Endocrine surgeon Catherine McManus, MD, is on a mission to redefine how medical students learn in the operating room. With a new, easy-to-use assessment tool, Dr. McManus aims to set clear expectations and provide real-time feedback, helping students gain confidence and clarity from day one. In this Q&A, she shares some background of the tool and its potential to standardize OR training across institutions, making a smoother path for students to build both their skills and professionalism.
Can you tell us a little bit about the background of this new OR assessment tool and why it’s needed?
Sure! This tool was actually born out of an initiative with the Association for Surgical Education. I joined the group when I transitioned from fellow to attending and started a fellowship in Surgical Education Research. That fellowship led me into surgical education and research, and I came up with this tool to help medical students better understand what’s expected of them in the operating room. Right now, there’s a lot of focus on how learners today engage best—how we can set expectations clearly and help students gain confidence and skills from day one.
How does it address the need for both setting expectations and delivering feedback?
Traditionally, we go over expectations in a guide or PowerPoint, but most students still end up asking each other, “What do I actually need to know for the OR?” That can lead to confusion, or they end up focusing on details that aren’t as relevant. And then there’s feedback, which can be tricky. It’s not always easy to deliver or receive, and often it comes too late to be really useful. This tool blends the two needs—expectations and feedback—by offering a quick six-item survey students can pull up on their phones at the end of an operation. They go through it with a resident or faculty member, and they get on-the-spot feedback, which is so much more valuable than hearing about it weeks later in an end-of-rotation evaluation.
What does engagement with this tool actually look like?
It’s really simple. The six items cover basic expectations in the OR, like identifying anatomy or knowing why a particular patient is undergoing surgery. Students rate their performance with a resident or attending based on three levels: needing assistance, needing prompting, or being able to do it independently. It’s all straightforward and very objective, so there’s no subjectivity around performance—just clarity on where they are and where they need to be.
How would you say this system is adapting to the changing ways that students learn?
Students these days lean less on traditional lectures and more on multimedia, interactive resources. They want something accessible and practical—something they can look at in real time. This tool is exactly that. It’s designed to give students real, practical guidance for when they’re in the OR, and they can reference it on their phone, which just fits better with how they learn now.
Can you talk a little bit about the six assessment categories and why they were chosen?
We actually based these six items on the main areas we evaluate students on at the end of their rotation: anatomy, potential complications, patient knowledge, technical tasks, and professionalism. For instance, we ask students if they introduced themselves to the OR team and the patient—something we value highly in terms of professionalism. The idea is to cover the essentials so that students know exactly what’s expected of them in the OR and have a consistent framework to meet those expectations.
Have you seen improvements since implementing the tool?
Yes! We started using it at the beginning of 2023, and we’ve found that about 92 percent of students scored highest in professionalism, though fewer reached that level in the knowledge domain. This makes sense because anatomy and patient knowledge vary with case complexity. But it’s reassuring to see that this tool really does measure what we intended. We’ve also found that students who score higher on the tool are more likely to earn honors in their final evaluations, which shows us the tool is working.
Do you hope to expand use of this tool? What does the future look like?
We’re planning to expand this study to other institutions, gathering feedback and data on the tool’s impact. Some groups of students will use the tool, and some won’t, so we can compare their experiences and outcomes. The big hope is that this tool could eventually standardize expectations in the OR across institutions, making things clearer for students everywhere. The focus isn’t on technical skills alone—of course, those are important—but on professionalism, communication, and how students interact with patients and team members. Those aspects often go unmeasured, and this tool is our way of putting that on the map.
As a busy surgeon, what would you say is the heart of your passion for education and improvement in training?
It’s really about helping every medical student understand their role in the OR, whether they end up in surgery or another specialty. We’re teaching them more than just skills; it’s about understanding what it means to be in this environment, interacting with patients, building professionalism, and being part of a team. This tool gives students a structure to learn and grow so they’re prepared for success on their rotations and beyond.
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