Patient and Surgeon Insights into Teaching during Awake Surgical Procedures

Abstract

INTRODUCTION: Surgical procedures on awake patients offer advantages such as shorter recovery times and decreased costs, but raise challenges related to teaching residents while patients are awake. We sought to determine how patients respond to overhearing resident teaching during awake procedures. METHODS: Surgeons performing awake procedures from 2 academic hospitals and patients undergoing awake procedures from 1 hospital were recruited to participate in semi-structured, audio-recorded interviews about their experiences. Interviews were transcribed, coded, and reviewed by 3 researchers using the constant comparative method until thematic saturation was reached. RESULTS: Twenty-three surgeons and 40 patients were interviewed. Surgeons felt that teaching during awake surgery increased patients' anxiety and described approaches to mitigate patient anxiety, such as excluding patients from the teaching conversation, limiting trainee involvement, and deceiving patients on the extent of trainee involvement. Most patients recognized teaching but did not identify it as positiveor negative. Seven of 40patients had a negative experience associated with teaching during their awake procedure. These negative experiences included perception of error, perception of trainee inexperience, and exclusion from the teaching conversation. CONCLUSIONS: Teaching during awake surgery creates new challenges for both academic surgeons and patients. Surgeons must learn to teach while the patient is listening, as patients dislike being excluded from the teaching conversation during awake procedures. Further research is needed to determine how best to incorporate teaching conversations into awake surgical procedures while optimizing the patient experience.