Division of Plastic Surgery, University of Western Ontario, Schulich School of Medicine and Dentistry, London, Ontario, Canada.
J Surg Educ. 2011 May-Jun;68(3):167-71. doi: 10.1016/j.jsurg.2010.12.004. Epub 2011 Jan 15.
The teaching and learning of critical appraisal skills and evidence-based practices by surgical residents has been identified as an unmet need in many surgical training programs.
Monthly journal clubs over a calendar year were the setting for a critical appraisal curriculum. Preassigned homework assignments and carefully selected articles with specific methodologies were posted electronically and formed the course material. Pretests and posttests on medical statistics and methodology were administered. Presurveys and postsurveys on attitudes toward evidence-based surgery (EBS) were administered.
Precourse surveys revealed a lack of confidence in residents' knowledge of epidemiology and biostatistics, with an increase in confidence postcourse (2.6 vs 2.9; p = 0.4). Precourse and postcourse, there was strong support for more critical appraisal training in residency (5.1 vs. 4.8; p = 0.1) and an agreement that understanding evidence-based practices is important for the clinical practice (4.6 vs. 4.6; p = 0.4) as well as the research endeavors of a plastic surgeon (5.4 vs. 5.5; p = 0.8). Pretest scores, when compared with PGY level, showed an increase in knowledge with increasing PGY level (p = 0.6). Average pretest scores were 6.5 of a total of 15 points, or 43%. Posttest scores were improved, at 7.8 of 15, or 52% (p = 0.6). Sixty-four percent of learners felt that journal club was a good venue for teaching critical appraisal skills precurriculum. Fifty percent of learners were still of that impression at course completion (p = 0.3). The modest improvement in test scores indicates an impact on critical appraisal skills, but reliance on journal clubs to teach these skills is insufficient.
Through monthly journal clubs and self-directed assignments, critical appraisal skills were improved across PGY levels in an academic surgical training program; however, other settings and methods of teaching are required to augment a curriculum in evidence-based surgery.
许多外科培训计划都发现，外科住院医师批判性评估技能和循证实践的教学和学习尚未得到满足。
在一学年中，每月一次的期刊俱乐部是批判性评估课程的设置。预先分配的家庭作业和精心挑选的具有特定方法的文章以电子方式发布，并构成课程材料。进行了医学统计学和方法学的预测试和后测试。进行了术前和术后对循证手术（EBS）态度的调查。
课程前的调查显示，住院医师对流行病学和生物统计学知识的信心不足，课程后有所增加（2.6 对 2.9；p = 0.4）。课程前和课程后，住院医师都强烈支持更多的批判性评估培训（5.1 对 4.8；p = 0.1），并一致认为理解循证实践对于临床实践（4.6 对 4.6；p = 0.4）以及整形外科医生的研究工作（5.4 对 5.5；p = 0.8）都很重要。与 PGY 水平相比，预测试成绩显示，知识水平随 PGY 水平的提高而提高（p = 0.6）。平均预测试得分为 15 分中的 6.5 分，即 43％。后测得分提高到 15 分中的 7.8 分，即 52％（p = 0.6）。64％的学习者认为期刊俱乐部是教授批判性评估技能的好场所，课程前为 50％，课程后为 50％（p = 0.3）。测试成绩的适度提高表明对批判性评估技能有一定的影响，但仅依靠期刊俱乐部来教授这些技能还不够。
通过每月的期刊俱乐部和自我指导的作业，在学术外科培训计划中，PGY 水平的批判性评估技能得到了提高；但是，需要其他设置和教学方法来补充循证手术课程。
