TEACHING IN THE OPERATING THEATRE
Medical Education SIG
R Jones
ANZCA, Melbourne, Vic
An essential component of the educational experience for anaesthetic trainees is to spend time in the operating theatre. The primary purpose of the operating room experience is for the anaesthetist to impart valuable teaching and for the trainee to obtain essential learning. However, precisely what is taught and what is learned, as well as the efficiency with which it is taught and learned, depends on a complex interaction of the physical and psychosocial environment that comprises the operating theatre.
Part of the priceless merit of the apprenticeship model embraced by medical specialist training is to practice the trainee directly in clinical activities and patient care within the environment where the successful trainee will eventually practice much of the science and art of anaesthesia upon their successful graduation. Naturally, wherever possible this invaluable experience is supplemented by courses, lectures, medical rounds, tutorials and study groups. The operating theatre offers many advantages and poses numerous challenges to education. Although all personnel within this environment have the potential to influence teaching and learning, the two primary persons are the Specialist Anaesthetist and the Trainee. This paper focuses upon the educational pros and cons of teaching in the operating theatre from the perspective of these two important people; the specialist and the trainee anaesthetist.
What can be Taught in the Operating Theatre?
Almost every aspect of anaesthetic practice can be taught within the operating theatre. This includes medicine, anatomy, pharmacology, physiology, measurement and even applied statistics. Invaluable psychomotor skills such as intubation, line insertion and spinal anaesthesia. Global skills and abilities such as the essential ability to effectively monitor the anaesthetic machine, patient colour and well-being during prolonged procedures. Also the many important non-clinical aspects of anaesthesia including effective communication, leadership, management, ethics and teaching. An added benefit is that because few apprentices can ever be better than their master, it forces the master to continually review, revise and update their own knowledge, skills and abilities.
Challenges and Benefits of the Operating Theatre as a Teaching Environment
The operating theatre can be a challenging place to teach. Patient safety must remain the paramount concern for all personnel and in this regard teaching takes a secondary role even within “teaching” hospitals. Although essential within the operating theatre the placement of education as a secondary is somewhat unusual compared to other teaching environments. Furthermore, the physical environment may be less than ideal for learning (for example, noise, disruptions and level of physical comfort) as may be the time requirements (for example, rapid turnover of patients within some lists or lengthy and extensive procedures). All of this is complicated by an unnatural environment in which a trainee may feel less than comfortable and the wearing of masks diminishing non-verbal communication (an important consideration as most communication is non-verbal and a great deal of communication makes use of facial expressions that may be hidden by masks). However, teaching in the operating theatre also offers powerful benefits. Most importantly is the opportunity for the trainee to learn in the environment where much of their practice for the remainder of their professional lives will take place.
Trainee Perspective
Several studies have focused upon identifying what trainees (or students) believe to be the greatest influences in successful teaching in the operating theatre (Cleave-Hogg & Rothman 1991, Lyon 2004, Schwind et al 2003). These include the:
- Specialist is a positive role model
- Tone of the specialist
- Quantity of interaction between specialist and trainee
- Trainee perception that their skills and knowledge improved when in the OT
- Teaching ability of specialist
- Quality of specialist feedback to trainee
- Nurses/technicians helpful and courteous
- Trainee performs pre-operative assessment
- The trainee has a specific role
- Positive relationship between the specialist and trainee
- Trainee values learning in the operating theatre
Specialist Perspective
Studies that have focused upon identifying what specialists believe to be of greatest influence in successful teaching in the operating theatre reveal several factors (Lyon 2004) including the:
- Trainee demonstrates interest in learning
- Trainee demonstrates interest in the procedure
- Trainee appears motivated and committed
- Trainee validates the specialist as a teacher
- Specialist values teaching in the operating theatre
Implications for Teaching in the Operating Theatre
Anaesthetists and trainees should accept that the operating theatre is replete with opportunities for both teaching and learning; that the realities of medical practice are such that it is rarely possible to predict progress of a particular procedure but that every procedure or list is a fertile ground for developing teaching and learning opportunities; entering into (at least) a brief discussion prior to commencement of the list is necessary to optimise the teaching and learning experience; and concerns of patient safety supersede those of teaching. It is the responsibility of the trainee to ensure they are prepared for the learning opportunities afforded in the operating theatre. Specialists will respond to the professionalism shown by trainees including their willingness to undertake pre-operative assessments, behaviour and appearance. Trainees should appear motivated and interested as this will have a marked effect on how a specialist will respond as a teacher. Trainees should identify specific learning aims for each operating room experience and communicate these aims to the anaesthetist ahead of time so that the anaesthetist can contribute to the aims wherever possible. Wenger (1998) describes a “community of practice” as having an established hierarchy, procedures and culture. Lyon (2004) argues that the operating theatre and its personnel form such a community of practice and that the trainee “must be granted legitimacy in order to gain access to the practice” (p. 1286). In this regard entrance to the operating room community can only be granted through the specialist. Furthermore specialists might consider the “needs of different learners in theatres and decide how to distribute valuable teaching time and opportunities for involvement in the team” (Lyon, 2004, p. 1281).
Time of Presentation
Saturday 13 May 2006 - 1030-1200
References
1. Cleave-Hogg, D & Rothman, A (1991). Discerning views medical students’ perceptions of their learning environment. Evaluation and the Health Professions; 14; 456-74.
2. Schwind, CJ, Boehler, ML, Rogers, DA, Williams, RG, Dunnington, G, Folse, R & Markwell, MA (2003). Variables influencing medical student learning in the operating room. The American Journal of Surgery; 187; 198-200.
3. Lyon, P (2004). A model of teaching and learning in the operating theatre. Medical Education; 38; 1278-87.
4. Wenger, E (1998). Communities of practice: Learning, meaning and identity. Cambridge: Cambridge University Press.
