Identifying Intraoperative Behaviors Associated With Surgical Resident Teachability

OBJECTIVE: The resident-attending dyad influences the intraoperative training of surgery residents. To better understand the role of trainees within the dyad, we hypothesized there is a measurable concept of teachability, a combination of the trainee's observed skills and behaviors with their performance. This study aims to define teachability and identify discrete intrao-perative behaviors that contribute to this concept. We posit that residents who are active learners as demon-strated by asking questions, proposing next steps, and initiating purposeful actions have higher teachability. DESIGN, SETTING, PARTICIPANTS: Previously recorded videos from 26 laparoscopic inguinal hernia repairs per-formed by two PGY-5 general surgery residents at a Mid-west tertiary care center were qualitatively reviewed for intraoperative behaviors. A summative content analysis identified behaviors associated with increased teachabil-ity and improved operative performance assessment scores. RESULTS: Average frequencies of intraoperative behav-iors for resident 1 and 2 (R1 and R2) were not signifi-cantly different, although R2 asked more medical knowledge and technical questions. While the rate of attending feedback was similar for both residents (x=3.82 vs 3.40, p=0.646), R1 consistently incorporated feedback (x=2.27 vs 0.40, p=0.001) whereas R2 needed frequent prompting (x=2.45 vs 1.55, p=0.239). R1 scored higher in all but one operative performance assessment category, including overall performance (x=4.17 vs 2.93, p=0.007), but R2 had a larger magni-tude of overall improvement (+1 vs +2). CONCLUSIONS: Teachability is a dynamic component of the resident-attending dyad. While intraoperative active learning behaviors do not appear to be associated with teachability, asking questions may increase the magnitude of improvement in performance. Most impor-tantly, the ability to incorporate intraoperative feedback in real time seems to be a critical aspect of teachability and warrants further research. ( J Surg Ed 80:30-38. (c) 2022 Association of Program Directors in Surgery. Pub-lished by Elsevier Inc. All rights reserved.)

Automated summary

This study aims to define "teachability" and identify intraoperative behaviors that contribute to this concept. Analysis of videos from laparoscopic hernia repairs showed that residents who asked questions, proposed next steps, and initiated purposeful actions had higher teachability. The residents' actual technical skills did not appear to be significantly associated with teachability, but asking questions increased the magnitude of improvement in performance. The ability to incorporate intraoperative feedback in real time seems to be a critical aspect of teachability.