Good evening. Welcome to today's webinar. I'm Dr. Susan Barr, the moderator for today's session. Before we begin, I'd like to share that we will be taking questions at the end of the webinar, but you can submit them at any time by typing them into the question box on the left-hand side of the event window. Today's webinar is titled Teaching in the Operating Room, and it's presented by Dr. Stephen Swift. Dr. Swift is a professor in the Department of Obstetrics and Gynecology, as well as being the director of the Division of Urogynecology at MUSC. Dr. Swift is board certified by ACOG in both general obstetrics and gynecology, as well as subspecialty board certification in female pelvic medicine and reconstructive surgery. He's the editor-in-chief of the International Urogynecology Journal. He's been involved in both APGO and CREOG Education Scholars Committees. And for the last 10 years, he's been part of the APGO Surgical Education Scholars Faculty. Dr. Swift. Thank you, Susan, Dr. Barr. And I'd like to welcome everybody tonight. First of all, I probably don't have as much to teach you all as you think, because you're all here, which means you're interested in being a better teacher. And I think that by definition makes you a good teacher to start with. So I hopefully will provide you maybe some hints and just codify some different things to sort of let you sort of organize a little better. Maybe you're teaching in the operating room. As Susan said, I've been a part of the faculty of the Surgical Education Scholars and the various hysteroscopy electrosurgery scholars programs at APGO over the last 10 years. And so I've been very fortunate that I've got to sit through session after session of some of, I think, the best teachers in our field. Many of them are urogynecologists, but certainly several of them are other disciplines as well. And you learn a lot listening to your colleagues and what they do. And so this talk is sort of a compilation of all the things that I've learned over the last 25 years in practice and certainly over the last 10 years, focusing on teaching teachers to be better teachers. So the objectives for tonight will be to hopefully help you recognize your learner. And this is just some tricks of, you know, we're in the operating room sometime with residents, sometimes with fellows, sometimes with faculty members teaching faculty new surgical procedures. And every learner is a little bit different. To also then learn your strengths as a teacher. Again, you're all here. So that means you're interested. And that's, I think, the biggest strength of teaching in the operating room. And then finally, just some ways to really optimize providing feedback to your learners. Because at the end of the day, providing good feedback is really what teaching is all about. I mean, I can show you how to do something. And if I watch you do it, and you do it wrong, and I don't correct you, and I don't use proper technique to correct you, you may never learn how to do it correctly. So I think feedback will be really important. And that's something we'll spend a little bit of time on. But if you think about teaching a surgical procedure, it kind of involves all the things on this slide. And they're kind of divided into steps or stages. The top row are the things that we're really teaching our junior learners. The middle row is the thing we're teaching are becoming advanced learners. And then the bottom row is something I think we're constantly learning. I mean, modifying and developing new techniques when something's not working, managing complications. I'd love to be able to give all of my residents all of my experience, but I can't. And I've gotten that experience because like all of us, I've had some complications, and I've had to struggle through them. And then I think one of the important things that's often overlooked is the operating room is a big stage production. It's a ballet and getting everybody focused on the patient on the task at hand, getting the task at hand done really means that you have to master all sorts of the aspects you have to be involved with anesthesia, you have to know your nurses you have to help your nurses be better. And then certainly you have to work with all the learners you're with. So these are all things that I'm when I'm teaching, I'm teaching all of this. Some of these are more medical student oriented. Some of these are more chief resident oriented, but they're all part of the teaching mission. So when I talk about know your learner, there's several aspects of that. First of all, their level of training, where are they? They have basic skills or not. And that doesn't always correlate with year to year. But certainly, you know, interns and medical students generally don't have the skill set that chief residents and fellows do. The other thing that we don't often ask them about is what do they want to learn? And this is that listen to your learner. I don't always do it. Because a lot of times I set the agenda because I'm very fortunate that I operate with one resident pretty much for six weeks at a time, and I take them through their their learning steps. But I also once we're into it, once they're starting to pick up things, I'll ask them, what are you struggling with? And what do you want to learn today from the cases we're going to be doing? And sometimes it's amazing what they tell you. And you're like, I thought you got that. But let's go back and review that. And we'll make sure you do that several times today. So taking just that few minutes to ask them what they want to learn. Sometimes they need guidance, because they say, well, I'm gonna learn how to do a vaginal hysterectomy, and they're an intern, you're like, well, that's not what you're going to learn today. You're going to learn how to handle your instruments, you're going to learn how to dissect tissue planes, you're going to learn how to tie really good knots, because in a vaginal hysterectomy, if your pedicles are all loosely tied, that's a bad day in the operating room. So sometimes we have to refocus them on truly what they do want to learn. When I think of the sort of the level of training and the general rules, these are kind of the things that I'm teaching, I'm teaching some anatomy, I'm teaching not time, because that's one thing oftentimes is overlooked. And then basic surgical techniques. That's how to handle your instruments. That's how to dissect your tissue, the sequence of steps that are unique to this procedure. And then where are your danger areas? And how can I make you bulletproof? You know, how do I make sure that you understand where danger is it and how to avoid it. And sometimes it's just simply where you point your scissors when you're dissecting. If you point them in this direction, there can be a problem. If you point them in this direction, you can go all the way to the patient's shoulder and you will not run into anything that's going to hurt you. So I constantly talk to the patients about my job is to make sure that you're a little bit bulletproof. And that's the avoiding complications. So first of all, when they come in and they tell you what they want to learn, this kind of brings together what they've already learned and some of their previous experiences. So it's a short discussion. Again, it's focused on they might not know what they want to learn. And sometimes you have to rein them in a little, but you should really get a feel for what they want to learn. This is a great sort of graft on going from unconsciously incompetent to unconsciously competent. And the learners go in one direction and to be a good teacher, you have to go in the opposite direction. And I'll tell you the example I always use. This is when you walk into a room full of medical students, which we do every six weeks on our rotation. And you tell them, oh, we're going to teach you guys how to tie a knot today. And they look at you and they're like, we know how to tie a knot. And you're like, no, you really don't. You do not know how to tie a square knot so that it stays down and it can make tissue hemostatic. So they walk in almost unconsciously incompetent. They don't even know that they don't know. And then you show them how to do a two-handed surgeon's knot. And they look at you like, what did you just do with your hands? I have no idea how to do that. And that's when they realize, wow, I am incompetent. I don't know how to tie a surgeon's knot in the operating room. You then have to take them through a sequence of steps. And it's interesting. I've done this probably 30 times. But every time I do it, I have to look away from my hands. Because if I'm looking at my hands, my hands just do what they do. I have to step away and break in and look away from my hands and break it down in to quote the cardinal motions by not watching myself, which is kind of weird. But again, it's I'm so unconsciously competent because I've tied a million knots that I really don't even know what I'm doing. And I do it so quickly that if I'm looking, I just do it. But if I look away, I have to stop with each motion. And that makes me a better teacher. And it also then you watch your students and you watch them as they're fumbling. It's like, why are they fumbling? What are they not seeing that I'm seeing when I look at my hands to tie a knot? And that's when you're making yourself kind of consciously incompetent. And then you bring them up to that level of consciously competent. And then you let them know, you know, repetition and experience is where you are going to get where you are unconsciously competent. And the same can be said for placing a Haney clamp at the time of a vaginal hysterectomy, doing the dissection off the sacral promontory, dissecting out the anterior vaginal wall during a coporaphy. Those are all things that we do all the time. And you don't think about the technique involved sometimes. And when you have a new learner or somebody who hasn't done it in a while, you have to be able to step back and say, why are they incompetent? How are they seeing this differently from I'm seeing it? The second thing is you got to kind of know yourself. What are your strengths? What are your strengths as a surgeon? And then the thing that nobody likes to talk about, but I think is something that is very important is what is your day like? If I've got a couple of really big cases and three or four cases to follow that, I really want to be done by five or 530 because I'm going to start losing my nursing staff at that point. And it takes longer to operate with residents and learners than it does by myself. So there are days when I'm really busy and I have to tell the resident, we got a lot to do today. I promise you, we're going to learn some things, but the things that you're not really going to learn, I'm going to kind of do. And we're going to get through these cases in a reasonable period of time. So what are your strengths as a teacher? Some of us are very good. I understand dorsal and ventral. I understand caudal. I understand cephalad. And I can really explain that. Some of us aren't. Some of us say you want to put the stitch a little bit higher. Well, what does higher mean to the learner and what does higher mean to you? You may be saying, I want you to go more caudal. And they think you say you're meaning more cephalad when you say higher. So you kind of have to decide how you're going to be a teacher. And if your students are not sort of cluing into your, into your descriptions, then you have to stop. And when I say higher, I mean here. And when I say lower, I mean, closer to the vaginal and troitus, things of that nature, which to me just seem normal and how I speak, but I have to set my student or my learners up to make sure they understand what I'm doing with that. There's textbook anatomy. There's anecdotal anatomy. I call things fascia in the vagina all the time that aren't really fascia. I do it because it makes sense. And I think it helps my learner. It's to the point where a Yuga ICS is actually developing a terminology for laparoscopic anatomy, because it's not necessarily the same as open anatomy. I don't know if I agree with that. I think it may just be another terminology document, but I think it's a very interesting concept. And it points out how anatomy sometimes is the perspective in which you perceive it. And it's not always the drawings from a net or textbook. And then finally, can you give up the role as the primary surgeon? And can you be a good first assistant? And that I think is one of the hardest things in teaching, particularly if we're not knowledgeable with our learner. But it's also, I think, one of the most important things. So if you can't do it, it's one of those things you need to push yourself a little bit to be better at and start with baby steps. All right, you do the cystoscopy. I'm going to go stand behind the back table while you do cystoscopy. Hopefully that's something most of our learners can do. But by being removed from the field, they can't rely on you to take them through every step. The other thing is that we're all experts at what we do, and we should teach what we're experts in. I'm mostly a vaginal surgeon. I probably am 99% a vaginal surgeon. So I should not be teaching retroperitoneal anatomy or operative vaginal deliveries. Maybe how to fix a operative vaginal delivery injury in a fourth degree laceration, but I teach vaginal surgery. We have very good laparoscopists. They teach laparoscopy, and I try not to get too much in their field and education-wise. And then finally, as we mentioned earlier, what's your day like? We know it takes extra time to do cases when you have residents and fellows. Sometimes towards the end of their training, there actually are exceptionally good first assistants and surgeons, and you do speed up. But early on, it can really slow you down, and you should be cognizant of that. Your patients are waiting. In our institution, our nurses have shifts, and when their shift is over, they may love you as a surgeon. They may love to work with you, but they're not going to get paid overtime, so they're going to want to be home with their families. And then finally, what's your mood? We all have bad days. There's absolutely no question. Sometimes we're a little bit cranky. Sometimes we're a little bit stressed, but we should recognize that and make the room, the operating room, as comfortable for our learners as we can, even if we're a little bit cranky and stressed, and we need to recognize that in ourselves. This next slide goes exactly to that learning environment, and it's a classic education slide. You need some stress for learning, so you don't give your learners a free pass on everything. Sometimes you need to fuss at them a little bit when they're just not getting a concept, but if you put too much stress on them, and you get two in their face, and you get two over the top with stress, then learning starts to go away, and you need to find that sweet spot where the stress is there. They understand the importance of learning, but you're being supportive, and they're getting that learning. And then finally, to spend a little bit more time, I'm going to go over feedback, and feedback comes in different ways. I think of feedback as formative or summative. Excuse me. Talking in the office all day, my voice is a little hoarse. I just took a sip of water. Formative is kind of that immediate. You need to hold the instrument this way. You should lift your elbow up a little bit higher when you're trying to throw that suture. You should turn your back a little bit in this direction because it's going to give you a better angle to make that tunnel and have less potential for complication. That's the formative stuff. That's the stuff that you're doing moment by moment in the operating room. The summative is more like, okay, how did you do today? You did really good with your cystoscopy. You're holding the assistoscope correctly. You're using the angled lens correctly, et cetera. And that's something that you don't need to work on much for next week because I think you got it versus you don't really understand the steps of the procedure well because you don't anticipate your next step. And so that's something I want you to work on. And then there's always that end of rotation evaluation that usually we sit down as our clinical competencies committee and we have to come up with a summative feedback form for the residents every six months. So how do we do good feedback and what is good feedback? Good feedback evaluates current performance and it should be timely. Now we just talked a little bit about summative feedback, which is kind of that end of rotation or end of year or every six months stuff. And that's important to give somebody information on how they're progressing in their development. But most feedback really should be timely and formative and current. And it should be constructive. In other words, I want to get you better. I don't want to sit there and say, you're terrible at this. You should never do this again in your life. This is awful. That's not feedback. That's criticism. And feedback is you're struggling with this step. Let's find ways for you to practice this more. Let's figure out why you're struggling. I'm going to watch your elbow. I'm going to watch your hand. I'm going to watch your wrist and I'm going to move it so that I think you can do this movement a little bit more smoothly. If you do that, what you find is that you've got a learner that's working with you and they'll get better much quicker. And then they become more of a colleague and then you can take them to more advanced education. And the other thing, hopefully by being very specific and very helpful with your feedback, they're going to start to self-assess themselves. And I love it when residents auto-correct because that means they're self-assessing. So if they're struggling to get a suture in a certain place or a needle in a certain place, and I watch them look at their, you know, where's my elbow? How is my wrist? How am I holding this instrument? And you can see their minds moving and you can see that they're self-assessing and self-correcting. That's when I think, right, they're getting this. They're really understanding the concepts we're trying to teach. When you look at improving a skill, feedback is so important. This is kind of the feedback loop that's often shown in education lectures. Somebody performs a skill and somebody observes it. Then in your mind, you're sort of assessing it. And as you assess it, that's when you develop your feedback. You then give the learner the action that you want them to do to improve. And then you watch the skill performed again and you observe. And it's a constant cycle of you watch, you observe, you provide feedback, you have the person do the skill, and it's continuous. Now some feedback do's and don'ts. We've all gotten good feedback, I'm sure. And we've all gotten not so good feedback. And probably we've even gotten bad feedback. I trained at a time in the mid-80s to the early 90s when there was still a lot of acrimonious screaming and yelling that went on in operating rooms. And senior surgeons would often yell and throw temper tantrums. Fortunately, those days are gone. But I got some awful bad feedback during those days when that kind of behavior was still allowed. But I also had people who were wonderful. And when you operated with them, they took the time to really go through and explain things to you, what you were doing wrong, how you could improve. And you thought to yourself, man, this is a great educator. So if you're having a bad day with the learner and they're not getting it, one of the best ways to start the feedback conversation is, how do you think you did? As opposed to, let me tell you how I think you did. When you start a conversation like that, they recognize that they're struggling and they tend to be more hard on themselves. So they'll say, oh, I didn't do this good. And I didn't do that good. And I didn't do that good. And oh, this was terrible. And you can say, well, maybe that wasn't great. But you can also then always throw in some positive, but look at you did this over here really well. And now all of a sudden you look like the good guy. So you're allowed to provide them some critical explanations on what they need to do better, but you're also able to look like a good guy. So if I have a bad day and the residents sort of know the trick, if they've been struggling, when I sit them down, I go, well, how do you think they did it? All right, we're going to have one of those talks, aren't we? And it's like, well, you tell me how you think you did. And then we'll see what the conversation goes like. And again, as we've mentioned several times, be specific, not general. You did a great job. Well, if I tell one resident on Monday, they did a great job. And I tell another resident on Tuesday, they did a fine job. Are those the same? Are those different? Those are very general terms. You did a good job tying down your knots today. They were very secure. We had no bleeding from the pedicles. That was a good job versus you did great with your clamps. So be specific as opposed to general. Focus on behavior, not personality. That's an obvious one. And then, as I mentioned, we have all had great mentors who have really taught us wonderfully emulate those people. Be like the people that you really learned from. And then, like we mentioned also earlier, listen to your learners. Try not to talk over them. Try to give them plenty of time to say what they need to say. And I always ask for feedback on my teaching. Some feedback don'ts. I try to do most of my feedback in private, particularly if I have to kind of say, you know what, you're not really doing this. So we got to come up with a new plan. And generally, we go away between cases or at the end of the day, and we'll sit down someplace over a cup of coffee or something, and we'll go through a feedback session for 20 minutes. Doesn't have to be super long. We go through everything. But it's where the learner is kind of in a quiet, safe, somewhat removed environment. I try not to give them an hour's worth of feedback. I try never to talk for more than about 30 minutes at the most. So you can see we're 22 minutes in. I should be done in the next eight minutes because I don't want to overwhelm them. And again, I don't want to create a negative environment and then be too general. And then finally, don't be like those people that used to drive you crazy. Don't be like people that used to scream and yell and rant. You know, I don't know that I learned much from them other than I didn't like the way they teach. I didn't like the way they treated nurses. I didn't like the way they operated. And I wanted to learn that as I'm not going to do it like this when I'm the teacher. This is one that I've been told is a little controversial. I like it. I love the feedback sandwich. I always, if I have to provide some critical, somewhat negative feedback, I always like to start it off with the positive. You know, we did well today. Everything went well. We didn't have any significant complications. You've really come a long way in that you're much better able to do cystoscopy. However, you continue to struggle with your knots. They're not being tied down tight enough. And we had some loose pedicles we had to go back and fix today. But we're going to come up with a plan to teach you how to do that. And I promise you, you're going to get better at that so that we're not going to have to have this type of conversation again. So that's the positive, critical, positive, and maybe a negative is a bad word in there. Some people have told me that that's not really adult learning. But anyway, it works for me. And I think most people appreciate it. And then finally, the evaluation. The evaluation is kind of the summative part of the feedback. The question is always, how do we evaluate? And can we evaluate? How do we evaluate? I think is difficult. Can we evaluate is obvious. We have to evaluate. Our patients expect us. Our boards expect us to evaluate. Our hospital credentialing committees expect us to evaluate. The clinical competency committee for residencies and fellowships expect you to evaluate. And then the board of trustees expect you to evaluate how your learners are doing. So I just want to take the last couple of minutes to talk about that. Final assessment versus grading every procedure. I'm a much bigger fan of providing some grading and feedback on every procedure because nobody should get to the end of a rotation or to be six months in and not know where they stand. They should know they're struggling and they should be given the time to correct. If they're doing great, cheers. And fortunately, the vast majority of our learners do great. But the ones that are struggling should never be a surprise for them. As far as grading every procedure, that's a bit overwhelming as well. But I think you can grade the majority of procedures. And there are different ways to do that. This is a tool that's in the ACGME toolbox. It comes out of the University of Ottawa, where between Toronto and Ottawa, they've done more for surgical education than I think anybody in the last 20 years. They have a global rating scale of operative performance that is a basically it's a checklist. And I believe there are eight things on it. And it's everything from handling instruments to handling tissue, proper use of assistants and all that. And years ago, about 15 years ago, they published a very good paper in the American Journal looking at OBGYN residents. And they showed that if you get about 12 preceptor ratings, you can really start to get a handle on how a learner is doing. And if you get about 12 to 15 ratings, then you can really start to see and you start to get good rate or inter-rate or reliability where the evaluations start getting very similar. And you can see if they're all good, great. That's the resident you don't have to worry about. That's a resident you can just continue to teach. But if they're all sort of bad, that also tells you that's the resident that's struggling, that may need extra help. So we use this. We use this in a lot of our observed structured assessment of technical skills. We don't use it in the operating room, which is interesting. Possibly we should. Instead, we use the MyTip report that was developed out of the University of North Carolina. Anna Marie Conley, who's a huge leader in our field, has done a lot to come up with a surgical feedback. They published a paper last year in the Obstetrics and Gynecology, the Green Journal. They had 440 learners, 443 teachers. This was a large multicenter study. And what they did is they showed that for the MyTip reports that there is construct validity. In other words, if I do MyTip reports on a first year resident versus a seventh year fellow, they're going to have different scores. And you're going to be able to follow somebody through their progression. The one thing I don't think it does as good a job at is it doesn't do as good a job at assessing for the learner that's struggling. For those of you who've used it, it's procedure specific. So that limits it because some of the procedures that we do aren't on there or they don't have MyTip reports. They're pretty good. I think it's a good way to provide residents feedback. There are spots for comments where you can type in, and I think that's the most important. So we use a lot of these, and I think they're very helpful. But what I would really like to see is that we are able to develop some sort of national norm, because it would be nice to know that all fourth year residents in these procedures should be considered supervision only at the time of graduation. So in summary, teach to the abilities of your learner. Figure out what your learner's abilities are, figure out what they want to learn, and then spend a little bit of time before you go into the operating room to identify those things and then work on those things for that day. You can certainly work on other things as well, but focus on the things that are important to them and important to you. Figure out your strengths as a teacher. Some of us are excellent surgical teachers. Some of us are better clinical teachers. But play to your strengths and be cognizant of your strengths and also be cognizant of your weaknesses and try to avoid those. There's the old saying, identify your weaknesses and make them your strengths. I'm old enough that I've identified my weaknesses. I've really never made them my strengths, and I'm very comfortable with that. And I play to my strengths because they're my strengths because I enjoy them, and I've made them my strengths. So that's why I play to my strengths. And then provide good feedback. Provide meaningful feedback, provide specific feedback, and provide timely feedback. Don't be embarrassed. Early on as a faculty member, I was like, well, I don't want to look like I'm fussing at the residents. Learners want to know how they're doing. They want to know how they can do better. And the only way that they get that is by good feedback. And then finally, I think we should all come up with some evaluation technique because, again, our residents at some point are going to be evaluated. Our learners at some point are going to be evaluated. Surgical evaluations are somewhere out there. You know, insurance providers, Medicare, hospital credentialing committees are all looking for ways to make sure that the people operating on their patients and in their hospitals are good and are competent at what they do. We don't have a great way of doing that right now, but evaluations will be somewhere in our future. And so getting residents used to it, becoming a good evaluator, finding a good evaluation tool, I think those are all important things for the future. And that's my last slide, and my 30 minutes is up. So I want to thank you all for listening to me tonight, and I'm open to questions. Thank you, Dr. Swift. We have a few minutes for questions, so if you can submit your questions in that box on the left-hand side of the window. One quick comment I'll add, you know, I think the importance you said of evaluating some as a rotation goes on or some cases while a resident's with you and not at the end also helps us because I think it's hard sometimes to forget the comments you wanted to make if you wait until the end of a rotation, and so you're checking a box rather than giving those meaningful comments. So I liked your comment, not to be redundant, on that part. First question we have is kind of the role of simulation. What do you see for OR simulation, either in planning a case, a resident planning to attend a case, or for an evaluation purpose? Simulation is a tough one. I mean, I teach a lot of simulation, and there's a ton of literature out there on simulation, but simulation is incredibly time-consuming, and it's incredibly resource-consuming, and if you put the time and the resources into it, do you get enough out of it that it makes it worth it? I think that eventually the American Board is going to use all of those simulation centers that they developed and that they've accredited, and we'll have to go to a simulation center to be able to get privileges to do a sling or to do a robotic sacrocolpopexy, and those simulation centers will be set up. We saw it happen two years ago when they introduced FLS to our residents that they have to pass their FLS before they can take their boards, and FLS, at the end of the day, is basically simulation. So it's coming, and it's going to take on a bigger role. Everybody's department's going to have to figure out a way, though, to get their residents through the simulation they need, and that may be the tough part, unless we can find some way to have non-physicians be the simulation evaluators. There's no question they've got it for FLS. They can tell you what your score is based on how well you did. They don't have to have a doctor standing there watching you. I don't think we've done that for most of our procedural-based things, but I think it's coming. There's no question that simulation, if you practice something and then you go to the operating room, you do better at it, and that's been shown in C-sections. That's been shown in maybe two or three other procedures that people that practice do better when they go to the operating room. So one of the roles that I see for simulation in our department is when I see a resident struggling with something, I come up with the simulation for them to do that so that they can practice that. Skinning a chicken, and particularly if you skin a duck, that's a great way to practice dissection of the vagina off the underlying endopelvic fascia and vaginal surgeries. Sometimes we'll have residents do those kind of things, but it's going to get more and more prevalent as we find ways to use it for evaluation. We don't have that yet, but it's coming. Okay. We have another question here, and it says, what have you done to try to standardize measurements amongst your faculty? So I assume like in evaluating a resident. Exactly. That's the hard part because you have to have grand rounds and educational opportunities for your faculty to learn how to be evaluators. It seems simple, but it's not. If the faculty member steps in every time the resident struggles and finishes the case, they're not being a really good evaluator because they say, ah, they couldn't finish the case. That's not really what the problem was. The problem was they were struggling with a portion of the case. Nobody gave them the feedback to get better at that portion so that they could move on. So you do have to sit down, and I do grand rounds at least once a year where it's essentially a lecture very similar to this, where I start out how to be a good teacher, and then we go through how to be a good evaluator. And in our simulation lab, we try to train all of our faculty how to be good evaluators because in the simulation lab, you have to be hands-off while you're doing the evaluation. Teaching comes later, and that's very difficult for people. So we don't have any method that we show other than we provide them educational opportunities to learn to be better teachers and better evaluators. I wish we did have a technique where we all took an exam once a year of how good are you at teaching, how good are you at evaluating, and then we could determine whose evaluations we could put more weight on, but we don't have that. Okay. I have another question that says, do you feel that tools like the one used in Ottawa and my tip report help the learner to become proficient sooner than with traditional feedback? If you're really good with your feedback, then I think that you don't need those tools. What those tools do is I think that helps you start the conversation. You know, you have to answer all the questions, and then for the both of those, the best way to do that is standing there with the resident. And for the my tip report, they actually have to answer some questions about their own performance, and then they have to make comments about what they thought went well and what they thought didn't go well for the procedure. And it's the written part of that. It's the written comments I think that are the really good part of the my tip report. Was I doing as good of a job before we started using my tip? And I would like to think that the answer to that is yes, but if you're having a difficult time starting the conversation, using one of those tools lets you start that conversation. And that does kind of then provide a framework for feedback. So as far as a way to standardize how feedback is given, if you're using those tools amongst all your faculty, then that kind of standardizes at least where you start with feedback. So I do think they're good. I don't think they're infallible, and I don't think they're better than good feedback. Okay. We have one last question here. So think back to maybe your first few years out of a fellowship, and what would you tell a new attending? What tip would you give them in terms of education where you're talking about ultimately you want to allow somebody else to be the primary surgeon, you want to be able to step back, but you've just gone from being the primary surgeon with an attending as your assistant to now you're the primary surgeon and you have a resident as your assistant. What advice would you give those people? First of all, don't be afraid because that's the biggest fear is that you're going to let them do something that you can't fix. And that was my biggest fear when I was a junior faculty member. But I would say in today's environment, and it's hard to say what any individual's environment is like, but I still occasionally struggle in the operating room and I have to call another faculty member. So when I say don't be afraid, it's like you're in a safe environment yourself. You're in a teaching hospital. Hopefully you've got faculty or partners that you can call to come and help you if you're struggling. So make sure the residents get exposure. Now, with that said, you still have to be comfortable. So that's also part of not being afraid. So what you have to do is you have to figure out which parts of the step or which parts of the procedure or steps are good teaching steps, but are also a little bit bulletproof. And that's a term I use a lot in the operating room, because I'm constantly teaching the residents, you're going to do this in practice. I want to make sure that you can do this in a bulletproof fashion so that you don't have to worry about, am I going to get into something I don't want to get into? But let me show you how to avoid getting into the bladder here. Let me show you how to avoid getting into a bleeder here. Let me show you where the blood vessels aren't. And so if you can pick those parts of the procedure that you know are really safe, and let the resident do those, that will give you confidence to let them do more. But the biggest thing is, don't be afraid, know you've got help, but also be comfortable. Great. Thank you. And so on behalf of the OGS Education Committee, I'd like to thank you, Dr. Swift, and everyone for joining us today. Our next webinar is going to be on July 10th, and it's entitled Optimizing Outcomes and Avoiding Complications in Robot-Assisted Surgery. See, there we go. That makes yourself bulletproof. Perfect. Then we also have OGS FPMRS Journal Club tonight at 8 p.m., and Dr. Elizabeth Geller will be presenting two articles, one on pelvic organ prolapse repair using the Uphold Vaginal Support System, and one on prolapse recurrence following sacrocopalpexy versus uterus sacral ligament suspension. Thank you. Dr. Barr, thank you very much for moderating tonight. I appreciate it, and thank you to everybody that tuned in. Like I said, you're all good teachers because you're here tonight, so that's a big step. Good night.

Teaching in the Operating Room

Dr. Stephen Swift

Department of Obstetrics and Gynecology

recognizing learners' needs

providing effective feedback

evaluating learner performance

simulation in teaching

standardized evaluation tools