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curriculum-based focus on both technical and nontechnical competencies.
Although popular didactic conferences like “indications conference” can serve
these goals, they are not individualized to the learner. If surgical teaching is to
incorporate a needs assessment, then the teaching and assessment need to begin
well before the patient is being prepared for surgery. Needs assessment of surgical
education has many opportunities for training programs in patient-centered com-
munication, learning models, training in interprofessional/interdisciplinary team
communication, and teamwork [ 42 ].
Learning Model
The first part of the chapter covers limitations of the current assessment methods.
There is evidence that observational assessment of technical skills is valid and sup-
ported, but the majority of studies don’t achieve a comprehensive analysis as judged
on a systematic review [ 43 ]. Additionally, most checklist forms demonstrate poorer
evidence of validity and reliability.
Many evaluation tools use scale systems and numbered scores. Narrative evalu-
ations are also picking up much attraction and being more effective. Experienced
teaching faculty often find scales and scoring methods cumbersome and use experi-
ence to teach and often teach very well. Standardized vocabulary, framework, and
articulating descriptive operating room teaching and assessment can help establish
teaching practices that not only help teachers evaluate learners but also track their
performance from a task orientation and goal orientation.
DaRosa et al. have reported on the “Zwisch model” which seeks to accomplish a
standardization in the conceptualization of the learning model [ 44 ]. The model pro-
poses four stages of supervision and divides faculty and resident behaviors for each
stage. These are summarized in Table 8.1 and adopted from the referenced article.
Again, these may seem intuitive to experienced teachers. However, it can give fac-
ulty and residents a common language for expectations and needs assessments.
Additionally, it may at some point translate into mapping milestones of surgical
technique.
Show and Tell Stage [ 44 ]
In the needs assessment, the faculty and resident will establish that the resident is
not experienced at the case and will be a focused observer and assistant. The resi-
dent should come into the case prepared having consulted the appropriate surgical
texts and/or videos and have reviewed the patient’s chart thoroughly. The faculty
has to be an active teacher in this environment. The attending “shows” and “tells”
the resident key aspects of the case in a “thinking aloud” method. There should be a
running commentary during the case that imparts the important technical points and
M. Mirza and J.F. Koenig