M. M. Esquivel1, I. Wapnir1, R. Yang1, M. L. Melcher1 1Stanford University,General Surgery,Palo Alto, CA, USA
Introduction:
We previously introduced an Educational Time Out (ETO) tool to promote discussions between attendings and trainees about the patient presentation, indications for surgery and surgical plan immediately before an operation. Our goal was to build on the pre-operative ETO and to develop a post-operative ETO to encourage immediate feedback and promote discussions on post-operative considerations. The aim was to expand the perioperative educational framework.
Methods:
A working group of two attendings and two general surgery residents at our institution was formed. The group met with faculty and residents of several surgical specialties and asked open-ended questions regarding their opinions on important elements to be included in a Pre- and Post-Operative ETO. These interviews were completed from March to July 2018. The working group summarized and prioritized concepts from the interviews and developed a pre-operative ETO with specifics for several surgical specialties and cases, and a post-operative ETO to be used across all specialties.
Results: T
he pre-operative ETO that was developed is represented by the PREDICT mnemonic. PREDICT stands for Presentation, Risk factors, Examination findings, Diagnosis/Differential, Incision/Intraoperative steps, Concerns, and Treatment. The post-operative ETO developed is represented by the COPE mnemonic, which stands for Closure, Operation, Performance, and Extension of care. Specific PREDICT characteristics for three surgeries were defined, as well as a detailed description of COPE, and are presented here (Table 1).
Conclusion:
We believe educational time outs, both pre- and post-operatively, should be a part of every surgical case. Education Time Outs not only promote communication between attendings and trainees, but they also foster resident education. Faculty can use PREDICT and COPE to provide a formal educational framework that reinforces key learning elements for trainees. These ETO models are simple and specific tools residents can use to organize their preparation for each surgical case. More research is needed to measure the impact of ETO use at our institution, with an implementation and control group.
