The Key Literature in Medical Education Podcast this past week covered looks at the delicate situation of when to ask for help in the operating room (operating theatre for everyone outside of North America). The principle investigator is a cardiac surgeon with decades of experience… and it is this experience, and his network, that allows him to probe for considerable insight among experienced and novice surgeon colleagues. As always, the most interesting bits are on the podcast. You can download it here. But if you’re pushed for time, check out the abstract below.
– Jonathan (@sherbino)
KeyLIME Session 95 – Article under review:
View/download the abstract here.
Bartlett KW, Whicker SA, Novick RJ, Lingard L, Cristancho SM. The Call, the Save, and the Threat: Understanding Expert Help-Seeking Behavior During Nonroutine Operative Scenarios. Journal of Surgical Education. 2015 Mar-Apr;72(2):302-9
Reviewer: Jonathan Sherbino
Background
There is a paradox in medical education…okay numerous paradoxes, paradoxi, paradice? (Apologies for the bad pun.) In this case, I am referring to the hidden curriculum that punishes a resident for seeking help (particularly at inconvenient times) from a staff physician (see Tara Kennedy’s excellent work on this, Med Ed 2009, BMJ 2009), while simultaneously suggesting that the complexity of medicine is best addressed via collaboration with other health professionals.
Asking for help is often intimated as weakness. Bravado is rewarded. This is the messy theme that the KeyLIME podcast wades into this week… and it involves surgeons!
Purpose
“The objective of this study is to explore surgeon-to-surgeon help-seeking behaviors during complex and unanticipated operative scenarios…to understand the conditions that prompt consultant surgeons to ask for help, the collaborative strategies that are negotiated among consultant surgeons after asking or being asked for help, the perceived value of the assistance rendered and the implications of help seeking.”
Type of Paper
Qualitative Research
Key Points on the Method
A constructivist grounded theory approach was used.
REB approval.
Purposive sampling of 4 junior, 4 midlevel and 6 senior attending surgeons (65% male, representing neurosciences, obstetrics & gynecology, and surgery) from 3 hospitals associated with one medical school.
Surgeons were asked about: “(1) instances during which they called another consultant into the operating room for assistance because of an unanticipated circumstance that had developed, (2) the processes they and their colleague went through to better understand and address the situation,(3) whether their colleague’s assistance was ultimately helpful or not, and(4) the consequences of requesting assistance.”
Transcripts were iteratively coded using a constant comparison approach. Sampling was continued until saturation. An external check of early findings was triangulated with education researchers and surgeons to ensure credibility.
Key Conclusions
The authors conclude…“Our “Call-Save-Threat” framework suggests that surgeons recurrently negotiate when and how to seek help in the interests of patient safety, while attending to the traditional cultural values of autonomy and decisive action.”
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