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Within the framework of learning from errors this study focused on how operative risks and potential errors are addressed in guidance to surgical residents during authentic surgical operations. The overall purpose is to improve patient safety and to diminish medical complications resulting from possible operating errors. Further in the process of the optimal contexts for instruction aimed at preventing risks and errors in the practical hospital environment was evaluated. The five authentic surgical operations were analyzed, all of which were organized as training sessions for surgical residents. The data (collected via video-recoding) were analyzed by a consultant surgeon and an education expert working together. The results showed that the risks and potential errors in the surgical operations were rarely addressed in guidance during operations. The guidance provided mostly concerned technical issues, such as instrument handling, and exploration of critical anatomical structures. There was little guidance focusing on situation-based risks and potential errors, such as unexpected procedural challenges, teamwork and practical decision making. The findings showed that optimal context of learning about risks and potential errors of surgical operation is not always the authentic operation context. The study was conducted in an authentic surgical operation-cum-training context. The originality of the study derives from its focus on guidance related to risk and error prevention in surgical workplace learning. The findings can be used to create a meaningful learning environment-including powerful guidance-for practice-based surgical learning, maximally addressing patient safety, but giving possibilities also for other training options.

On-the-job medical training is known to be challenging due to the fast-paced environment and strong vocational profile. It relies on on-site supervisors, mainly doctors and nurses with long practical experience, who coach and teach their less experienced colleagues, such as residents and healthcare students. These supervisors receive pedagogical training to ensure that their guidance and teaching skills are constantly improved. The aim of such training is to develop participants’ patient, collegiate and student guidance skills in a multiprofessional environment, and to expand their understanding of guidance as part of their work as supervisors of healthcare professionals. In this paper, we investigate open-ended answers on guidance experience of 281 healthcare supervisors that participated in these training courses. To automate the analysis of the contents of the answers, we apply clustering to the natural language processed textual data. The results summarize the most common guidance experiences and allow an automatic grouping of the healthcare supervisors’ reflection. Such an evidence-based knowledge can be used to further improve the organization of the training courses.

Background. Surgical training in authentic work environments needs guidance practices, including simulation training within a competence-based framework. The use of simulators may actually have negative effects on professional learning if there is a lack of competence-based goals, tools, and guidance, integrated with work practices, and applied by trainers. Intervention. We designed simulation training tools to promote the surgical residents’ abilities to perform competently in basic surgical skills. Our educational and surgical team worked together and (i) specified the goals for the tasks, (ii) specified the skills to be achieved, (iii) and analyzed the learning outcomes. The assumption was that after completing the simulation training, the resident would gain precise basic skills. Methods. Eight (8) licensed doctors, starting their specialization in surgery or gynecology, participated in the study. In accordance with the training design the residents were asked to self-assess their achieved skills by completing questionnaires, before and after the training period. In addition, the skills achieved were assessed individually by the trainer at the end of the training period. All the assessments were carried out on a scale based on OSATS (Objective Structured Assessment of Technical Skills) and modified specifically for this study. Results. The residents and their trainers evaluated the simulation training design as effective, and as beneficial for learning basic surgical skills. However, it proved difficult for the residents to achieve the targets consistently and to assess their own skills. Some fine-tuning is needed to enhance the integration of simulation training tools with practical learning. Discussion. The simulation training appeared to motivate the trainees. Overall, there is a need for discussion on the implications for competence-based theories and simulation practices. Limitations. The small number of participants limited the possibilities for statistical analysis. The analyses and results should be seen as merely indicative. Further studies are needed.