Disparity Between Resident and Faculty Surgeon's Perceptions of Pre-operative Preparation, Intra-operative Teaching and

1. Disparity Between Resident and Faculty Surgeon’s Perceptions of Pre-operative Preparation, Intra-operative Teaching and Post-operative Feedback Joel S. Rose, MD, Brett H. Waibel, MD, & Paul J. Schenarts, MD Division of Surgical Education, Department of Surgery East Carolina University Greenville, NC

2. Introduction • Greater focus of intra-operative teaching • Limited duty hours • Fewer but more complexoperations • Inexperience with basic operations • Concerns of readiness to enter practice • Inability to perform independently Am Surg. 2010;76:578-582. Arch Surg. 2000; 135:570-575. Arch Surg. 2005; 140:137-145. SeminVasc Surg. 2006;19:214-217. Ann Surg. 2009;249:719-724. JAMA. 2009;302:1301-1308.

3. Specific responsibilities for residents and faculty Pre-operative preparation • Reading about the procedure & anatomy • Discuss case with faculty Intra-operative • Act as a learner • Act as a teacher Post-operative feedback

4. Purpose: Characterize perceptions of residents and faculty regarding pre-operative preparation, intra-operative teaching and post-operative feedback • Hypothesis: Perceptions of these variables differ between residents and faculty

5. Methods • IRB approval • Modification of a previously validated survey was piloted • Responses were on a 5-point Likert scale • Survey was sent and completed electronically • 3 separate email reminders sent

6. Analysis • Responses averaged and compared using Wilcoxon-Mann-Whitney test • Statistical significance set as p<0.05

7. Results • 27 Residents and 30 Attendings • 100% Response Rate

8. Need for improved intra-operative education p = 0.223

9. Pre-operative variables p < 0.001 p = 0.371 p < 0.001

10. Intra-operative variables p = 0.185 p = 0.067 p = 0.06

11. Intra-operative variables p = 0.048 p = 0.001 p = 0.002 p < 0.001

12. Intra-operative variables p = 0.007

13. Post-op variables p = 0.01 p = 0.009

14. Discussion of preoperative variables • There was agreement on the need to improve intra-operative education. • Significant disparities in the perceptions of the amount of pre-operative reading and anatomy review performed by the residents. • This may be due to how residents demonstrate their preparation or how the faculty assess their preparation

15. Discussion of intra-operative variables • Significant disagreement in the teaching of technical skills. • Residents are more concerned with the technical aspects of operations. • Faculty are more concerned with natural history of disease and outcomes. J Surg Educ. 2007;64:250-255

16. Discussion of Feedback • There may be differences in perceptions of constructive intra-operative feedback. • Residents and faculty had significantly different perceptions of both positive and negative feedback.

17. Barriers to intra-operative teaching • Financial pressures • Need for efficiency • Unforeseen intra-operative complications • Conflicting duties to patients and residents • Development of automaticity by faculty

18. Limitations • Single institution • Modest numbers • Time of year survey conducted

19. Conclusion Areas of Agreement: • Need to improve intra-operative education • Pre-operative discussion took place • Faculty demonstrated anatomy and asked pertinent questions Areas of Disparity: • Pre-operative reading and anatomy review • Teaching of technical skills in the OR • Possibly intra-operative feedback • Post-operative feedback