The Expert Blind Spot - Impact on Surgical Education
The expert blind spot: advanced knowledge of surgery can lead to less effective teaching
Or, more formally:
Expert blind spots are areas where, because of advanced content knowledge, people with greater expertise tend to make assumptions about student learning that turn out to be in conflict with students’ actual development.1
The best performers are rarely also the best coaches. The best researchers are rarely the best teachers. Most of us that have participated in sports, music, higher education or any field in which expertise can be attained have experienced this phenomenon in our personal lives.
There are many plausible explanations for the expert blind spot, including1:
- experts demonstrate less access to memory traces of cognitive processes
- experts tend to have automated cognitive processes
- experts are overly reliant on concise abstract representations
- experts can no longer imagine what it is like to not understand the world the way they do
If we think about the 4 stages of competence that skill development passes through:
- Unconscious incompetence (I don’t know what I don’t know)
- Conscious incompetence (I know what I don’t know)
- Conscious competence (I know what I know)
- Unconscious competence (This skill has become second nature)
Surgical experts (most teaching surgeons) have developed their abilities to the level of unconscious competence, while most surgical residents inhabit the first two levels for the majority of their training. A great resident may reach the third level — but there is still a vast gap between most upper level residents and attending surgeons.
Why do we care?
We believe that the expert blind spot has held back surgical education.
Content experts without formal training or knowledge on how to teach novices (most teaching surgeons) often have views of learning that are at odds with the actual learning processes of novices.
On the micro level, this limits the effectiveness of 1:1 teaching in the OR. On the macro level, the people with the time, power, and resources to reshape the way surgical education is performed are also expert surgeons; surgeons that look at potential programmatic or curricular innovations through their own partially blinded lenses.
In our discussions with attending surgeons, we have found that many of them don’t appreciate the potential value of various multimedia educational tools for trainees- including video libraries or material teaching surgical anatomy using actual surgical images. It just seems too simplistic to them. Why waste resources teaching such a basic topic? They have no idea that their residents are actually struggling with some of these concepts.
Meanwhile, trainee feedback couldn’t be more decisively in favor of these interventions.
We want to encourage all surgical educators to try to remember what it was like to learn surgery from first principles.
You can’t just ask your trainees what they know either—their whole job is to appear competent to you. They want to be competent, to be granted more autonomy, to be thought of positively, to receive excellent evaluations. They have been trained by years of medical training to highlight their strengths and hide their weaknesses.
Don’t just take our word for it. Look into the data for yourself.2-10 Video- and image-based surgical education is remarkably effective, and trainees want more of it.
Next time you are thinking about how to improve surgical education, remember your expert blind spot and think about ways that you can:
- uncover some of your unconscious decision-making that you can pass on to your trainees
- truly innovate in the way you educate your residents, regardless of how trivial some content might seem from your current perspective
Citations
1Nathan, Koedinger, and Alibali, “Expert Blind Spot: When Content Knowledge Eclipses Pedagogical Content Knowledge.”
2Engelhardt et al., “A National Mixed-Methods Evaluation of Preparedness for General Surgery Residency and the Association With Resident Burnout.”
3Singh et al., “A Randomized Controlled Study to Evaluate the Role of Video-Based Coaching in Training Laparoscopic Skills.”
4Hu et al., “Complementing Operating Room Teaching With Video-Based Coaching.”
5Hayden, Seagull, and Reddy, “Developing an Educational Video on Lung Lobectomy for the General Surgery Resident.”
6de’Angelis et al., “Educational Value of Surgical Videos on YouTube.”
7McKinley et al., “Feasibility and Perceived Usefulness of Using Head-Mounted Cameras for Resident Video Portfolios.”
8Guerlain et al., “Improving Surgical Pattern Recognition through Repetitive Viewing of Video Clips.”
9Soucisse et al., “Video Coaching as an Efficient Teaching Method for Surgical Residents-A Randomized Controlled Trial.”
10Rapp et al., “YouTube Is the Most Frequently Used Educational Video Source for Surgical Preparation.”