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Teaching Tips

Teaching Procedures at the Bedside and Operating Room

By Matthew Rustici, MD

Proceduralists and surgeons are often gifted teachers who teach a wide range of technical and cognitive skills while at the same time ensuring patient safety in high-risk situations. Additionally, teaching a hands-on medical procedure requires patience, particularly when working with learners at various training levels. A current challenge for teachers is deciding how to help learners master skills faster with decreased exposure due to work hour restrictions and decreased total number of procedures as many patients are being managed with less invasive techniques.

Below, you will find five tips derived from the literature and six years of feedback from faculty development workshops that will help you teach learners so they master procedures as efficiently as possible.

  1. Ask for a focused play-by-play before the procedure. Level of training is not a perfect marker of expertise. Avoid asking learners questions like “how many of these have you done” and instead ask them to walk you through a specific part of the procedure step-by-step. You will get a much clearer picture of their skill level in a very short time which will help you decide how much supervision you need to give during the different aspects of the case.
  2. Break it up into pieces to share the wealth and speed things up. When there are multiple learners, try to break up the procedure so each learner gets to do the part of the procedure that is challenging for him or her. When done effectively, all learners stay engaged, but the teacher is able to limit how much each learner slows down the completion of the procedure.
  3. Be quiet while learners are deep in thought. When first learning a new motor skill, the frontal lobe is highly activated with just trying to process the procedure. If you notice a learner’s mental gears are grinding, it is NOT a good time to start “pimping” about complications or anatomic landmarks. Wait for them to get to a less mentally demanding part of the case and then ask questions. Learning new motor skills takes practice, so be patient and let your learners struggle through it.
  4. Focus on the product first, and the process second. Inexperienced learners hold their bodies in ridiculous – and often uncomfortable – positions. Avoid correcting this when these learners are starting out. Often the brain is trying to conserve capacity by “locking off” non-essential parts of the body. This looks like “chicken wing” arms or learners awkwardly bending over. If the learner is proficient with the procedure (i.e., no longer grinding the gears mentally) and has developed bad physical habits from the learning process, use nonverbal feedback such as a tap on the arm, to remind them to fix their inefficient form.
  5. Make them sweat, but not cry. The best teachers find ways to consistently push learners a little out of their comfort zones and are patient enough to give each learner a chance to struggle. Optimal learning happens with a mild amount of stress. However, large amounts of stress severely impair long-term learning. Watch your learners carefully when they are struggling to gauge how stressed they are. Make sure they aren’t too comfortable, but be careful not to push them too far.