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LSI Pilot Enhances Understanding in Surgical Education 


As part of the introduction of the “LSI pilot in Understanding Patients with Reproductive and Surgical Needs”, we presented to the Departments of Surgery, Obstetrics and Gynecology, and Anesthesiology a brief talk on “Improving Education in the Operating Room.” Many surgeons, including some of our own, have contributed to this body of work, with multiple surgical journals regularly publishing research in surgical education.

Hampton et al[1] describe four categories of OR learning for all students:

  • Development of a foundation of clinical knowledge
  • Surgical technique and skill acquisition
  • Personal insight into career choice
  • Surgical culture and OR functioning 

There are several basic ways to improve teaching and learning in the operating room for both students and residents:

  • Trainees and faculty work together to establish learning goals for each per case or day. These should be discussed before the case and then evaluated (“debriefed”) after the case in a manner that is honest but educational and not punitive.[2] Without this type of plan, education may easily take a back seat to stress, efficiency and purely technical description, and what is taught will tend to vary widely and be unfocused.[3]
  • Students and residents must read about and meet the patient preoperatively and read about the disease process, planned operation, anesthetic and post-operative care.
  • All members of the team should learn and use each other’s names.
  • Teachers should talk about decisions they are making and how they make them, as opposed to strictly giving technical directions (e.g., “hold this”, “stop”, “turn this up,” etc.)

Mental Practice is a technique of preparation by detailed visualization. This is much more detailed than reviewing basic steps and can be guided by a script that includes sight, sound, and textures beyond a simple checklist. In its formal application, this technique has proven to be effective in improving performance and decreasing trainee stress.[4] However, even a self-guided, informal visualization is likely to improve one’s performance as well.

Like many things, paying attention to teaching in the operating room is an excellent first step. Beyond that is an evolving science of education that is ripe to be joined by interested faculty and trainees alike.

[1] Hampton BS, Magrane D, Sung V. Perceptions of operating room learning experiences during the obstetrics and gynecology clerkship. J Surg Educ. 2011 Sep-Oct;68(5):377-81.

[2] Ahmed M, Sevdalis N, Paige J, Paragi-Gururaja R, Nestel D, Arora S. Identifying best practice guidelines for debriefing in surgery: a tri-continental study. Am J Surg. 2012 Apr;203(4):523-9. 

[3] Roberts NK, Brenner MJ, Williams RG, Kim MJ, Dunnington GL. Capturing the teachable moment: a grounded theory study of verbal teaching interactions in the operating room. Surgery. 2012 May;151(5):643-50.

[4] Arora S, Aggarwal R, Sirimanna P, Moran A, Grantcharov T, Kneebone R, Sevdalis N, Darzi A. Mental practice enhances surgical technical skills: a randomized controlled study. Ann Surg. 2011 Feb;253(2):265-70. Arora S, Aggarwal R, Moran A, Sirimanna P, Crochet P, Darzi A, Kneebone R, Sevdalis N. Mental practice: effective stress management training for novice surgeons. J Am Coll Surg. 2011 Feb;212(2):225-33.



Posted on 17-Sep-12 by Maloon, Adam
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