In the world of medicine, surgical training is a critical aspect of a resident’s education. Technical skills, communication abilities, and hands-on experiences form the cornerstones of a successful surgical career. A particular training ground for these skills is during awake surgical procedures, where the balance between patient care and educational opportunities must be meticulously managed.
DOI: 10.1016/j.jsurg.2019.04.007
A recent study, as reported in the *Journal of Surgical Education*, presents the resident perspective on the unique challenges and effective educational techniques encountered during awake surgical procedures. The study conducted by a team of researchers from the University of Chicago, including Claire S. Smith, Robert Nolan, Kristina Guyton, Mark Siegler, Alexander Langerman, and Nancy Schindler, highlighted the resident experience as a valuable insight into refining surgical education.
The qualitative study, which involved 25 residents in Urology, Obstetrics and Gynecology, and General Surgery, used recorded focus groups to gather data. The residents, who had partaken in at least 10 or more awake surgical procedures, contributed to a rich conversation that was then transcribed, coded, and reviewed using the constant comparative method until thematic saturation was reached.
The findings of the study revealed several key educational strategies that were positive for training during awake procedures. Preprocedural communication was named as crucial, allowing for an understanding of the procedure and the role of the resident. Educators who explained the teaching process and the nature of the resident’s involvement contributed to a positive learning environment. Additionally, alternative forms of communication, such as whispering and nonverbal cues, were sometimes used effectively alongside involving the patient directly in the education process. A sense of confidence from the educator was essential to instill trust and facilitate learning.
However, not all strategies were successful. Some residents expressed hesitation to ask questions or to correct a peer, which might indicate a fear of appearing unprepared or undermining the educator in a sensitive setting. Whispering and nonverbal communication, though helpful at times, could also lead to confusion or miscommunication. Moreover, overtaking the procedure without proper communication could lead to educational failures.
The research emphasized that besides these educational techniques, informed consent during awake procedures is a pivotal area requiring adaptation. Some residents suggested that the consent process should include more detailed descriptions of the resident’s role during the procedure.
The study underscores the value of good communication in the operating room and insists it begins before the actual procedure takes place. It also identifies the unique challenges that teaching in this context presents, often related to unclear communication.
This research is vital in helping to shape the future of surgical training. It provides a framework for addressing both the educational needs of residents and the care considerations for patients during awake surgical procedures. Additionally, it pushes for an enhanced consent process that accurately reflects the participation of residents in these surgeries.
Keywords
1. Awake surgical procedures
2. Surgical education
3. Resident teaching strategies
4. Effective communication in surgery
5. Informed consent in surgery
References
1. Smith, C. S., Nolan, R., Guyton, K., Siegler, M., Langerman, A., & Schindler, N. (2019). Resident Perspectives on Teaching During Awake Surgical Procedures. Journal of Surgical Education, 76(6), 1492-1499. DOI: 10.1016/j.jsurg.2019.04.007
2. DaRosa, D. A., Zwischenberger, J. B., Meyerson, S. L., George, B. C., Teitelbaum, E. N., Soper, N. J., & Fryer, J. P. (2013). A theory-based model for teaching and assessing residents in the operating room. Journal of Surgical Education, 70(1), 24-30. DOI: 10.1016/j.jsurg.2012.06.027
3. Roberts, N. K., Williams, R. G., & Kim, M. J. (2014). Relationships between residents’ performance on a multiple-station standardized patient examination and communication skill, knowledge, and clinical performance ratings. Medical Education, 48(2), 157-165. DOI: 10.1111/medu.12348
4. Ahmad, S., De Oliveira, G. S., & McCarthy, R. J. (2012). Factors associated with residents’ satisfaction with their operative experience. American Journal of Surgery, 203(6), 767-773. DOI: 10.1016/j.amjsurg.2011.08.013
5. Makary, M. A., Sexton, J. B., Freischlag, J. A., Holzmueller, C. G., Millman, E. A., Rowen, L., & Pronovost, P. J. (2006). Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. Journal of the American College of Surgeons, 202(5), 746-752. DOI: 10.1016/j.jamcollsurg.2006.01.017