It’s time for a time-out

Anyone who has been in the OR or in the ICU during a procedure is familiar with the concept of the “time-out.”  It’s something that has been around for a number of years and came into being as a way to enhance patient safety in the operating room.  The operative time-out itself continues to evolve, with many surgeons developing an “extended time-out” checklist for their OR, something I can definitely see benefit to doing.  For the last week, I’ve experimented with a variant extension to the time-out; when we were at the American College of Surgeons my friend  Mary Klingensmith Tweeted a challenge to the surgical education community to incorporate

an education time-out at the beginning of cases for their learners.  I’ve been trying to find ways to increase the teaching focus in the OR, and this seemed an almost foolproof way to do it.

The education time-out in our OR occurs just after the patient safety time out.  I identify each resident of medical student on the operative team, and I challenge them to tell me what their learning goal is for the case.  Goals provided by learners last week were sometimes technical, sometimes about decision-making, and sometimes related to the patient’s overall medical status but have little to do with the operation itself.  During the course of the case, I seek to address the questions raised by each learner, using a largely Socratic method (yes, I am still asking questions of them!).  What benefits do I see a week into this “experiment”?

• The students and residents are pushed to be self-directed learners, and to articulate how they are guiding their learning.  I’m not identifying their goals, they are.  This is critical if we are going to “raise” life-long learners.
• Having the learning goals provides us with a focus for the case.  While I like to think that I’m mostly above-average in taking time to teach in the OR, I have definitely noticed that this keeps me on-point.
• The entire team is learning from one another, including our anesthesia team members and our scrub techs and OR nurses.  While patient care is still our #1 focus, the presence (and use!) of the education time out raises the perceived importance of education in what we are doing every day.

I’m still trying to perfect the system, and I am curious to take a good look at how it impacts both teaching and learning in the OR over time.  From a subjective and personal evaluation, I’m finding the education time out to be an important improvement in my work as both a clinician and an educator.  Surgical teachers, give it a try and I hope you’ll share your experience.  Surgical learners, encourage your teachers to try it. They might just find themselves with an important new teaching tool!