Lisa Hadfield-Law and Ronnie Davies reflect on legacy, change, and the future of surgical education

This has proved more flexible and accessible for those who are limited in their opportunities to leave their home and their practice. I’ve become increasingly interested in differential attainment and the inequalities of opportunity for clinicians worldwide. AO courses are a good example; these are open to individuals who have personal resources or work at institutions and in countries where funding is available. One of the initiatives here in the UK and Ireland is the opportunity to join AO Introductory Days for Medical students. Many of those places are funded by AO members and faculty. When they come across students interested in trauma and orthopaedics, they fund the 100 CHF place on the course.

Spaced learning, also known as spaced repetition, is an educational strategy that distributes learning over time, rather than cramming content into a short period. This approach leverages the psychological spacing effect, which suggests that spacing out learning events enhances memory retention and recall.  How could we integrate this into our current programmes, often seductively short and focused? The reality is that firing information and experiences into our audiences over a 2,3 or 4-day course feels efficient but can be likened to trying to sip water from a fire hose. 

Similarly, interleaving is a learning strategy that involves mixing different topics or types of problems during our programme instead of focusing on one topic or type of problem at a time (known as blocking). This enhances learning and retention by promoting better integration of knowledge and skills, encouraging the brain to engage in problem-solving across various contexts. So perhaps the way we construct our programmes, both synchronous and asynchronous, should be reviewed with this in mind. The learning logs we have created may be structured more effectively.

Our feedback needs some work, too.  We have made significant inroads into providing structured opportunities for learning but could be rather pedestrian and dated in our approaches to feedback.  Just telling learners what they are doing “right” or “wrong” can’t be considered a feedback conversation.  It was you, Ronnie, who challenged my use of Pendleton’s rules around what went well and next time and introduced me to the Advocacy with Inquiry model.  Pendleton's Rules and Advocacy Inquiry are both frameworks used to facilitate feedback; Pendleton's Rules are primarily focused on providing structured feedback but rarely delve deeply into the "why" behind feedback and can feel formulaic or prescriptive if used without genuine engagement.

Advocacy with Inquiry, conversely, is a conversational and collaborative approach that focuses on engaging in a dialogue about performance, understanding different perspectives, and finding solutions together. It typically involves two components:

1. Advocacy: clearly stating one's own viewpoint, suggestions, evaluations or observation, but without judgement.
2. Inquiry: actively engaging others in dialogue to understand their perspectives, thoughts, and feelings.

Maybe integrating aspects of both approaches would work for AO faculty.