All aboard the Wiki train!

I’ll start with a question:

How many of you have heard people throwing around the term “wiki” as a collaboration tool, but have no idea what a wiki actually is?

Yeah, I thought so.  And yes, Wikipedia is a form of a wiki.  The idea behind a wiki is that visitors can easily contribute to a conversation, participate in a dialogue, potentially even edit a collaborative document.   Within our medical school and residency, we use Canvas for our learning management system, and the discussion feature within Canvas provides a form of a Wiki, in which anyone enrolled in the course can start or contribute to a discussion.

I’m a big fan of collaborative learning exercises, although they are admittedly difficult to create for clinical medical students.  I’m also a big fan of participating in asynchronous discussions and learning, as evidenced by my activity on Twitter and the premises underlying our group’s development of the IGSJC.  I spent two years trying to figure out how to get my surgery students to use the Wiki/ Discussion feature in Canvas, and I currently have some hope that I might have cracked the code.  I mean, if my friend Jonathan White can successfully implement Wikis with his students, why can’t I?

When I first wanted to implement the Wiki, I reached out on Twitter and…crickets.  I was unable to easily identify anyone who was routinely using a Wiki in medical education, at least through social media crowdsourcing.  I knew if I “required” Wiki participation, it was destined to fail.  Sure, the students would participate, but if it’s one more mandatory thing, there’s often a certain lack of enthusiasm that goes with it; one study in undergraduate and graduate students showed that a group of students with required Wiki use were ambivalent at best about its value, as opposed to a group for whom it was voluntary.  Knowing that Wikis aren’t yet widely used, I wanted to help the students see what I perceive as the value as a place for discussion and team-based learning.  I tried encouraging the students to post their Power points from their mini-Clinical Pathology Correlation sessions, nothing.  I tried encouraging them to share things they looked up for their specific rotations, and again, nothing.  Honestly, I felt like I was hitting a wall.

Now to air some dirty laundry- last year we had a higher-than-expected (and higher than is acceptable) rate of failure on the NBME Surgery Subject Exam.  It’s an admittedly difficult exam to help students prepare for, primarily because it contains plenty of questions that are, at best, only peripherally related to surgery.  I’ve struggled with how I can better prepare them without teaching to the test, and I realized that the Wiki is my chance!  We’re now using the Wiki for me to post a question (hopefully related to surgery and that they are likely to see content from on their exam) twice a week for them to discuss.  I’ll admit that I am incredibly excited even though I’m only about 6 weeks into the experiment with the participation so far; no, not everyone is talking, but I’m seeing discussion, and I’m seeing students ask each other questions as well.  It’s definitely a start.

So, thoughts on how you are using a Wiki or might use one?  It just makes sense to me, but getting it off the ground has not been easy.  Updates to follow- both on shelf scores AND Wiki success!

The Future of Surgical Education Research

(Note:  Cross-posted from the AAS Blog)

April 10-12 was the annual meeting of the Association for Surgical Education (ASE). This meeting brings together those with a significant interest in surgical education, and the highlight of the ASE meeting is always the level of scholarship that is now being brought to the field of surgical education research. As someone who has been involved with ASE since my residency, and who completed the Surgical Education Research Fellowship (SERF) program over a decade ago, the ever-expanding diversity and depth of education research is exciting and timely. For many years, being a surgical educator mostly implied being a teacher, and for some it also subsumed administrative roles with clerkships or residencies. In more modern terms, being a surgical educator now means that someone is a teacher, an administrator, and a researcher.

Deb DaRosa, a former ASE President and a distinguished PhD surgical educator, provided arguably the most motivational talk of the meeting in which she provided us with a call to advance a more ambitious research agenda in surgical education. She challenged us to work to establish an infrastructure for identifying and studying “mega-trends” in education that require investigation. She encouraged the ASE to have an annual RFP for systematic reviews. Dr. DaRosa also encouraged us to find ways to cultivate extramural funding sources to support critical education research issues. Most importantly, she reminded us of the importance of continuing to improve the scientific rigor and the diversity of methods used in surgical education research. The meeting program certainly reflected an important trend in this direction; in particular, more qualitative research was presented at the ASE this year than in any year to date.

Within the ASE, the Multi-institutional Education Research Group (MERG) is already doing important work in this direction. This group became a “full” ASE committee just one year ago, but has already completed a Delphi process to identify key issues in surgical education that merit multi-institutional studies. The “Top 10” list identified in this manner includes the following items:

  1. What are the performance criteria a resident has to meet to be considered competent and before independent practice is allowed?
  2. Which are the best methods to assess resident performance and competence (intraoperative, and clinical, procedural, and cognitive)?
  3. What are the best milestones and assessment methods to determine if a resident should be promoted to the next PGY year?
  4. What are the most effective methods to improve faculty teaching ability and promote interest in teaching?
  5. What is the level of perceived and actual readiness of graduating residents for independent practice?
  6. Which is the best method to identify and remediate residents with poor cognitive, technical, or behavioral skills?
  7. What is the optimal method to provide intraoperative teaching and feedback to residents and how is it best assessed?
  8. Will the incorporation of the ACGME/ RRC milestones in residency training improve training quality and the skill of graduating residents?
  9. What are the most common deficiencies in the training of general surgery residents and fellows?
  10. Which is the best training modality (simulation, animal or cadaver models, or combination thereof) for the optimal acquisition of surgical skill by residents outside the operating room?


MERG also has a systematic review of multi-institutional surgical education research studies published in the last decade under way, with submission for publication anticipated later in 2014. This group is taking leadership in setting the agenda for surgical education research, and I anticipate ongoing exciting developments through their efforts.


As more links are established between education and patient quality and safety, the interplay of educators with our colleagues in other areas of surgery will become ever more important. This change will also mandate ever-increasing rigor in the study of our educational interventions. This year’s ASE meeting provided an excellent sampler of ways in which surgical education research is becoming a vibrant discipline, and one conducive to a rich academic surgical career.