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Interactive Learning as a Solution to Decreasing Surgical Exposure

机译：交互式学习作为减少手术暴露的解决方案

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A description of the changing scenario of obstetrics and gynecology residency training by Gupta et al in the September 2015 issue of the Journal of Graduate Medical Education confirms what many of us are experiencing in our residency programs.1 As a junior faculty member of my training program, I witnessed residents suffer less exposure to procedures and high-risk emergent clinical scenarios. The problems we face with decreased exposure to surgical procedures is not unique to my field and permeates throughout all medical specialties. The prevailing question is: What can be done? As Gupta et al1 point out, many believe that the main limitation is the limit on resident duty hours.2,3 However, these changes are here to stay, not only for the benefit of the residents, but for patient safety as well. Therefore, the main challenge and objective for residency programs is maximizing the quality of learning during the hours available. In the era of milestones, we must be able to evaluate the progression of knowledge, skills, and attitudes of our residents. In response to this new evaluation system, we must develop new teaching techniques. The system relied on for teaching in the clinical setting, the use of lectures to communicate knowledge, and an apprenticeship model for teaching surgical skills are obsolete.3,4 Residency programs need to implement learning curricula that promote acquisition of structured and progressive knowledge, paired with faculty and resident skill development and self-motivation. Implementation requires both faculty and residents to be engaged, together with a supportive environment where repetition and problem solving guides discussions in clinics and in the classroom. Faculty unprepared for this challenge may need to participate in courses that offer knowledge in teaching techniques promoting interactive learning and case discussion. As faculty evolve, residents must be empowered to develop self-learning techniques, use their prior knowledge, and find value in discussions that offer the tools to consolidate, apply, and prepare for the active management of patients. Furthermore, curricular changes will enhance exposure to surgical procedures. As Gupta et al propose, the number of procedures performed does not reflect competency in the skill.1 Even with a lower number of procedures, if residents utilize every encounter to review indications, diagnoses, alternatives, equipment, and any aspect that is involved in managing the patient, they will learn to consolidate knowledge, optimize the exposure, and develop confidence to move to an independent level.2 Medical education confronted radical changes in the past century for the benefit of today's trainees and their patients. Let us be part of the changes that will improve future generations in training, and in the short term, improve the quality of care provided to the nation.
机译：Gupta等人在2015年9月期的《研究生医学教育杂志》中描述了妇产科住院医师培训不断变化的情况，这证实了我们许多人在住院医师项目中正在经历的事情。1作为我的培训课程的初级教师，我亲眼目睹了居民减少了程序暴露和高风险的紧急临床情况。我们减少接触外科手术所面临的问题并不是我的领域独有的，并且遍及所有医学专业。普遍存在的问题是：可以做什么？正如Gupta等人[1]指出的那样，许多人认为主要的限制是对居民工作时间的限制。2,3然而，这些变化将继续存在，不仅是为了居民的利益，也是为了患者的安全。因此，居住计划的主要挑战和目标是在可用时间内最大程度地提高学习质量。在里程碑时代，我们必须能够评估居民的知识，技能和态度的发展。为了响应这种新的评估系统，我们必须开发新的教学技术。该系统已在临床环境中用于教学，无法使用讲座进行知识交流，也没有用于培训外科技能的学徒模型。3,4住院医师课程需要实施学习课程，以促进结对结构化和渐进性知识的获取具有教师和居民的技能发展和自我激励能力。实施需要教师和居民共同参与，并需要一个支持性环境，其中重复和问题解决可以指导诊所和教室中的讨论。对于这一挑战没有做好准备的教师可能需要参加一些课程，这些课程应提供有关促进交互式学习和案例讨论的教学技术知识。随着教职员工的发展，必须授权居民开发自学技术，使用他们的先验知识并在讨论中找到价值，这些讨论提供了巩固，应用和为患者的积极管理做准备的工具。此外，课程变化将增加对外科手术的暴露。正如Gupta等人所建议的那样，执行的程序数量并不反映技能水平。1即使程序数量较少，如果居民利用每次相遇来检查适应症，诊断，替代方法，设备以及涉及的任何方面，在管理患者方面，他们将学习巩固知识，优化暴露水平并建立独立自主的信心。2在过去的一个世纪中，医学教育面临着巨大的变化，以使当今的受训者及其患者受益。让我们成为变革的一部分，这些变革将改善子孙后代的培训，并在短期内提高为国家提供的护理质量。

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