retracting tissue, or holding the laparoscope. These tasks
expose the student to different components of surgical care, and it is the student’s understanding of these
components that should be assessed. For example, students pre-rounding and recording vitals do not want
and should not need feedback on whether they copied
the numbers correctly. Instead, their understanding of
the importance of the vital signs they recorded can and
should be evaluated. Tachycardia in a postoperative
patient, for instance, should lead to a brief discussion of
the normal range of vital signs and a longer discussion
of the differential for postoperative tachycardia.
Surgical residents are primarily concerned with two
main tasks: mastering technical operative skills and
patient management. The feedback they receive should
focus on those two domains and should be specific to
the level of training. 19 Expecting a surgical intern to
perform any laparoscopic procedure skin-to-skin with
minimal guidance may be possible for only a few select
individuals, as most interns have yet to attain the skills
and confidence needed to succeed. In contrast, a senior
surgical resident at many programs would be expected
to perform all aspects of the surgical encounter from
consent, positioning, and setup (including the ability to
troubleshoot the oft malfunctioning laparoscopic instrumentation), and safely perform the critical aspects of the
procedure with minimal coaching.
Many medical students and residents shy away from providing feedback to their attending surgeons, but their
hesitation may be unwarranted. The surgeon who takes
a job at an academic hospital and is involved in resident
education does so knowing that medical student and
resident education is a vital responsibility. 20 Although
potentially intimidating, it is appropriate for a resident
to approach an attending and provide feedback after an
operation. In fact, this dialogue is necessary for all parties to gain the most from an experience. Importantly,
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Effective formative feedback provides the opportunity for self-assessment and usually ends with a plan for improvement.
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