Rotation as a Course: Lessons Learned from Developing a Hybrid Online/On-Ground Approach to General Surgical Resident Education

Purpose: To improve the consistency and the quality of resident education on clinical rotations, 5 surgical rotations (thoracic, bariatrics, surgical oncology, pediatrics, and critical care) were restructured "as courses" with learning objectives, educational activities (online and on-ground), pretests, posttests, and oral examinations. Setting/Participants: University surgical training program in a large metropolitan area, which serves approximately 65 residents per year. Methods: The online course management system, WebCT/VISTA (Blackboard Inc., Washington, DC), was used to build 5 online course sites. To engage and garner support from faculty, several organizational change tactics and resources were employed, such as Grand Rounds presentations, a faculty retreat, consultation and support from professional staff, and the use of residents as reviewers and codevelopers. To support resident use of the online sites, a designated education coordinator provided individual and group orientation sessions and employed weekly tracking and reminder systems; completion of pretests and posttests was mandated. Results: Between 6 and 8 learning modules were created per rotation, with over 50 reading assignments (collectively) and 45 online presentations. Since July 2006, 53 residents have completed a total of 106 rotations on these services. Preliminary results from a longitudinal study suggest that the hybrid approach is well received and effective when fully executed, but that online course materials are used by residents only if they feel that the faculty members are truly engaged and actively promoting the site. Conclusions: Changing the culture of learning on rotation to include learning objectives, assessment, and integrated online/on-ground activities takes significant leadership, resident input, professional staff support, faculty engagement, and time.