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Exploring educational models within the operating room

INTRODUCTION Surgical training has a long history of unique educational approaches and communities of practice, historically driven by exclusion of surgeons from the medical world. The Hippocratic Oath sworn by physicians states ‘I will not use the knife, not even on sufferers from stone, but will withdraw in favour of such men as are engaged in this work’, which permits an understanding of how surgical practice previously split from the medical profession and with no authoritative institution adopted an apprenticeshiptype training. This apprenticeship model still plays a prominent role in modernday resident training in the operating room, particularly with regard to the development of meaningful personal interactions between the trainee and the trainer, and trust when performing and assisting in delicate aspects of a procedure. However, structured surgical training in England began to take form following the Calman reforms in the 1990s, which called for extensive trainee assessments including the introduction of surgical membership examinations, and the Modernising Medical Careers movement in 2005 and the Shape of Training report in 2013, which defined postgraduate competencies required at each stage of training. The most recent change to surgical training in England was the introduction of the Improving Surgical Training pilot, which emphasises the importance of longterm attachments to trained and committed supervisors to improve the development of surgical skills. Through these reforms surgical training has evolved to include standardised training as part of an Intercollegiate Surgical Curriculum Programme in the form of workplacebased assessments, including casebased discussions, direct observations of procedural skills and multisource multidisciplinary feedback assessments. The recording and assessment of these supervised learning events forms a curriculum which allows for the evaluation of both technical and nontechnical competencies of the learner and generates a benchmark for surgical trainees to progress in seniority. This surgical curriculum has been developed based on established educational theories, and it is essential that supervising surgeons understand these fundamental concepts. This article describes the central educational models which are at play in the operating room and how they influence surgical training at all stages.