This resident has got to learn!

A a junior surgical trainee in the University of Alberta’s General Surgical Residency Program, I found that one of my mentors was exceedingly patient in instructing me, step by step, on the fundamentals of surgical technique. One day as I was completing an intestinal anastomosis and receiving patient, persistent feedback at each step, while being watched by the operating team (and conscious of the clock), I realized that my mentor shared equal determination for me to succeed when he exclaimed “This resident has got to learn!” This time-honoured approach of deconstructing a surgical procedure with timely feedback has been investigated by Backstein and colleagues at Toronto’s Mount Sinai Hospital and the University of Toronto’s Surgical Skills Centre in this issue of the Canadian Journal of Surgery (page 195). These investigators evaluated the efficacy of videotaped feedback over 3 consecutive practice sessions on a vascular anastomosis bench model. The study showed no significant difference in the outcome of technical checklists and global rating for residents who received repeated video feedback compared with a control group that received expert surgical feedback alone. This study carries some extremely valuable messages. The value of individualized verbal feedback from an expert surgeon remains an outstanding model for teaching surgical skills. This is an important reason for us to recognize the importance of providing time for surgeons to teach in the operating room, particularly as training program enrolments increase in order to meet the future needs of surgical care in Canada. Although the video feedback with expert review did not appear to add significant benefit, this modality should not be discarded as an adjunct to effective teaching. Operating room experience and faculty hours become increasingly challenged by cost and availability of time to teach. Surely, a videotaped instruction session with specific feedback could help meet this challenge. The challenge of videotaping, as for all technology, is to identify rigorous models with additional investigations. A plethora of new systems are under development and increasingly available to surgical instructors. Metrics of these systems exist to track time errors, trajectory of tools, path lengths, instrument misses, tissue damage, tissue tension, clamp placement and even blood loss. Emerging data show that experts and novices differ when these metrics are precisely tracked. The task is to incorporate these metrics into a videotaped analysis as was used in the current study. After all, the videotaped skill of a surgeon is commonly used to select participants for clinical multicentre trials to minimize the “workmanship effect.” This may agree with the investigators’ contention that video feedback is better as an advanced instruction aid. A major challenge facing surgical educators is to develop sophisticated education centres that bring together the expertise of teachers and investigators in surgical skills development. The Toronto Surgical Skills Centre is a prime example. Recent initiatives by the American College of Surgeons have identified the need to develop a network of centres of excellence in education across approximately 20 sites in North America. These centres will not replace the standard approach of residency education programs but complement and extend Coeditors Corédacteurs