Enriching Operating Room Based Student Learning Experience: How should we structure it?

Authors

  • Nida Maryam
  • Zaitoon Zafar
  • Hassan Hafeez
  • Talat Waseem

DOI:

https://doi.org/10.48111/2022.01.03

Keywords:

Operating Room, Operation Theater, Surgical Education, Learning Models, Koen's Model, BID Model, Apprenticeship Model, OMP, Lyon's Model

Abstract

IMPORTANCE The Operating Room (OR) is a high-pressure setting where multiple complex educational, and administrative facets interplay. The learning process, dictated by the operation list, is disparate, opportunistic, unstandardized, and at times suboptimal. Upon reviewing existing published literature regarding the learning experience in the OR setting, it was clear that this field is, to this day, unstructured and ambiguous, with many grey areas that need to be worked on. To achieve an optimized and enhanced theatre experience, it is of immense importance to recognize the pros and cons of available models that can be employed within this setting and deduce ways to improvise them into a most beneficial method. This study aims to recognize the role of a structured learning process for medical graduates in the setting of the OR. The study also explores pertinent questions; whether the learning models currently being used for residents are appropriate for medical graduates and how must we structure learning activities within OR settings.

METHODOLOGY The study involved an extensive literature review and thematic analysis to generate themes and subthemes, which were subjected to a modified Delphi technique where residents and teachers participated to identify debate and produce a consensus on the relative importance of each method when employed in Operation Theater based learning.

RESULTS While structured learning is essentially goal-oriented, student-friendly, and time-saving and provides qualitative outcomes, it, however, has drawbacks owing to a lack of faculty and resources. Various potential problems in the implementation of a structured learning process were identified and components in making the structured learning meaningful were formulated. The models each have their potential advantages and disadvantages when implemented in the OR for learning.

CONCLUSIONS Structured learning process within the OR setting should at least cover the minimum standards that a graduate essentially requires. It should be a balanced program according to the specialty. However, the quality of evidence to substantiate these aspects remains contextual with low external validity and generalizability.

References

Ahmed M, Arora S, Russ S, Darzi A, Vincent C, Sevdalis N. 2013. Operation debrief: A SHARP improvement in performance feedback in the operating room. Ann Surg. 258(6):958–963.

Al-eraky MM, Donkers J, Wajid G, Merrienboer JJGVAN. 2014. A Delphi study of medical professionalism in Arabian countries?: The Four-Gates model.

Bauer F, Rommel N, Kreutzer K, Weitz J, Wagenpfeil S, Gulati A, Wolff KD, Kesting MR. 2014. A novel approach to teaching surgical skills to medical students using an ex vivo animal training model. J Surg Educ.

Boulkedid R, Abdoul H, Loustau M, Sibony O, Alberti C. 2011. Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLoS One [Internet]. [accessed 2019 Jul 21] 6(6):e20476. http://www.ncbi.nlm.nih.gov/pubmed/21694759

Bowrey DJ, Kidd JM. 2014. How Do Early Emotional Experiences in the Operating Theatre Influence Medical Student Learning in This Environment? Teach Learn Med [Internet]. [accessed 2019 Jul 5] 26(2):113–120. http://www.tandfonline.com/doi/abs/10.1080/10401334.2014.883986

Broderick TJ, Russell KM, Doarn CR, Merrell RC. 2002. A Novel Telemedicine Method for Viewing the Open Surgical Field. J Laparoendosc Adv Surg Tech.

Chapman SJ, Hakeem AR, Marangoni G, Raj Prasad K. 2013. How can we enhance undergraduate medical training in the operating room? A survey of student attitudes and opinions. J Surg Educ.

Chaudhry Z, Campagna-Vaillancourt M, Husein M, Varshney R, Roth K, Gooi A, Nguyen L. 2019. Perioperative Teaching and Feedback: How are we doing in Canadian OTL-HNS programs? J Otolaryngol - Head Neck Surg.

Cope A, Bezemer J, Sutkin G. 2019a. Models of Teaching and Learning in the Operating Theatre. In: Nestel D, Dalrymple K, Paige JT, Aggarwal R, editors. Adv Surg Educ Theory, Evid Pract [Internet]. Singapore: Springer Singapore; p. 171–182. https://doi.org/10.1007/978-981-13-3128-2_16

Cope A, Bezemer J, Sutkin G. 2019b. Models of Teaching and Learning in the Operating Theatre. In: [place unknown]: Springer, Singapore; p. 171–182.

Cope AC, Mavroveli S, Bezemer J, Hanna GB, Kneebone R. 2015. Making Meaning from Sensory Cues: A Qualitative Investigation of Postgraduate Learning in the Operating Room. Acad Med. 90(8):1125–1131.

Croghan SM, Phillips C, Howson W. 2019a. The operating theatre as a classroom: a literature review of medical student learning in the theatre environment. Int J Med Educ.

Croghan SM, Phillips C, Howson W. 2019b. The operating theatre as a classroom: a literature review of medical student learning in the theatre environment. Int J Med Educ [Internet]. [accessed 2019 Jul 5] 10:75–87. http://www.ijme.net/archive/10/operating-theatre-classroom/

Fernando N, McAdam T, Youngson G, McKenzie H, Cleland J, Yule S. 2007. No Title. Surgeon. 5(5):271.

Flannery T, Gormley G. 2014a. Evaluation of the contribution of theatre attendance to medical undergraduate neuroscience teaching-A pilot study. Br J Neurosurg.

Flannery T, Gormley G. 2014b. Evaluation of the contribution of theatre attendance to medical undergraduate neuroscience teaching – A pilot study. Br J Neurosurg [Internet]. [accessed 2019 Jul 5] 28(5):680–684. http://www.tandfonline.com/doi/full/10.3109/02688697.2014.896873

Flinn JT, Miller A, Pyatka N, Brewer J, Schneider T, Cao CGL. 2016. The effect of stress on learning in surgical skill acquisition. Med Teach.

Fraenkel JR, Wallen NE, Hyun HH. 1932. How to Design and Evaluate Research in Education. [place unknown].

Gallagher KC, Matevish LE, Neuzil K, Evans PT, Eastham SC, Terhune KP, Eskind SJ. 2019. Peer-led Surgical Clerkship Programming Support Through the General Surgery Interest Group at the Vanderbilt University School of Medicine. J Surg Educ [Internet]. [accessed 2019 Aug 4]. http://www.ncbi.nlm.nih.gov/pubmed/31129002

Hampton BS, Magrane D, Sung V. 2011. Perceptions of operating room learning experiences during the obstetrics and gynecology clerkship. J Surg Educ.

Hasson F. 2000. Research guidelines for the Delphi survey technique. J Adv Nurs [Internet]. [accessed 2019 Jul 22] 32(4):1008. http://doi.wiley.com/10.1046/j.1365-2648.2000.01567.x

Hee JM, Yap HW, Ong ZX, Quek SQM, Toh YP, Mason S, Krishna LKR. 2019. Understanding the Mentoring Environment Through Thematic Analysis of the Learning Environment in Medical Education: a Systematic Review. J Gen Intern Med.

Hexter A, Hunter A. 2019. Response to: Factors that influence medical student learning in the operating room: Medical students’ perspective. Med Teach.

Hexter AT, O’Dowd-Booth C, Hunter A. 2019a. Factors that influence medical student learning in the operating room. Med Teach [Internet]. [accessed 2019 Jul 5] 41(5):555–560. https://www.tandfonline.com/doi/full/10.1080/0142159X.2018.1504163

Hexter AT, O’Dowd-Booth C, Hunter A. 2019b. Factors that influence medical student learning in the operating room. Med Teach [Internet]. [accessed 2019 Jul 5] 41(5):555–560. https://www.tandfonline.com/doi/full/10.1080/0142159X.2018.1504163

Hexter AT, O’Dowd-Booth C, Hunter A. 2019c. Factors that influence medical student learning in the operating room. Med Teach [Internet]. [accessed 2019 Jul 21] 41(5):555–560. https://www.tandfonline.com/doi/full/10.1080/0142159X.2018.1504163

Irani JL, Greenberg JA, Blanco MA, Greenberg CC, Ashley S, Lipsitz SR, Hafler JP, Breen E. 2010. Educational value of the operating room experience during a core surgical clerkship. Am J Surg [Internet]. [accessed 2019 Jul 5] 200(1):167–172. https://linkinghub.elsevier.com/retrieve/pii/S0002961009006278

Kable AK, Pich J, Maslin-Prothero SE. 2012. A structured approach to documenting a search strategy for publication: A 12 step guideline for authors. Nurse Educ Today. 32(8):878–886.

Labadie B, Patel RM, Gandy Labadie J, Hwang C, Okhunov Z, Landman J. 2017. Assessing the Effect of an Intensive 2-Week Surgical Training and Innovation Program for High-School Students. J Surg Educ.

Landry EC, Yong M, Pauwels J, Chadha NK. 2019. The use of video glasses improved learning of tonsillectomy and adenoidectomy surgery: A randomized controlled trial. Int J Pediatr Otorhinolaryngol.

Lee SC, Huang H, Minard CG, Schackman J, Rajagopalan S. 2018. The use of podcast videos for airway skills. Clin Teach.

Linstone HA, Turoff M, Helmer O. The Delphi Method Techniques and Applications Edited by. [place unknown].

Lyon P. 2004a. A model of teaching and learning in the operating theatre. Med Educ [Internet]. [accessed 2019 Jul 5] 38(12):1278–1287. http://doi.wiley.com/10.1111/j.1365-2929.2004.02020.x

Lyon P. 2004b. A model of teaching-learning in the operating theatre. Med Educ.

Lyon P. 2004c. A model of teaching-learning in the operating theatre. Med Educ. 38(12):1278–1287.

Maggio LA, Cate O Ten, Irby DM, O’Brien BC. 2015. Designing evidence-based medicine training to optimize the transfer of skills from the classroom to clinical practice: Applying the four-component instructional design model. Acad Med. 90(11):1457–1461.

Martin TG, Clarke DR, Bowrey DJ. 2012. Medical students in theatre: Setting the scene. Med Teach [Internet]. [accessed 2019 Jul 5] 34(4):337–337. http://www.tandfonline.com/doi/full/10.3109/0142159X.2012.661892

Massarelli A, Martini JG, Lino MM, Spenassato D, Massaroli R, Massaroli A, Martini JG, Lino MM, Spenassato D, Massaroli R. 2018. MÉTODO DELPHI COMO REFERENCIAL METODOLÓGICO PARA A PESQUISA EM ENFERMAGEM. Texto Context - Enferm [Internet]. [accessed 2019 Jul 21] 26(4). http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-07072017000400320&lng=pt&tlng=pt

van Merrienboer JJG, Dolmans DHJM. 2015. Research on instructional design in the health sciences: From taxonomies of learning to whole-task models. In: Res Med Educ. [place unknown]: Wiley; p. 193–206.

Monkhouse S. 2010. Learning in the surgical workplace: Necessity not luxury. Clin Teach.

Morzycki A, Hudson A, Williams J. 2016. Medical Student Presyncope and Syncope in the Operating Room: A Mixed-Methods Analysis. J Surg Educ.

Moulton CA, Regehr G, Lingard L, Merritt C, MacRae H. 2010. Operating from the Other Side of the Table: Control Dynamics and the Surgeon Educator. J Am Coll Surg. 210(1):79–86.

Nasiri M, Amirmohseni L, Mofidi A, Pires Padilha Paim C, Bigdeli Shamloo MB, Asadi M. 2019. Educational games developed for students in perioperative nursing: A systematic review and appraisal of the evidence. Nurse Educ Pract.

O’Neill R, Shapiro M, Merchant A. 2018. The Role of the Operating Room in Medical Student Education: Differing Perspectives of Learners and Educators. J Surg Educ.

Palmer EJ, Devitt PG. 2007. Assessment of higher-order cognitive skills in undergraduate education: modified essay or multiple choice questions? Research paper. BMC Med Educ. 7:1–7.

Pilieci SN, Salim SY, Heffernan DS, Itani KMF, Khadaroo RG. 2018. A Randomized Controlled Trial of Video Education versus Skill Demonstration: Which Is More Effective in Teaching Sterile Surgical Technique? Surg Infect (Larchmt).

Pope C, Smith A, Goodwin D, Mort M. 2003. Passing on tacit knowledge in anaesthesia: A qualitative study. Med Educ. 37(7):650–655.

Powell C. 2003. The Delphi technique: myths and realities. J Adv Nurs [Internet]. [accessed 2019 Jul 21] 41(4):376–382. http://doi.wiley.com/10.1046/j.1365-2648.2003.02537.x

Ravindra P, Fitzgerald JE, Bhangu A, Maxwell-Armstrong CA. 2013. No Title. J Surg Educ. 70(4):495.

Ravindra Pravisha, Fitzgerald JEF, Bhangu A, Maxwell-Armstrong CA. 2013. Quantifying Factors Influencing Operating Theater Teaching, Participation, and Learning Opportunities for Medical Students in Surgery. J Surg Educ [Internet]. [accessed 2019 Jul 5] 70(4):495–501. https://linkinghub.elsevier.com/retrieve/pii/S1931720413001128

Roberts NK, Williams RG, Kim MJ, Dunnington GL. 2009. The Briefing, Intraoperative Teaching, Debriefing Model for Teaching in the Operating Room. J Am Coll Surg. 208(2):299–303.

Rothenberger J, Seyed Jafari SM, Schnabel KP, Tschumi C, Angermeier S, Shafighi M. 2015. Evaluation of medical students’ attitudes and performance of basic surgery skills in a training program using fresh human skin, excised during body contouring surgeries. J Surg Educ.

Rüetschi U, Olarte Salazar CM. 2020. An e-Delphi study generates expert consensus on the trends in future continuing medical education engagement by resident, practicing, and expert surgeons. Med Teach. 42(4):444–450.

Schwind Cathy J., Boehler ML, Rogers DA, Williams RG, Dunnington G, Folse R, Markwell SJ. 2004. Variables influencing medical student learning in the operating room. Am J Surg.

Schwind C J, Boehler ML, Rogers DA, Williams RG, Dunnington G, Folse R, Markwell SJ. 2004. No Title. Am J Surg. 187(2):198.

Shipper ES, Miller SE, Hasty BN, De La Cruz MM, Merrell SB, Lin DT, Lau JN. 2018. Determining the educational value of a technical and nontechnical skills medical student curriculum. J Surg Res.

Torbjörnsson E, Olivecrona C, Sonden A. 2018. An interprofessional initiative aimed at creating a common learning resource for the operating room ward. J Interprof Care.

Trevelyan EG, Robinson PN. 2015. Delphi methodology in health research: how to do it? Eur J Integr Med [Internet]. [accessed 2019 Jul 21] 7(4):423–428. https://www.sciencedirect.com/science/article/abs/pii/S1876382015300160

Vandewaetere M, Manhaeve D, Aertgeerts B, Clarebout G, Van Merriënboer JJG, Roex A. 2015. 4C/ID in medical education: How to design an educational program based on whole-task learning: AMEE Guide No. 93. Med Teach. 37(1):4–20.

Weinberg D, Saleh M, Sinha Y. 2015. Twelve tips for medical students to maximise learning in theatre. Med Teach.

Williams PL, Webb C. 1994. The Delphi technique: a methodological discussion. J Adv Nurs [Internet]. [accessed 2019 Jul 21] 19(1):180–186. http://doi.wiley.com/10.1111/j.1365-2648.1994.tb01066.x

Zundel S, Wolf I, Christen HJ, Huwendiek S. 2015. What supports students’ education in the operating room? A focus group study including students’ and surgeons’ views. Am J Surg.

Downloads

Published

2022-03-30

Issue

Section

Original Research Communication

How to Cite

Enriching Operating Room Based Student Learning Experience: How should we structure it?. (2022). Archives of Surgical Research, 3(1), 12-26. https://doi.org/10.48111/2022.01.03