The Flipped Operating Room: Establishing Best Practices in Surgical Education Using Resident-Initiated, Inquiry-Based Preoperative Briefing

OBJECTIVE:We performed a pilot study of a resident-initiated, inquiry-based preoperative briefing (R-PROB) to determine the feasibility and potential impact on the educational experience. DESIGN:A prospective, qualitative pilot study was performed in a general surgery residency program. The R-PROB included pre-operative emails to faculty with case summaries, learning goals, and questions. Faculty responded by email, phone, or in-person. Semi-structured interviews were completed before and after R-PROB implementation. Interviews were transcribed, coded, and analyzed through collaboration with a mixed-methods laboratory. SETTING:An urban, university-based general surgery residency PARTICIPANTS: Ten attendings from three university affiliated hospitals based on frequency of resident interaction, variation in experience and case types were selected. Thirteen residents that worked closely with the selected attendings, ranging from Clinical Year 1-5, were then recruited to participate. RESULTS:The R-PROB was viewed overall positively and felt to be easily incorporated into the curriculum. The R-PROB significantly improved attending perception of resident preparedness. Junior residents (CY1-3) affirmed that R-PROB very strongly improved case preparation. The preoperative exchange was valued by both participants as improving communication frequency, transparency, and quality. The majority of attendings stated that the R-PROB enabled tailored teaching to each resident's level both preoperatively and in the operating room. Residents affirmed attending teaching to be more targeted towards their goals and objectives after the R-PROB. Challenges included late case assignments and minor time limitations. CONCLUSIONS:A resident-initiated, inquiry-based preoperative briefing intervention is feasible and overall positively perceived by both participants. The briefings had a positive impact on resident preparedness, bi-directional communication, and permitted focused attending teaching.