The word “doctor,” derived from Latin docere, to teach, epitomizes the intimate relationship between medicine and teaching.¹ Surgical education requires integration of clinical reasoning and technical skill in a background of complex anatomy and pathology.² The modern trainee must assimilate a rapidly expanding body of medical knowledge and surgical procedures with increasing administrative demands, during a shortened residency containing more required “nonsurgical” curricular elements (quality improvement, patient safety, health care disparities, interprofessional training), while operating within work hour restrictions. This great pressure to optimize operative learning has expanded interest in surgical education innovation.³

Examples of innovation can be found in the Scott Department of Urology at Baylor College of Medicine, with initiatives such as the Surgical Time Out and Debrief Feedback Model, the Resident Wellness Curriculum, patient-specific robotic surgical rehearsal and the virtual sub-internship elective. In this article, we will focus on educational initiatives that have inspired program culture shifts and collaborative learning by embracing technology and modern concepts in well-being and feedback (see Figure).

Figure. Examples of educational innovations for surgical training.

One example of faculty and trainees collaborating to effect positive change is our Surgical Time Out and Debrief model, developed with the goal of maximizing the educational value of each surgical case experience through structured preoperative and postoperative discussion between residents and attendings. The preoperative Time Out allows the resident to identify and discuss unique aspects of patient history pertinent to surgical decision making along with technical considerations, and the resident specifies an individualized goal for the case. The postoperative Debrief calls for immediate real-time feedback guided by validated surgical assessment tools, to provide specific and actionable feedback.³ With pre- and post-implementation surveys and serial evaluations with the validated assessment tools, we found this initiative resulted in improved perceptions among resident and attending physicians of perioperative surgical technical discussions, improved satisfaction with feedback frequency and objective improvement in resident technical skills. This initiative highlights the value in fostering an open dialogue between residents and faculty that begins before the incision, to align goals and expectations, which hopefully increases entrustability and surgical autonomy. This dialogue continues following the case to review the resident’s performance and reinforce learning points. The legacy of this initiative is a sustained culture shift supporting structured preoperative goal-setting and postoperative discussions. We have incorporated technology into this model with innovative platforms such as the SIMPL application, in which residents can track their individual progress through longitudinal collection of real-time evaluations, including recorded verbal feedback, from attendings.

Our residents also complete a curriculum for simulated learning of minimally invasive skills, leveraging the da Vinci^® simulation trainer and the Fundamentals of Laparoscopic Surgery course, utilizing our institution’s Simulation Lab. Employing patient-specific 3-D models of kidneys with renal masses derived from cross-sectional imaging, residents practice renal mass resections tailored to specific cases.⁴ Skill development is also tracked using a robotic case “passport” to monitor successful execution of critical portions of a case amongst varying attendings. Simulation can extend beyond technical skills to patient safety analyses and interprofessional interactions as well.

With unexpected changes to in-person medical student learning in the spring of 2020 from the coronavirus pandemic, our department utilized its innovative to host a novel virtual sub-internship experience for fourth-year medical students. Basing many elements on the virtual sub-internship in urology guidebook created by educators in the Society of Academic Urologists, we called on department faculty and trainees to be educators in a virtual elective. Active learning was preserved using broadcast meeting technology. The elective included simulated patient cases and journal clubs led by residents and fellows, virtual participation in live clinic visits, surgical case livestreaming, self-directed learning and reflection, and opportunities for inpatient census discussion with resident teams. Participating students noted key strengths in the real-time discussions in the operating room, the high overall educational quality and meaningful engagement with faculty.⁵ This educational endeavor simultaneously employed technology to adapt to the challenges presented by the pandemic while also giving agency to residents as educators through dedicated teaching sessions. Using tools first employed in this elective, we now archive surgical case videos more systematically for a novel video-based coaching teaching conference, where residents review nuanced tips with faculty experts in a classroom setting.

Educational innovation also includes focus on personal development, through initiatives such as our Resident Wellness Curriculum, instituted after identifying program-specific targets for improvement.⁶ Program leadership implemented a series of innovations, utilizing resident feedback, over several years designed to reduce resident burnout. The curriculum consists of a faculty-sponsored resident wellness fund, organized social outings, “social groups” with 1 faculty member and 1–2 trainees, one-on-one structured mentorship, and formal wellness education.A key observation was the importance of the department’s tangible investment in additional infrastructure, such as hiring a new scheduling assistant at the local county hospital to alleviate administrative burden, thereby mitigating resident workload. The goal of this resident-initiated, program-supported curriculum was to create humanizing experiences beyond the clinical environment, to build relationships and generate a peer program support system. Through serial assessments using validated surveys, burnout rates significantly decreased and fellowship among residents and faculty increased.⁷

This curriculum has since inspired biannual flipped-classroom discussions to bring resident concerns and observations to program leaders from a designated resident ombudsman who collates resident input. This established focus on wellness also provided the basis for new initiatives, such as a department-wide course in mindfulness and resilience, supported by an internal medical education grant.

In urological surgical training, we increasingly recognize the importance to develop both technical and nontechnical skills for surgical and clinical competence.⁸ Innovations that adapt to an everchanging health care climate can serve as catalysts and foster a culture that values ongoing learning, promotes a sense of agency among residents and faculty alike, and equally prioritizes technical skill acquisition along with strong nontechnical skills. Surgical training has undergone a major paradigm shift from that of the Halstedian apprenticeship to standardized clinical and surgical assessments.⁸ Innovations focused on resident empowerment, wellness and use of technology can augment this shift to train holistic, confident, surgically competent urologists.