Developing a practice-based learning and improvement curriculum for an academic general surgery residency.

Abstract

Program directors in surgery are now facing the challenge of incorporating the ACGME's practice-based learning and improvement (PBLI) competency into residency curriculum. We introduced a comprehensive PBLI experience for postgraduate year 2 (PGY2) residents designed to integrate specific competency goals (ie, quality improvement, clinical thinking, and self-directed learning) within the context of residents' clinical practice. Fourteen PGY2 residents participated in a 3-week PBLI curriculum consisting of 3 components: complex clinical decision making, individual learning plan, and quality improvement (QI). To assess how effectively the curriculum addressed these 3 competencies, residents rated their understanding of PBLI by answering a 12-question written survey given pre- and post-rotation. Resident satisfaction was assessed through standard post-rotation evaluations. Analysis of the pre- and post-rotation surveys from the 14 participants showed an increase in all measured elements, including knowledge of PBLI (p < 0.001), ability to assess learning needs (p < 0.001), set learning goals (p < 0.001), understanding of QI concepts (p = 0.001), and experience with QI projects (p < 0.001). Fourteen QI projects were developed. Although many residents found the creation of measurable learning goals to be challenging, the process of identifying strengths and weaknesses enhanced the resident's self-understanding and contributed to overall satisfaction with the rotation. The initial implementation of our PBLI curriculum demonstrated that residents report personal progress in their clinical decision making, self-directed learning, and familiarity with QI. This comprehensive PBLI curriculum was accepted by surgical residents as a valuable part of their training. We are encouraged to continue a clinically grounded PBLI experience for PGY2 residents.