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eam training: A tool to improve resident teamworknd communicationicole Fox MD, MPH, Steven Johnson MD, Nicholas Gagliano MD,rent Passarello MD, Carol Moore RN, Debra Resurreccion RN,

ames Reed MPHhristiana Care, Newark, DE

NTRODUCTION: Senior surgical residents at our ACS-verified Leveltrauma center are responsible for leading trauma activations. They doot receive formal training in leadership, teamwork, or communication.onsequently, we observe varying levels of competency in these areasuring the trauma response. We used the TeamSTEPPS curriculumeveloped by the Agency for Healthcare Research and Quality/epartment of Defense to train residents in teamwork and communi-

ation skills. Our hypothesis is if residents receive standardized training,eam functioning and communication will improve.

ETHODS: Surgical residents were surveyed (n � 26) to assessheir perception of teamwork prior to team training. A 4-hour train-ng session was held in July 2007. One trauma conference/monthnd 2 surgical grand rounds were dedicated to reinforcing team train-ng skills. In May 2008, the initial survey was repeated.

ESULTS: Data were analyzed using the t test for equality ofeans. Residents perceived an improvement in the team’s ability toeasure performance (p� .01). They felt that team roles were better

efined (p�.04), the team worked well together (p�.001), commu-icated more effectively (p�.05), and perceived an improvement inhe team’s ability to resolve conflict (p�.02).

ONCLUSIONS: Surgeons typically do not receive formal trainingn leadership, teamwork, and communication, yet they are expectedo serve as leaders in areas such as the operating room and trauma bay.ur results indicate that teaching these skills using a standardized

urriculum improves teamwork and communication. Furthermore,reliminary data suggest improved ED disposition times and a pos-tive impact on ED to OR transfer time.

moderated journal club is more effective than annternet journal club in teaching critical appraisalkillsobin S McLeod MD, FRCSC, FACS, Helen MacRae MD, FRCSC,arg McKenzie RN, Charles Victor MSc,aren Brasel MD, MPH, FACSount Sinai Hospital, University of Toronto, ON, Canada, andedical College of Wisconsin, Milwaukee, WI

NTRODUCTION: With restrictions in resident work hours, there isreat appeal in providing education via the Internet despite littlevidence that it is as effective. A randomized controlled trial wasonducted to determine whether teaching critical appraisal skills us-ng Evidence Based Reviews in Surgery (EBRS) via the Internet is asffective as a faculty moderated, in-person journal club.

ETHODS: Twelve general surgery programs were cluster random-zed to an Internet group (IG) (6 programs; 227 residents; 23–47esidents/program) or a moderated journal club (JCG) (6 programs,

16 residents, 21–72 residents/program). Each EBRS package in- u

S1132009 by the American College of Surgeons

ublished by Elsevier Inc.

ludes a clinical and methodological article plus clinical and meth-dological reviews. Residents in the IG completed 8 EBRS packagesnline plus participated in an online discussion group. Residents inhe JCG attended 8 journal clubs moderated by a faculty memberhere EBRS articles were discussed. All residents completed a vali-ated test assessing expertise in critical appraisal.

ESULTS: In the IG, only 8.4% of residents completed the EBRSackages compared with 64% in the JCG (p�0.05).Fifty seven per-ent of residents completed the test in the IG compared with 73% inhe JCG (p�0.05). The JCG scored significantly better on the crit-cal appraisal test with a mean score of 42.1 compared with 37.4 inhe IG (p�0.05) with a moderate effect size (0.60 SD).

ONCLUSIONS: A moderated journal club is significantly better ineaching critical appraisal skills. This is likely due to low participationn the Internet education program.

eveloping a problem-based learning andmprovement curriculum for an academic generalurgery residencyrin O’Connor MD, Robert McDonald PhD, Eugene F Foley MD,ennis Lund MD, David M Mahvi MD, FACSniversity of Wisconsin, Madison, WI

NTRODUCTION: Program directors in surgery are now facing thehallenge of incorporating the ACGME’s practice-based learningnd improvement (PBLI) competency into residency curriculum.e introduced a PBLI experience for PG2 residents designed to

ntegrate specific competency goals (quality improvement, clinicalhinking, and self-directed learning) within a clinical context.

ETHODS: Eight PG2 residents participated in a 3-week PBLIurriculum consisting of 4 components: Surgical Nutrition, Com-lex Clinical Decision Making, Individual Learning Plan, and Qual-ty Improvement. A 12-question written survey given prerotationnd postrotation allowed residents to rate their understanding ofBLI, ability to assess their CCDM and learning needs, and experi-nce with QI. Resident satisfaction was assessed through standardostrotation evaluations.

ESULTS: Analysis of the prerotation and postrotation surveyshowed an increase in all measured elements, including knowledge ofBLI (p�.01), ability to assess learning needs (p�.01) and set learn-

ng goals (p�.01), understanding of QI concepts (p�.01), and ex-erience with QI projects (p�.001). Eight QI projects were devel-ped and are in various stages of implementation. Although manyesidents found the development of measurable learning goals to behallenging, the process of identifying strengths and weaknesses en-anced the resident’s self-understanding and contributed to overallatisfaction with the rotation.

ONCLUSIONS: The initial implementation of our PBLI curricu-um demonstrates that residents report personal progress in theirlinical decision making, self-directed learning, and familiarity withuality improvement. This structured PBLI curriculum was acceptedy surgical residents as a valuable part of their training, encouraging

s to continue a directed PBLI experience for PG2 residents.

ISSN 1072-7515/09/$34.00