Out of Touch: A Nationwide Mixed-Methods e-Learning Needs Assessment of General Surgery Residents

Abstract

Introduction: The digital age has transformed health professions education, making online learning (e-learning) essential for instruction, assessment, and evaluation. However, general surgery residents are dissatisfied with current study methods and routines. As they progress through the new Entrustable Professional Activities (EPA) milestones, adapting content delivery to their learning preferences is crucial for engagement, a key element in the Kirkpatrick training evaluation model. This study explores general surgery residents' experiences, attitudes, and preferences toward e-learning to enhance instruction in the EPA era of surgical education.

Methods: We used a convergent parallel design, distributing a national survey and conducting semi-structured interviews with general surgery residents from 22 U.S. institutions. The survey examined e-learning resource utilization, satisfaction, and financial investment in medical school and residency. Interviews provided insights into residents' desired features of effective e-learning. Data analysis included comparative statistics for survey results and reflexive thematic analysis for interviews.

Results: The survey was completed by 106 general surgery residents. Residents reported higher satisfaction with e-learning resources utilized in medical school (e.g., UWorld, Sketchy Medical) than those in residency (e.g., TrueLearn, SCORE Web Portal) (mean difference = 0.4, 95% CI = [0.3,0.5], p < 0.001). Learners' financial investment in USMLE preparation was significantly higher than for ABSITE (74% vs. 21% willing to spend >$500; p < 0.001). Separately, 30 general surgery residents participated in semi-structured interviews, which highlighted preferences for mobile learning, multimedia, gamification, and competency-based assessments. Residents noted a gap between current e-learning resources and the EPA assessment paradigm.

Conclusions: General surgery residents find current e-learning resources in residency lacking clinical relevance and alignment with competency-based assessments. In the EPA era of surgical education, there is a need to develop innovative e-learning platforms that prepare residents for standardized examinations and support clinical competency development. Addressing these gaps will enhance the quality and efficiency of surgical training to better prepare residents for independent practice.

Keywords: Online learning; competency-based education; digital age; e-learning; entrustable professional activities; surgical education.