How to Use
The Surgical Education Checklist
Maximising Learning
Effective teaching should target the trainee’s zone of proximal development or growth zone - the space between what they can already do independently (comfort zone) and what lies beyond their current capability (panic zone). Not every learning opportunity requires a trainee to perform a case skin-to-skin. Most operations can be broken into key parts, allowing targeted, part-task training that is tailored to a trainee’s needs and maximises educational value.
Briefing
(Start of the day, or earlier to allow preparation)
Confirm who is present and each team member’s level of experience. With familiar teams, briefly revisit recent goals and learning points, and link these to today’s list. Agree overall goals for each case and clarify who is likely to perform which steps. Where possible, share the training plan with the wider theatre team at the start-of-day briefing. This helps the list run smoothly and frames training as an expectation, not an apology.
Time Out
(Before each case)
Just before the case, for example, whilst scrubbing, recap who will perform each step and what the trainee’s goals are. Discuss levels of supervision appropriate to the trainee’s experience (e.g. proactive vs passive assistant; trainer scrubbed in, nearby, or outside theatre). Anticipate likely challenges and agree how the trainer will step in if needed. This reduces trainee anxiety and reframes trainer takeover as part of the plan, not a failure.
Do It
(Intra-operative)
Be mindful that cognitive load is high for both trainer and trainee. Signpost agreed learning opportunities as they arise. Give specific, actionable coaching: “Keep doing [x] with your left hand, stop doing [y] with your right, and try [z] instead.” If the trainee is struggling, pause and question (e.g. “What could improve the retraction?”), if it’s safe to do so, rather than immediately taking over. This “safe struggle” is where great learning happens.
Sign Out
(After each case)
Once the operation has finished, quickly reflect on how things went, whether the goals were achieved and if not, why not. Give short, specific feedback about what went well, things that could be done better next time and/or should be done the same.
Debrief
(End of the day)
Start by asking the trainee if there’s anything in particular they want feedback on or want to discuss. If there’s something on their mind, they will find it harder to take on board other feedback. Identify what went well and what could be improved on, in general and in relation to the goals for the day. Develop these learning points into action plans that the trainee can work on going forward.
The Surgical Education Checklist
Key Principles
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Keep it short: Each stage can be done in 1–2 minutes
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Mutual responsibility: The SEC works best when both trainee and trainer are pro-active
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Embed in routine: Link checklist use to moments that already exist in the theatre workflow
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Flexible use: In elective lists the full checklist can be applied; in acute cases, briefing and debrief may be dropped