Alexandra Cope

“Do you have another Johan?” Negotiating meaning in the operating theatre

This paper discusses language use at a workplace in a context of instability and diversity. Its focus is on the operating theatre, where communication is an integral part of complex, collaborative tasks, impacting on patient-safety, staff well-being and overall quality of health care. In the operating theatre health care professionals gather to work on the recurring task of surgical operations, in teams that exist only for the duration or parts of the task. Not only do the members of these unstable teams have different professional backgrounds, such as surgery and nursing, they also draw on different, social, cultural and linguistic resources. The paper shows how this instability and diversity which is so characteristic of contemporary society plays out in the moment-by-moment use of language at the operating table. On the basis of prolonged fieldwork in a London hospital and a unique set of audio- and video-recordings we show how surgeons formulate requests and how nurses and surgical trainees disambiguate these requests on the basis of their prior experiences with surgical instruments and equipment, the surgical procedure, and, crucially, the surgeon‘s ‗idiolect‘. We analyze instances where this process of disambiguation is highly successful, as well as examples where it is not. We tease out the strategies that nurses and surgeons deploy to deal with this ambiguity and explore ways to deal with instability and diversity in professional communication.

Holding the Scalpel Achieving Surgical Care in a Learning Environment

In this article, we show what surgical training looks like in situ. Drawing on fieldwork in a London hospital, we explore how a trainer and trainee jointly achieve surgical care when the trainee holds the scalpel. We make this common pedagogic arrangement visible through transcription and analysis of audio- and video-recorded interaction in the operating theater. Through moment-by-moment analysis of the temporal unfolding of action and speech, we show that the actions performed by the trainee with the scalpel serve as mini-gestures, signaling to the trainer where and when the trainee is going to cut. The trainer “reads” these gestures and prompts the trainee to continue or change his course of action through spoken utterances. We use our ethnographic account as a detailed empirical point of reference for reflecting on the challenges and possibilities of surgical education and patient safety in the operating theater.

‘You see?’ Teaching and learning how to interpret visual cues during surgery

The ability to interpret visual cues is important in many medical specialties, including surgery, in which poor outcomes are largely attributable to errors of perception rather than poor motor skills. However, we know little about how trainee surgeons learn to make judgements in the visual domain.

Making meaning from sensory cues: a qualitative investigation of postgraduate learning in the operating room

Purpose The authors aimed to map and explicate what surgeons perceive they learn in the operating room. Method The researchers used a grounded theory method in which data were iteratively collected through semistructured one-to-one interviews in 2010 and 2011 at four participating hospital sites. A four-person data analysis team from differing academic backgrounds qualitatively analyzed the content of the transcripts employing an immersion/crystallization approach. Results Participants were 22 UK surgeons, some of whom were in training at the time of the study and some of whom were attending surgeons. Major themes of learning in the operating room were perceived to be factual knowledge, motor skills, sensory semiosis, adaptive strategies, team working and management, and attitudes and behaviors. The analysis team classified 277 data points (short paragraphs or groups of sentences conveying meaning) under these major themes and subthemes. A key component of learning in the operating room that emerged from these data was sensory semiosis, defined as learning to make sense of visual and haptic cues. Conclusions Although the authors found that learning in the operating room occurred across a wide range of domains, sensory semiosis was found to be an important theme that has not previously been fully acknowledged or discussed in the surgical literature. The discussion draws on the wider literature from the social sciences and cognitive psychology literature to examine how professionals learn to make meaning from “signs” making parallels with other medical specialties.

Surgical decision making in a teaching hospital: a linguistic analysis

The aim of the study was to gain insight in the involvement of non‐operating surgeons in intraoperative surgical decision making at a teaching hospital. The decision to proceed to clip and cut the cystic duct during laparoscopic cholecystectomy was investigated through direct observation of team work.

Participation of Surgical Residents in Operations: Challenging a Common Classification

BackgroundOne important form of surgical training for residents is their participation in actual operations, for instance as an assistant or supervised surgeon. The aim of this study was to explore what participation in operations entails and how it might be described and analyzed.MethodsA qualitative study was undertaken in a major teaching hospital in London. A total of 122 general surgical operations were observed. A subsample of 14 laparoscopic cholecystectomies involving one or more residents was analyzed in detail. Audio and video recordings of eight operations were transcribed and analyzed linguistically.ResultsThe degree of participation of trainees frequently shifted as the operation progressed to the next stage. Participation also varied within each stage. When trainees operated under supervision, the supervisors constantly adjusted their degree of control over the resident’s operative maneuvers.ConclusionsClassifications such as “assistant” and “supervised surgeon” describing a trainee’s overall participation in an operation potentially misrepresent the varying involvement of resident and supervisor. Video recordings provide a useful alternative for documenting and analyzing actual participation in operations.

Are Surgeons Born or Made? A Comparison of Personality Traits and Learning Styles Between Surgical Trainees and Medical Students.

OBJECTIVE Medical students and surgical trainees differ considerably in both their preferential learning styles and personality traits. This study compares the personality profiles and learning styles of surgical trainees with a cohort of medical students specifically intent on pursuing a surgical career. DESIGN A cross-sectional study was conducted contrasting surgical trainees with medical students specifying surgical career intent. The 50-item International Personality Item Pool Big-Five Factor Marker (FFM) questionnaire was used to score 5 personality domains (extraversion, conscientiousness, agreeableness, openness to experience, and neuroticism). The 24-item Learning Style Inventory (LSI) Questionnaire was used to determine the preferential learning styles (visual, auditory, or tactile). χ(2) Analysis and independent samples t-test were used to compare LSI and FFM scores, respectively. SETTING Surgical trainees from several UK surgical centers were contrasted to undergraduate medical students. PARTICIPANTS A total of 53 medical students who had specifically declared desire to pursue a surgical career and were currently undertaking an undergraduate intercalated degree in surgical sciences were included and contrasted to 37 UK core surgical trainees (postgraduate years 3-4). RESULTS The LSI questionnaire was completed by 53 students and 37 trainees. FFM questionnaire was completed by 29 medical students and 34 trainees. No significant difference for learning styles preference was detected between the 2 groups (p = 0.139), with the visual modality being the preferred learning style for both students and trainees (69.8% and 54.1%, respectively). Neuroticism was the only personality trait to differ significantly between the 2 groups, with medical students scoring significantly higher than trainees (2.9 vs. 2.6, p = 0.03). CONCLUSIONS Medical students intent on pursuing a surgical career exhibit similar personality traits and learning styles to surgical trainees, with both groups preferring the visual learning modality. These findings facilitate future research into potential ways of improving both the training and selection of students and junior trainees onto residency programs.

Microanalysis of video from the operating room: an underused approach to patient safety research

Video recording technologies offer a powerful way to document what happens in clinical areas.1 Cameras, and to a lesser extent, microphones, can be found in a growing number of modern operating rooms in the USA, UK and other parts of the world. While they could be used to create a detailed record of what happens in and around the operating table, this is still rarely being done; the vast majority of operations are still only documented in written operation notes. When operations are being recorded, it is primarily for educational purposes: for instance, to broadcast a live feed of a surgical demonstration to a remote audience; to provide an ‘adjunct’ to live observation;2 to collect authentic footage for edited, instructional videos on a surgical technique or procedure; to facilitate video enhanced debriefing and coaching; or to formally assess surgical skills. Recently, Makary et al 1 ,3 have proposed that video equipment in the operating room could be used as an auditing tool. They also argue that making video recording a routine occurrence would improve performance and make surgical care more transparent. They propose that a video archive of operations could prove useful for surgeons preparing to operate on a patient who had been operated on before—to check the anatomy and density of adhesions for example. It has also been suggested that when used routinely, video could be used to investigate adverse events.4–6 What has gone relatively unnoticed in these recent discussions about the potential of video in the operating room is the possibilities it opens up for empirical research . While videos can only provide a partial representation of what happened and are always open to interpretation, they do provide a relatively objective, shareable point of reference. Using video, clinical events can be looked at from …

What attitudes and values are incorporated into self as part of professional identity construction when becoming a surgeon

Purpose To make explicit the attitudes and values of a community of surgeons, with the aim of understanding professional identity construction within a specific group of residents. Method Using a grounded theory method, the authors collected data from 16 postgraduate surgeons through interviews. They complemented these initial interview data with ethnographic observations and additional descriptive interviews to explore the attitudes and values learned by surgeons during residency training (2010–2013). The participants were attending surgeons and residents in a general surgical training program in a university teaching hospital in the United Kingdom. Results Participating surgeons described learning personal values or attitudes that they regarded as core to “becoming a surgeon” and key to professional identity construction. They described learning to be a perfectionist, to be accountable, and to self-manage and be resilient. They discussed learning to be self-critical, sometimes with the unintended consequence of seeming neurotic. They described learning effective teamwork as well as learning to take initiative and be innovative, which enabled them to demonstrate leadership and drive actions and agendas forward within the health care organization where they worked. Conclusions To the authors’ knowledge, this is the first study to systematically explore the learning of professional identity amongst postgraduate surgeons. The study contributes to the literature on professional identity construction within medical education. The authors conclude that the demise of the apprenticeship model and the rise of duty hours limitations may affect not only the acquisition of technical skills but, more important, the construction of surgeon professional identity.

Teaching, Learning, and Performance in the Surgical Workplace: Insights From the Examination of Intraoperative Interactions

abstract This Conversations Starter article presents a selected research abstract from the 2017 Association of American Medical Colleges Central Region Group on Educational Affairs annual spring meeting. The abstract is paired with the integrative commentary of three experts who shared their thoughts stimulated by the study. These thoughts explore the value of examining intraoperative interactions among attending surgeons and residents for enhancing instructional scaffolding; entrustment decision making; and distinguishing teaching, learning, and performance in the workplace.