P. P. Patel1, E. Y. Chan1 1Rush University Medical Center,General Surgery,Chicago, IL, USA
Introduction:
Practice-based Learning and Improvement (PBL) is one of the six core competencies set by the Accreditation Council for Graduate Medical Education. It is defined as the ability to investigate and evaluate care of patients, appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. Although this competency has been established for more than 10 years, many general surgery training programs have struggled with the best method to incorporate this skill into their curriculum. The purpose of our study is to demonstrate that the preparation and presentation of surgical debates by residents is an effective method of applying PBL.
Methods:
Senior residents were assigned controversial debate topics that focused on common general surgery scenarios based on self-identified strengths, deficiencies and limits in their knowledge base. They were provided a month to set learning goals and complete the appropriate learning activities. These learning activities focused on locating and critically appraising evidence from scientific studies relating to their clinical scenario and assimilating this information into a grand rounds presentation in the form of a debate. The debates were conducted by two senior residents who using evidence based data centered on current literature defended their surgical approach to approximately 50 surgical attendings and residents. Four debates were held throughout the year. To evaluate the efficacy of this teaching method, presenters were asked if participation in this debate increased proficiency at acquiring and critically reviewing medical literature. Additionally, they were asked if the skills acquired during the debate would be applied to practice evidence based surgery and improve patient care in the future. As a secondary measure, the audience was asked if this debate influenced their approach.
Results:
In preparing for their presentation, each resident reviewed on average 20 articles and cited 14 journal articles. Half of the residents stated they felt more comfortable searching for and reading scientific literature after completing their presentation. At the conclusion of the year, 75% of residents expressed that they were now more likely to practice evidence-based surgery and refer to literature to justify their patient care plan. As a secondary measure, more than 50% of the audience stated that the debate influenced their decision on approach to the clinical scenario presented.
Conclusion:
Overall, the debate format to acquire the core competency of PBL was successful in more than 50% of participants. Surgical debates provide an innovative and effective way to incorporate PBL into the general surgery residency curriculum.