TAASE Educational Development Framework May Be Useful for Surgical Trainees

by Amy E. Hamaker •

Can otolaryngology surgeons successfully use the Technician, Anatomist, Anticipator, Strategist, Executive (TAASE) surgical education developmental framework?

Bottom Line: As a whole, otolaryngology and general surgery faculty expressed similar ideas about each developmental stage and a common arc to operative maturity reflected by the TAASE trajectory.

Commentary: “This article classifies the maturation process of a surgeon. Previously, general surgeons proposed a framework known as TAASE, which stands for Technician, Anatomist, Anticipator, Strategist, and Executive. Each stage represents the acquisition of progressive abilities along a continuum of surgical development. While this study was undertaken with otolaryngology residency training as the frame of reference, the descriptions and pathway are likely to resonate with all otolaryngologists. Figure 1 creates a wonderful visual representation that captures the essence of lifelong learning.’ This article offers a universal language that can be used with any learner, including colleagues, advanced practice providers, and ourselves.”. —Sarah Bowe, MD

Background: Developmental frameworks are narrative descriptions of learner performance that may provide useful operative feedback tools in surgical education. Study authors previously proposed the TAASE framework using data collected from general surgeons within general surgery and conjectured its applicability in other surgical specialties. As a result, the relevance of this model to other surgical specialties such as otolaryngology is unclear. 

Study design: Audio-recorded interviews of 10 attending academic faculty.

Setting: Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, Calif.

Synopsis: Interviewees described surgical development as a process in which progressive abilities are acquired along a continuum, with focus shifting as trainees progress in technical and cognitive abilities. Interviewees characterized novice trainees as focused on developing anatomy knowledge and basic technical skills, including knot tying and instrument handling. Junior trainees moved toward performing meaningful operative steps with an improved understanding of anatomy, but were unable to use their knowledge to successfully solve nonstandard problems. Senior trainees had mastered basic technical skills with strong standard anatomy knowledge and were able to plan and anticipate next steps. When trainees became independent, the focus shifted toward autonomous decision-making (“agency”). There were diverse views on expert surgeons, but experience was a key mediator of expertise, and experts were able to understand the operation from a more holistic perspective, including patient experience and expectations. Several interviewees described healthy emotional states that can facilitate learning, but extreme levels that can be a hinderance. Limitations included participation from a single institution, researcher data sensitization, and interviews that did not include resident perspectives or their actual behaviors.

Citation: Zhao NW, O’Sullivan PS, Huang E. Enhancing operative feedback: A descriptive trajectory for surgical development in otolaryngology. J Surg Educ [published online ahead of print December 3, 2019]. doi: 10.1016/j.jsurg.2019.11.009.