Unpacking the surgical approach to nonpalpable breast lesions: bridging the knowledge gap between educators and trainees

Purpose The surgical technique for excising a nonpalpable breast lesion (NBL) can vary by surgeon and by pathology, posing a unique challenge for transfer of knowledge from educators to trainees. The objective of this study is to examine the teaching and learning of this procedure to bridge knowledge gaps to ultimately create a standardized paradigm for instruction regarding NBLs. Methods This was a multi-institutional, observational study in which six educators and six trainees underwent video-stimulated interviews. Interviews were transcribed and qualitative analysis was performed to identify common themes. Results Educator themes included “Experience-Based Skill Development”, “Under-Appreciated Difficulty of Lumpectomies by Trainees”, and “Challenges in Educating Trainees”. Trainee themes included “Request for Autonomy” and “Difficulty Understanding Key Steps from Educators”. Breast surgery educators discussed that part of the challenge is inherent to the operation, as there are no anatomical boundaries within the breast, thereby requiring the use of spatial thinking, further complicated by limited visualization due to a small incision. Trainees discussed the limits of verbal teaching, inability to conceptualize the location of the NBL, while also visualizing the operative working space Both educators and trainees expressed that the most effective interactions involved preoperative planning together and communication of expectations. Based on these results, a six-step structured paradigm was developed as a tool for educators to teach excision of nonpalpable breast lesions. Conclusion This study exposes key differences in concepts that educators and trainees consider during excision of NBLs. Understanding these challenges and consistently using the proposed structured paradigm may improve the teaching and learning of the skills required for this operation.