Surgical Education
Operating room introduction for the novice
Vishal Patel, M.R.C.S.*, Rajesh Aggarwal, Ph.D., M.A., M.R.C.S.,
Elizabeth Osinibi, B.Sc., Dave Taylor, M.Sc, M.B.C.S., Sonal Arora, B.Sc., M.R.C.S.,
Ara Darzi, F.R.Eng., F.Med.Sci., M.D., F.A.C.S., F.R.C.S., F.R.C.S.I.
Division of Surgery, Imperial College London, St Mary’s Hospital, London, UK
Abstract
BACKGROUND: This study assessed the implementation of a theater induction curriculum through
a didactic lecture, an online Second Life operating room, and a simulated operating suite.
METHODS: Sixty operating room novices were randomized into 4 groups: control (n = 15), didactic
lecture (n = 15), Second Life (n = 15), and simulated operating suite (n = 15). The study followed a
pretest and posttest design with a training intervention between operating room attendances. Outcome
measures were knowledge, skills, and attitudes, measured using observed behavior and a self-report
scale, with knowledge further assessed using multiple-choice questionnaires.
RESULTS: The lecture, Second Life, and simulated operating suite groups demonstrated significant
improvements in all outcome measures. After the intervention, these 3 groups had significantly higher
behavior (P .001), self-report (P .05), and knowledge (P .05) scores than the control group.
CONCLUSIONS: This study demonstrates the value of delivering a theater induction curriculum for
operating room preparation.
© 2012 Elsevier Inc. All rights reserved.
KEYWORDS:
Operating room;
Novice training;
Second life;
Simulated operating
suite;
Virtual worlds
The operating room is a high-pressure, dynamic environ-
ment with multiple medical specialties collaborating toward
the sole purpose of enhancing patient outcomes.
1
With no
defined role, novices’ first exposure may be both intimidating
and unproductive, with students learning through humiliation.
2
This can be detrimental to students’ initial learning curves,
with a possible impact on their future career decisions,
3
with a
decline in interest in general surgery being evident.
4
The operating room is unique in that it provides an
opportunity for students to enhance their knowledge and
potentially improve their skills within the same setting.
However, there has been an emphasis on alternative learn-
ing environments, such as clinical wards and outpatient
departments, as the optimal source of student education.
2
There currently is a requirement to provide structured train-
ing and education to undergraduate medical students in
preparation for the operating theater. For the purposes of
this study, a novice was defined as a medical student with no
previous operating theater experience.
Lyon
2
postulated that students need to manage learning
across 3 domains within the operating room environment.
These incorporate managing the demands of the working
environment, the educational tasks, and the learning and
social relations of the operating theater. Students able to
successfully manage these have an enhanced experience
within the operating theater. Although it is imperative to
provide a continuum of optimal education throughout a
student’s course, it is equally important to establish that a
* Corresponding author. Tel.: 44-0-203-886-1012; fax: 44-0-203-312-
6309.
E-mail address: v.patel20@imperial.ac.uk
Manuscript received July 19, 2010; revised manuscript March 13, 2011
Dr Aggarwal is funded by a Clinician Scientist Award from the Na-
tional Institute of Health Research (London, UK).
0002-9610/$ - see front matter © 2012 Elsevier Inc. All rights reserved.
doi:10.1016/j.amjsurg.2011.03.003
The American Journal of Surgery (2012) 203, 266 –275