By Monica J. Smith

BOSTON—Discussions about optimizing surgical education often focus on what educators can do to set trainees up for success, but a session at last year’s Clinical Congress of the American College of Surgeons focused instead on what trainees and surgeons at any stage in their careers can do to get the most out of training.

By tapping into social media, podcasts, surgical coaching and other adjuncts to traditional education, experts presented various strategies-inside and outside of the operating room-to enhance learning and strive toward excellence.

Social Media

In a profession that traditionally has been hierarchical, social media can level the playing field and help trainees overcome barriers to equity in education, research, collaboration and even job searching, said Heather Yeo, MD, MHS, an associate professor of surgery at NewYork-Presbyterian Weill Cornell Medical Center, in New York City.

“One of the most beneficial uses I’ve seen is the dissemination of academic information and research through online article sharing and discussions with people who do similar research,” Dr. Yeo said. She met many researchers in her field by tagging them or reading their research and commenting on their articles.

For on-the-spot tutorials, social media platforms can be a warehouse of procedural videos, but it’s prudent to keep in context any video’s source, regardless of the platform. “You can get good videos on YouTube, Facebook and institutional databases; ours has a large database of procedures for residents to watch before they go into the OR,” she said.

Instagram, X and other platforms can facilitate rapid communication on patient management questions to discuss case scenarios (being mindful to withhold patient identifiers), help people connect around health advocacy and awareness, and bolster patient education efforts, Dr. Yeo said. “For example, March is Colorectal Cancer Awareness Month. I spend a lot of time in March tweeting information to raise awareness about the disease process.”

The virtual interview, which gained popularity during the COVID-19 pandemic and probably will last for a while, allows people to attend interviews they might not have been able to afford to travel to in person, perhaps applying in more competitive fields. “Virtual interviews have allowed people to do broader applications,” Dr. Yeo said.

She encourages surgeons to join all the social media platforms in areas they are interested in, but with some caveats. First, know your institution’s social media guidelines because violating them could result in termination. Most of these guidelines revolve around HIPAA requirements, patient compliance and being careful about what you post. “Those guidelines also get into how you should interact with your institution—whether it wants you to claim your affiliation with them, whether to tag them and others within your institution.”

Most importantly, be aware that nothing posted online is private and anything can be misinterpreted. “Would you be comfortable with your grandmother, your patient or your boss reading what you’ve texted or tweeted? If not, don’t do it,” Dr. Yeo said.

Podcasts

Presenting the case for podcasts, Jason Bingham, MD, an associate professor of surgery at Madigan Army Medical Center, in Tacoma, Wash., and the co-founder of “Behind the Knife: the Surgical Podcast,” made a couple of points: 1) surgeons need to master more and more information in less time, and 2) technology has changed not only the way we acquire information, but how we learn. “It’s rewired our brains. Because of these two points, I believe podcasts are an integral method of asynchronous learning and indispensable.”

There is a third point that podcasts might help address: the dissatisfaction of trainees with current learning resources, Dr. Bingham said. “A survey of Mass General surgery residents showed only 10% are happy with current study materials, and 96% are willing to try a new study method.”

What is it about podcasts that makes them an appealing learning tool for today’s learners? “What you read about in millennial education is the five R’s of modern learners,” but these five R’s apply to all learners who are inundated with information, he said. “Learners want research-based methods that are relevant, rational, delivered in a relaxed environment and that provide rapport, community.”

Podcasts provide a platform for discussions of research and clinical challenges, hot topics, debates, technique and ethical issues. These subjects are “things difficult to discuss on other platforms. But really, podcasts deliver the five R’s, give modern learners what they’re looking for and create that network of knowledge,” Dr. Bingham said.

Furthermore, podcasts are everywhere. When he was in Guyana in early 2023, doing an open inguinal hernia repair with a resident, the young surgeon recognized Dr. Bingham’s voice from “Behind the Knife.” “He said they consider it core curriculum.” Before he knew it, eight to 10 surgeons were standing shoulder-to-shoulder watching the procedure. “This just points to the reach podcasts have. They really bring equity to medical education.”

However, the podcast space is largely dominated by health-and-wellness influences. “Our voice is absent,” Dr. Bingham said, noting that surgeons have started to catch on, with “Butts & Guts” from Cleveland Clinic, and the ACS-launched “The House of Surgery” and “Surgical Readings from SRGS.”

“We have an opportunity here, and I think there are roles for all of us: for institutions and for societies, as creators, moderators and curators,” he noted.

Surgical Videos

With high-resolution video being integrated into the OR, surgeons and others are thinking about how it can be used in documentation, quality improvement initiatives, patient care, self-assessment and medical training. Increasing professional and public interest in surgical recording make it likely to become commonplace.

But there are barriers, which fall into three main categories, said Alexander Langerman, MD, SM, a head and neck surgeon and surgical recording thought leader at Vanderbilt University, in Nashville, Tenn. These are “one, ownership and access; two, liability implications; and three, privacy and surveillance.”

Dr. Langerman often is asked who owns a surgical video. “Ownership is a big topic—what they call a bundle of sticks, with a number of rights incorporated: access, restricting access, transference, sale. What we need to think about is ownership design: who should have some rights over this video based on what values and behaviors we want to promote.”

Regarding liability, the evidentiary value of surgical videos may be limited. “People think videos would be unequivocal proof of negligence or exoneration, but there are few established standards in surgery as far as how it’s supposed to be done,” Dr. Langerman said, noting that introducing video into courts today may bias juries and would still be open to interpretation and debate, “just like experts debate over the operative report.”

Privacy is a big deal, obviously, and not just for patients. “Surgeons, other team members, hospitals, payors and makers of proprietary devices might all be stakeholders interested in protecting video content. And, if we manipulate data to protect privacy or obfuscate identity, we need to think about how that affects the quality of the data for a given purpose.”

In addition, there is the institution’s resources to consider. What sort of infrastructure will be needed to manage surgical videos, conduct analyses and protect data? “This could mean huge costs for institutions if we’re not delicate about the way we proceed,” Dr. Langerman said.

He advised keeping those challenges in mind and reading your institution’s policies and reviewing contracts. “Videos you record may be property of the hospital, and video recording providers or analysis providers might have rights over it. It’s important to read contracts and stay aware of laws, regulations and guidelines, and find ways to protect your data.”

Lastly, if you’re going to make recording procedures routine in the OR, be sure to promote the positive aspects of surgical recording. “Stress the ability to deliver better patient care, instead of a punitive aspect where we’ll be watching to make sure you do the right thing,” Dr. Langerman said.

“As we move forward with surgical video, we need to clarify how the videos will be used and how they will impact our professional lives,” Dr. Langerman pointed out.

The Case for Surgical Coaching

Medical education and continuing medical education are based on the same tradition: to establish competency, “not for us to improve or optimize our performance. Daily, we practice medicine and surgery, but do we practice with the intent of continuing to improve our performance?” asked Kristine Lombardozzi, MD, a trauma surgeon and surgical intensivist at Spartanburg Regional Medical Center, in Spartanburg, S.C.

There are gaps in surgery: gaps between intended outcomes and actual outcomes, gaps in technical skills that account for variation in outcomes, gaps between expectations and reality that affect professional satisfaction.

“We need to move from outcome measurements to strategies that actually improve performance,” Dr. Lombardozzi said. And, fairly recently, research has shown that surgical coaching can help surgeons make sustained improvements in their practice and close gaps in all the above-mentioned areas (Ann Surg 2018;267[5]:868-873).

Coaching lies somewhere between teaching and mentoring, using open-ended questions and challenges to mental models to stimulate individual learning, development and growth, explained Dr. Lombardozzi, who is herself a certified surgical coach. “This process can be facilitated by video review but doesn’t require it. Even more importantly, with some instruction, this coaching can be done by our surgical peers,” she said.

Why do surgeons need coaching to optimize their performance? Results and outcomes are the consequences of one’s behaviors and actions, which are based on conditioned thinking and one’s experience, and it’s simply not easy to make sustained changes in behavior, Dr. Lombardozzi said.

“Coaching understands how our unconscious conditioned thinking and experiences drive what we do and moves us from what’s visible to what’s invisible. By working both above and below that line, we can get sustained behavior change,” she said.

Dr. Lombardozzi gave the example of an accomplished and esteemed breast surgeon who discovered her reexcision rates were higher than those of her peers. She thought she was doing the best operation for the patient at the time based on her training and judgment. How was she supposed to do it differently?

“This surgeon engaged a surgical coach, and through the coaching process of reflection, thoughtful inquiry, feedback and goal setting, was able to get her reexcision rate back on a par with her departmental colleagues within a short period of time,” Dr. Lombardozzi said. Coaching helped her see how her unconscious thoughts, conditioned thinking and experiences were driving her behaviors, which allowed her to change the behaviors and improve her outcomes.

“We don’t want just to be competent; we want to be excellent. We don’t want to be static; we want to improve. I’m [saying] that coaching, combined with deliberate practice, is the most effective way to enhance surgical performance in its broadest definition. It doesn’t matter if you’re in training, new faculty, mid-career or late career—every surgeon deserves a coach,” Dr. Lombardozzi said.