Maximizing Learning in the Operating Room: Residents’ Perspectives

Published:February 19, 2021DOI:


      • Residents who practice self-regulated learning display traits that are associated with perceived improvement in OR learning opportunities and experience
      • Residents who communicate their specific goals of the procedure, especially after discussing their vulnerabilities with parts of the case, are more likely to obtain control of the case
      • Residents who can narrate their thought process intraoperatively, and demonstrate comfort with the procedure by thinking ahead in the case, maintain control
      • When residents reflect on cases, via dictating operative notes or other means, they are able to identify better their successes, weaknesses, and failures.
      • Residents who prepare for surgical cases in part by reflecting on prior experiences are able to set specific goals for the procedure.
      • When allowed to safely struggle, residents feel they have the best educational experience possible in the OR



      Few studies examine how residents can optimize their educational experience in the OR on their terms. This study aimed to examine residents’ perceptions of how learners can maximize their education in the OR.


      Using constructivist grounded theory methodology, the authors conducted focus groups with general surgery residents, PGY1-5, followed by semi-structured interviews with attending surgeons from a single, academic medical center. Constant comparison was used to identify themes and explore their relationships. Theoretical sampling was used until saturation was achieved.


      Residents and attendings participated. Two phases of OR learning were identified, intra-operative and inter-operative. Characters that made optimized learning included control, struggling, and reflection. Residents who practiced self-reflection with their experiences, and were able to articulate this awareness to attendings, felt the OR was an ideal learning environment. Attendings echoed similar findings.


       Providing residents with a method of maximizing OR learning is critical to postgraduate clinical education. Currently, observation passively morphs into active learning and eventually independent operating in the OR. However, residents who practice self-regulated learning, and are able to discuss their educational goals with attendings, seem to find the OR a better learning environment and progress to independence more quickly. This was echoed by practicing attendings. Providing residents with a generalizable, self-regulated learning framework specific to operative educational experiences could maximize learning potential and expedite resident progression in the OR.


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