Table 1. The primary sources
Author Year Country Population Research Method Themes Identified
Lyon5 2003 Australia Medical students and surgeons Mixed Methods -   Group interviews (medical students)           -   In-depth semi-structured interviews (students, n=15 and surgeons, n=10) -   Questionnaire (n=197, response -   rate 87%) Learning goals unclear for medical students
Fear in strange environment may hamper learning
Embarrassment / fear of looking foolish experienced by students Time versus educational benefit of theatre
attendance questioned by students
Ravindra33 2013 UK Recently qualified medical school graduates Questionnaire (n=209, 67% response rate) Learning goals unclear for medical students
Victimisation and humiliation experienced by students
Students desire active participation / to ‘scrub in’
Time versus educational benefit of theatre attendance questioned by students
Zundel11 2015 Germany Medical students from year three upwards Surgeons Series of focus groups (medical students, n=17 and surgeons, n=10) Common themes identified included: Learning goals unclear for medical students Teaching strategy of faculty influences learning Fear in a strange environment may hamper learning
Fernando13 2007 Scotland Final year medical students Questionnaire (medical students, n=54 response rate 90%) Learning goals unclear for medical students
Feeling welcome important to students
Fernando12 2007 Scotland Final year medical students Consultant trainers Questionnaire (medical students, n=46 100% response rate; consultants, n=42 46% response rate) Learning goals unclear / discordant
Lack of visualisation an issue for students
Irani14 2010 US Medical students and faculty Mixed – field observations and satisfaction ratings.  Assessing amount and type of teaching in the operating theatre, relative to curriculum goals. Student n=11. Learning goals unclear / discordant
Students may not require active
participation to have a positive experience
O’Neill15 2017 US Third-year medical students, attending surgeons, surgical residents Questionnaire answered by 57 total participants: Medical students, n= 25 (43.8% response rate) of those who have completed their third-year surgical clerkship, n= 14 (24.6% response rate) of those who have not completed their third-year surgical clerkship, attending surgeons, n=9 (15.8% response rate), surgical residents, n = 9 (15.8% response rate) Learning goals unclear / discordant
Feeling burdensome an issue for students
Hampton4 2011 US Fourth-year medical students on Obstetrics & Gynecology clerkship and faculty Focus groups (two focus groups including 13 medical students, one focus group including five faculty members) Learning goals more aligned students/ faculty in this study
Practical learning a relevant goal in view of some faculty
Welcomeness / integration into team recognised as important by faculty
Flannery16 2014 Northern Ireland Third-year medical students completing a neurosurgery placement Questionnaire (n=22, 8% response rate of all students, however not all were eligible as had not attended neurosurgery theatre) Preparedness of students important
Learning goals (can be) unclear (or lack a degree of clarity) for students
Teaching strategy/style of faculty influences learning
Lee17 2005 Scotland Fourth-year medical students following ENT placement Questionnaire (n=152, response rate 100%) Learning goals sometimes unclear / discordant / not achieved
Lack of visualisation an issue for students objectives
Hampton18 2014 US Medical students on Obstetrics & Gynaecology clerkships Pre and post intervention questionnaire (n=68 completed post-clerkship and n=27 completed at six months post-clerkship, of a group of 70) The benefit of clearly stipulated learning objectives
Positive opinion of faculty teaching correlated with high satisfaction overall
Hubbell19 1996 US Medical students Questionnaire, medical student n=48 (98% response rate) The benefit of setting clear learning objectives
Teaching strategies - the role of visual reinforcement
Callcut21 2004 US Surgical faculty and medical students 70+/- 7 student evaluations of 74 academic surgeons Teaching strategy/style of faculty influences learning
Bowrey7 2014 UK Third and fourth-year medical students on a perioperative care placement Semi-structured interviews (n=9 of 83 invited students) Fear in a strange environment may hamper learning
Intimidation experienced by students
Feeling welcome, team integration important to students
Morzycki24 2016 Canada Medical students of all years Questionnaire (n=180, response rate 40%) Fear in a strange environment may hamper learning
Intimidation experienced by students
Teaching strategies – the benefit of preparatory course
Chapman25 2013 UK Medical students of all years Questionnaire (n=292, response rate 20.8%) Feeling welcome, team integration important to students
Active participation important to students
Stone23 2015 Canada Final year medical students and recent graduates Questionnaire (n=72, response rate 21%) Fear in a strange environment may hamper learning
Intimidation experienced by students
Teaching strategies – the benefit of preparatory course anticipated by students
Miandoab26 2016 Iran Medical students in semester 4 and semester 8 Questionnaire (n=62) Feeling welcome, team integration important to students
Lyon27 2004 Australia Final year medical students Mixed Methods - Group interviews (medical students)           - In-depth semi-structured interviews (students, n=15 and surgeons, n=10)                                        - Questionnaire (n = 197, response rate 83%) Humiliation
Feeling welcome, team integration important to students
Active participation important to students
Teaching strategy/style of faculty influences learning
Thomas28 2006 UK Final year medical student Personal reflection Humiliation
Teaching strategies: benefit of a preparatory (simulated operating theatre) course
Pettitt29 2004 US Third-year medical students Questionnaire (n = 84, response rate 83%) Fear in a strange environment may hamper learning
Mistreatment experienced by students
Coveney32 2013 Ireland Third and fourth-year medical students Free recall experimental model, assessing recall in two different learning environments The learning of medical students as assessed by the short-term recall can be preserved in a variety of environments
Knight34 2017 UK Penultimate year medical students who had just completed their neurosurgical placement Questionnaire (n =201, response rate 81.4%) Feeling welcome, team integration important to students
Students perceive theatre exposure as useful
Cloyd35 2008 US First-year medical students involved in a ‘Surgical Skills Elective.’ Implementation of Surgical Skills elective followed by questionnaire (n=55 questionnaire responses from 30 students, response rate 88.7%) Feeling welcome, team integration important to students   Feeling burdensome common amongst medical students   Teaching strategies – the benefit of a surgical skills workshop  
Active participation important to students
Hong38 1996 Canada Fourth-year medical students on surgical clerkship Implementation of computer-based tutorials on human anatomy before theatre attendance.  Evaluated by questionnaire (n= eight medical students and an additional questionnaire completed by faculty also) The benefit of setting clear learning objectives
Teaching strategies – the benefit of a preparatory anatomy course
Patel39 2013 US First and second-year medical students Medical students enrolled in an introductory workshop ‘Surgical Saturday’ and completed pre and post-workshop questionnaires (n=33) Students lack confidence regarding operating theatre etiquette and behaviour
Teaching strategies – the benefit of a preparatory workshop
Patel40 2012 UK First-year medical students Intervention - students were randomized into four groups for operating theatre preparation: control, didactic lecture, ‘second life,’ and simulated operating suite.  Participants completed a pre and post intervention questionnaire. N=60 Teaching strategies – the benefit of a preparatory workshop
Martin41 2012 UK Medical students A workshop for medical students was designed based on responses of medical students (n=36) and consultant surgeons (n=8) to a questionnaire.  A workshop was then delivered to 147 medical students and feedback collected by questionnaire. Teaching strategies – the benefit of a preparatory workshop
Students lack confidence in the operating theatre environment
Drolet42 2014 US Pre-clinical medical students Implementation of a preclinical elective in surgery, using a paired resident-mentorship model.  Student exposure and confidence with clinical activities evaluated by questionnaire before and after the elective (N = 24, 100% response rate). Teaching strategies – the benefit of a preparatory course
Students lack confidence in the operating theatre environment
Shipper43 2018 US Pre-clinical medical students Implementation of a technical and nontechnical skills curriculum, evaluated by semi-structured interviews of students (n=8) and instructors (n=5). Teaching strategies – the benefit of a preparatory course
Fear in a strange environment may hamper learning
Intimidation experienced by students
Broderick44 2002 US Variety of theatre staff The trial of an endoscopic video camera and telescope attached to an operating table, with common objects placed on the operating table in mock surgical fields.  Persons (n=11) from a variety of medical backgrounds evaluated the images on the adequacy of visualization. Lack of visualisation an issue for students
Berman45 2008 US Third-year medical students Questionnaire (n=116, response rate 89%) following a surgical clerkship, during which a structured mentorship programme was in place. Teaching strategies – the benefit of a preparatory course
Active participation important to students
Teaching strategy of faculty influences learning
Schwind46   2004 US Medical students Questionnaire (completed for 114 learning episodes in the operating room) Active participation – may not be important to students
Teaching strategy of faculty influences learning
Time versus educational benefit of theatre attendance questioned by students
Stark47 2003 UK Fourth-year medical students and consultant clinical teachers Focus groups of medical students (n=20 total) and semi-structured interviews of consultants (n=13) Teaching strategy of faculty influences learning
Time versus educational benefit of theatre attendance questioned by students
McIntyre50 2008 US Third-year medical students on surgical clerkship The pilot of teleconferencing sessions (live broadcasting of procedures to a classroom setting where students were based along with a faculty member).  Observation performed of students (by educators) in operating theatre and the teleconference setting (n=23 observations) and questionnaires completed by students (n=78)   Teaching strategies – the benefit of a novel approach to intra-operative teaching
Teaching strategy of faculty influences learning
Time versus educational benefit of theatre attendance questioned by students
Jensen20 2018 Denmark 4th-year medical students enrolled in an undergraduate surgical introduction initiative involving assisting in the operating room with a surgical mentor (senior surgeon) Ethnographic observation (n=7 students, 70 hours of observation) Learning goals – hidden curriculum exists
Students may lack confidence in the operating theatre environment
Teaching strategies – the benefit of a novel approach to intra-operative teaching
Teaching strategy of faculty influences learning
Int J Med Educ. 2019; 10:75-87; doi: 10.5116/ijme.5ca7.afd1