Explicitly Verbalizing Anatomy Makes Intraoperative Clinical Reasoning Accessible

Surgical trainees frequently face difficulty translating foundational anatomical knowledge into safe, efficient intraoperative decisions, potentially leading to surgical errors, procedural hesitation, and reduced operative autonomy. To investigate how surgical educators and trainees integrate anatomical knowledge into intraoperative clinical reasoning, researchers conducted a constructivist grounded theory study across three Canadian academic hospitals.

The investigation gathered observational field notes across six operative days covering 16 surgical procedures, paired with follow-up semi-structured interviews involving six general surgery consultants and eight surgical residents. Data analysis revealed three distinct themes characterizing intraoperative guidance interactions: establishing trust, aligning understanding throughout operative progress, and teaching future decision-making.

From these themes, the investigators developed a model of anatomy-based guidance interactions. The findings indicated that anatomy functions as a shared communication tool, provides common landmarks for operative progression, and renders tacit clinical reasoning processes explicit. Explicitly verbalizing anatomy established and maintained a shared mental model between faculty and trainees, enabling attending surgeons to assess resident cognitive processing while allowing residents to observe how expert surgeons connect foundational anatomy to active intraoperative judgment.