It's making me think outside the box at times: a qualitative study of dynamic capabilities in surgical training.

Adarsh Shah*, Kim Walker, Kenneth G. Walker, Lorraine Hawick, Jennifer Cleland

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Craft specialties such as surgery endured widespread disruption to postgraduate education and training during the pandemic. Despite the expansive literature on rapid adaptations and innovations, generalisability of these descriptions is limited by scarce use of theorydriven methods. In this research, we explored UK surgical trainees’ (n=46) and consultant surgeons’ (trainers, n=25) perceptions of how learning in clinical environments changed during a time of extreme uncertainty (2020/2021). Our ultimate goal was to identify new ideas that could shape post-pandemic surgical training. We conducted semi-structured virtual interviews with participants from a range of working/training environments across thirteen Health Boards in Scotland. Initial analysis of interview transcripts was inductive.
Dynamic capabilities theory (how efectively an organisation uses its resources to respond to environmental changes) and its micro-foundations (sensing, seizing, reconfguring) were used for subsequent theory-driven analysis. Findings demonstrate that surgical training responded dynamically and adapted to external and internal environmental uncertainty. Sensing threats and opportunities in the clinical environment prompted trainers’ institutions to seize new ways of working. Learners gained from reconfgured training opportunities (e.g., splitting operative cases between trainees), pan-surgical working (e.g., broader surgical exposure), redeployment (e.g., to medical specialties), collaborative working (working with new colleagues and in new ways) and supervision (shifting to online supervision). Our data foreground the human resource and structural reconfgurations, and technological innovations that efectively maintained surgical training during the pandemic, albeit in diferent ways. These adaptations and innovations could provide the foundations
for enhancing surgical education and training in the post-pandemic era.
Original languageEnglish
Pages (from-to)499-518
Number of pages20
JournalAdvances in Health Sciences Education
Issue number2
Early online date26 Oct 2022
Publication statusPublished - May 2023

Bibliographical note

The authors would like to thank Graham Haddock, Satheesh Yalamarthi, and Mark Vella for their assistance with participant recruitment.

Funding Information:
This work was supported by the Royal College of Surgeons of Edinburgh [Grant number RG-15026].


  • COVID 19
  • Dynamic capabilities
  • Graduate medical education
  • Qualitative research
  • Surgical training
  • Training programs


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