“It’s making me think outside the box at times”: a qualitative study of dynamic capabilities in surgical training

Abstract

Craft specialties such as surgery endured widespread disruption to postgraduate education and training during the pandemic. Despite the expansive literature on rapid adaptations and innovations, generalisability of these descriptions is limited by scarce use of theory-driven methods. In this research, we explored UK surgical trainees’ (n = 46) and consultant surgeons’ (trainers, n = 25) perceptions of how learning in clinical environments changed during a time of extreme uncertainty (2020/2021). Our ultimate goal was to identify new ideas that could shape post-pandemic surgical training. We conducted semi-structured virtual interviews with participants from a range of working/training environments across thirteen Health Boards in Scotland. Initial analysis of interview transcripts was inductive. Dynamic capabilities theory (how effectively an organisation uses its resources to respond to environmental changes) and its micro-foundations (sensing, seizing, reconfiguring) were used for subsequent theory-driven analysis. Findings demonstrate that surgical training responded dynamically and adapted to external and internal environmental uncertainty. Sensing threats and opportunities in the clinical environment prompted trainers’ institutions to seize new ways of working. Learners gained from reconfigured training opportunities (e.g., splitting operative cases between trainees), pan-surgical working (e.g., broader surgical exposure), redeployment (e.g., to medical specialties), collaborative working (working with new colleagues and in new ways) and supervision (shifting to online supervision). Our data foreground the human resource and structural reconfigurations, and technological innovations that effectively maintained surgical training during the pandemic, albeit in different ways. These adaptations and innovations could provide the foundations for enhancing surgical education and training in the post-pandemic era.

Scratching beneath the surface: How organisational culture influences curricular reform

“…77 IST was implemented in 2018, and that change takes time, our data collection took place as planned in 2020-2021. However, data collection then clashed with the Covid-19 pandemic, when surgical service delivery was heavily disrupted, 78,79 service-training tensions 80,81 magnified and specific aspects of IST -namely the planned programme of simulation-based training events for CTs -disabled temporarily. Given that extreme external stimuli or events impact on change, 82 we suggest that the organisations involved in surgical training were so focused on managing Covid-19 disruptions that they had no capacity for anything else, let alone change planned before the pandemic and for "steady state" conditions.…”

Context matters in curriculum reform: An analysis of change in surgical training

“…We developed a semi-structured interview schedule 37 informed by the IST document and associated publications, 30,38,39 the wider literature on surgical training, informal discussions with those involved in planning and implementing IST and data we had collected from trainees and trainers as part of the wider programme of study. 40 Interview questions were designed to explore participants' perceptions of the IST curriculum and its implementation across the United Kingdom 41 Table 1 provides an overview of the participants.…”

“…The research team continually reviewed and discussed the patterns that emerged during the inductive data analysis. Credibility was ensured through triangulation of data sources (stakeholder interview data, document data and comparison with data from the wider case study involving trainees and trainers 40,58 in which the current work was nested). 29 The study protocol was adhered to throughout with regards to participant recruitment and data collection and data management.…”

“…Perhaps the phenomena described in this paper would have been different at another time: we have no way of knowing. What we do know is that systems adapted rapidly in response to the uncertainty 40. However, the short-term and long-term impact of the COVID-19 pandemic on the IST curriculum reform may be worthy of further evaluation.Finally, although our context was the United Kingdom, curriculum reform in postgraduate medical education and training happens globally.…”