Before the scalpel: Exploring surgical residents' preoperative preparatory strategies

Abstract

Objective This study sought to increase understanding of preoperative preparatory strategies utilised by senior surgical residents and identify how social and material forces come together to shape practice. Summary/Background Data Preoperative preparation can play a powerful role in operative learning. Residents rarely receive guidance, feedback, or explicit expectations on how to prepare for the OR. Understanding current practice and how to support preoperative preparation represents an important gap in our efforts to improve surgical training. Methods Constructivist grounded theory with sensitizing concepts from sociomateriality guided data collection and analysis. Fifteen senior surgical residents from a range of surgical disciplines were purposefully sampled and participated in an in‐depth individual interview. Two return‐of‐finding focus groups followed with seven residents. Rigor was enhanced through constant comparison, theoretical sampling, pursuit of discrepant data, and investigator triangulation. Results Residents utilised a range of strategies addressing four areas of focus: develop technical skills, improve procedural knowledge, enhance patient‐specificity, and know surgical preferences. However, residents also described receiving limited guidance on what it means to ‘be prepared’ and experience significant challenges in achieving preparedness. A mix of social and material things that enabled or constrained preparatory efforts influenced individual strategies. These included rotation structure, relationships, the OR list, and time. Conclusions Our findings offer possible solutions by elaborating on preparatory variability and considerations for residents, faculty, and programs to improve practice. As a first step, we suggest programs begin to engage in explicit dialogue and reflection with their residents, faculty, and residency program committees.

What are the learning objectives in surgical training – a systematic literature review of the surgical competence framework

“… Technical skills Learning by reflection, learning by doing Yes Kumins et al (2021) [ 33 ] Student, N = 221 General Knowledge test, survey, n/a Performance assessment, self-report, MCQ knowledge test and objective skill exam (GRS) Self-directed progressive video training is effective and improves technical skills and knowledge Technical skills, knowledge Learning by modelling, self-directed study No Peshkepija et al (2017) [ 34 ] Residents, N = 120 General Writing task n/a Self-report Qualitative content analysis, Summary statistics Meaningful self-reflection was initially uncommon among all residents, but we were able to more than double this across the consortium by continuous process improvement. Non-technical skills Learning by reflection Yes Cadieux et al (2021) [ 35 ] Residents, N = 20 General Interview n/a Self-report Qualitative analysis Residents used a range of preoperative preparatory strategies addressing four areas of focus: develop technical skills, improve procedural knowledge, enhance patient-specificity, and know surgical preferences Technical skills, knowledge Learning by self-directed study Yes Dressler et al (2018) [ 36 ] Student, N = 56 General Writing task n/a Self-report Qualitative analysis Students could reflect on their experiences. Short format writing can be an effective format for reflection ...…”