How to teach.
Surgeons that are either full-time or part-time academic faculty are the teachers and mentors of surgical residents. Although there is the occasional lecture and/or presentation at Grand Rounds or elsewhere, most teaching and learning takes place in a clinical setting, with patients in the hospital or in the operating room. The residents are keen to learn their future profession and the faculty are aware of their responsibility to ensure the residents are competent and safe surgeons when they depart the program and become independent practitioners.
A few general observations for the teacher. Flexibility is a useful teacher trait; residents are individuals and not all are the same. Teach in a way that engages a particular resident. Encourage and reward as well as criticize and correct; don’t undermine the resident’s confidence. Have appropriate expectations; first year and fifth year residents differ substantially in their knowledge and experience.
On the floors I questioned the resident about their assessment of the patient’s course and any plans for future care. Then a discussion can ensue but the resident must first articulate their thinking. They will learn little if they are passive observers.
In the operating room much depends on the post graduate year level. Operations should not be unduly prolonged but junior residents need to develop basic skills and get over any performance anxiety. Supervising and instructing as they make an incision, tie a knot or suture a wound is essential. Don’t just leave them to it. Senior residents’ first requirement is to have read and/or watched a video of the operation. Before becoming the operating surgeon, they should have witnessed, ideally assisted, the operation previously, If not they only assist. If prepared the surgeon allows them to describe a plan and then get started. Guidance and encouragement are ideal behaviors. When the resident begins to stumble or be uncertain the teacher can give them the opportunity to sort things out. They will learn more if they have to think things through even if eventually the attending must take over or give specific instructions.
