title: Distance learning improves attainment of professional milestones in the early years of surgical training.
abstract: OBJECTIVE
  To assess the impact of a surgical sciences e-learning programme in supporting the academic development of surgical trainees during their preparation for professional examination.
  
  
  BACKGROUND
  In 2007, a 3-year online part-time Master of Surgical Sciences (MSc) degree programme was launched, utilizing an innovative platform with virtual case scenarios based on common surgical conditions addressed by the curriculum relating to the Membership Examination of the Royal Colleges of Surgeons (MRCS). Multiple-choice questions with feedback and discussion boards facilitated by expert clinical tutors provided formative assessment. Summative assessment comprised written examination at the end of each of the first 2 years (equivalent to MRCS level), culminating in submission of a research dissertation in year 3 toward an MSc.
  
  
  METHODS
  Students' age, gender, and level at entry to the programme were documented. Anonymized student feedback from 2008 to 2012 was examined using online questionnaires, and performance in the MSc programme was compared to MRCS examination outcomes for students who had consented to release of their results.
  
  
  RESULTS
  A total of 517 surgical trainees from 40 countries were recruited over the 6-year period, and 116 MSc students have graduated to date. Of 368 students, 279 (76%) were foundation doctors (interns) and had not commenced formal surgical training on enrolling in the MSc programme. However, level at entry did not influence performance (P > 0.05 across all 3 years). Average pass rates since the programme launched, for those students completing all of the required assessments, were 84% ± 11% in year 1, 85% ± 10% in year 2, and 88% ± 7% in year 3 of the MSc programme. MSc students had significantly higher MRCS pass rates than nonenrolled trainees (67% vs 51%, P < 0.01, n = 352). There was a significant correlation between MRCS examination performance and overall performance in the MSc (R = 58%; P < 0.01, n = 37). Of 248 respondents, 202 (81%) considered that the MSc would improve their chances of gaining a surgical training post, and 224 (90%) would recommend the programme to their peers.
  
  
  CONCLUSIONS
  The online MSc programme supports academic development of trainees in the early years of surgical training, is well received by students, and is associated with improved success in their professional examination.
authors.affiliation: Department of *Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh †Department of Anaesthetics, Royal Infirmary of Edinburgh ‡Learning Technology Section, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland.
authors.forename: Paula J W
authors.initials: PJ
authors.lastname: Smith
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Wigmore
authors.forename: Anna
authors.initials: A
authors.lastname: Paisley
authors.forename: Peter
authors.initials: P
authors.lastname: Lamb
authors.forename: Jennifer M J
authors.initials: JM
authors.lastname: Richards
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Robson
authors.forename: Erica
authors.initials: E
authors.lastname: Revie
authors.forename: Dermot
authors.initials: D
authors.lastname: McKeown
authors.forename: David
authors.initials: D
authors.lastname: Dewhurst
authors.forename: O James
authors.initials: OJ
authors.lastname: Garden
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003479:Curriculum; D020375:Education, Distance; D004521:Educational Measurement; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D008297:Male; D006113:United Kingdom
references.citation: Med Teach. 2008;30(2):155-8
references.pmid: 18464139
references.citation: Postgrad Med J. 2011 Dec;87(1034):795-9
references.pmid: 21984742
references.citation: Surgeon. 2011;9 Suppl 1:S6-7
references.pmid: 21550000
references.citation: Surgeon. 2011;9 Suppl 1:S8-9
references.pmid: 21550001
references.citation: J Surg Educ. 2010 Sep-Oct;67(5):283-9
references.pmid: 21035767
references.citation: J Am Coll Surg. 2008 May;206(5):804-11; discussion 811-3
references.pmid: 18471701
references.citation: Health Info Libr J. 2005 Dec;22 Suppl 2:20-32
references.pmid: 16279973
references.citation: BMJ. 2011 Mar 22;342:d1580
references.pmid: 21427046