Pedagogy in Education

The following is a summary of the lecture/video podcast on intraoperative teaching given as part of the Education Scholarship CME program. The lecture was inspired and based on a recent article by Thompson and Brag1. You can access the full recording of the session here: https://vimeo.com/1008133397

Introduction

Teaching in the operating room (OR) poses several unique challenges due to the high-stakes environment where patient safety is the top priority . Despite these challenges, attending anesthesiologists must find ways to ensure that residents gain essential hands-on experience. This balance is difficult but necessary, particularly during critical moments of patient care . Effective OR teaching strategies can help mitigate these difficulties while maintaining a focus on resident education and patient safety.

Challenges of OR Teaching

The OR is a fast-paced, high-pressure environment where patient care takes precedence over teaching. This is particularly evident during high-risk or time-sensitive procedures, where balancing education and efficiency can be difficult. Additionally, time and production pressure in the OR is constant, and teaching can sometimes disrupt the flow of the procedure, leading to conflicts between educational goals and efficiency.

For less experienced residents, the complexity of surgeries combined with the rapid influx of information can result in cognitive overload, making it harder to focus on both the task at hand and new learning . Furthermore, the OR is full of distractions – from urgent clinical needs to equipment noise – making it difficult for residents to concentrate on instruction.

Another challenge is the wide range of experience levels among residents, requiring instructors to tailor their teaching to individual needs while managing the complexities of the case . Additionally, high-stress situations frequently arise in the OR, particularly during critical phases such as airway management or hemodynamic instability, which are not ideal moments for detailed instruction but often contain valuable lessons .

Given the limited downtime for teaching, residents may struggle to find moments to absorb new information during long or complex procedures . Attending physicians are also required to observe and supervise multiple tasks simultaneously, which can limit their ability to give residents the autonomy they need to develop their skills . Finally, the OR’s team-based environment often demands clear communication and coordination, and managing the team can sometimes overshadow teaching opportunities.

Effective Teaching Strategies in the OR:

Despite these challenges, attending physicians can adopt several strategies to effectively teach in the OR:

• Set clear learning goals and context before the procedure. Communicating specific objectives helps residents focus on key concepts that are directly relevant to the case . For instance, in a complex procedure like an open AAA repair, a resident can focus on critical tasks such as induction and vascular access .

• Tailor teaching to the resident’s experience level by assessing their knowledge base and adjusting the complexity of teaching accordingly. Less experienced residents should first grasp foundational concepts, while more advanced residents can be exposed to intricate aspects of the surgery .

• Balance autonomy with supervision by assigning specific tasks to residents while remaining available to intervene if needed. This hands-on approach allows residents to build confidence without compromising patient safety .

• Provide real-time feedback and encourage reflection . Immediate, actionable feedback after a task reinforces correct actions and corrects mistakes. Asking reflective questions like “What would you have done differently?” promotes critical thinking and self-awareness.

• Use probing questions to challenge residents’ thinking. For example, during a procedure, asking “What would you do if the blood pressure dropped after cross-clamping?” encourages residents to apply their knowledge and problem-solving skills.

• Time teaching moments appropriately by using natural pauses in the procedure to discuss important concepts without disrupting the surgical flow. This ensures that teaching does not compromise the efficiency of the operation.

• Encourage self-directed learning by suggesting post-procedure readings and encouraging reflection on the case . This fosters continuous learning and allows for deeper engagement with the material .

• Use the “teach-back” method by having residents explain a concept or procedure in their own words . This technique reinforces learning and highlights any knowledge gaps that can be addressed immediately .

• Focus on a few key learning points to avoid overwhelming residents with too much information . Concentrating on 2-3 essential points per case helps residents absorb critical concepts without cognitive overload .

• Encourage self-assessment by prompting residents to reflect on their performance with questions like “What went well?” and “What could be improved?” This self-reflection fosters responsibility for learning and encourages continuous development .

• Demonstrate flexibility and adaptation by being open to different approaches suggested by residents . Encouraging them to implement their ideas under supervision promotes creativity and critical thinking.

Conclusion

Teaching in the OR is a delicate balance of patient safety and resident education . By applying evidence-based strategies, attending physicians can create a learning environment that not only fosters resident growth and confidence but also maintains the highest standards of patient care. The ability to provide immediate, tailored, and reflective feedback ensures that residents can develop their skills effectively while contributing to patient safety and team-based care in the OR.