Design, management, and critical evaluation of a surgical basic/clinical science curriculum: the role of an educational chief resident

Shea C Gregg, Dan Eisenberg, Andrew J Duffy, Walter E Longo
Journal of Surgical Education 2008, 65 (1): 36-42

OBJECTIVE: To demonstrate that a surgery "educational" chief resident can develop a resident-centered, evidence-based, surgical basic/clinical science curriculum that will improve American Board of Surgery In-Training Examination (ABSITE) scores.

DESIGN: Retrospective cohort study.

METHODS: Two curriculums were developed by 2 surgical "educational" chief residents (in their final year of training), for the academic years 2005-2006 and 2006-2007. The primary roles of these individuals were to design and maintain a surgical curriculum under the ongoing supervision of the program director. In 2005/2006, a baseline weekly lecture series was developed by assigning topics from multiple textbooks to members of the surgical faculty based on their respective surgical specialties. In 2006/2007, a similar approach was used; however, the lecture series was accompanied by additional activities that have been described in the literature as useful in improving ABSITE performance. These activities included recommended reading assignments, ABSITE-styled questions based on the weekly lecture topic, problem-based learning conferences, and an ABSITE remediation course. To assess the 2 approaches, conference attendance and mean ABSITE total test percent correct scores for categorical and preliminary surgical residents in their 1st through 4th postgraduate years (PGY) of training in 2005/2006 and 2nd through 5th years in 2006/2007 were followed. Subgroup analysis of conference attendance and mean ABSITE percent correct scores was performed on those participating versus those not participating in the ABSITE remediation course. A Likert survey was performed to assess our surgical curriculum in 2007.

RESULTS: Twenty-five residents participated in both the 2005/2006 and the 2006/2007 surgical curriculums. Twelve residents were assigned to mandatory remediation, whereas 13 were not required to participate in remediation in 2006/2007. Conference attendance did not significantly change between 2005/2006 and 2006/2007 among remediating residents (75% vs 69%, p = 0.23) but did significantly increase among nonremediating residents (76% vs 83%, p = 0.05). Overall, mean ABSITE percent correct scores significantly increased between the 2006 and the 2007 tests (64.8% vs 71.0%, p = 0.002). In subgroup analysis, those who underwent ABSITE remediation significantly increased their ABSITE score by an average of 10.2 percentage points (p = 0.0002), whereas those not participating in the course did not significantly change their score (2.5 percentage points, p = 0.36). A Likert survey assessing this year's curriculum showed that all components of this year's curriculum were "Somewhat useful" to "Very useful" in both improving surgical knowledge base and preparing for the ABSITE.

CONCLUSION: An educational chief resident designed surgical curriculum, including weekly reading assignments, weekly ABSITE-styled questions, monthly chief resident problem-based conferences, and an ABSITE remediation course, may augment a basic/clinical science lecture series and may improve ABSITE performance.

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