"At the Table or Behind the Curtain":A Randomized Study to Evaluate the Influence of Students' Position in Theatre-Based Learning

Thilo Sprenger; Felix Beucher; Martin Reichert; Anca-Laura Amati; Christopher Tuffs; Martin Schneider; Anne Kauffels

doi:10.1016/j.jsurg.2025.103436

"At the Table or Behind the Curtain":A Randomized Study to Evaluate the Influence of Students' Position in Theatre-Based Learning

J Surg Educ. 2025 Jan 23;82(4):103436. doi: 10.1016/j.jsurg.2025.103436. Online ahead of print.

Authors

Thilo Sprenger¹, Felix Beucher¹, Martin Reichert¹, Anca-Laura Amati¹, Christopher Tuffs¹, Martin Schneider¹, Anne Kauffels²

Affiliations

¹ Justus-Liebig-University, Giessen, Germany; Department of General, Visceral, Thoracic and Transplantation Surgery, University Hospital Giessen, Germany.
² Justus-Liebig-University, Giessen, Germany; Department of General, Visceral, Thoracic and Transplantation Surgery, University Hospital Giessen, Germany. Electronic address: anne.kauffels-sprenger@chiru.med.uni-giessen.de.

PMID: 39854954
DOI: 10.1016/j.jsurg.2025.103436

Abstract

Objectives: The influence of students' positioning within the theatre on their learning progress is unknown. The present study aimed to investigate whether position of undergraduate medical students in the operating theatre-at the operating table or behind surgical drapes-influences their learning.

Design setting and participants: We conducted a single-blind prospective randomized study with 2 parallel arms. Undergraduate medical students allocated to the operating theatre in the course of the regular surgical curriculum were invited to participate. Participants were randomly assigned to either a position at the operating table, or behind surgical drapes during a visit to the operating theatre. After surgery, the students prepared sketches of essential procedural steps, which were evaluated by 3 independent surgeons using a predefined scoring system in a blinded fashion. Additionally, students were asked to answer a questionnaire for comparative self-assessment of pre- and postvisit knowledge concerning 4 aspects: routines within the theatre, sterile behaviour, essential procedural steps of the surgery and insight into the work of a surgical resident.

Results: In total, 84 sketches and questionnaires (= 42 surgeries) were evaluated. Sketches prepared by the group positioned at the operating table reached significantly higher scores with regard to the essential procedural steps of the surgery (p = 0.012). Comparative self-assessment revealed a significant learning progress, with no significant difference between the groups.

Conclusions: Visiting the operating theatre significantly improved undergraduate medical students' understanding of procedural steps and theatre-specific routines regardless of the position within the theatre. However, specific knowledge of surgical procedures is significantly was enhanced when students are positioned at the operating table rather than behind the surgical drapes. Appropriate structures, enabling involvement of students directly at the operating table, should be enforced in hospitals partaking in undergraduate surgical education.

Keywords: Theatre-based learning; Undergraduate surgical education; Workplace-based assessment; Workplace-based learning.