#KeyLIMEPodcast 259: Surgical Teaching – Halstead 2.0

What makes for an effective educator? In Jon’s article selection, the researchers looked at a cohort of academic surgeons’ personal qualities and teaching methods to identify what characteristics and styles the highly effective surgical educators had in common.

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KeyLIME Session 259

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Swendiman et., al. Qualities and Methods of Highly Effective Surgical Educators: A Grounded Theory Model J Surg Educ. 2019 Sep – Oct;76(5):1293-1302


Jon Sherbino (@sherbino)


Ok. Time for a trip down memory road. A long time ago in a galaxy far far away… Jason.. you are playing Princess Leia in this version… I completed my first #HPE study. It was an educational bundle on how to structure clinical teaching in the Emergency Department. (If you have insomnia, you can read more about ED STAT here. Want to guess who was the second author on this study? Yep… Princess Leia. So, I would argue that this podcast has a partial bias or interest in teaching models. The most popular clinical teaching models in #MedEd are ambulatory based. We covered Irby’s model on Episode 242. And many KeyLIMErs will use (or have read) Neher’s one-minute preceptor model.

So, if there are established and effective teaching models, why are we covering another one. Is this yet another example of endless duplication in #HPE? In this episode I am going to argue this is theory producing scholarship and not duplication. The surgical teaching environment is unique. Not only is the geography different (e.g. the OR), but the mix of supervision (indirect during rounds and call, often direct in the OR) and immediacy of feedback on patient management decisions requires a tailored approach.

Even if you’re not a surgeon I’m pretty confident that this episode will provide a few pearls for consideration in your own clinical teaching practice.


To identify personal qualities and teaching methods of highly effective surgical educators using a novel research design.”   (And 3..2..1.. Lara’s head explodes as she reads that GT is considered novel.)

Key Points on the Methods

The authors used grounded theory, presumably a positivist (or objectivist) GT, although this is not stated in the manuscript.

General surgery, plastic surgery and vascular surgery residents (n=77) from a single centre were surveyed to identify exemplary faculty teachers in and out of the operating room, from a provided list of core surgical faculty(n=72).

The top 13 identified teachers were invited to participate in a semi structured interview, representing the top 15th percentile. Twelve interviews were conducted by a single medical student. All faculty interviewed were male; females account for 20% of the teaching faculty. Ten of the faculty interviewed were Caucasian. Mean years in practice was 14 (range 3-31), working a self-reported 71 hours per week (range 50-105).

An inductive and iterative analysis was performed by 4 of the investigators using open, axial and selective coding to identify themes. Saturation was achieved after 9 interviews.

Interestingly this study was exempted from requiring ethics approval without a justification from the REB.

The methods did not comment on theory informing their analysis, reflexivity, triangulation of the data, or the audit process for analysis.

Key Outcomes

The top nominated teachers had low-positive correlations for humanism (Spearman’s rho =0.37) and perceived technical skill (0.116) as ranked by the residents.

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  1. Patient care is the foundational point where teaching is situated.
  2. Teaching is tailored to the learner, using multiple modalities (patient exam, technical procedure, diagnostic imagining) and progressive granting of autonomy.
  3. A good teacher is deliberate about their education practice, passionate about surgery and influenced by past mentors.
  4. Good teaching requires psychological safety, personal accountability and collegiality.

Key Conclusions

The authors conclude…

“We identified personal characteristics and teaching styles of highly effective educators in a cohort of academic surgeons… Many of the derived themes, such as learner autonomy, accountability, importance of prior surgical mentors, and education as a mission harken back to traditional, Halstedian values. At the same time, educators also saw the utility of newer approaches, such as creating a culture of psychological safety, multimodal learning, and teaching as a means of preventing self-burnout.”

Spare Keys – other take home points for clinician educators

The discussion section talks about self-direct learning and adult learning theory. Both of these theories have been highly criticized recently in the HPE literature as lacking evidence to justify their description as a theory.

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