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    1 Comment for this article
    Improving surgical education through human factors training
    Ira L. Leeds, AB | Emory University School of Medicine
    Cahan et al highlight the importance of incorporating human factors (HF) into surgical curricula as a means of improving the quality of surgical education for medical students. The authors also recognize that these curricula are also an important way for academic programs to emphasize the relative importance of educational activities in comparison to clinical care and research. Although a critical examination of the trends in surgical education is warranted, the experimental design of this study cannot adequately demonstrate some of the authors’ conclusions. Arguably, the most interesting suggestion by the authors is that HF educators are better teachers as demonstrated by improved evaluations and a greater number of teaching awards. However, the HF curriculum implemented by the authors invited surgical educators to voluntarily participate. Part of the analysis described was between those who had willingly participated in a program designed to improve one’s pedagogical skills versus those who declined to participate. Thus, the findings of the authors that HF educators were more likely to receive teaching awards than their colleagues should not be surprising given the likely inherent selection bias. However, whether the specialized HF training these educators received actually had a measurable effect on the outcomes reported cannot without longitudinal results. As the adoption of such standardized HF curricula proceeds, studies must look at how educator and student performance evolve over time.

    Conflict of Interest: None declared
    Original Article
    July 2011

    Transforming the Culture of Surgical Education: Promoting Teacher Identity Through Human Factors Training

    Author Affiliations

    Author Affiliations: Department of Surgery (Drs Cahan, Larkin, and Litwin), Center for Clinical Communication and Performance Outcomes (Mss Starr and Sullivan and Dr Quirk), and Department of Family Medicine and Community Health (Dr Quirk), University of Massachusetts Medical School, Worcester.

    Arch Surg. 2011;146(7):830-834. doi:10.1001/archsurg.2011.157

    Context Promoting a culture of teaching may encourage students to choose a surgical career. Teaching in a human factors (HF) curriculum, the nontechnical skills of surgery, is associated with surgeons' stronger identity as teachers and with clinical students' improved perception of surgery and satisfaction with the clerkship experience.

    Objective To describe the effects of an HF curriculum on teaching culture in surgery.

    Design, Setting, Participants, and Intervention Surgeons and educators developed an HF curriculum including communication, teamwork, and work-life balance.

    Main Outcome Measures Teacher identity, student interest in a surgical career, student perception of the HF curriculum, and teaching awards.

    Results Ninety-two of 123 faculty and residents in a single program (75% of total) completed a survey on teacher identity. Fifteen of the participants were teachers of HF. Teachers of HF scored higher than control participants on the total score for teacher identity (P < .001) and for subcategories of global teacher identity (P = .001), intrinsic satisfaction (P = .001), skills and knowledge (P = .006), belonging to a group of teachers (P < .001), feeling a responsibility to teach (P = .008), receiving rewards (P =.01), and HF (P = .02). Third-year clerks indicated that they were more likely to select surgery as their career after the clerkship and rated the curriculum higher when it was taught by surgeons than when taught by educators. Of the teaching awards presented to surgeons during HF years, 100% of those awarded to attending physicians and 80% of those awarded to residents went to teachers of HF.

    Conclusion Curricular focus on HF can strengthen teacher identity, improve teacher evaluations, and promote surgery as a career choice.