TOTB-02: PRE-OPERATIVE PLANNING MODULES - A NOVEL APPROACH TO TEACHING AND LEARNING IN SURGERY
Carol-anne Moulton, MD, PhD, Tobi Lam; University Health Network

What problem in education is addressed by this work?:
With training over time, residents and fellows are expected to master the level of surgical judgment required to become an expert. It is assumed that their preoperative plans should align with staff surgeons as they advance in their training and upon completion of fellowship. There are many existing instructional materials for teaching procedural knowledge, and internationally accepted guidelines for the treatment and management of diseases. However, our previous research has shown that it is hard to obtain consensus for preoperative planning even amongst experts in the field. Differences in technique and approach can be dependent on the patient and the surgeon’s own preference and experience. We believe that cases showing different approaches and pre-operative plans will enhance surgical training by exposing learners to a wider range of expert examples outside their immediate training environment. Our pre-operative planning modules are an ambitious and novel approach that aim to translate and consolidate what is currently known about situational awareness, clinical judgment, and preoperative planning by global experts in HPB surgery into an online educational resource for surgical trainees in hepato-pancreato-biliary surgery.

Describe the intervention:
Our case module template was informed by previous research, iterative feedback, re-design cycles, and needs assessments of knowledge users. We have worked closely with knowledge users (residents, researchers, fellows and surgeons) and educational designers to ensure we have an effective teaching model. Our case modules are designed to improve surgical planning and judgement in standard procedures, and emphasise recognising procedure and patient-specific key decision-making points. “Slowing down when you should” moments are characteristic of expert surgical judgment and may be anticipated and proactively planned for, or triggered by unanticipated situations that arise during the operation. Each case captures expert discussions of preoperative plans, including the following: 1. Introduction for trainees to establish and contextualize the situation; 2. Analysis of imaging information; 3. Feedback via video discussion of experts’ analysis; 4. Distilled videos of the surgical procedure; 5. Post-operative debrief.

Describe how this intervention could be applied at other institutions. Please specifically comment on identified barriers that could exist and how they could be overcome:
A safe, and cost effective way to reach a large global audience is to use an online platform with the use of video technology, where trainees can access a library of surgical cases. We have partnered with the International and Americas Hepato-Pancreato-Biliary Associations to produce and promote these modules. They are now available on a global platform to allow residents, fellows, and surgeons access to surgical expertise from across the globe.