Journal of Surgical Simulation 2019; 6: 45 - 54

Published: 07 January 2020


Original article

Can virtuoso musicians teach surgeons how to cut? Self-regulated learning as a tool in surgical education: a thematic analysis of expert musician interviews

Hannah Winter and Jacqueline Rees-Lee
Corresponding author: Hannah Winter, Breast Unit, 1st Floor, West Wing, St Bartholomew’s Hospital, London, EC11 7BE, UK. Email:


Background: Observing musicians may offer illuminating parallels with surgical training, with several similarities between the two professions. Both utilize fine motor skills and are vocations, which involve in what can often be a stressful environment. As pressures on time within surgical training increase and learning opportunities decrease, understanding how to assist surgical trainees to reach the highest levels of achievement and become autonomous learners becomes increasingly important. Self-regulated learning (SRL) is a framework for lifelong learning used by musicians. It refers to self-generated ideas and thoughts that are planned and adapted to achieve personal goals. Within this dynamic framework adapted for medical education are four interacting cyclical processes: planning (goal setting); learning (learning styles and strategies); assessment (self-assessment alongside external feedback) and adjustment (selfevaluation transferable to surgical training to assist surgical trainees in becoming independent learners and to maximize learning opportunities. 

Methods: Semi-structured interviews were performed with four expert cellists and data were analysed with six steps of thematic analysis. 

Results: Several themes emerged from the data that fell within the predefined phases of the SRL framework, including listening and strategy. The former highlighted the importance of critically listening to one’s self, and to peers, teachers and critics. A pivotal master teacher was described by all as instrumental in the process of becoming independent learners. Two learning strategies were identified that may be transferable to surgical training: the use of video and audio recording analysis and the concept of instrument-free planning time, when the musicians spend time studying the musical score and planning bowings and fingerings before attempting to play. 

Conclusion: This study serves to generate ideas of how to integrate the teaching of SRL within surgical training to assist surgical trainees to reach higher levels of learning. Both learning strategies identified could be applied to surgical training, and indeed educators could be trained on how best to teach SRL amongst surgical trainees.


self-regulated learning; self-assessment; self-critique; simulation; surgical education