• Elena A Vikis, Tanis V Mihalynuk, Dan D Pratt, and Ravi S Sidhu.
• Division of Vascular Surgery, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada.
• Am. J. Surg. 2008 May 1;195(5):594-8; discussion 598.

BackgroundThe transformation of a trainee into a surgeon is influenced strongly by communication patterns in the operating room (OR). In the current era of limited educational opportunities, elucidation of teaching and learning strategies in this environment is critical. The aim of this study was to further understand the elements of an effective communicative instructional interaction (CII) as perceived by surgical residents.MethodsQualitative research methodology was used to explore University of British Columbia surgery residents' perceptions of what constitutes an effective CII in the OR. Purposeful sampling was used to select participants from various years of training. Eighteen residents participated in semistructured interviews to facilitate reflection of their OR experiences. Interviews were transcribed, analyzed, and fed back to residents to confirm their accuracy. Independent coding and analysis led to the development of key emergent themes.ResultsThemes represented the interplay of ideals expressed by the residents. The primary emergent theme was that both teacher and learner play a major role in the creation of an effective CII. The ideal teacher had an instructional plan, facilitated surgical independence, and showed support and empathy for the surgical resident. The ideal resident was receptive, prepared, and acknowledged limitations. The contextual constraints of the OR played a central role in learning, and residents identified ways to maintain educational value despite primarily nonmodifiable contextual elements (ie, time constraints).ConclusionsIn a unique environment such as the OR, both teacher and learner may benefit by an enhanced understanding of the elements of an effective CII.

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