Fellow’s research on transition to surgical practice earns medical education funding grant

Tina Gao, a gynecologic oncology fellow in the ob-gyn department, has received a project grant from the Royal College for her research. She is undertaking a systematic review of experiences of early-career surgeons to highlight opportunities for coaching and development, facilitating the transition from trainee to independent practitioner.

The Robert Maudsley Fellowship for Studies in Medical Education provides Gao with funds of $36,500 for up to two years. The award is designed to help specialists acquire medical education skills to develop educational programs and evaluation methods to benefit the profession.

Gao graduated from UBC’s ob-gyn residency program and is completing a Master of Science in Health Professions Education at McMaster University. Writer Matthew Tierney caught up with Gao to learn more about the current surgical curriculum and the pressures on surgeons in the early years of practice.

What led you to identify a surgeon’s transition period as an area in need of research?

The main focus of surgical residency is to prepare surgeons to perform operations independently and proficiently. But new staff surgeons also need to be a surgical teacher and supervisor in the operating room. They are expected to become such leaders while making an overnight transition to autonomous practice, providing safe patient care while continuing to develop technical proficiencies.

Throughout my own training, I came to realize there’s very little formal training to prepare us for these additional responsibilities of independent practice.

I also recognized that, during residency, we receive ongoing supervision, feedback and technical coaching from experienced staff surgeons, but this structured system of mentorship and feedback largely disappears after our completion of postgraduate surgical training. Increasingly I became interested in how we can better improve one’s transition during this important stage of their careers.

How can we improve the surgical residency curriculum?

Surgical residency provides extensive training in technical skills and clinical decision-making and has the evaluative metrics to track these based on Entrustable Professional Activities. But there is no consistent formal milestone or assessment that evaluates a resident's readiness to teach, manage OR caseloads, or run a clinical or academic practice, despite these becoming immediate expectations in independent practice. 

Many surgeons develop these skills informally by observing their mentors in the operating room during training. Those experiences can vary tremendously depending on the cases, supervisors and teaching environments that each resident encounters. That means every surgeon graduates with a different experience, making it difficult to ensure everyone feels equally prepared to teach and lead when they enter practice.

My research aims to better understand these gaps.

What potential impact can your research have on the profession?

There is currently no synthesized review in the literature regarding the experiences of early-career surgeons. This systematic review will be rigorous, and the first of its kind.

We have the opportunity to examine this infrequently studied topic and to identify challenges and gaps in early practice. My aim is to produce high-quality evidence on this critical transition period, with hopes to inform how postgraduate training programs can better support trainees in their transition to practice. Also, the findings of this study could potentially form the backbone of a near-peer coaching and mentorship program that can be adopted and implemented across surgical specialties.

Overall, I hope this work will help inform residency curricula, continuing professional development objectives, and future surgical coaching programs that support surgeons well beyond graduation, and that it can form a community of practice.

What does winning this grant mean to you?

Receiving the Robert Maudsley Fellowship is an incredible honour and provides an opportunity to pursue a research question that I am deeply passionate about. I'm especially grateful to the many mentors who have shaped my journey and modelled excellence in surgery and education, particularly my previous residency program director Dr. Hanna Ezzat from UBC and my current fellowship program director and research supervisor Dr. Brenna Swift from U of T, whose guidance and encouragement have been instrumental in developing this project. I hope this research reflects the investment they have made in my development!