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objectively assessing surgeons’ teaching on effective
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Most teaching events were prompted by resident performance errors. 13 High-acuity situations often demand
instrumental interactions without additional communications to ensure patient safety. Banter and pure
teaching help to set the tone in the OR and provide
lasting educational lessons, respectively. Being mindful
of these different forms of operative interactions and
striving to balance their use can enhance the learning
experience in the OR.
Operative performance assessments
A variety of rating scales, procedure-specific checklists,
and indices of surgical competency have been developed in the last few decades and provide a standardized
means of assessing learner performance. Examples
include the Objective Structured Assessment of Technical Skills and the Global Operative Assessment of
Laparoscopic Skills. 15
Although many assessment scales focus primarily on
technical skills, the mark of a proficient surgeon includes
not only mastery of the technical elements but also an
ease and efficiency of movement and a situational awareness that promotes the efficiency of the entire surgical
team. Therefore, scoring systems, which aim to evaluate
overall surgical competence and incorporate all of these elements, are an ideal tool for this setting. One example is the
Ottawa Surgical Competency Operating Room Evaluation
(O-SCORE), which evaluates residents’ pre-procedure plan,
case preparation, knowledge of specific procedural steps,
technical performance, visuospatial skills, post-procedure
planning, efficiency and flow, and communication with the
surgical staff. When this tool was piloted in the division
of orthopaedic surgery at the University of Ottawa, ON,
faculty indicated that the tool made trainee assessment
easier. Post-hoc analysis proved that the tool was able to
differentiate between junior and senior residents, thereby
validating the model. 16 As objective measures of resident
competence become increasingly important in education,
Identifying specific learning objectives before operative cases
is helpful in maximizing surgical education. However, many
opportunities for education are unplanned. These teachable
moments may arise from either technical errors by the learner
or demonstrated knowledge deficits within the case.
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