A multidisciplinary systems-based practice learning experience and its impact on surgical residency education.

摘要

OBJECTIVE: To design and implement a multidisciplinary systems-based practice learning experience that is focused on improving and standardizing the preoperative quality of care for general surgical patients. DESIGN: Four parameters of preoperative care were designated as quality assessment variables, including bowel preparation, perioperative beta-blockade, prophylactic antibiotic use, and deep venous thrombosis prevention. Four groups of general surgery residents (PGY I-V), each led by 1 chief resident, were assigned a quality parameter, performed an evidence-based current literature review, and formulated a standardized management approach based on the level of evidence and recommendations available. Because preoperative preparation includes anesthetic care and operating room preparation, we presented our findings at the Department of Surgery Grand Rounds in a multidisciplinary format that included presentations by each resident group, the Department of Anesthesia, the Department of Medicine, and the Department of Nursing. The aim of the multidisciplinary quality assurance conference was to present the evidence-based literature findings in order to determine how standardization of preoperative care would alter anesthetic and nursing care, and to obtain feedback about management protocols. To determine the educational impact of this model of integrated systems-based practice quality assessment on the teaching experience, residents were queried regarding the value of this educational venue and responses were rated on a Likert scale. RESULTS: Resident participation was excellent. The residents garnered valuable information by performing a literature review and evaluating the best preoperative preparation given each parameter. Furthermore, integration of their findings into systems-based practice including anesthesia and nursing care provided an appreciation of the complexities of care as well as the associated need for appropriate medical knowledge, communication, and professionalism. The derivation of treatment protocols included an opportunity to incorporate several competencies across multiple disciplines. The residents evaluated 5 questions and deemed the educational exercise an effective model to enrich surgical resident education while simultaneously improving patient care. The residents also strongly agreed that they would participate in similar projects in the future as well as recommend this educational exercise to other residents. A finalized preoperative order set was created and distributed to all residents for use in the preoperative care of general surgery patients. CONCLUSIONS: Our multidisciplinary systems-based practice learning experience focused on improving and standardizing the preoperative quality of care for patients, and general surgery residents were pivotal participants in that process. This exercise had a positive impact on our general surgery residency education program and proved to be a valuable model of systems-based practice competency.