title: The reflective statement: a new tool to assess resident learning.
abstract: OBJECTIVE
  Continued assessment and redesign of the curriculum is essential for optimal surgical education. For the last 3 y, we have asked the residents to reflect on the previous week and describe "the best thing" they learned. We hypothesize that this statement could be used to assess the weaknesses or strengths of our curriculum.
  
  
  METHODS
  Starting in 2007, residents filled out surveys approximately 4 times/y at the start of a mandatory conference. They were asked to describe the "best thing" they learned that week, where it was learned, and who taught it. Residents were not asked to classify the item learned by core competency (communication, knowledge, patient care, practice-based learning, professionalism, and systems-based practice). This categorization into core competencies was done as part of our study design. Attending, fellow, resident, or other were used as groups designating who taught each item. Where the item was learned was fit into either clinic, conference, operating room (OR), wards, or self. The impact of postgraduate year (PGY) level on learning was also assessed. χ(2) analysis was used to compare groups.
  
  
  RESULTS
  During the study period, 304 surveys were completed and returned by 65 residents. The majority of responses came from PGY 1 residents (134, 43%). Patient care and knowledge were the most common core competencies learned. As PGY level increased, learning of professionalism (P = 0.035) increased. A majority of learning was experiential (wards and OR, P < 0.0125). Self-learning and learning in clinic was a minor component of learning (P < 0.0125). Learning on wards (P < 0.001) decreased as residents progressed and learning from the OR (P = 0.002) had the opposite trend.
  
  
  CONCLUSIONS
  Patient care and knowledge are the most frequently cited competencies learned by the residents. Self-learning is not a significant source of learning, and the majority of the learning is experiential. It is not known if this was a sign that there was a lack of self-directed learning or that self-directed learning was not an efficient method of learning. In addition, each PGY level learns differently (teacher and location of learning), perhaps reflecting the different needs and/or structure of each PGY. We believe the reflective statement has been and will be a useful tool to assess our curriculum.
authors.affiliation: Rhode Island Hospital/Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA.
authors.forename: Sean F
authors.initials: SF
authors.lastname: Monaghan
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Blakely
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Richardson
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Miner
authors.forename: William G
authors.initials: WG
authors.lastname: Cioffi
authors.forename: David T
authors.initials: DT
authors.lastname: Harrington
mesh_terms: D003479:Curriculum; D004521:Educational Measurement / Q000379:methods*; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D007858:Learning