Clinics in Medical Education

Operating Room as a Stage and Classroom: Intraoperative Learning in Anesthesiology

Robina Matyal, MD

Published July 3, 2025 | Clinics in Medical Education 

Issue 7 | Volume 1 | June 2025

Goals of Ethics and Professionalism Curricula

In fields like aviation, about 90% of training occurs in controlled practice environments, with approximately only 10% of learning in real-time execution. In medicine, especially in anesthesia, the balance is reversed: 10% of training occurs in a practice setting, while 90% unfolds in live execution. The operating room functions as a dynamic stage where clinicians apply technical and communication skills in real time, learning and teaching simultaneously. This creates an environment of continuous micro-teaching: guiding procedures, anticipating next steps, managing high-stress moments, and reinforcing critical points in the moment of care. Experiential learning is the primary modality of instruction for both anesthesia practice and broadly in medical education.

Defining Practice and Execution in Clinical Anesthesia

Practice in anesthesiology involves deep understanding of basic sciences such as physiology, pharmacology, and anatomy. It comprises of theoretical knowledge of anesthetic agents, along with their mechanisms of action, dosages, side effects, and interactions. Further, it includes familiarity with techniques, protocols, and standards of patient care. This knowledge is usually gained through formal education, simulation training, reading literature, and case discussions.
Execution, by contrast, represents the real-time application of this knowledge. It includes technical skills like airway management, vascular access, regional blocks, and intraoperative monitoring. More critically, it requires real- time clinical judgment, such as responding to sudden hypotension, unexpected allergic reactions, or difficult airways. The practitioner must synthesize information and make critical decisions under pressure in a dynamic clinical situation.

TABLE 1

These touchpoints are not just teaching moments; they are opportunities to ensure patient safety while optimizing resident development. Transfer of knowledge through the clinical practice experience is essential for supporting the progression of residents to independent practitioners.

Creating a Structured Learning Environment in the OR

Despite the unpredictable and high-pressure nature of the OR, we can create structured opportunities for learning:
  • Use the case itself as the foundation for problem-based learning. Build discussions around physiological responses, pharmacologic decisions, and unexpected developments.
  • Encourage residents to anticipate and plan responses to possible outcomes both typical and atypical.
  • Reinforce decision-making frameworks rather than rote memorization, fostering flexible, adaptive thinking.
This approach transforms the OR into a dynamic classroom, rooted in real-world physiology and pathology. It ensures that the resident is not a passive observer but an active participant in patient care and clinical reasoning

A Different Training Model

Unlike aviation, where trainees simulate for thousands of hours before touching a real aircraft, anesthesiology residents are learning on the job. While simulation and didactics are valuable, the OR remains the core site of skill acquisition and judgment formation.

Given this reality, we must maximize the learning potential of the OR:

  • Normalize microrunning commentaries during surgery: short, focused guidance that keeps the resident engaged without overwhelming.
  • Build a culture of immediate, respectful, and constructive feedback.
  • Debrief with intent: not just what happened, but why, and how to do better next time.

FIGURE 1

An attending teaching medical students and residents in the operating room

The Contrast with the Aerospace Industry

In industries like space and aviation, training prioritizes exhaustive simulation and theoretical preparation, with pilots spending thousands of hours in simulators before ever operating a real aircraft, devoting roughly 90% of their time to practice and only a small portion to actual execution. This model minimizes risk and prepares individuals for rare, high-stakes events through meticulous rehearsal. In contrast, anesthesiology, embedded in the real-time clinical environment, reverses this approach: execution itself becomes the primary platform for learning, while practice is integrated through structured training sessions, mentorship, and ongoing education. Given the high stakes and relentless pace, anesthesiology demands a continuous cycle of learning, application, reflection, and adaptation.

Conclusion

In anesthesiology, the operating room is both the stage and the classroom. It is where residents perform, learn, and grow under the direct guidance of experienced faculty. Through structured feedback, problem-based teaching, and active participation, the intraoperative setting becomes the most authentic and powerful learning environment available.

To train safe, thoughtful, and adaptive anesthesiologists, we must invest in teaching during care, not after. That means embracing intraoperative teaching as a deliberate act, even in the face of production pressure. Only then can we ensure that our learners are prepared—not just to practice medicine, but to execute it with excellence.