The operative dictation: a review of how this skill is taught and assessed in surgical residency programs

Background: The operative dictation (OD) is the cornerstone of surgical communication, yet there appears to be a lack of formal education of this skill by training programs. We conducted a review of the literature to assess the teaching and quality of OD in surgical residency programs.

Study design: Multiple databases were searched for studies pertaining to "OD," "surgical education," and "formal teaching." Of 50 the studies, 13 were retained and assigned to one or more of the following categories: (1) surveys of the surgical community evaluating current perceptions of formal OD education (n = 5), (2) studies assessing the quality of OD performed by residents (n = 5), and (3) educational interventions for improving OD skills (n = 4).

Results: (1) Between 12% and 25% of survey respondents reported formal teaching of OD skills in their surgical programs. Surveyed residents and program directors were in favor of the implementation of structured teaching 60% to 91% of the time. (2) Multiple studies demonstrated significant deficiencies in residents' ODs, with key information missing in up to 76% of cases. The completeness of OD did not consistently correlate with level of training. (3) In one of the studies, a formal educational session was found to improve OD quality scores (p < 0.001). In 2 studies, the use of synoptic report maximized the completion rate of OD up to 92% from less than 70%. Synoptic reports were significantly more complete than conventional ODs with regard to general information (p < 0.001) and procedural aspects (p < 0.001). A single randomized trial demonstrated an improvement in junior residents' ODs after the implementation of a template (p = 0.02).

Conclusion: Current evidence suggests that only a small proportion of residency programs offer formal OD instruction, despite a demonstrable need for improvement in residents' OD skills. Educational interventions and synoptic reporting present possible solutions, although this continues to be an area of evolving interest.