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Investigación en Educación Médica

2022, Number 41

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Inv Ed Med 2022; 11 (41)

Teaching surgical skills: relevant educational theories (part one)

Gaxiola-García MÁ, Kushida-Contreras BH, Sánchez-Mendiola M

Language: Spanish
References: 87
Page: 82-96
PDF size: 634.95 Kb.


ABSTRACT

Introduction: There is no globally accepted precise definition of surgical education. Educational theories and theoretical frameworks that support the teaching of surgery are fragmented and scattered, without being part of an integrated model that allow a holistic approach with academic rigour.
Objective: To obtain an approximation of the concepts and theories used in surgical education that can potentially be included in an integrative model.
Methods: A scoping review of the literature about surgical education and its theoretical-conceptual frameworks was carried out, relationships between concepts were determined when appropriate. The analysis was structured as follows: challenges of surgical education, educational paradigms, structured vs. unstructured programs, characteristics of an effective surgical mentor, cognitive theory of learning in the operating room, taxonomies for teaching and learning of surgery, novice to expert model, and models for surgical teaching.
Results: The concepts that support the teaching of surgery are multiple; its application and utility have been demonstrated in medical and non-medical learning contexts. The use of these concepts or models by mentors provide schemes that facilitate the assessment and, when appropriate, the modification of teaching strategies. The theoretical grounding of surgical teaching allows migrating from programs based on arbitrary time periods or workloads to planned and modulated learning experiences.
Conclusions: There are theoretical resources that can be used in the whole spectrum of surgical education, from the selection of the surgical apprentice to the autonomous performance of the experienced surgical professional. The use of these concepts or theories makes it possible to achieve quality surgical teaching, limiting the effects of chance in learning.


REFERENCES

  1. Peracchia A. Presidential Address: Surgical education in the third millennium. Ann Surg. 2001;234(6):709-12. https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC1422129/

  2. Pellegrini CA. Surgical education in the United States 2010: Developing intellectual, technical and human values. Updates Surg. 2012;64(1):1-3. doi:10.1007/s13304-011-0113-4

  3. Ramani S, Leinster S. AMEE guide no. 34: Teaching in the clinical environment. Med Teach. 2008;30(4):347-64. doi:10.1080/01421590802061613

  4. Sullivan ME. Applying the science of learning to the teaching and learning of surgical skills: The basics of surgical education. J Surg Oncol. 2020;122(1):5-10. doi:10.1002/ jso.25922

  5. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med. 2018;169(7):467-73. doi:10.7326/M18-0850

  6. Khan S, Mian A. Medical education: COVID-19 and surgery. Br J Surg. 2020;107(8):e269. doi:10.1002/bjs.11740

  7. Lin J, Reddy RM. Teaching, Mentorship, and Coaching in Surgical Education. Thorac Surg Clin. 2019;29(3):311-20. doi:10.1016/j.thorsurg.2019.03.008

  8. Fritz T, Stachel N, Braun BJ. Evidence in surgical training- A review. Innov Surg Sci. 2019;4(1):7-13. doi:10.1515/iss- 2018-0026

  9. Bjerrum F, Thomsen ASS, Nayahangan LJ, Konge L. Surgical simulation: Current practices and future perspectives for technical skills training. Med Teach. 2018;40(7):668-75. doi:10. 1080/0142159X.2018.1472754

  10. Grigorian A, Sicklick JK, Kingham TP. International surgical residency electives: A collaborative effort from trainees to surgeons working in low- and middle-income countries. J Surg Educ. 2014;71(5):694-700. doi:10.1016/j. jsurg.2014.03.003

  11. Dauphine C, Neville AL, Moazzez A, et al. Can Deficiencies in Performance Be Identified Earlier in Surgical Residency? An Initial Report of a Surgical Trainee Assessment of Readiness Exam. J Surg Educ. 2018;75(6):e91-e96. doi:10.1016/j. jsurg.2018.07.030

  12. Moore RL. Developing lifelong learning with heutagogy: contexts, critiques, and challenges. Distance Educ. 2020; 41(3):381-401. doi:10.1080/01587919.2020.1766949

  13. Baker L, Wright S, Mylopoulos M, Kulasegaram K, Ng S. Aligning and Applying the Paradigms and Practices of Education. Acad Med. 2019;94(7):1060. doi:10.1097/ ACM.0000000000002693

  14. Sadideen H, Alvand A, Saadeddin M, Kneebone R. Surgical Experts – Born or Made ? Int J Surg. 2013;11:773-8.

  15. Sadideen H, Kneebone R. Practical skills teaching in contemporary surgical education: How can educational theory be applied to promote effective learning? Am J Surg. 2012; 204(3):396-401. doi:10.1016/j.amjsurg.2011.12.020

  16. Tseng J. Learning theories and principles in surgical education and technical learning. J Surg Oncol. 2020;122(1):11-4. doi:10.1002/jso.25936

  17. Wallace L, Raison N, Ghumman F, Moran A, Dasgupta P, Ahmed K. Cognitive training: How can it be adapted for surgical education? Surg. 2017;15(4):231-9. doi:10.1016/j. surge.2016.08.003

  18. Drossard S. Structured surgical residency training in Germany: An overview of existing training programs in 10 surgical subspecialties. Innov Surg Sci. 2019;4(1):15-24. doi:10.1515/iss-2018-0033

  19. Memon MA, Brigden D, Subramanya MS, Memon B. Assessing the Surgeon's Technical Skills: Analysis of the Available Tools. Acad Med. 2010;85(5):869-80. doi:10.1097/ ACM.0b013e3181d74bad

  20. Hoffmann H, Oertli D, Mechera R, et al. Comparison of Canadian and Swiss Surgical Training Curricula: Moving on Toward Competency-Based Surgical Education. J Surg Educ. 2017;74(1):37-46. doi:10.1016/j.jsurg.2016.07.013

  21. Dickinson KJ, Bass BL, Pei KY. The Current Evidence for Defining and Assessing Effectiveness of Surgical Educators: A Systematic Review. World J Surg. 2020;44(10):3214-23. doi:10.1007/s00268-020-05617-9

  22. Swendiman RA, Hoffman DI, Bruce AN, Blinman TA, Nance ML, Chou CM. Qualities and Methods of Highly Effective Surgical Educators: A Grounded Theory Model. J Surg Educ. 2019;76(5):1293-302. doi:10.1016/j.jsurg.2019.02.011

  23. Sutton PA, Beamish AJ, Rashid S, Elsey E, Mohan HM, O’Regan D. Attributes of excellent surgical trainers: An analysis of outstanding trainers. Int J Surg. 2018;52(October 2017):371-5. doi:10.1016/j.ijsu.2017.10.007

  24. Dean B, Jones L, Garfjeld Roberts P, Rees J. What is Known About the Attributes of a Successful Surgical Trainer? A Systematic Review. J Surg Educ. 2017;74(5):843-50. doi:10.1016/j.jsurg.2017.01.010

  25. Vidal F, Meckler C, Hasbroucq T. Basics for sensorimotor information processing: Some implications for learning. Front Psychol. 2015;6(FEB):1-14. doi:10.3389/fpsyg.2015.00033

  26. Klink PC, Jeurissen D, Theeuwes J, Denys D, Roelfsema PR. Working memory accuracy for multiple targets is driven by reward expectation and stimulus contrast with different time-courses. Sci Rep. 2017;7(1):1-13. doi:10.1038/s41598- 017-08608-4

  27. Cowan N. What are the differences between long-term, shortterm, and working memory? Prog Brain Res. 2008;169:323- 38. doi:10.1016/S0079-6123(07)00020-9

  28. Miller GA. The magical number seven, plus or minus two: some limits on our capacity for processing information. Psychol Rev. 1956;63(2):81-97. doi:10.1037/h0043158

  29. Babchenko O, Garland CB, Bentz ML, Poore SO. Psychological Theory as It Applies to Surgical Training. Ann Surg. 2019;269(5):812-4. doi:10.1097/SLA.0000000000003180

  30. Young JQ, O’Sullivan PS, Ruddick V, Irby DM, Cate O Ten. Improving Handoffs Curricula: Instructional Techniques from Cognitive Load Theory. Acad Med. 2017;92(5):719. doi:10.1097/ACM.0000000000001664

  31. Sewell JL, Maggio LA, ten Cate O, van Gog T, Young JQ, O’Sullivan PS. Cognitive load theory for training health professionals in the workplace: A BEME review of studies among diverse professions: BEME Guide No. 53. Med Teach. 2019;41(3):256-70. doi:10.1080/0142159X.2018.1505034

  32. Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med. 2004;79(10 Suppl.):70-81. doi:10.1097/00001888-200410001-00022

  33. Ericsson KA, Krampe RT, Tesch-Römer C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev. 1993;100(3):363-406. doi:10.1037/0033- 295X.100.3.363

  34. Gladwell M. Outliers THE STORY OF SUCCESS. Little, Brown and Company; 2008.

  35. Clifford Y Ko et al. What is the ‘best’ method of surgical training? Arch Surg. 1998;133(I):900-3.

  36. Purcell Jackson G, Tarpley JL. How long does it take to train a surgeon? BMJ. 2009;339(November):1062-4. doi:http:// dx.doi.org.ezproxy.auckland.ac.nz/10.1136/bmj.b4260

  37. Hashimoto DA, Sirimanna P, Gomez ED, et al. Effect of deliberate practice on learning and surgical performance: a randomized control trial. J Am Coll Surg. 2013;217(3):S118.

  38. Verrier ED. The Elite Athlete, the Master Surgeon. J Am Coll Surg. 2017;224(3):225-35. doi:10.1016/j.jamcollsurg.2016.11.004

  39. Anders Ericsson K. Deliberate Practice and Acquisition of Expert Performance: A General Overview. Acad Emerg Med. 2008;15(11):988-994. doi:10.1111/j.1553-2712.2008.00227.x

  40. Schunk DH. Learning Theories. An Educational Perspective; 2012.

  41. Dath D, Hoogenes J, Matsumoto ED, Szalay DA. Exploring how surgeon teachers motivate residents in the operating room. Am J Surg. 2013;205(2):151-5. doi:10.1016/j. amjsurg.2012.06.004

  42. Schunk DH, DiBenedetto MK. Motivation and social cognitive theory. Contemp Educ Psychol. 2020;60(December 2019):101832. doi:10.1016/j.cedpsych.2019.101832

  43. Eccles JS, Wigfield A. From expectancy-value theory to situated expectancy-value theory: A developmental, social cognitive, and sociocultural perspective on motivation. Contemp Educ Psychol. 2020;61(May):101859. doi:10.1016/j. cedpsych.2020.101859

  44. Kunanitthaworn N, Wongpakaran T, Wongpakaran N, et al. Factors associated with motivation in medical education: A path analysis. BMC Med Educ. 2018;18(1):1-9. doi:10.1186/ s12909-018-1256-5

  45. Harley JM, Pekrun R, Taxer JL, Gross JJ. Emotion Regulation in Achievement Situations: An Integrated Model. Educ Psychol. 2019;54(2):106-26. doi:10.1080/00461520. 2019.1587297

  46. Pelaccia T, Viau R. Motivation in medical education. Med Teach. 2017;39(2):136-40. doi:10.1080/0142159X.2016.1248924

  47. Ericsson KA. Acquisition and maintenance of medical expertise: A perspective from the expert-performance approach with deliberate practice. Acad Med. 2015;90(11):1471- 86. doi:10.1097/ACM.0000000000000939

  48. Louis E. Yelle. The learning curve: historical review and comprehensive survey. Decis Sci. 1979;10(2):302-28.

  49. Thompson BM, Rogers JC. Exploring the Learning Curve in Medical Education: Using Self-Assessment as a Measure of Learning. Acad Med. 2008;83(Supplement):S86-S88. doi:10.1097/ACM.0b013e318183e5fd

  50. Pusic M V., Boutis K, Hatala R, Cook DA. Learning Curves in Health Professions Education. Acad Med. 2015;90(8):1034- 42. doi:10.1097/ACM.0000000000000681

  51. Rogers DA, Elstein AS, Bordage G. Improving continuing medical education for surgical techniques: Applying the lessons learned in the first decade of minimal access surgery. Ann Surg. 2001;233(2):159-66. doi:10.1097/00000658- 200102000-00003

  52. Hopper AN, Jamison MH, Lewis WG. Learning curves in surgical practice. Postgrad Med J. 2007;83(986):777-9. doi:10.1136/pgmj.2007.057190

  53. Adams NE. Bloom’s taxonomy of cognitive learning objectives. J Med Libr Assoc. 2015;103(3):152-3. doi:10.3163/1536- 5050.103.3.010

  54. Magas CP, Gruppen LD, Barrett M, Dedhia PH, Sandhu G. Intraoperative questioning to advance higher-order thinking. Am J Surg. 2017;213(2):222-6. doi:10.1016/j.amjsurg. 2016.08.027

  55. Raman M, Donnon T. Procedural skills education - Colonoscopy as a model. Can J Gastroenterol. 2008;22(9):767-70. doi:10.1155/2008/386851

  56. Sawyer T, White M, Zaveri P, et al. Learn, See, Practice, Prove, Do, Maintain: An Evidence-Based Pedagogical Framework for Procedural Skill Training in Medicine. Acad Med. 2015; 90(8):1025-33. doi:10.1097/ACM.0000000000000734

  57. Sideeg A. Bloom’s Taxonomy, Backward Design, and Vygotsky’s Zone of Proximal Development in Crafting Learning Outcomes. Int J Linguist. 2016;8(2):158. doi:10.5296/ ijl.v8i2.9252

  58. Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990;65(9):S63-7. doi:10.1097/00001888- 199009000-00045

  59. Norcini JJ. ABC of learning and teaching in medicine: Work based assessment. BMJ. 2003;326(7392):753-5. doi:10.1136/ bmj.326.7392.753

  60. Hurreiz H. The evolution of surgical training in the UK. Adv Med Educ Pract. 2019;10:163-8. doi:10.2147/AMEP.S189298

  61. Norcini J, Burch V. Workplace-based assessment as an educational tool: AMEE Guide No. 31. Med Teach. 2007;29(9- 10):855-71. doi:10.1080/01421590701775453

  62. Cruess RL, Cruess SR, Steinert Y. Amending Miller’s Pyramid to Include Professional Identity Formation. Acad Med. 2016;91(2):180-5. doi:10.1097/ACM.0000000000000913

  63. Al-Eraky M, Marei H. A fresh look at Miller’s pyramid: assessment at the ‘Is’ and ‘Do’ levels. Med Educ. 2016;50(12): 1253-7. doi:10.1111/medu.13101

  64. Ten Cate O, Carraccio C, Damodaran A, et al. Entrustment Decision Making. Acad Med. 2020;Publish Ah. doi:10.1097/ ACM.0000000000003800

  65. Sánchez Gómez S, Ostos EMC, Solano JMM, Salado TFH. An electronic portfolio for quantitative assessment of surgical skills in undergraduate medical education. BMC Med Educ. 2013;13(1):65. doi:10.1186/1472-6920-13-65

  66. DaRosa DA, Zwischenberger JB, Meyerson SL, et al. A theory-based model for teaching and assessing residents in the operating room. J Surg Educ. 2013;70(1):24-30. doi:10.1016/j.jsurg.2012.07.007

  67. Furley PA, Memmert D. The role of working memory in sport. Int Rev Sport Exerc Psychol. 2010;3(2):171-94. doi:10. 1080/1750984X.2010.526238

  68. Reznick RK, MacRae H. Teaching Surgical Skills — Changes in the Wind. Cox M, Irby DM, eds. N Engl J Med. 2006; 355(25):2664-9. doi:10.1056/NEJMra054785

  69. Mitchell EL, Arora S. How educational theory can inform the training and practice of vascular surgeons. J Vasc Surg. 2012;56(2):530-7. doi:10.1016/j.jvs.2012.01.065

  70. Kotsis SV, Chung KC. Application of the “see one, do one, teach one” concept in surgical training. Plast Reconstr Surg. 2013;131(5):1194-201. doi:10.1097/PRS.0b013e318287a0b3

  71. Yardley S, Teunissen PW, Dornan T. Experiential learning: AMEE Guide No. 63. Med Teach. 2012;34(2):e102-e115. doi: 10.3109/0142159X.2012.650741

  72. Mavroudis CL, Tong J, Wirtalla C, et al. (Re)thinking the Residential in Residency: Modern Surgical Practice Continues to Move Away From the Inpatient Setting. J Surg Educ. December 2020. doi:10.1016/j.jsurg.2020.12.005

  73. Dreyfus SE. The five-stage model of adult skill acquisition. Bull Sci Technol Soc. 2004;24(3):177-81. doi:10.1177/0270467604264992

  74. Gobet F, Chassy P. Expertise and intuition: A tale of three theories. Minds Mach. 2009;19(2):151-80. doi:10.1007/s11023- 008-9131-5

  75. Carraccio CL, Benson BJ, Nixon LJ, Derstine PL. From the educational bench to the clinical bedside: Translating the Dreyfus developmental model to the learning of clinical skills. Acad Med. 2008;83(8):761-7. doi:10.1097/ ACM.0b013e31817eb632

  76. Schneider JR, Coyle JJ, Ryan ER, Bell RH, DaRosa DA. Implementation and Evaluation of a New Surgical Residency Model. J Am Coll Surg. 2007;205(3):393-404. doi:10.1016/j. jamcollsurg.2007.05.013

  77. Klingensmith ME, Awad M, Delman KA, et al. Early Results from the Flexibility in Surgical Training Research Consortium: Resident and Program Director Attitudes Toward Flexible Rotations in Senior Residency. J Surg Educ. 2015;72(6):e151-e157. doi:10.1016/j.jsurg.2015.05.007

  78. Drolet BC, Marwaha JS, Wasey A, Pallant A. Program Direc- tor Perceptions of the General Surgery Milestones Project. J Surg Educ. 2017;74(5):769-72. doi:10.1016/j.jsurg.2017.02.012

  79. Gardner AK, Timberlake MD, Dunkin BJ. Faculty Development for the Operating Room: An Examination of the Effectiveness of an Intraoperative Teaching Course for Surgeons. Ann Surg. 2019;269(1):184-90. doi:10.1097/SLA.0000000000002468

  80. Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10(1):1-13. doi:10.1186/ s13012-015-0242-0

  81. Angelo RL, Ryu RKN, Pedowitz RA, et al. A Proficiency- Based Progression Training Curriculum Coupled with a Model Simulator Results in the Acquisition of a Superior Arthroscopic Bankart Skill Set. Arthrosc - J Arthrosc Relat Surg. 2015;31(10):1854-71. doi:10.1016/j.arthro.2015.07.001

  82. Walter AJ. Surgical Education for the Twenty-first Century: Beyond the Apprentice Model. Obstet Gynecol Clin North Am. 2006;33(2):233-6. doi:10.1016/j.ogc.2006.01.003

  83. Franzese CB, Stringer SP. The Evolution of Surgical Training: Perspectives on Educational Models from the Past to the Future. Otolaryngol Clin North Am. 2007;40(6):1227- 35. doi:10.1016/j.otc.2007.07.004

  84. Potts JR. Shifting Sands of Surgical Education. J Am Coll Surg. 2018;227(2):151-62. doi:10.1016/j.jamcollsurg.2018.02.012

  85. Shaharan S. Evaluation of surgical training in the era of simulation. World J Gastrointest Endosc. 2014;6(9):436. doi:10.4253/ wjge.v6.i9.436

  86. Kotsis S V, Chung KC. Application of See One, Do One, Teach One Concept in Surgical Training. Plast Reconstr Surg. 2013;131(5):1194-201.

  87. Ribeiro BF, Chaplin S, Peel ALG, Treasure T, Leopard PJ, Jackson BT. Surgery in the United Kingdom. Arch Surg. 2001;136(9):1076-81. doi:10.1001/archsurg.136.9.1076




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