Kyla Terhune, MD None financial Recognize that I am still in a learning phase Technically capable want to be better Advantage: I am teachable Spent many years thinking about thinking Almost as a hobby have enjoyed thinking about how people think First teaching: 8 years old Montessori Lunch sessions in the locker room Went to teach high school because Enjoy it and by default, teaching skills Know your audience here and there Surgeon-Educators: What I think you need, + What you think you need Sometimes congruent, sometimes not. OBJECTIVE: My model (my perspective) Having thought about this Currently experiencing it Thinking about how to enact it Exposure (numbers and breadth) Repetition (in close temporal content) Feedback (constructive verbal first) Are some residents not teachable? Focus Persistence Ability to take feedback WIZARDS RADIOLOGISTS When you study, you learn more. When you practice, you get better. Interview with a resident: doing the same operation with the same people when I began to imagine what I would do next when I began thinking in planes After that: accrue experience No longer focusing on routine What we THINK surgery is (interns): Technical working with hands Team working in the OR What surgery actually is (R4/R5 year): Knowing when to operate Knowing how to operate Accruing the experience to be creative Ability to recognize and adapt to the unexpected Patient outcome Preoperatively (in clinic) Operatively (good judgment, avoid errors) Postoperatively Technical skills: should be routine and universal Seeing the planes BEFORE ACCRUE EXPERIENCE: operative decision-making (No longer focusing on the routine) Seeing the planes BEFORE ACCRUE EXPERIENCE: operative decision-making (No longer focusing on the routine) What skills need to be in place? How soon can we get them there? Seeing the floor BEFORE AFTER Strategy Decision-making Dribbling Passing 1-on-1 defense GAMES (12) GAMES (30) Tournaments R1: Instruments Knot-tying, suturing Tissue Handling R2: Steps of procedure R3: Exposure, dissection R4, R5: Attending modeling R1: Recognizing the sick Roles within acute care R2: Acute decision making R3: When/who to operate on R4, R5: Attending modeling TECHNICALPATIENT-CARE R1: Basics R2: Steps R3: Exposing R4, R5: Modeling R1: Basics R2: Steps R3: Deciding R4, R5: Modeling TECHNICALPATIENT-CARE When you study, you learn more. When you practice, you get better. How to get there faster So that I can spend more time on Accruing experiences Operative decision making Being intentional Example Intern Orientation: Central Line What is routine? Assessment Montessori School Sweeping up Styrofoam peanuts Cleaning already-clean sinks Basketball Free-throws, drills (creating simulated setting) Progression drill:game ratio (practice: operation) College: Chemistry lab Teacher and Coach: Lab skills Skills on the court (tennis) Junior Resident: Working on my own skills Critical Care Fellow: First experience: simulated code Partial task trainers/simulation to gen surg Senior Resident: Translating those skills into operative technique Availability Proximity Cost Realism Protected Time Rotations Time out of rotations Qualified instructors Attending buy-in Departmental buy-in (financial support) Overcome apprehension (fear of observation) 10/14 residents : ATTENDINGS many attendings think that it is bogus lot of people (especially older attendings) do not feel it is useful we need more attending input I think any resident can do this stuff independently but they may be teaching themselves to do things the wrong way because no one is watching. Buy-in Supplementation not substitution Reminding people that they have used simulation their entire lives Athletics Oral board questions (low fidelity system) Question: would you rather have a resident who shows up knowing how to tie knots, suture? I want to have skills Why? Obligations: Patients Operating room staff Partners Timing of Simulation as tool (perceived need) Seeing the planes BEFORE ACCRUE EXPERIENCE: operative decision-making (No longer focusing on the routine) Julia Shelton, MD Kevin Sexton, MD Surgical Residents of VUMC John Tarpley, MD