Micro-relational interdependencies are the essence of teaching and learning in the OR.

Autor: Sutkin G; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA., Littleton EB; University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Arnold L; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA., Kanter SL; Association of Academic Health Centers, Washington, DC, USA.
Jazyk: angličtina
Zdroj: Medical education [Med Educ] 2020 Dec; Vol. 54 (12), pp. 1137-1147. Date of Electronic Publication: 2020 Sep 09.
DOI: 10.1111/medu.14353
Abstrakt: Context: In the high-stakes, time-critical environment of the operating room (OR), attendings and residents strive to complete safe, effective surgeries and ensure that learning occurs. Yet meaningful resident participation often receives less attention, and that impedes residents' ability to learn and achieve autonomous operative practice. We need a new conceptual framework for understanding progression to autonomous practice that can guide both faculty and residents. Thus, we sought a new conceptualisation of intraoperative teaching and learning (IOT&L) through the lens of Eraut's notion of informal workplace learning and Billett's theory of relational interdependence between social and individual agency.
Methods: We viewed authentic examples of IOT&L in video and transcripts of live OR cases and interviews with participating attendings and residents. By systematically applying Eraut and Billet's theories to the transcripts and interviews, we developed concrete descriptions about how IOT&L occurs, categorised them into theory-based principles and derived a conceptualisation and related research ideas about IOT&L.
Results: Established workplace learning theories frame IOT&L as socially negotiated processes transpiring in distinct interdependent interactions between residents' individual cognitive experiences and their OR social experiences that direct their learning. As the surgery unfolds, spontaneous events and the rules of surgery create opportunities for unplanned and informal learning. These authentic interrelated cognitive and social experiences are stimulated when residents reveal a learning need or attendings recognise a learning gap, and efforts ensue to bridge that gap. Through these minute distinct exchanges, labelled here as 'atomic' IOT&L, residents gain crucial knowledge and skill.
Conclusion: Framing authentic OR interactions between attendings and residents in terms of micro-relational interdependencies shows how granular teaching/learning exchanges yield high-value informal learning. To improve IOT&L, we must examine and change it at this fundamental level by using and testing this new theoretical conceptualisation. These insights produced ideas about IOT&L to test and research.
(© 2020 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje