Teaching and assessing in the operating room

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In the operating room of a teaching hospital, there is a need to balance surgical efficiencies, patient safety issues, and time management with preparing residents for mature practice. Gaps exist between attendings’ perspectives and residents’ perspectives on the quality of surgical teaching, wherein residents may perceive an unfocused stream of talk rather than a direct, structured approach. Based on a guided discovery learning model and a review of existing approaches for surgical teaching, the BID model—Briefing, Intraoperative, Debriefing—was applied for teaching in the operating room. The briefing adopts the precepts of deliberate practice while focusing on a small number of specific learning objectives. The intraoperative teaching segment consists of immediate feedback and guidance directed by the learning objectives. The debriefing element solidifies the learning that occurred and allows residents an opportunity to reflect on their performance. This approach guides future practice while fitting within the busy constraints of teaching surgeons.