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Let’s use an inguinal hernia repair as an example. At an intern level, the resident
is learning the anatomy and memorizing the steps of the procedure. The defined
objective set at the “briefing” may be simply closing the incision or properly inject-
ing local anesthetic. The senior resident can teach the junior resident proper sutur-
ing techniques and principles of inguinal nerve anatomy and analgesia. As the
learner progresses, focus may be changed to elements such as nerve identification,
cord mobilization, sac dissection, prosthesis placement, and so forth. Ultimately,
special situations and their management such as persistent incarceration, sliding
defects, rarer hernia types, and non-prosthetic repairs become suitable foci of teach-
ing effort.
With more experienced residents, such as a chief resident, and under the supervi-
sion of an attending surgeon, it is an excellent learning opportunity for both resi-
dents to have the chief resident walk a junior resident through a case. The chief
resident must have extensive knowledge about the patient, disease process, anat-
omy, and operative steps. In some ways, this gives the senior resident the greatest
degree of autonomy allotted in our current training paradigm. It develops both the
junior resident and senior resident’s operative skills while also developing the senior
resident’s ability to teach. Using this model, the attending, senior resident, and
junior resident can define a particular objective to focus on through the case. The
attending and senior resident should give feedback to the junior resident regarding
his or her technical performance. In addition, the senior resident can receive feed-
back from the attending and junior resident regarding his or her teaching style.
Striving for Excellence as a Resident Teacher
As a resident matures becoming a mid-level and on to a chief resident, the mindset
must change to not only growing in one’s own medical knowledge, clinical judg-
ment, and technical skills but also to one of teaching and leading a team. Leadership,
emotional intelligence, and both self- and team management skills become more
critical and represent transitional skills in the progression from graduate to post-
graduate lifelong learning. Over the next few paragraphs, we will outline strategies
senior residents can use to begin to incorporate some of these skills in their most
common and high-stakes learning environment, the operating room.
Developing Intraoperative Teaching Skills
Cox and Swanson described five key elements that characterized outstanding opera-
tive instructors, which include (1) demonstration of awareness and sensitivity to
resident learning needs, (2) provision of direct and ongoing feedback regarding resi-
dent progress, (3) possession of technical expertise and up-to-date knowledge, (4)
encouragement of resident participation, and (5) maintenance of a respectful and
supportive learning environment [ 46 , 47 ]. As outlined above, in many ways, senior
residents can be the best teachers of junior residents. Senior residents may often be
J. Feimster et al.