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In order to graduate to the next step, the resident must demonstrate:- Having done the homework
- Understanding of indications and approach
- Understanding of anatomy and pathophysiology
- Being able to articulate procedural steps
- Understanding of the key decision-making parts of the case
- Understanding of potential errors/complications
The focus in this stage is priming the resident for task-oriented steps, and the
learning environment is very active. The attending must be invested to teach and
find the learner motivated and committed as “sizing up” happens.
Smart Help Stage [ 44 ]
The resident at this stage will assume the role of surgeon for parts of the surgery. In
the needs assessment, the attending will review expectations and judge patient com-
plexity, and then based on the resident’s level, the resident and attending will decide
the expectations regarding which parts of the surgery the resident will perform. The
understanding is that the role of surgeon and assistant is fluid between the faculty
and residents. The attending taking over as surgeon is not a criticism of the resident
but rather part and parcel of the instructional strategy in which the surgeon role is
“fair play.” Residents perceive faculty takeovers negatively as unfair and indicative
of poor teaching [ 45 ]. The negative perception can be curtailed in an active learning
environment where expectations are reviewed in advance. When the resident is per-
forming as the surgeon, the faculty is engaged in instruction, constructive criticism,
and encouragement toward independence. The resident can be very task oriented in
the beginning levels of this stage and become more goal oriented in the advanced
levels of this stage.
The graduating steps are:
- Resident is technically capable.
- Resident can safely perform the major and key portions of the case with minimal
correction or direction. - Resident knows all the steps of the operation.
Dumb Help Stage [ 44 ]
In the needs assessment, the resident and attending agree that although the resident
can technically perform most major components of the surgery, the resident still
requires attending’s help in providing anatomical exposure as well as first assistance
from the attending or from someone with a higher level of understanding of the
M. Mirza and J.F. Koenig