The embodiment of practice thresholds: from standardization to stabilization in surgical education.
Competency-based medical education
Embodiment
Procedural variation
Situational analysis
Sociomaterial practice
Surgical education
Journal
Advances in health sciences education : theory and practice
ISSN: 1573-1677
Titre abrégé: Adv Health Sci Educ Theory Pract
Pays: Netherlands
ID NLM: 9612021
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
19
11
2019
accepted:
11
05
2020
pubmed:
18
5
2020
medline:
21
10
2021
entrez:
18
5
2020
Statut:
ppublish
Résumé
Surgeons practice their own variations on a procedure. Residents experience shifting thresholds between variations that one surgeon holds firmly as principle and another takes more lightly as preference. Such variability has implications for surgical education, but the impact is not well understood. This is a critical problem to investigate as programs seek to define procedures for competency-based medical education (CBME) and improve learning through deliberate practice. Our study analyzes the emergence of procedural variation in an early-adopter CBME program through a situational analysis of tonsillectomy, a foundation level procedure in this otolaryngology, head and neck surgical program. An earlier phase of the study identified frequent variations (n = 12) on tonsillectomy among co-located surgeons who routinely perform this procedure (n = 6). In the phase reported here we interviewed these surgeons (n = 4) and residents at different stages of training (n = 3) about their experiences of these variations to map the relations of contributing social and material actors. Our results show that even a basic procedure resists standardization. This study contributes a sociomaterial grounded theory of surgical practice as an embodied response to conditions materialized by intra-relations of human and more-than-human actors. Shifting root metaphors about practice in surgical education from standardization to stabilization can help residents achieve stable-for-now embodiments of performance as their practice thresholds continue to emerge.
Identifiants
pubmed: 32417985
doi: 10.1007/s10459-020-09974-x
pii: 10.1007/s10459-020-09974-x
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
139-157Références
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