Residents in the Operating Room: Discordant Opinions about Learning

Surgical Rounds®, July 2014,

A new study explores the disparity in surgical residents' and their attending surgeons' perceptions operating room guidance.

The experiences surgical residents undergo in the operating room (OR) teach technique, bolster confidence, and prepare them for independent, autonomous practice. As such, educators are routinely concerned about residents’ perceptions of how and what they learn in the OR.

Concordance of a resident’s and the attending surgeon’s perception of guidance is called guiding efficiency, and it’s critical for optimal OR training experiences. However, each generation has a different learning style. Researchers at Brigham and Women’s Hospital, Boston, MA, recently published a study that explores the disparity in surgical residents’ and attending surgeons’ perceptions of OR guidance.

Using 8 prerecorded surgical cases, the researchers asked 2 attending surgeons and one surgical resident to observe the procedure and classify the attending surgeons’ OR guidance by type. A total of 9 attending surgeons and 8 surgical residents participated. They employed an established taxonomy for OR guidance types that designed each action as:

  • teaching (i.e. showing how to operate, explaining the surgeon’s thought process, or simply verbalizing information about instruments for future operation)
  • directing (i.e. verbally prompting the resident technique or special orientation)
  • assisting (i.e. facilitating OR team support or reassuring the resident’s judgment)

The researchers identified 116 OR guidance events. When both observing and attending surgeons agreed that guidance was provided and on the OR guidance type, the researchers designated that event as a concordant guidance behavior. Eight of the 116 events were thus designated, and in 73 of the 80 behaviors, observing and attending surgeons agreed on the guidance type. Then, the researchers compared these 80 events to the residents’ assessments.

In 49 of the 80 (61%) events, residents agreed with attending surgeons that guidance was provided. However, more than half the time, residents disagreed with attending surgeons concerning the OR guidance type. Residents and attending surgeons were most likely to agree on the teaching guidance (66.67%), but least likely to agree on the assisting guidance (36.84%).

The study found that when attending surgeons indicate they are “assisting,” but residents believe the surgeon is “directing,” the surgeon may overestimate the residents’ ability because the surgeon may believe the resident has made an independent decision, whereas the resident believes he or she is following direction. Having similar perceptions about the presence and the OR guidance type is critical for residents to develop autonomy.

This study appears in the Journal of Surgical Education.