Alphonsus Chong's Personal Wiki

Teaching complex and uncommon operative procedures require instruction on technical skill and cognitive decision-making frameworks. To understand this dynamic process, several adult learning theories are discussed including the Fitts-Posner's three stage theory, transfer learning theory, and expert performance theory. By understanding how trainees can deconstruct complex task and transfer learning from more basic operative cases, surgical educators can reflect on how they structure and stratify operative and simulation experiences to maximize learning.

“Surgical trainees will transfer skills and/or problem solving if they can connect previous task learning to the new situation. The development of a mental set can aid trainees in retrieving this information. Trainees should approach basic operative procedures with the idea that the skill and knowledge they acquire will be able to apply to future procedures. Therefore, learning uncommon and complex procedures begins prior to participating in that case. Their mental set is created during teaching on basic cases by setting the expectations that they should connect skills to the more complex procedures they will experience later in training. Ericson connects this to the development of expertise by demonstrating that transfer of training from existing knowledge to new knowledge is more effective than novel learning.”

Breaking down the learning or teaching of surgery to:

• tasks that can be practiced, e.g. microsurgical anastomosis
• learning specific aspects of each real case, e.g.after Dunnington of South Illinois

“Lawrence Way, MD suggests that we already have a model that works, “…Halsted had it figured out 100 years ago, and in my opinion, the formula has not changed much since. The program, which nowadays is called a cognitive apprenticeship, would consist of operating together and gradually shifting the responsibility to the learner as the learner progresses. At the end, the learner would be independent of the mentor, and the latter would be available, but not scrubbed unless needed…The learner must work his way through enough cases that he will have encountered the full spectrum of contextual variety.”

Peyre, S. E., & Ashley, S. W. (2011). Teaching Uncommon and Highly Complex Operations: Maximizing The Teaching and Learning. Journal of Gastrointestinal Surgery, 15(10), 1724–1725. https://doi.org/10.1007/s11605-011-1570-2