Training surgeons to do evidence-based surgery: a collaborative approach

Three of the Accreditation Council for Graduate Medical Education general competencies contain specific wording indicating that trainees must learn how to locate, appraise, and integrate the best information from the literature into their patient care practices. What is less clear is how to best translate evidence-based concepts into the workday of the resident, fellow, or attending surgeon. In this article we describe our use of the assignment-based training program we developed to ensure that our trainees can actually do what is required to practice evidence-based operations.

Our collaborative program draws on the expertise of an attending surgeon, a medical librarian, and a research coordinator. The curriculum is designed so that all residents in our program develop and refine their evidence-based surgery skills in a context relating to their clinical practice. They are given a practice-related clinical question and are asked to demonstrate their competence in finding the best available evidence to answer it. This involves restating the question as a well-formulated clinical question, doing a focused literature search, critically appraising the results to find the best evidence, and integrating the information into practice, if appropriate. Search assignments are evaluated using a structured form and additional training is designed based on the results. Another question is then assigned to assess improvement.

Residents' performance on a first assignment showed specific weaknesses in use of textwords and limiters. Performance was strongly related to a resident's ability to obtain the best evidence in answer to a clinical question (p = 0.011). Substantial improvement was shown on a second assignment after additional training.

Our hands-on, performance-based program allows us to document trainees' progress in developing skills that will allow them to efficiently locate the best evidence available to inform their patient care decisions.