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• W2913332016 abstract "Introduction A gap of almost 50 years in age may exist between 20-somethings in their final years of medical school and tenured clinical surgeons nearing retirement [10]. The educational experience in residency and medical school evolves with each passing generation. In the past, an instructor’s approach to teaching may have relied almost exclusively on printed material, lectures, and multiple-choice examinations [5]. But the operating room is predicated on team interaction. And in recent years, the mode in which medical knowledge is delivered and assessed has changed dramatically with a heavy reliance on smartphones [1], simulations, group-based learning, and interactive videos [3]. The current challenge for the orthopaedic educator then is to adapt or utilize technology familiar to the learner. Both basic science and clinical faculty are adjusting on the fly by not only adopting the preferred communication tools of their residents but also adjusting to the way in which residents prefer to learn. Today, medical schools are transitioning from the traditional lecture format for resident learning to “active learning,” where students are engaged in the process through team-based or problem-based learning. Lectures are now streamed online, and medical schools are implementing a “flipped classroom” approach whereby the content for a topic will be introduced at home prior to class, often with online modules. Class is then reserved for group discussion and clarification [4, 6, 9]. It is unclear if this method provides a better educational experience when compared to traditional lectures. A recent survey of medical students who were exposed to the “flipped classroom” were evenly divided as to preference over traditional lectures [4]. Furthermore, the use of simulation in medical school, such as with the mandate of live patient clinical skills portion of the United States Medical Licensing Examination, has become a common means of improving patient interaction skills. Given the technological advancements in residency education and the evolving structure of residency programs, how can educators enhance the educational experience in the operating room? Here are five tips: Take advantage of residents’ hyper-connectedness. Traditional methods of education have given way to technologically advanced approaches, specifically using smartphone applications. Orthopaedic educators are beginning to capitalize on this method of learning. From 2010 to 2014, orthopaedic residents increased their use of smartphone applications in the clinical setting from 60% to 84%. Attendings increased their use from 41% to 61% during that same time period [2, 8]. In an era of instant gratification, it is not surprising that students often expect immediate performance assessments for certain procedures. The American Board of Orthopaedic Surgery is currently trialing a new smartphone application that provides an immediate feedback on several common orthopaedic procedures. Divide a procedure into steps and incorporate video. This approach to preoperative planning is not new, but still works well with any learner who desires efficient, structured learning in the operating room. Having the resident outline the sequential steps before surgery provides a useful framework of preoperative study. A resident can proceed with appropriate supervision if they have demonstrated they can competently complete a step, and it allows a framework to provide better assessment and feedback. Attendings and educators can also utilize and share procedure clips from YouTube (after being properly vetted by faculty) as a way to enhance residents’ step-by-step preoperative planning for the operating room. For other aspects of the procedure, observation and assisting may be a better educational tool. Be mindful of your leadership style. Kissane-Lee and colleagues [7] surveyed 20 interns and 20 mid-level residents about leadership styles in the operating room, characterizing them as “authoritative”, whereby the attending makes decisions and communicates them firmly; “consultative”, when the leader consults with trainees when important decisions are made; “explanatory”, when the leader makes decisions but explains them completely; and “delegative”, when the decision is based on majority decision. Trainees felt they experienced most often an authoritative leadership style but preferred the explanatory or consultative styles. Preoperative discussions that review expectations and explain indications will help the learner feel more engaged. The addition of a postoperative debrief to review what went well and what could be improved, as well as preview future educational goals can maximize residents’ learning opportunities. Faculty still have to set the professional tone in the operating room. A “self-check” with the operating room team is a useful way to assess the environment. Asking the question “how can we improve?” or “what can I do to improve things?” at the end or during a case is one example of how faculty can receive some feedback. Adapt to the unexpected. Data derived decision-making is desirable when clear data exist. Medical practice often is shaped by experience, as not all clinical problems have clear solutions. Learning to cope with ambiguity or the unexpected in the operating room is an important aspect of independent surgical practice, especially for those just graduating. One technique to relate experience is to connect to real cases or patients and give examples of “when things go wrong”. This can be done pre-procedure, in a preoperative conference (team approach), or in a debrief. A key point we can help our younger colleagues to realize is that we may not always have the luxury of perfect information, and yet we still must make high-stakes decisions. Talking through the skills needed to do this—as well as the anxiety and other emotions it engenders—may be especially helpful. Modeling integrity by giving examples of how we have learned from the harm we have caused by doing our best in the face of incomplete information may also be important. Find the time to learn your residents’ educational goals. Getting to know an individual resident’s strengths and weaknesses while also working on an educational plan for a rotation is a goal for every faculty who works with residents. This can be a challenge since residency programs are large, and rotations are increasingly shorter compared to previous generations. There is less time available to connect with your residents because of work-hour constraints and an emphasis on patient “throughput.” Faculty should consider reviewing Accreditation Council for Graduate Medical Education or institutional survey data about the residency program and conducting a needs assessment for improving the time available to teach by faculty. Conclusion Residency programs and clinical faculty have showed a surprisingly fair amount of flexibility and willingness to alter their traditional methods of teaching by adopting new means of communication and crafting and delivering educational plans that take advantage of residents’ hyper-connectedness while also maintaining adherence to firm work-hour restrictions. Although residency programs are adapting to the new world around them, the goals of residency programs have not changed—we need to produce competent orthopaedic surgeons upon graduation who have lifelong learning skills." @default.
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• W2913332016 date "2019-02-12" @default.
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• W2913332016 title "CORR® Curriculum — Orthopaedic Education: Generational Opportunities for Teaching in the Operating Room" @default.
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