Serious Play: Using the Operation® Board Game to Strengthen Intraoperative Feedback in Plastic Surgery

Background: Plastic surgery faculty are often required to provide feedback to trainees in the midst of high-pressure procedures that demand technical precision, quick judgment, and clear communication. However, most faculty development efforts in teaching feedback rely on passive learning or case-based role play, with few opportunities to practice giving real-time feedback in the operative setting. Traditional simulation training often omits the emotional and procedural complexity unique to surgery. To address this gap, we developed a simulation that allows educators to rehearse intraoperative feedback strategies in a controlled, low-risk environment. Methods: We created a procedural feedback simulation using the classic board game “Operation®” to mimic a foreign body removal case, simulating fine motor demands typical of hand surgery. Piloted in the 2025 Accreditation Council for Graduate Medical Education – Washington University “Developing Faculty Competencies in Assessment” course1, faculty participants first observed a resident actor perform the procedure with a course facilitator. This aided subsequent performance dimension training using a custom framework developed by author KC, listing observable behaviors across preop, operative, and postop phases. These included identifying goals for learning preoperatively, demonstrating appropriate tissue handling, and expressing realistic appreciation of the results. Faculty took turns serving as “preceptors” for the procedure, delivering real-time feedback using the BID (Briefing, Intraoperative teaching, and Debriefing) model2 while the resident performed the task using scripted variations in skill, insight, and receptivity to feedback. Structured group debriefs followed each round for the “preceptor” to receive feedback from the faculty observers and resident on their feedback skills (Fig.1). Results: Twenty-four faculty engaged in the activity; five served as preceptors. Participants described the experience as realistic and applicable to procedural training. The use of a resident actor and physical task introduced a sense of urgency and unpredictability, enhancing emotional authenticity. Participants reported improved confidence in offering observation-based feedback in real time. Specificity of feedback improved, shifting from general comments (“be more careful”) to clear technical advice (“try resting your wrist on the board to stabilize your hand”). The simulation was described as easy and enjoyable. Conclusion: This simulation offers a low-cost method for improving intraoperative feedback delivery in plastic surgery. It provides a psychologically safe environment where faculty can practice coaching technical and non-technical performance during an active task. The model’s portability and adaptability make it well-suited for faculty development initiatives. It strengthens surgical education by enhancing faculty confidence and improving the quality of feedback delivered in real operative settings.