Annals of Surgical Oncology 11:226-232 (2004)
© 2004 Society of Surgical Oncology
Operative Surgical Education: Results of a Society of Surgical Oncology Fellowship Survey and Proposal for an Operative Database
Kathryn A. Spanknebel, MD,
Margo Shoup, MD,
Larissa K. Temple, MD,
Daniel G. Coit, MD,
Murray F. Brennan and
David P. Jaques, MD
From the Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
Correspondence: Address correspondence and reprint requests to: David P. Jaques, MD, Memorial Sloan-Kettering Cancer Center, Department of Surgery, 1275 York Ave., New York, NY 10021; Fax: 212-717-3224; E-mail: jaquesd{at}mskcc.org
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ABSTRACT
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Background: Preparation of surgical trainees for oncological operative procedures is challenging. The purpose of this survey was to focus on identifying methods and resources used by trainees to prepare for procedures and to ascess the need for additional educational tools.
Methods: A 34-item survey was mailed electronically to 97 surgical oncology fellows at 14 Society of Surgical Oncology–approved training programs. General surgery residents at an affiliate training program (n = 65) and residents attending an American Board of Surgery In-Training Examination review course (n = 129) were polled via hard-copy mailings. The survey was distributed with the Dillman method. Self-education practices, factors influencing operative education, and strengths/weaknesses of available resources were identified.
Results: Response rates were 56% and 78% for fellows and residents, respectively. Trainees prepare for more than 50% of cases they perform (82%; 169 of 205), devoting up to 1 hour (87%; 178 of 205) in review the evening before a procedure (64%; 131 of 205). Time availability and attending of record were dominant factors influencing resident preparation, whereas case complexity was the most important variable motivating fellows. Surgical atlases, texts, anatomical references, and case discussion with attending staff were the most useful and available resources rated by trainees. Skills stations were recognized as the least valuable. Critical assessment of six educational resources identified no one particular area for improvement.
Conclusions: There is a need for contemporary operative educational tools, incorporating time-sensitive and procedure-specific needs of surgical trainees preparing for oncological operative procedures.
Key Words: Surgical education • Residents • Fellows • Database • Operative education
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INTRODUCTION
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Surgical education is under increasing pressure to deliver higher-quality programs in the context of shorter resident work hours1 and increasing resident caseloads.2 One of the biggest concerns is that, as a result, education is suffering.
Acquiring technical skills and operative judgment is a core competency for surgical residents and fellows. The surgical suite is the most important venue in which trainees develop such skills, yet training residents in the operating room is costly and time consuming.3 Training programs have focused on ways to improve operative surgical education through hands-on skill stations,4 computer-based programs,5–7 and other nonbiological models.8 Self-education has traditionally been considered essential in operative preparation. However, junior residents have been found to devote as little as 2% of their in-hospital time to self-education.9
Surgical trainees represent a heterogeneous group of individuals with varying needs based on level of experience, knowledge, and skill. Although several types of operative educational resources are available, their relative value to the student is unclear. This is particularly true in the case of surgical fellows, who are actively acquiring operative skills and judgment for specialized, complex, and, at times, relatively uncommon procedures. In addition, studies have not demonstrated whether trainees are satisfied with the educational tools available or whether significant improvements are necessary.
The objectives of this study were to identify (1) the self-education practices of surgical residents and surgical oncology fellows, (2) the educational resources they use most frequently, (3) the variables influencing their operative surgical education, and (4) the limitations of currently available educational resources. From this information, strategies can be developed to address identified educational needs.
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METHODS
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A survey was designed to understand how surgical trainees prepare for an operative procedure and to identify opportunities to improve this process. Questions for the survey were generated after polling surgical educators at Memorial Sloan-Kettering Cancer Center (D.G.C. and D.P.J.) and three senior surgical oncology fellows (postgraduate years 8–10). The feasibility of the survey was tested among surgical oncology fellows at Memorial Sloan-Kettering Cancer Center through a pilot survey, and comments and changes were incorporated into the final survey.
The final survey included 34 items. Demographic questions included the respondent’s status (resident or fellow), postgraduate year of clinical training, and specific area of clinical focus (three items). Trainees were queried on aspects of operative education that included self-education and factors influencing operative preparation (12 items), the specific resources used for operative preparation (3 items), the utility of currently available educational resources (9 items), and the need for improved resources (7 items). For most questions (27 of 34), trainees were asked to answer the questions by using a Likert-type scale of 1 to 5. For seven questions, trainees were asked to provide short answers or to fill in comments.
Three groups completed questionnaires: (1) surgical oncology fellows at 14 Society of Surgical Oncology (SSO)-approved surgical oncology training programs, (2) residents from an affiliate program, and (3) residents attending an American Board of Surgery In-Training Examination (ABSITE) review course. Residents were asked to either complete the survey while at the ABSITE course or return the survey by mail. E-mail addresses of all trainees were gathered through the individual SSO training programs. An introductory letter and survey were sent electronically to all surgical oncology fellows. Three separate mailings over a 3-month period were performed according to the Dillman method.10,11
Data were entered into SPSS, version 10.0 (SPSS Inc., Chicago, IL). Qualitative responses were recorded and categorized. Descriptive statistics were computed for each survey item as appropriate. Resident and fellow responses were evaluated in aggregate and separately. Because the data are exploratory in nature, comparisons between residents and fellow groups were not evaluated statistically.
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RESULTS
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Demographics
The survey was completed by 205 trainees, with an overall response rate of 70% (205 of 291). Fifty-six percent of surgical oncology fellows (54 of 97) from 14 SSO-approved training programs and 78% of general surgery residents (151 of 197) from an ABSITE review course (129 of 129) and affiliate surgery program (22 of 65) responded. Most fellows (78%; 42 of 54) indicated an interest in practicing general surgical oncology, and most surgery residents were interested in general surgery (27%; 41 of 51) or were undecided (24%; 36 of 151; data not shown).
Self-Education Practices
All trainees recognized the need for preparing for operative procedures; most (82%; 169 of 205) prepared for 50% or more of the cases they performed (Fig. 1). Most residents and fellows allocated 30 to 60 minutes to preparation (82% and 93%, respectively; Fig. 2), generally the night before an operative procedure (52% and 76%, respectively; Fig. 3). Residents, however, were less likely to prepare for cases and more likely to review within the hours or minutes before an operative procedure (22% and 46%, respectively) than fellows (6% and 22%, respectively). Most fellows (87%; 47 of 54) believed that they were "frequently" or "always" prepared. Although many residents were also "frequently" prepared (51%; 77 of 151), an equal number were only "occasionally" or "seldom" prepared (49%; 74 of 151). In general, residents reported feeling less prepared than fellows (49% and 10%, respectively; Fig. 4).
Received for publication March 15, 2002.
Accepted for publication September 30, 2003.
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ABSTRACT
INTRODUCTION
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