Education of the modern surgical resident: Novel approaches to learning in the era of the 80-hour workweek

Introduction: Implementation of the 80-hour work week has resulted in limitations on the hours available for resident education, creating a need for innovative approaches to teach surgical residents successfully. Herein we report the methods and results of an innovative didactic learning program at a large academic surgerical residency program. Methods: Between 2004 and 2005, based on known principles of adult education and innovative learning techniques, a didactic learning program was instituted in a major academic surgery program. The course work consisted of a structured reading program using Schwartz's Textbook of Surgery, with weekly testing and problem-based learning (PBL) groups led by surgical faculty. The residents' progress was assessed by American Board of Surgery In-Training Examination (ABSITE) training scores before and after program implementation. A resident survey was also conduced to assess residents' attitudes toward the new program. Results were reported as a mean, and categoric variables were compared using a paired Student's t-test. Results: During the academic year of the structured reading program, the mean ABSITE score improved by 10% (P = 0.02) from the previous year. The postgraduate year 4 class had the largest change, with a score increase of 17% over the previous year's performance (P = 0.02). Survey results demonstrated that 64% of the responders agreed that the small-group PBL was preferable for achieving educational goals. Furthermore, 89% of residents responded that the PBL groups improved interaction between residents and faculty members. Conclusions: An innovative formal learning program based on a major surgical textbook with weekly testing and small group sessions can significantly improve surgical training in the modern era of work-hour restrictions. Furthermore, surgical trainees find this format to be innovative and useful for improving didactic teaching.