Models of Teaching and Learning in the Operating Theatre

  • Alexandra CopeEmail author
  • Jeff Bezemer
  • Gary Sutkin
Part of the Innovation and Change in Professional Education book series (ICPE, volume 17)


This chapter presents an evidence-based overview of what is known about content and process of teaching and learning in the operating theatre. It starts out by identifying theoretical perspectives on learning and teaching and their methodological implications. Following that the possibilities and challenges of teaching and learning in the operating theatre are explored, highlighting its distinct features as an educational venue. In the following parts, various teaching methods and typologies of content domains of learning are discussed and illustrated. The remainder of the chapter is focused on the verbal, gestural and haptic features of interactions between surgical educator, trainees and other members of the team. The chapter ends with questions for further research and a summary.


Dunnington Bargaining Intraoperative Hands-on Community of practice Deictic Teachable moment Quizzing Co-construction Behavioural expectations Banter Professionalism Postgraduate trainee Supervision Feedback Training Briefing BID model SHARP model Sensory semiosis IRF IREW Physical actions Gaze Nonverbal instruction Pure teaching interaction Verbal communication Interprofessional Theoretical perspectives Evidence base Operating theatre Teaching Learning Typology Decision-making Amphitheatre Teaching methods Agency Knowles adult learning Threshold concepts Theory-based methods Tacit knowledge 


  1. 1.
    Knowles, M. S. (1984). Andragogy in action. Applying modern principles of adult education. San Francisco: Jossey Bass.Google Scholar
  2. 2.
    Pugh, C. M., DaRosa, D. A., Glenn, D., & Bell, R. H., Jr. (2007). A comparison of faculty and resident perception of resident learning needs in the operating room. Journal of Surgical Education, 64(5), 250–255.CrossRefGoogle Scholar
  3. 3.
    Land, R., Meyer, J., & Flanagan, M. (Eds.). (2016). Threshold concepts in practice. Educational futures: Rethinking theory and practice. Rotterdam: Sense Publishers.Google Scholar
  4. 4.
    Fitts, P., & Posner, M. (1967). Human performance. Co Belmont: Brooks/Cole Publishers.Google Scholar
  5. 5.
    Kopta, J. (1971). An approach to the evaluation of operative skills. Surgery, 70, 297–303.Google Scholar
  6. 6.
    DaRosa, D., Zwischenberger, J., Meyerson, S., George, B., Teitelbaum, E., Soper, N., & Fryer, J. (2013). A theory-based model for teaching and assessing residents in the operating room. Journal of Surgical Education, 70(1), 24–30.CrossRefGoogle Scholar
  7. 7.
    Reznick, R. (1993). Teaching and testing technical skills. American Journal of Surgery, 165(3), 358–361.CrossRefGoogle Scholar
  8. 8.
    Scallon, S. E., Fairholm, D. J., Cochrane, D. D., & Taylor, D. C. (1992). Evaluation of the operating room as a surgical teaching venue. Canadian Journal of Surgery, 35(2), 173–176.Google Scholar
  9. 9.
    Schwind, C. J., Boehler, M. L., Rogers, D. A., Williams, R. G., Dunnington, G., Folse, R., & Markwell, S. J. (2004). Variables influencing medical student learning in the operating room. American Journal of Surgery, 187(2), 198–200.CrossRefGoogle Scholar
  10. 10.
    Fernando, N., McAdam, T., Youngson, G., McKenzie, H., Cleland, J., & Yule, S. (2007). Undergraduate medical students’ perceptions and expectations of theatre-based learning: How can we improve the student learning experience? Surgeon Journal of the Royal Colleges of Surgeons of Edinburgh & Ireland, 5(5), 271–274.CrossRefGoogle Scholar
  11. 11.
    Rose, J., Waibel, B., & Schenarts, P. (2011). Disparity between resident and faculty surgeons’ perceptions of preoperative preparation, intraoperative teaching, and postoperative feedback. Journal of Surgical Education, 68(6), 459–464.CrossRefGoogle Scholar
  12. 12.
    Vollmer, C., Newman, L., Huang, G., Irish, J., Hurst, J., & Horvath, K. (2011). Perspectives on intraoperative teaching: Divergence and convergence between learner and teacher. Journal of Surgical Education, 68(6), 485–494.CrossRefGoogle Scholar
  13. 13.
    Butvidas, L., Anderson, C., Balogh, D., & Basson, M. (2011). Disparities between resident and attending surgeon perceptions of intraoperative teaching. The American Journal of Surgery, 201(3), 385–389.CrossRefGoogle Scholar
  14. 14.
    Levinson, K., Barlin, J., Altman, K., & Satin, A. (2010). Disparity between resident and attending physician perceptions of intraoperative supervision and education. Journal of Graduate Medical Education, 2(1), 31–36.CrossRefGoogle Scholar
  15. 15.
    Chen, X., Williams, R., & Smink, D. (2014). Do residents receive the same OR guidance as surgeons report? Difference between residents’ and surgeons’ perceptions of OR guidance. Journal of Surgical Education, 71(6), e79–e82.CrossRefGoogle Scholar
  16. 16.
    Hindmarsh, J., & Pilnick, A. (2002). The tacit order of teamwork: Collaboration and embodied conduct in anaesthesia. The Sociological Quarterly, 43(2), 139–164.CrossRefGoogle Scholar
  17. 17.
    Pope, C., Smith, A., Goodwin, D., & Mort, M. (2003). Passing on tacit knowledge in anaesthesia: A qualitative study. Medical Education, 37(7), 650–655.CrossRefGoogle Scholar
  18. 18.
    Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. Cambridge, UK: Press syndicate of University of Cambridge.CrossRefGoogle Scholar
  19. 19.
    Aggarwal, R., & Darzi, A. (2006). Training in the operating theatre: Is it safe? Thorax, 61(4), 278–279.CrossRefGoogle Scholar
  20. 20.
    Lyon, P. M. A. (2003). Making the most of learning in the operating theatre: Student strategies and curricular initiatives. Medical Education, 37(8), 680–688.CrossRefGoogle Scholar
  21. 21.
    Lyon, P. (2004). A model of teaching and learning in the operating theatre. Medical Education, 38(12), 1278–1287.CrossRefGoogle Scholar
  22. 22.
    Dunnington, G., DaRosa, D., & Kolm, P. (1993). Development of a model for evaluating teaching in the operating room. Current Surgery, 50(7), 523–527.Google Scholar
  23. 23.
    Cox, S., & Swanson, M. (2002). Identification of teaching excellence in operating room and clinic settings. American Journal of Surgery, 183(3), 251–255.CrossRefGoogle Scholar
  24. 24.
    Moulton, C. (2010). Operating from the other side of the table: Control dynamics and the surgeon educator. Journal of American College of Surgeons, 210(1), 79–86.CrossRefGoogle Scholar
  25. 25.
    Lingard, L. (2002). Team communications in the operating room: Talk patterns, sites of tension and implications for novices. Academic Medicine, 77(3), 232–237.CrossRefGoogle Scholar
  26. 26.
    Crofts, T. J., Griffiths, J. M., Sharma, S., Wygrala, J., & Aitken, R. J. (1997). Surgical training: An objective assessment of recent changes for a single health board. BMJ, 314(7084), 891–895.CrossRefGoogle Scholar
  27. 27.
    Raja, A. J., & Levin, A. V. (2003). Challenges of teaching surgery: Ethical framework. World Journal of Surgery, 27(8), 948–951.CrossRefGoogle Scholar
  28. 28.
    Mayer, R. (2004). Should there be a three-strikes rule against pure discovery learning? The case for guided methods of instruction. Am Psychology, 59, 14–19.CrossRefGoogle Scholar
  29. 29.
    Roberts, N., Williams, R., Kim, M., & Dunnington, G. (2009). The briefing, intraoperative teaching, debriefing model for teaching in the operating room. Journal of the American College of Surgeons, 208(2), 299–303.CrossRefGoogle Scholar
  30. 30.
    Temple, J. (2010). Time for training: A review of the impact ofhte the European Working Time Directive on the quality of training.Google Scholar
  31. 31.
    Ahmed, M., Arora, S., Russ, S., Darzi, A., Vincent, C., & Sevdalis, N. (2013). Operation debrief – a SHARP improvement in performance feedback in the operating room. Annals of Surgery, 258(6), 958–963.CrossRefGoogle Scholar
  32. 32.
    Cope, A., Mavroveli, S., Bezemer, J., Hanna, G., & Kneebone, R. (2015). Making meaning from sensory cues in the operating room – an important content area of post-graduate surgical learning. Academic Medicine, 90(8), 1125–1131.CrossRefGoogle Scholar
  33. 33.
    Law, B., Atkins, M. S., Kirkpatrick, A. E., & Lomax, A. J. (2004). Eye gaze patterns differentiate novice and experts in a virtual laparoscopic surgery training environment, Proceedings of the 2004 symposium on Eye tracking research & applications (pp. 41–48). San Antonio: ACM.Google Scholar
  34. 34.
    Richstone, L., Schwartz, M., Seideman, C., Cadeddu, J., Marshall, S., & Kavoussi, L. (2010). Eye metrics as an objective assessment of surgical skill. Annals of Surgery, 252(1), 177–182.CrossRefGoogle Scholar
  35. 35.
    Bleakley, A. (2006). Towards an aesthetics of healthcare practice: Learning the art of clinical judgement. Denmark: University of Aarhus.Google Scholar
  36. 36.
    Hauge, L. S., Wanzek, J. A., & Godellas, C. (2001). The reliability of an instrument for identifying and quantifying surgeons’ teaching in the operating room. American Journal of Surgery, 181(4), 333–337.CrossRefGoogle Scholar
  37. 37.
    Blom, E. M., Verdaasdonk, E. G. G., Stassen, L. P. S., Stassen, H. G., Wieringa, P. A., & Dankelman, J. (2007). Analysis of verbal communication during teaching in the operating room and the potentials for surgical training. Surgical Endoscopy, 21(9), 1560–1566.CrossRefGoogle Scholar
  38. 38.
    Roberts, N., Brenner, M., Williams, R., Kim, M., & Dunnington, G. (2012). Capturing the teachable moment: A grounded theory study of verbal teaching interactions in the operating room. Surgery, 151(5), 643–650.CrossRefGoogle Scholar
  39. 39.
    Sutkin, G., Littleton, E., & Kanter, S. (2015). How surgical mentors teach: A classification of in vivo teaching behaviors part 1: Verbal teaching guidance. Journal of Surgical Education, 72(2), 243–250.CrossRefGoogle Scholar
  40. 40.
    Mehan, H. (1979). Learning lessons: Social organisation in the classroom. Cambridge, MA: Harvard Press.CrossRefGoogle Scholar
  41. 41.
    Wells, G. (1993). Re-evaluating the IRF sequence: A proposal for the articulation of theories of activity and discourse for the analysis of teaching and learning in the classroom. Linguistics and Education, 5, 1–37.CrossRefGoogle Scholar
  42. 42.
    Healy, J., & Yoo, P. In defense of “Pimping”. Journal of Surgical Education, 72(1), 176–177.Google Scholar
  43. 43.
    Hu, Y., Peyre, S., Arriaga, A., Roth, E., Corso, K., & Greenberg, C. (2012). War stories: A qualitative analysis of narrative teaching strategies in the operating room. The American Journal of Surgery, 203(1), 63–68.CrossRefGoogle Scholar
  44. 44.
    Chen, X., Williams, R., Sanfey, H., & Smink, D. (2015). A taxonomy of surgeons’ guiding behaviors in the operating room. The American Journal of Surgery, 209(1), 15–20.CrossRefGoogle Scholar
  45. 45.
    Sutkin, G., Littleton, E., & Kanter, S. (2015). How surgical mentors teach: A classification of in vivo teaching behaviors part 2: Physical teaching guidance. Journal of Surgical Education, 72(2), 251–257.CrossRefGoogle Scholar
  46. 46.
    Bezemer, J., Cope, A., Faiz, O., & Kneebone, R. (2012). Participation of surgical residents in operations. World Journal of Surgery, 36(9), 2011–2014.CrossRefGoogle Scholar
  47. 47.
    Bezemer, J., Cope, A., Kress, G., & Kneebone, R. (2013). Holding the scalpel: Achieving surgical care in a learning environment. Journal of Contemporary Ethnography, 43(1), 38–63.CrossRefGoogle Scholar
  48. 48.
    Cope, A., Bezemer, J., Kneebone, R., & Lingard, L. (2015). ‘You see?’ Teaching and learning how to interpret visual cues during surgery. Medical Education, 49(11), 1103–1116.CrossRefGoogle Scholar
  49. 49.
    Lingard, L., Reznick, R., DeVito, I., & Espin, S. (2002). Forming professional identities on the health care team: Discursive constructions of the ‘other’ in the operating room. Medical Education, 36, 728–734.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of General Surgery and University of Oxford: Department of Continuing EducationFrimley Health Foundation TrustFrimleyUK
  2. 2.UCL Institute of EducationUniversity College LondonLondonUK
  3. 3.Female Pelvic Medicine and Reconstructive Surgery, Departments of Biomedical and Health Informatics and Obstetrics and GynecologyUniversity of Missouri-Kansas City School of MedicineKansas CityUSA

Personalised recommendations