Next we're going to talk about each of the portions of the BID model. So the first is the briefing. And the rationale for the briefing is that you want to set some clear focused learning objectives for the operation. And I say learning objectives because I want to make clear that it's different from your operative objectives. So you're always going to have operative objectives. These are exposing and delivering and so forth. But I want you to think about learning objectives. So what should the learner carry out of the operating room? So setting this learning objective focuses the learning and the teaching for the rest of the operation. And I talked to you earlier about how we'd studied how surgeons teach in the operating room and how we found that there's a lot of teaching but it's not particularly focused. One of the things that setting an objective in the briefing does is it allows you to provide a filter, both for yourself as the teacher and for your learner. Now the nice thing about this is that we found in testing that, you could do this briefing in about two minutes. You can do it at the scrub sink, you can do it almost anywhere. You can do it as the patient's being draped. Just sometime prior to the operation, set one clear learning objective. And the way that you can elicit this from your learner is you can ask, What would you like to learn during this operation? Or you can say explicitly to your learner, Here's what I'd like you to focus on during this operation. One of the things that sometimes people get a little bit worried about is what if my learner sets an objective that is not appropriate? I would never suggest that you give up your expertise. You are the expert, so what you're doing when you elicit a learning objective from your learner is you're getting a needs assessment from them. You're learning what they think they need to know. And then you as the expert get to decide if that's what you think they need to know. Setting an objective is setting a compact. This is what we're going to focus on in this operation. So let's think about how we might apply this to other settings. >> So let's talk about setting objectives in other settings. I think it's important that the learner set the objective. For example, if we ask a learner to learn the Krebs cycle and it's not something that they feel is relevant to what they're doing, then they're really not going to learn it deeply or intentionally and kind of retain it. And so it's probably really important that they determine what the objective is. >> I agree for the most part, but I do think that there's a role for the expert to shape the objective. So sometimes learners will come up with objectives that don't really quite make sense. Especially a novice may not know exactly where they are in the learning trajectory, and so that's part of the role of the expert, is to say well that's an interesting objective. We'll reach it in this way, but here's what I want you to focus on now. So for instance, I watched an operation where a third-year medical student said he wanted to learn the natural history of cholelithiasis. And the surgeon said, No, what you're going to learn is how to take care of this patient post-operatively, because that's not the kind of thing you learn in an operation. And so there's a role for that. But I think, yeah, it's absolutely critical that the learner have some investment in the objective that gets set. >> I remember once Nediaya came in, because I thought, I'd learned that this learning objectives and setting them yourself was really important. And I turned to my learner and I said, So what do you want to learn today? What are your objectives? And they looked at me like I was crazy. So I think it's gotta become a habit. >> That is absolutely the case. The first time you do this, your learners are going to go, why are you asking me that? You always set the objectives. And so it has to become part of your standard practice. It's not something that comes naturally. Once it becomes part of your standard practice, then it becomes natural for everybody and they start to expect it. But the first time you do it, it's going to be a little strange. >> Yeah, I think so. And I think it does work in different settings. I think if you're in a less clinical setting, you may be setting the objectives more about what you might learn that day, or how you might approach something. In the emergency department we focus a lot on kind of flow and workforce issues of how do you keep things organized, and how do you task switch and those sorts of things, and so often I'll hear the learners set that as an objective. But I also find it really helps because then as we get to the next step I can correct and help them with those when we move on. >> Right, and I think it is really important, especially in a place like an emergency room, where if you're a novice in an emergency room, I've been a novice, not even a novice, an uninformed person in an emergency room, and it looks like chaos. And so by working with a learner to set a learning objective for that day, you start to manage that chaos, and that helps them actually learn something. >> What if they set the learning objective that's too high? Does it need to be something that they can achieve that day, or can it be kind of that future goal or future state? >> Well, I think that if a learner were to set a learning objective that seemed like it was way too high or way too broad, what I would what I might say is, that's something that you're going to learn over the course of this rotation. So you have a four week rotation here. I think that by the end of this rotation, you should be able to have accomplished that goal. Now let's think a little bit more granularly. What do you want to learn today? And if it's their first day in the emergency room, you might tell them, here's what I want you to learn today. I want you to learn how do we take in patients or something like that. >> No, I think that makes sense. I think it's also important that the objectives be something that's somewhat measurable, or something that's achievable. And so I sometimes find that I have to break it down. If they say, I want to work on flow today, I'm like, well what does that mean? Does that mean discharging patients rapidly, doing your charts on time? What does that mean? So that you can have specific behaviors that achieve that goal that everybody kind of knows where the steps are to get there. >> Right, because it's going to be impossible at the end of the day to debrief on flow. >> Yeah. >> There's just too many aspects to flow. So I think your inclination is proper. It's what exactly are we going to look for at the end of the day that will let us know that we have accomplished this learning goal for you? I think that's the way to think about that. >> Yeah, I think that's really helpful. Great, thanks. >> Thank you. >> Welcome to the service. >> Thanks, I'm glad to be here. >> Yeah, we're glad to have you. Today we're going to be doing a suseptomy in the neobladder. Should be a fun case. Why don't you tell me your about your experience with this operation? How many of these have you done? >> Well, I've done as far as suseptomy neobladder, I've done one these with Dr. Fez over at the VA, so I got to learn the basic steps of the operation and sort of how he did it. But I understand everybody does these differently, and so I'm eager to learn what your steps are. >> Great. Well, and you're right, there is a little bit of variation between us, but I'd like to make sure we highlight two or three parts of the operation, where we're really going to focus on, and really try to do some good teaching around that. So are there two or three areas, when you did that case, that you felt like you wanted to spend more time on? >> Yeah, one of the things that I want to get better with, definitely with this operation, is the lymph node dissection. I know that you do a very thorough lymph node dissection, but I want to be able to make sure I'm doing it [INAUDIBLE] and make sure that it's efficient too. Another one is to do the uretero-enteric anastomoses to make sure that that's better, and that I know the steps of that and I can sort of recreate it and run through it in my mind and get better at that. And also just the creation of the neobladder. I think that there's a lot of different aspects of that that I'd like to learn today as well. >> Fantastic. We're going to make sure during those parts of the operation we spend some time and really make sure you have a good sense of those. >> Great. >> Great. >> Cut.
