Intelligent Cooperation is Influenced by Learning Theories
Conditions: Surgical Education
Sponsor: University of Missouri, Kansas City

OPTIMIZING SURGICAL TEACHING THROUGH THE LENS OF SOCIOCULTURAL 
LEARNING THEORY 
Gary Sutkina, MD; Eliza B. Littletonb, PhD; Louise Arnoldc, PhD; Steven L. Kanterd, MD 
 
Corresponding author: Gary Sutkin, MD 
Female Pelvic Medicine and Reconstructive Surgery 
University Missouri Kansas City School of Medicine 
2411 Holmes Street, Kansas City, MO 64108 
phone 816-235-6785 
email sutking@umkc.edu 
 
date: April 14, 2021 
NCT number: not available 
 
MATERIAL AND METHODS 
from draft of manuscript to be submitted: 
2.1 Setting, Participants and Data Collection 
In this qualitative study we examined authentic examples of intraoperative teaching exchanges 
between attending and resident surgeons. These examples were taken from two previous studies 
conducted at a large women’s hospital: the objectives of those studies were to compare attending 
and resident responses regarding avoiding intraoperative errors[31] and to develop the previously 
mentioned Intelligent Cooperation framework.[10] The 10 surgical cases were gynecologic, 
representing open abdominal, laparoscopic, and vaginal approaches. Surgical cases were chosen 
by convenience, according to the schedule of the filmographer. Participants included ten surgical 
attendings, four fellows, and eleven Obstetrics and Gynecology residents, ranging from PGY1 to 
PGY4. We conducted interviews with all ten attending surgeons and five of the residents. The 
data for this study included the case video, deidentified transcripts of the cases, and deidentified 
transcripts of the interviews. Our qualitative approach was most informed by Sandelowski’s 
concept of developing rich qualitative descriptions.[32]  
 

2.2 Research Team 
Our interdisciplinary research team consisted of a female pelvic surgeon with twenty years of 
surgical teaching experience (GS), a medical education researcher and educational sociologist 
(LA), a neurosurgeon and administrator with 30 years of experience across the continuum of 
medical education (SK), and a cognitive psychologist with expertise in surgical education 
research (EBL). 
 
2.3 Data Analysis 
We reviewed and discussed the works of key sociocultural learning scholars, as described in our 
Introduction. Our discussions were converted into a list of “key tenets” of the SCLTs, with 
associated examples from K-12 and Higher Education. (see Table 1) We then independently 
coded all transcripts according to the key tenets and examples from our list, noting which 
exchanges reflected various sociocultural theories. Counting themes was not part of the 
methodological approach in this study because it was inconsistent with the intent of the study to 
develop deep, rich, and comprehensive insights about teaching in the OR.[33] We subsequently 
met as a group to review our coding, convert them into themes of teaching and learning 
advanced surgical skills, and select notable examples from our data. (see Table 2) These themes 
were then transformed into instructional strategies to improve surgical teaching, based on the 
sociocultural theories. (see Table 3) Disagreements were settled by group discussion. Data 
saturation was determined according to our study objective[34], to identify intraoperative 
instructional strategies related to the social cultural learning theories. We stopped analyzing 
transcripts when we had generated no new instructional strategies.  
 

2.4 Reflexivity and Ethics 
During our meetings, we maintained a reflexive atmosphere, reflecting on our backgrounds, 
experience, and biases and how those might affect our interpretation of the data. We challenged 
those biases often. We reached consensus regarding differences in data interpretation through 
group discussion. Our University IRB approved this study as exempt.