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Multi-institutional Surgical Education Interventions

A Scoping Review

Salles, Arghavan MD, PhD*; Milam, Laurel MA*; Sevdalis, Nick PhD; Alseidi, Adnan MD, Ed.M; Mellinger, John MD§; Stefanidis, Dimitrios MD||; Nahmias, Jeffry MD, MHPE; Kulaylat, Afif N. MD, MSc**; Kim, Roger H. MD§; Falcone, John L. MD, MS††,‡‡; Arora, Tania K. MD§§; Phitayakorn, Roy MD, MHPE||||; Cochran, Amalia MD, MA¶¶

doi: 10.1097/SLA.0000000000003203

Objective: The aim of the study was to identify and evaluate scholarship in multi-institutional interventional surgical education trials.

Summary Background Data: Most research on interventions in surgical education occurs at individual institutions. These studies typically involve a small number of learners in a unique environment, thereby limiting their generalizability. The status of multi-institutional studies in surgical education remains unknown.

Methods: We searched the Pubmed, ERIC, PsycINFO, SCOPUS, and CINAHL databases for all English language articles published from January 1, 2000 to December 31, 2015 using the keywords “medical education,” “surgical education,” “multi-institutional,” “multi-center,” and related terms. Articles published in an English language peer-reviewed journal that described an educational intervention conducted at more than one institution and involving surgeons were included.

Results: Of 3511 identified articles, 53 met criteria for full-text review and inclusion in this review. The median number of institutional sites was 4, with a range of 2 to 54. The 2 most common areas of focus were technical skills (43% of studies) and clinical knowledge (32% of studies). These were also the 2 most commonly measured outcomes (technical skills 32% of studies, clinical knowledge 21% of studies). Thirteen percentage of studies measured only learner attitudes and perceptions rather than learning outcomes.

Conclusions: Multi-institutional surgical education studies do not uniformly incorporate characteristics of high quality research, particularly related to study design, measurable outcomes, and assessment tools used. Coordinated support, including grant funding, that addresses the challenging nature of multi-institutional surgical education research may improve the quality of these studies.

*Washington University in St. Louis, Department of Surgery, St. Louis, MO

King's College London, Health Service and Population Research Department, London, United Kingdom

Virginia Mason Medical Center, Seattle, WA

§Southern Illinois University School of Medicine, Department of Surgery, Springfield, IL

||Indiana University School of Medicine, Department of Surgery, Indianapolis, IN

University of California, Irvine, Department of Surgery, Orange, CA

**Nationwide Children's Hospital, Ohio State University, Columbus, OH

††Owensboro Health, Department of Surgery, Owensboro, KY

‡‡University of Louisville, Department of Surgery, Louisville, KY

§§Geisinger Health System Department of Surgery, Danville, PA

||||The Massachusetts General Hospital Department of Surgery, Boston, MA

¶¶The Ohio State University Department of Surgery, Columbus, OH.

Reprints: Arghavan Salles, MD, PhD, Washington University in St. Louis, Department of Surgery, 4901 S Euclid Box 8109, Suite 920, St. Louis, MO. E-mail:

Sevdalis’ research is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust. Sevdalis is also a member of King's Improvement Science, which is part of the NIHR CLAHRC South London and comprises a specialist team of improvement scientists and senior researchers based at King's College London. Its work is funded by King's Health Partners (Guy's and St Thomas’ NHS Foundation Trust, King's College Hospital NHS Foundation Trust, King's College London and South London and Maudsley NHS Foundation Trust), Guy's and St Thomas’ Charity, the Maudsley Charity and the Health Foundation. The funding bodies had no input to the content of this study or manuscript. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

The authors report no conflicts of interest.

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