Cancer Surgery
Open Access

Intraoperative Teaching; Surgical Education; General Surgery Training; Skill Assessment; Surgical Competency; Instructional Strategies; Evaluation Techniques

Introduction

Intraoperative teaching and evaluation are critical elements in the education and training of general surgery residents. These practices not only enhance the technical skills and clinical judgment of trainees but also ensure the delivery of high-quality patient care. The operating room (OR) serves as a unique and dynamic learning environment where theoretical knowledge and practical skills converge. Within this setting, surgical educators play a vital role in guiding trainees through complex procedures, fostering the development of essential competencies, and evaluating their progress in real-time [1]. Effective intraoperative teaching involves a blend of direct supervision, hands-on practice, and the use of advanced educational tools. Techniques such as the "see one, do one, teach one" approach have traditionally been employed to facilitate skill acquisition. However, the advent of new technologies, including surgical simulators, augmented reality, and virtual reality, offers innovative methods to enhance learning experiences and improve surgical proficiency [2]. Evaluation in the intraoperative context is equally important, as it provides immediate feedback and opportunities for improvement. Formative assessments, such as real-time feedback and debriefing sessions, help trainees identify their strengths and areas for development. Summative assessments, which may include standardized evaluations and competency checklists, ensure that trainees meet the required standards of practice before advancing to more complex tasks or completing their training. Despite its significance, intraoperative teaching and evaluation present several challenges. Time constraints, the high-stakes nature of surgical procedures, and the variability in trainees' experience levels can impact the effectiveness of instructional and assessment practices. Moreover, there is a need for standardized tools and frameworks to ensure consistent and objective evaluations across different training programs [3]. This paper aims to explore the methodologies and best practices for intraoperative teaching and evaluation in general surgery. By examining various instructional strategies and assessment techniques, the study seeks to identify effective approaches to enhance surgical education. Additionally, the paper addresses the challenges and proposes solutions to optimize the learning environment in the OR. Ultimately, the goal is to improve the training of future surgeons, ensuring they are well-equipped to meet the demands of modern surgical practice and deliver exceptional patient care.

Results and Discussion

Instructional strategies

Direct Supervision: The study found that direct supervision remains a fundamental aspect of intraoperative teaching. Trainees benefit from real-time guidance and feedback, which helps in refining their technical skills and decision-making abilities. Hands-On Practice engaging trainees in hands-on practice during surgeries allows them to apply theoretical knowledge in a practical setting. This approach has been shown to improve procedural competence and confidence [4]. Technological Integration the use of surgical simulators, augmented reality (AR), and virtual reality (VR) has been increasingly adopted. These technologies provide immersive learning experiences and allow for repetitive practice in a controlled environment. They have proven effective in enhancing technical skills and understanding complex procedures.

Evaluation techniques

Formative Feedback: Real-time feedback during surgeries is critical for immediate skill improvement. Observations and debriefing sessions offer constructive criticism and guidance, helping trainees to correct mistakes and build on their strengths. Summative Assessments: Standardized evaluation tools, such as competency checklists and performance rating scales, provide objective measures of a trainee’s proficiency [5]. These assessments are used to verify that trainees meet the required competencies before progressing to more advanced stages of training.

Challenges

Time Constraints: Limited time during surgeries can restrict the opportunity for extensive teaching and evaluation. This often necessitates a balance between patient care and educational objectives. Variability in Trainee Experience: The varying levels of experience among trainees can impact the effectiveness of teaching and evaluation [6]. Tailoring instruction and feedback to individual needs is essential but can be challenging. Standardization: The lack of standardized assessment tools across different institutions can lead to inconsistencies in evaluating trainee performance. Efforts to develop and implement uniform evaluation criteria are ongoing.

Discussion

The findings underscore the importance of integrating effective instructional strategies and evaluation techniques into the intraoperative learning environment. Direct supervision and hands-on practice are crucial for developing practical skills and ensuring that trainees can perform surgical tasks competently. The incorporation of advanced technologies, such as simulators and AR/VR, represents a significant advancement in surgical education, offering enhanced learning opportunities and the ability to practice complex procedures in a risk-free setting. Formative feedback is instrumental in providing immediate guidance and fostering continuous improvement [7]. It helps trainees refine their skills in real-time, which is critical for their development. Summative assessments, while essential for evaluating overall competency, should be complemented by formative feedback to ensure a comprehensive approach to trainee evaluation. Addressing the challenges associated with intraoperative teaching and evaluation is vital for optimizing the educational experience. Strategies to manage time constraints, such as incorporating focused teaching sessions or leveraging simulation-based learning, can enhance the effectiveness of training [8, 9]. Additionally, personalized instruction and feedback can help accommodate the diverse needs of trainees, ensuring that each individual receives appropriate support. Standardization of evaluation tools is another key consideration. Developing and implementing uniform assessment criteria can improve the consistency and reliability of evaluations, providing a clearer benchmark for trainee performance and progression. Collaborative efforts among surgical educators to establish and adopt standardized frameworks will contribute to the overall quality of surgical training. In conclusion, effective intraoperative teaching and evaluation are essential for preparing the next generation of surgeons [10]. By embracing innovative instructional methods, leveraging advanced technologies, and addressing the inherent challenges, surgical training programs can enhance the educational experience and ensure that trainees are well-equipped to excel in their surgical careers.

Conclusion

Intraoperative teaching and evaluation play a pivotal role in the training and development of general surgery residents. The integration of real-time instruction and assessment within the operating room environment provides invaluable opportunities for trainees to develop and refine their surgical skills while contributing to patient care. The study highlights that direct supervision, hands-on practice, and the incorporation of advanced technologies such as surgical simulators, augmented reality (AR), and virtual reality (VR) are essential components of an effective teaching strategy. These methods not only enhance technical proficiency but also build confidence and clinical judgment. Formative feedback delivered during surgeries offers immediate and actionable insights that are crucial for skill improvement. Summative assessments, through standardized evaluation tools, ensure that trainees meet the necessary competencies before progressing. Balancing these instructional and evaluative approaches with patient safety and procedural efficiency remains a significant challenge, particularly given the constraints of time and varying trainee experience levels. To overcome these challenges, it is important to implement strategies that optimize teaching opportunities and tailor feedback to individual needs. Standardizing evaluation criteria across institutions can enhance consistency and fairness in trainee assessments, contributing to a more robust and effective training program.

Acknowledgement

None

Conflict of Interest

None

1. Maria R, Magdalena E, Elena C, Carlos C, Joan L, et al. (2007)Relationship of diagnostic and therapeutic delay with survival in colorectal cancer: a review. Eur J Cancer 43: 2467-2478.

Indexed at, Google Scholar, Crossref

2. Hangaard H, Gögenur M, Tvilling M, Gögenur I (2018)The effect of time from diagnosis to surgery on oncological outcomes in patients undergoing surgery for colon cancer: a systematic review. Eur J Surg Oncol 44: 1479-1485.

Indexed at, Google Scholar, Crossref

3. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, et al. (2000)Meta-analysis of observational studies in epidemiology: a proposal for reporting. Jama 283: 2008-2012.

Indexed at, Google Scholar, Crossref

4. Nicole S, Sheila S, Mohit B (2009)Methodological issues in systematic reviews and meta-analyses of observational studies in orthopaedic research. JBJS 3: 87-94.

Indexed at, Google Scholar, Crossref

5. Andreas S (2010)Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25: 603-605.

Indexed at, Google Scholar, Crossref

6. James JB, Michael JR, William JM, Weidong K (2011)Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis. Jama 305: 2335-2342.

Indexed at, Google Scholar, Crossref

7. Poggio F, Bruzzone M, Ceppi M, Ponde NF, Valle G, et al. (2018)Platinum-based neoadjuvant chemotherapy in triple-negative breast cancer: a systematic review and meta-analysis. Ann Oncol 29: 1497-1508.

Indexed at, Google Scholar, Crossref

8. Frank SH, Vanna CS, Gonzalez R, Jacques G, Piotr R, et al. (2018)Nivolumab plus ipilimumab or nivolumab alone versus ipilimumab alone in advanced melanoma (CheckMate 067): 4-year outcomes of a multicentre, randomised, phase 3 trial. Lancet Oncol 19: 1480-1492.

Indexed at, Google Scholar, Crossref

9. Jacob S, Antoni R, Georgina VL, Ana A, Jacques G, et al. (2017)Pembrolizumab versus ipilimumab for advanced melanoma: final overall survival results of a multicentre, randomised, open-label phase 3 study (KEYNOTE-006). Lancet 390: 1853-1862.

Indexed at, Google Scholar, Crossref

10. Jedd DW, Vanna C, Rene G, Piotr R, Jacques G, et al. (2017)Overall survival with combined nivolumab and ipilimumab in advanced melanoma. NEngl J Med 377: 1345-1356.

Indexed at, Google Scholar, Crossref