131typically may not know how to accomplish relatively simple tasks such as writing a
progress note or inserting orders into the electronic medical record. The intern
learns how to perform these duties from his or her senior resident. Initially, this
requires close monitoring and frequent help from the senior resident to ensure
appropriate task completion and learning. As the intern develops experience and
demonstrates trustworthiness in reliable completion of the task under direct obser-
vation, the senior resident should give further independence to the intern and begin
teaching the intern more complex tasks ideally while maintaining intermittent ongo-
ing monitoring of tasks already entrusted to ensure continued appropriate
execution.
BID Model
Another model specifically designed for teaching surgical residents in the operating
room, the BID model, was introduced by Roberts et al. [ 45 ]. The briefing, intraopera-
tive teaching, and debriefing model allows the learner and the teacher to set specific
objectives prior to beginning an operation in order to deliberately focus on a particu-
lar aspect of the learner’s performance as the point for improvement and growth. This
model is easy to remember and fits well into the busy schedule of an attending sur-
geon’s practice. During briefing, the teacher asks the learner what he or she would
like to focus on during the procedure, or with very inexperienced learners, the sug-
gested focus may be provided by the teacher. This interaction, which can occur with
a succinct conversation at the scrub sink, assesses the needs of the learner while also
deliberately setting an objective for educational focus and improvement during the
case. The objective set during the briefing allows for focused intraoperative teach-
ing. During the procedure, the teacher may coach the learner through the operation
but pays particular attention to instruction which applies to the outlined objective.
Purposeful slowing down at this point can help provide an optimal context for learn-
ing at the point of maximal impact while allowing for required operative efficiencies
during the less educationally productive portions of the case. Finally, during closing
the teacher and learner debrief together. Debriefing consists of four elements, namely,
reflection, rule, reinforcement, and correction. It is a time to allow the resident to
reflect on his or her overall performance while assimilating a “rule” to guide future
practices. The teacher should inquire on what the learner recognized and would do
differently in the future, and ask why, and reinforce aspects of the resident’s perfor-
mance that were done well while correcting mistakes. Reinforcement not only
encourages the learner during his or her development, it also emphasizes portions of
the performance that should be repeated in the future. Correcting mistakes is also
crucial for the learner to improve his or her skill level but should always be addressed
in a way to avoid embarrassment or degradation. The BID model allows the teacher
and the learner to intentionally focus on one learning objective which then guides the
intraoperative teaching and is further solidified during debriefing. The learner not
only receives immediate constructive feedback, it occurs in a way that is conducive
to the demanding schedule of a busy attending surgeon.
7 Teaching Residents to Teach: Why and How