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The Path to Better Teaching: A Revealing Surgeon’s Symposium

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Dr. Levy shows Dr. Julie Vargas how TAGteach is used to

teach surgical skills to medical students

Trainers are essentially teachers. Our learners are not just the animals we train; our learners are also our clients, students, employees, and colleagues. Most of us spend a great deal of time perfecting our animal-training knowledge and skills, but few of us focus on skills that relate to the human learners—often creating our biggest challenges. I recently spoke at a surgeon’s symposium in New York City that highlighted the universality of these challenges.

The invitation to participate in the symposium came from Dr. Martin Levy, a practicing orthopedic surgeon at Montefiore Medical Center. Dr. Levy had teamed up with Karen Pryor and Theresa McKeon to explore using TAGteach principles to teach basic surgical skills to medical students, such as setting up surgical instruments, using various tools, and tying suture knots. You can read a brief summary of the project. For a more in-depth look, check out this article in Scientific American. The symposium brought nine speakers together to show doctors in the New York City area the history of training, the science behind it, and the results of the project to date.

A more general goal was to identify what a good teacher must do in order to set the learner up for success.
After the event, all of the speakers got together for a private meeting that had two main goals. The first was to figure out how best to convince the medical community to abandon their old-school methods and switch to positive teaching techniques. But, a more general goal was to identify what a good teacher must do in order to set the learner up for success.

Here are some of the requirements we identified during that post-symposium meeting:

  1. Know the science and tools well. Stay current with new scientific breakthroughs, and master the new skills.
  2. There are different types of learners. Adapt your teaching style accordingly. For example, new medical students are part of the generation referred to as millennials. Some research indicates that this generation has a shorter attention span, thinks independently, and is accustomed to learning through electronic media.
  3. Break skills into the smallest possible components. The learner can then master each of the smaller tasks that make up the larger, finished procedure. A surgeon must learn to use each tool and become proficient with handling and using those tools. Only after learning each individual skill can the whole sequence be put together successfully.
  4. Achieve fluency at each skill. Fluency is about achieving mastery or proficiency at a task, and that includes accuracy, speed, quality, and pace, among other things. It is important to “over practice” each skill so that it becomes second nature. Fluency is so important in the teaching process because it allows the learner to go from success to success, with few or no mistakes. Fluency is fun!
  5. Peer coaching. In most disciplines, eventually learners need to pass on what they have learned to others. Just because a medical student has learned a skill proficiently doesn’t mean he or she can teach others. The learning process needs to include the student learning to coach and help fellow students, and coaching ability consists of a different skill set. The surgical program included peer-coaching in the learning process from the very start.
  6. Collect and interpret your data. You need quantifiable evidence that the new tools are improving or enhancing the acquisition of skills or accomplishing your desired goal. This is where it is useful to enlist the aid and skill of behavior analysts.
  7. Examples of success. While data are essential, it is critical to have video or living examples that demonstrate clearly how the new tools have improved the task in some way. The scientific data alone is often not enough to convince people to adopt new tools.
  8. Assessment and feedback. Even the most successful programs can find areas for improvement. Evaluate the entire teaching process regularly so it can be adjusted and enhanced.

What became so clear to me during our discussions was that the steps and strategies for introducing professionals to new tools and ideas are similar across disciplines. I’ve worked with and seen successful transitions at Guide Dogs for the Blind, various law enforcement agencies, and organizations that have used TAGteach (such as Dr. Levy’s surgical teaching program), and I’ve seen again and again that being persuasive goes beyond simply understanding the science of learning.

To persuade other professionals to switch to our methods, we must have more than a well-thought-out and proven process.
While we know intuitively that using positive reinforcement is helpful and beneficial, convincing others of its power is not always easy, particularly teaching professionals who are already skilled and knowledgeable in their specific disciplines. Not surprisingly, doctors who teach surgical skills to medical students are slow to adopt a new teaching method; after all, the techniques they have been using have worked. Sadly, traditional medical teaching methods often include lots of yelling, criticizing, and cajoling (sound familiar?). To persuade other professionals to switch to our methods, we must have more than a well-thought-out and proven process. There is another factor critical in getting our message to others: we must be careful about how we refer to a new procedure when introducing it to other professionals. If we say our technique is “better,” it implies that what our colleagues have been doing is bad or wrong. We must avoid giving that impression, or people will be less open to listening and learning. Instead, we should refer to the procedure as a new tool to add to their toolbox. We can then make a compelling case for the use of that tool, and allow them to choose when and if they will use the tool on their own.

The many steps and skills needed to introduce professionals to new skills or ideas can be frustrating. But we should take heart and find hope in the successes we see all around us. This recent breakthrough in the surgical community is just one more great example of the successful use of positive reinforcement and the application of good teaching skills.

Happy Training,


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