Online endocrine surgery curriculum

David R. Farley, M.D., of the Section of Endocrine Surgery, Department of Surgery, at Mayo Clinic in Rochester, Minn., says: "Recent data suggest many current surgical trainees will likely do fewer operations in their training, see fewer patients, and be placed under the gun less often than their surgical teachers and mentors were during their respective surgical residencies.

"Will less repetition and less practice result in less mastery? Surgery program directors around the country support duty-hour regulations with clear benefits to well-being, family and lifestyle concerns. However, many program directors and surgical educators are nervous the final training product of duty-hour-limited surgical programs may be inferior to graduating chief residents in the past."

Dr. Farley was the director of the General Surgery (GS) Residency Program at Mayo Clinic in Minnesota for 15 years; more than 300 surgical trainees arrived and departed under his watch, and he is anxious but optimistic about future graduates.

Dr. Farley explains: "Although I see a very real possibility of less experience, less depth and less repetitions for surgeons in training, I see great opportunities for improvement. Mayo Clinic has an exceptional GS training program, which includes separate rotations with our four endocrine surgeons. Mayo GS trainees typically graduate in five years having seen, helped with and performed more than 15 parathyroidectomies, 20 thyroidectomies and five adrenalectomies; such volume puts each over the 90th percentile for endocrine surgery experience among U.S. general surgery graduates. A single Mayo endocrine surgery fellow spends an additional full year with endocrine surgeons, endocrinologists, radiologists and pathologists and will participate in more than 200 endocrine operations."

Dr. Farley continues: "The problem boils down to how do you train young physicians to become outstanding surgeons in less time? Clearly using the time spent in the hospital, operating room, clinic, intensive care unit and emergency room more efficiently is important. Additionally, time spent at home or at leisure could be utilized. If teaching and learning became enhanced, greater gains would be possible in less time. If learners came to the operating room better prepared, this would be ideal."

Video training modules

Dr. Farley has created more than 1,100 video clips that are compiled into 18 separate modules on how to perform general surgery operations. Taking whiteboard audiovisual clips that explain relevant anatomy and operative technique and sequentially inserting actual operative clips with voice-over allows surgeons in training to grasp the issues and problems and then watch the procedure unfold. The thyroid, parathyroid and adrenal surgery how-to modules each take about 25 minutes to watch. They are available online 24/7 for all Mayo surgery residents.

Dr. Farley's expectation is that after watching the video, trainees will take a multiple choice exam on the subject and procedure. They must obtain 100 percent correct prior to being allowed to assist in any procedure involving Dr. Farley, who explains: "Our patients deserve a competent trainee assisting with the procedure, and our trainees deserve to be well-prepared and taught before embarking on a stressful procedure with real ramifications."

Early feedback would suggest the pilot project is working well. Dr. Farley highlights: "Trainees love the videos and ask for other staff to generate the same how-to curriculum. As a staff person, I see a more engaged and capable learner. I get less blank stares when asking a question or pondering what the next step might be."

And what if the trainee doesn't get 100 percent on the quiz? Dr. Farley answers: "It hasn't happened yet. The answers are on the video, and trainees can repeat the exam. I just want them more knowledgeable when they operate on our patients."

Preliminary work with online surgical games suggest developing a more interactive curriculum works even better, and Dr. Farley and his research team are developing games to challenge learners in thyroidectomy, parathyroidectomy and laparoscopic adrenalectomy. Dr. Farley concludes: "It is a great time to be a surgical educator and, I hope, to be a surgical resident."