What Makes for Good Anesthesia Teaching by Faculty in the Operating Room? The Perspective of Anesthesiology Residents

Abstract

BackgroundTeaching during patient care is an important competency for faculty. Little is known about anesthesiology resident preferences for teaching by anesthesiology faculty in the operating room (OR). If the behaviors and characteristics of anesthesia teaching in the OR that are most valued by residents were identified, faculty could incorporate that best practice to teach residents during OR cases. The objective of this phenomenological study was to interview anesthesiology residents to determine what they perceive the best faculty teachers are doing in the OR to educate residents.MethodsThirty randomly selected anesthesiology residents (10 in each post-graduate year class) were interviewed using a semi-structured approach with a predetermined question: “Based on your experiences as a resident, when you think about the best-attending teachers in the OR, what are the best-attending teachers doing in the OR to teach that other faculty maybe are not doing?” Interviews were recorded, transcribed, converted into codes, and grouped into themes derived from the cognitive apprenticeship framework, which includes content, teaching methods, sequencing, and social characteristics.ResultsResident responses were separated into a total of 134 answers, with similar answers grouped into one of 27 different codes. The most commonly mentioned codes were: autonomy – step back and let resident work through (mentioned by 13 residents), reasoning – explain why attending does things (12), context – teach something relevant to the case (8), commitment – take time to teach (8), literature – bring relevant papers (8), prior knowledge – assess the baseline level (7), flexibility – be open to trying different approaches (7), focus on just a few learning points (6), reflection – ask resident questions (6), provide real-time feedback (6), teach back – ask residents to explain what they were taught in their own words (5), belonging – facilitate communication with the OR team (5), psychological safety – be open and approachable (5), equanimity – stay calm and collected (5), select proper timing for instruction when the resident is not occupied with patient care (5), visualization – use graphs or diagrams (5), and specify learning goals ahead of time (5).ConclusionThe best practice for OR teaching, as perceived by anesthesia residents, includes social characteristics, such as context, commitment, psychological safety, equanimity, and proper timing, as well as teaching methods, such as autonomy, reasoning, literature, prior knowledge, flexibility, reflection, real-time feedback, and teach back. Further studies can determine if training anesthesiology faculty to incorporate these elements increases the caliber of daily teaching in the OR.

Attributes of excellent clinician teachers and barriers to recognizing and rewarding clinician teachers’ performances and achievements: a narrative review

“…Seventy-one studies that defined the skills and behaviours of excellent clinician teachers for general feedback to faculty, or to inform FD programs were identified during our screening process. 51,[117][118][119][120][121][122][123][124] Our analysis demonstrated that there is a lack of evidence concerning the key perceived attributes of excellent clinician teachers that underpin recognition and reward decisions, with no new articles published on the topic in over a decade. 77 The lack of publications that define and clearly delineate what constitutes excellence in clinical teaching for recognition and reward decisions is a clear barrier to understanding this phenomenon and its potential effects on the clinical teaching workforce.…”

Resident Autonomy

“…Wakatsuki et al interviewed anesthesia residents to find out what their most effective attending teachers in the operating room were doing that others were not and found that fostering autonomy was one of the nine key behaviors these faculty exhibited [10]. This behavior and the other effective teaching behaviors identified in this study fit within the cognitive apprenticeship framework of learning, which includes teaching methods such as scaffolding, modeling, articulation, reflection, and exploration [11].…”

How I Teach: Ultrasound-guided Peripheral Venous Access

“…We highlight that although low stakes procedurally, USPIV placement is a skill that requires significant experience to master and that we will be giving real-time feedback and instruction at the bedside to support them through a successful IV insertion to encourage an open dialogue between the learner and instructor. This establishes the learning environment and psychologic safety, which has been described in many educational settings to beneficial for learning ( 22 – 24 ). Specifically, the psychological safety that we aim to establish emphasizes the trainee’s ability to fully engage in the learning experience without a sense of needing to preserve their image or be concerned about judgement.…”