· opinion
The OR is a Bad Learning Environment
Instead of always asking more and more from people trying to optimize the old system, we need to try something new.
The research on productivity and focus all seems to agree on a few points:
- humans cannot multi-task
- frequent distractions and task-switching are significant barriers to learning/productivity
Given these facts, the operating room is a terrible learning (or teaching) environment.
The resident trying to operate is bombarded with distractions: the constant beep of the anesthesia machine monitoring the patient’s vital signs, OR phones ringing, background noises and conversations, numerous other personnel in the room, questions from junior residents, intrusive thoughts about patients potentially decompensating on the floor, pagers that could be signalling an imminent emergency elsewhere, and more “mundane” concerns about hunger, fatigue, or the need for a bio-break.
Faculty surgeons are only marginally better off. While shielded from the majority of acute patient care complaints or pages from the floor, they are still often the subject of patient/clinic/triage phone calls. They also feel time pressure to finish the operation in a timely manner, manage administrative responsibilities, get to meetings, and finish their ever-expanding EHR charting responsibilities.
Unfortunately, the only place where we can currently learn or teach surgery is the operating room. So we have two options:
- try to improve teaching/learning in the OR
- try to do more teaching/learning surgery outside of the OR
The problem with option 1 is that it we are fighting science and human nature. The OR is inherently a bad learning environment in many ways, and asking our residents and faculty to be superhuman—just get better, overcome the distractions—is not sustainable. Even if we could improve performance, our teachers and learners would still be limited from reaching their fullest potential.
Option 2 has promise, and is the premise behind strategies to introduce more simulation into surgical education. (However, at Edu-rrhaphy, we don’t believe that simulation as currently defined is the answer—more on that in another post).
Moving some learning outside of the operating room will allow learners to retain more material and progress more quickly. It will also allow faculty to teach more effectively, and give both parties a shared foundation of knowledge to build off of right from their first case together.
Instead of always asking more and more from people trying to optimize the old system, we need to try something new.