Near-Peer Coaching to Enhance Operative Learning: An Educational Innovation for Surgical Training

Alexander J. Papachristos, Elizabeth Molloy, J. Chui, Monica Ghidinelli, Simon Kitto, Debra Nestel, Benjamin P. T. Loveday
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Abstract

To design, implement, and evaluate a near-peer coaching model to enhance operative learning in general surgery training. There is an urgent need to maximize operative learning in surgical education. Trainees find barriers to operative learning difficult to navigate and often sacrifice educational opportunities for the sake of impression management. A prospective cohort study was conducted over a 6-month period following design and implementation of a trainee-led near-peer coaching model; “SPICE” (Set goals, Plan, Imagine, Comment and feedback, Evaluate and reflect). Semistructured interviews were conducted to explore trainees’ experiences of the model. Twelve trainees participated in the study. The near-peer coaching encounters provided trainees with the psychological safety to be honest about learning needs, validated insecurities, and mitigated the pressures associated with impression management that consistently shaped consultant–trainee relationships. Trainees described improved operative performance, increased self-confidence, and a greater ability to adapt to the unexpected. Trainees adapted the use of the SPICE model to conventional consultant–trainee dynamics, which facilitated learning conversations and negotiation of operative opportunities. On a broader scale, trainees noticed an improvement in the teaching culture of the unit, describing that the use of the model legitimized the importance of perioperative learning conversations and increased consultant enthusiasm for teaching. Near-peer coaching created a unique psychological safety that facilitated authentic reflection and goal setting and improved trainee confidence. The benefits of the SPICE model were translated to other contexts and facilitated entrustment in conventional consultant–trainee relationships.
近距离指导,提高手术学习效果:外科培训的教育创新
设计、实施和评估一种近距离同伴辅导模式,以加强普外科培训中的手术学习。 目前迫切需要在外科教育中最大限度地提高手术学习效果。受训人员发现手术学习的障碍难以跨越,往往会为了印象管理而牺牲教育机会。 在设计和实施由学员主导的近似同伴辅导模式 "SPICE"(设定目标、计划、想象、评论和反馈、评估和反思)后,我们进行了一项为期 6 个月的前瞻性队列研究。我们进行了半结构式访谈,以探讨学员对该模式的体验。 12 名学员参与了这项研究。近乎同侪的辅导接触为受训者提供了心理安全感,使其能够坦诚地表达学习需求,验证了不安全感,并减轻了与印象管理相关的压力,而这种压力一直影响着顾问与受训者之间的关系。据学员描述,他们的手术表现得到了改善,自信心得到了增强,适应意外情况的能力也得到了提高。受训人员将 SPICE 模型运用到传统的顾问-受训人员动态关系中,促进了学习对话和手术机会的协商。在更大范围内,受训人员注意到科室的教学文化得到了改善,他们认为该模式的使用使围手术期学习对话的重要性合法化,并提高了顾问对教学的热情。 近距离同伴辅导创造了一种独特的心理安全感,促进了真实的反思和目标设定,提高了学员的自信心。SPICE模式的益处还被应用到其他环境中,促进了传统顾问与受训者关系中的委托。
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