Assisted Performance and the Zone of Proximal Development (ZPD); a Potential Framework for Providing Surgical Education

Purpose: To apply educational models of the Zone of Proximal Development (ZPD) and approaches to assisted performance to existing knowledge about surgical skill acquisition, and thus provide a framework for potentially enhancing surgical education. Summary: The stages of the ZPD appear to be consistent with existing psychomotor theories of skill acquisition. The fourth phase of the ZPD, where the performance of skills can deteriorate, and which can occur for a number of reasons such as ill health or absence from routine duties, is not well described in the surgical literature. Approaches to assisted performance may provide additional insights into the complexities of how to teach surgical skills, how to approach the process of hand-over of responsibility from teacher to learner, and the importance of enhancing teaching skills of surgical educators. Conclusions: The ZPD and approaches to assisted performance would appear to provide a valuable framework for planning and assessing surgical education programs.