Listening to Learners: A Resident-Driven Approach to Program-Wide Curriculum Reform in General Surgery

Imagine a General Surgery residency program as a massive, high-speed train. The passengers are the residents (doctors in training), and the tracks they travel on are their education. For a long time, this train had three different types of engines running at once: classroom lessons (didactic), practice drills (simulation), and real-world driving (on-rotation). The problem was that the engineers (program directors) were trying to fix the tracks while the train was still moving, and they weren't always sure which tracks the passengers actually needed repaired.

This paper describes how the engineers decided to stop guessing and start listening to the passengers to redesign the entire journey.

The Map They Used: "Kern's Six-Step"

Instead of just making random fixes, the team used a famous blueprint called Kern's Six-Step approach. Think of this like a strict, step-by-step recipe for baking a perfect cake. You don't just throw ingredients in a bowl; you measure, mix, bake, and taste in a specific order. The authors say that while many people know this recipe, few actually follow every single step when trying to fix a whole program.

Step 1: Asking the Passengers (The Focus Groups)

First, the team held "town hall" meetings with the residents. They didn't just ask, "Is the food good?" They asked deep questions about the strengths and weaknesses of all three parts of the training (classroom, practice, and real surgery).

• The Crowd: Out of 75 residents, 70 (93%) showed up to talk. That's a huge turnout!
• The Process: They recorded these conversations, listened carefully, and sorted the complaints and ideas into neat piles (themes).

Step 2: Voting on What Matters Most (The Survey)

Once they had the list of ideas from the town halls, they turned them into a survey. This was like handing out a ballot to the residents to vote on which fixes were most urgent.

• The Vote: 50 residents (67%) cast their votes, giving the team a clear, data-backed "to-do" list.

Step 3: Making the Changes (The Overhaul)

Using the votes, the program made specific, concrete changes to all three "engines" of the train:

1. Classroom Lessons: They reorganized the schedule to follow a specific, proven guide (SCORE-based), making the lessons more logical.
2. Practice Drills: They introduced a new digital system to manage learning and created a strict, standard routine for what happens before and after practice drills (pre- and de-briefing), so everyone knows exactly what to expect.
3. Real-World Driving: They launched a pilot program specifically for the newest residents (PGY-1) to help them navigate their first rotations better.

Step 4: Checking the Results (The Evaluation)

After the changes were in place, the team asked the residents again: "Is the ride better?"

• The Feedback: About 62% of the residents responded.
• The Verdict:
  • Nearly half (48.5%) of those who remembered the old way said the classroom lessons were now better.
  • A strong majority (73.5%) said the practice drills had significantly improved.

The Bottom Line

The paper concludes that when you listen to the people actually doing the work (the residents) and use a strict, step-by-step recipe (Kern's model) to fix the training, you get real results. It wasn't a chaotic guess; it was a systematic, evidence-based renovation that made the whole program smoother and more effective. The authors believe this method is a "blueprint" that other programs can copy to fix their own training systems.