of residents. This information can contribute to improve the learning climate in the operating room and task-specific procedural training.

Keywords: Faculty development; Intraprocedural variation; Surgical education; Workplace-based learning and teaching.

MeSH terms

Clinical Competence
Humans
Internship and Residency*
Netherlands
Operating Rooms
Perception
Surgeons*