MENU ▼
Read by QxMD icon Read
search
OPEN IN READ APP
JOURNAL ARTICLE

Resident hesitation in the operating room: does uncertainty equal incompetence?

Michael Ott, Alan Schwartz, Mark Goldszmidt, Georges Bordage, Lorelei Lingard
Medical Education 2018, 52 (8): 851-860
29574896

CONTEXT: In postgraduate medical programmes, the progressive development of autonomy places residents in situations in which they must cope with uncertainty. We explored the phenomenon of hesitation, triggered by uncertainty, in the context of the operating room in order to understand the social behaviours surrounding supervision and progressive autonomy.

METHODS: Nine surgical residents and their supervising surgeons at a Canadian medical school were selected. Each resident-supervisor pair was observed during a surgical procedure and subsequently participated in separate post-observation, semi-structured interviews. Constructivist grounded theory was used to guide the collection and analysis of data.

RESULTS: Three hesitation-related themes were identified: the principle of progress; the meaning of hesitation, and the judgement of competence. Supervisors and residents understood hesitation in the context of a core surgical principle we termed the 'principle of progress'. This principle reflects the supervisors' and residents' shared norm that maintaining progress throughout a surgical procedure is of utmost importance. Resident hesitation was perceived as the first indication of a disruption to this principle and was therefore interpreted by supervisors and residents alike as a sign of incompetence. This interpretation influenced the teaching-learning process during these moments when residents were working at the edge of their abilities.

CONCLUSIONS: The principle of progress influences the meaning of hesitation which, in turn, shapes judgements of competence. This has important implications for teaching and learning in direct supervision settings such as surgery. Without efforts to change the perception that hesitation represents incompetence, these potential teaching-learning moments will not fully support progressive autonomy.

Comments

You need to log in or sign up for an account to be able to comment.

No comments yet, be the first to post one!

Related Papers

Available on the App Store

Available on the Play Store
Remove bar
Read by QxMD icon Read
29574896
×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"