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>> So we just got an opportunity to watch a videotape of a briefing at the sink.
And I'd like to take a minute to debrief with Cheryl about that briefing.
I think the thing that was really strong about that was that
the learner came in with three pretty well identified goals.
And help me remember what they were.
I remember the last one but the first two were?
>> Sure, we were going to do some work around a lymph node dissection.
We're also going to do some work building a urethra-internal anastomosis.
In other words, connecting a ureter to a piece of intestine.
And then we were going to do some work creating a anastomosis of our neobladder.
So, I think the thing that's really nice about having those three identified goals
is that that means this is a complicated operation, and they're multiple,
multiple things going on.
Now Cheryl and her learner have three
specific areas of the operation where they can focus their attention.
Cheryl can focus her teaching and the learner can focus his learning.
The one thing that I wondered, though I wondered if maybe there were
maybe the last piece, the neobladder, if there were
steps to that that it would be helpful to have the learner identify specific steps
that he felt were problematic, or that he really wanted to focus on?
>> Yeah, and this is something we can probably delve into a bit more.
Because that one part of the operation really is comprised of several pieces.
And so for us to delve into maybe a more specific aspect of that,
an anastomotic creation, might even further focus our teaching at that point.
I think this concept of operative goals and learner goals is something that,
as surgeons, we don't think about, because we think about the operation, and
doing the operation, as the learning.
So it's interesting to have this broader context,
maybe you could talk a little bit about those different types of goals.
>> Right, so this stems from the work on deliberative practice.
So this is a way to make the practice deliberate.
So in other words it's focusing the learner's actions on
areas of the operation where he's less certain,
where he needs to have the expert feedback.
And so when you make the goals so
broad that you're not focused on the actual piece of action
that the learner has to do, then you're really setting an operative goal, and
as we always say, of course you have to have operative goals.
You can't not have them.
It's nice to be able to have a learning objective that's
focused on what is the learner going to do.
What is the learner going to take out of the room, what is he going to know and
be able to do differently from when he walked in.
I think that's, it seems like a fine distinction because you are used to doing,
see one, do one, teach one.
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And we're kind of trying to shift a little bit toward see one, do one, practice one.
Practice again, let me give you some feedback.
Let you do some thinking and reflecting on that.
And that will build your expertise.
>> Yeah, and I think it's really important to acknowledge these kinds of goals early
on, before the surgery starts, because as you mentioned when you're in the middle of
a complex surgery, it's very easy to bypass many different areas.
Even if you outlined those as areas you wanted to talk about.
So the fact that you both have acknowledged that this is something you're
going to do also allows, I think, the learner to call you on it.
And to remind you that this is the area you're going to talk more about it.
>> Great point.
Sally Santen, M.D., Ph.D.Associate Professor - Emergency Medicine
