One size does not fit all: identifying differences in intraoperative teaching preferences of junior versus senior surgical residents

Purpose Intraoperative teaching is a critical component of surgery residents’ education. Prior efforts to guide faculty on best intraoperative teaching practices have failed to address potential differences in the needs of the junior versus senior resident in the operating room (OR). The objective of this study was to determine the qualities of effective intraoperative teachers from the resident’s perspective based on their level of training. Methods Using constructivist grounded theory methodology, categorical general surgery residents of the same post graduate year (PGY) participated in five focus groups to explore their opinions regarding intraoperative faculty teaching strategies. Focus group discussions were recorded, transcribed, and coded in an iterative process. Emerging themes were identified, along with corresponding sub-themes. Results Thirty-nine general surgery residents participated in the focus groups from June to August of 2021. PGY4 and PGY5 residents were considered “senior residents” and PGY1-3 “junior residents.” Senior residents preferred to be allowed to struggle before takeover and valued intentional faculty silence, whereas junior residents disliked silence and appreciated active guidance while operating. Furthermore, while junior residents reported frequent harassment by ancillary staff in the OR without faculty intervention as contributing to a negative learning environment, this was not a factor for senior residents. Conclusion We identified important differences in the attributes of effective teachers from the perspective of junior versus senior residents which may guide faculty teaching to be the most relevant to the needs of their learners. It is critical for faculty surgeons to be trained to identify harassment and intervene effectively.