Title: ‘You see?’ Teaching and learning how to interpret visual cues during surgery
Abstract: Medical EducationVolume 49, Issue 11 p. 1103-1116 Learning Visual Cues ‘You see?’ Teaching and learning how to interpret visual cues during surgery Alexandra C Cope, Corresponding Author Alexandra C Cope Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK Leeds Institute of Medical Education, Faculty of Medicine and Health, University of Leeds, Leeds, UKCorrespondence: Alexandra C Cope, Leeds Institute of Medical Education, 7.09 Worsley Building, University of Leeds, Leeds, LS2 9JT Tel: 00 44 113 3437234; E-mails: [email protected]; [email protected]Search for more papers by this authorJeff Bezemer, Jeff Bezemer Department of Culture, Communication and Media, University College London Institute of Education, London, UKSearch for more papers by this authorRoger Kneebone, Roger Kneebone Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UKSearch for more papers by this authorLorelei Lingard, Lorelei Lingard Centre for Education Research & Innovation, Schulich School of medicine and Dentistry, Western University, London, Ontario, CanadaSearch for more papers by this author Alexandra C Cope, Corresponding Author Alexandra C Cope Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK Leeds Institute of Medical Education, Faculty of Medicine and Health, University of Leeds, Leeds, UKCorrespondence: Alexandra C Cope, Leeds Institute of Medical Education, 7.09 Worsley Building, University of Leeds, Leeds, LS2 9JT Tel: 00 44 113 3437234; E-mails: [email protected]; [email protected]Search for more papers by this authorJeff Bezemer, Jeff Bezemer Department of Culture, Communication and Media, University College London Institute of Education, London, UKSearch for more papers by this authorRoger Kneebone, Roger Kneebone Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UKSearch for more papers by this authorLorelei Lingard, Lorelei Lingard Centre for Education Research & Innovation, Schulich School of medicine and Dentistry, Western University, London, Ontario, CanadaSearch for more papers by this author First published: 22 October 2015 https://doi.org/10.1111/medu.12780Citations: 37Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract Context The ability to interpret visual cues is important in many medical specialties, including surgery, in which poor outcomes are largely attributable to errors of perception rather than poor motor skills. However, we know little about how trainee surgeons learn to make judgements in the visual domain. Objectives We explored how trainees learn visual cue interpretation in the operating room. Methods A multiple case study design was used. Participants were postgraduate surgical trainees and their trainers. Data included observer field notes, and integrated video- and audio-recordings from 12 cases representing more than 11 hours of observation. A constant comparative methodology was used to identify dominant themes. Results Visual cue interpretation was a recurrent feature of trainer–trainee interactions and was achieved largely through the pedagogic mechanism of co-construction. Co-construction was a dialogic sequence between trainer and trainee in which they explored what they were looking at together to identify and name structures or pathology. Co-construction took two forms: ‘guided co-construction’, in which the trainer steered the trainee to see what the trainer was seeing, and ‘authentic co-construction’, in which neither trainer nor trainee appeared certain of what they were seeing and pieced together the information collaboratively. Whether the co-construction activity was guided or authentic appeared to be influenced by case difficulty and trainee seniority. Co-construction was shown to occur verbally, through discussion, and also through non-verbal exchanges in which gestures made with laparoscopic instruments contributed to the co-construction discourse. Conclusions In the training setting, learning visual cue interpretation occurs in part through co-construction. Co-construction is a pedagogic phenomenon that is well recognised in the context of learning to interpret verbal information. In articulating the features of co-construction in the visual domain, this work enables the development of explicit pedagogic strategies for maximising trainees’ learning of visual cue interpretation. This is relevant to multiple medical specialties in which judgements must be based on visual information. Supporting Information Filename Description medu12780-sup-0001-VideoS1.m4vvideo/m4v, 4.7 MB Video Clip S1. ‘It looks like she's got adenomyosis.’ medu12780-sup-0002-VideoS2.m4vvideo/m4v, 6.1 MB Video Clip S2. ‘That's the CBD there, okay?’ medu12780-sup-0003-VideoS3.m4vvideo/m4v, 4.6 MB Video Clip S3. ‘I think it's going… up here, isn't it?’ medu12780-sup-0004-VideoS4.m4vvideo/m4v, 15.4 MB Video Clip S4. ‘It's really weird it's twisting round each other…’ medu12780-sup-0005-VideoS5.m4vvideo/m4v, 11.1 MB Video Clip S5. ‘So this is the classic anatomy…’ medu12780-sup-0006-VideoS6.m4vvideo/m4v, 10.4 MB Video Clip S6. ‘So that's the artery – likely to be…’ Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. References 1Norman G, Brooks L, Regehr G, Marriott M, Shali V. 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