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her study does not include residents, it does drive home very important points about
managing the relationship of a teacher and learner.
The central concept of her model is a process called “sizing up.” Surgeons and
learners are engaged in a continuous dynamic of observation of each other’s behav-
iors. Surgeons have to consider the task at hand, manage the operating room team,
as well as teach technical skills and meaningful concepts. They “size up” the learner
and gage the level of motivation and commitment, which in turn translates to how
they respond as teachers. Levels of motivation and commitment can be demon-
strated by preparedness, inquisitiveness, engagement, attitude, and demeanor.
Legitimacy and trust are central to the processes of teaching and learning in the
operating room.
The learning environment of the operating room starts with a commitment in the
training program that teaching and learning are essential components of the daily
activity. Faculty need to engage the learner and have clear learning objectives as the
surgical day begins. Residents need to come in prepared and motivated so when
they are “sized up,” their teachers sense the commitment and reciprocate via an
engaged process in which they constantly look for opportunities to meet the objec-
tives and advance the training of the resident.
Needs Assessment to Set the Stage of the Learning
Environment
Teaching in the operating room rarely starts with a needs assessment. Residents are
assigned to cases based on some internal institutional culture. These could be
assignments based on service models, mentorship models, or chief residents assign-
ing cases based on seniority and perceived level appropriateness. Busy academic
practices challenge these models greatly since operative opportunities and learning
are more numerous than the available resident compliments.
Surgical faculty and residents have different perceptions regarding the residents’
learning needs. The disparity between faculty and resident perception of residents’
learning needs in the operating room was demonstrated by Pugh et al. in a study
designed to evaluate learning resources utilized by residents when preparing for
surgical cases [ 40 ]. This underscores the importance of residents to be included in
needs assessments relating to surgical training.
Residents come to the operating room with differing learning needs that are
dependent on expectations, learning styles, skill level, knowledge, and experience.
Their self-assessment and preparation for a case may start with the case assignment.
There is minimal faculty input at this level. Residents will utilize variable resources
including surgical atlases, surgical texts, advice from colleagues, web resources,
videos, as well as previous operative reports [ 41 ].
More often than not, the faculty surgeon sees the assisting resident in the operat-
ing room as the patient is being prepared for surgery. Although the time from patient
setup to beginning of procedure is short, a conversation around needs assessment is
M. Mirza and J.F. Koenig