A Disease-Specific Hybrid Rotation Increases Opportunities for Deliberate Practice.
OBJECTIVE
Incorporating deliberate practice (DP) into residency curricula may optimize education. DP includes educationally protected time, continuous expert feedback, and a focus on a limited number of technical skills. It is strongly associated with mastery level learning.


OBJECTIVE
Determine if a multidisciplinary breast rotation (MDB) increases DP opportunities.


METHODS
Beginning in 2010, interns completed the 4-week MDB. Three days a week were spent in surgery and surgical clinic. Half-days were in breast radiology, pathology, medical oncology, and didactics. The MDB was retrospectively compared with a traditional community rotation (TCR) and a university surgical oncology service (USOS) using rotation feedback and resident operative volume. Data are presented as mean ± standard deviation.


METHODS
Oregon Health and Science University in Portland, Oregon; an academic tertiary care general surgery residency program.


METHODS
General surgery residents at Oregon Health and Science University participating in either the MDB, TCR or USOS.


RESULTS
A total of 31 interns rated the opportunity to perform procedures significantly higher for MDB than TCR or USOS (4.6 ± 0.6 vs 4.2 ± 0.9 and 4.1 ± 1.0, p < 0.05). MDB was rated higher than TCR on quality of faculty teaching and educational materials (4.5 ± 0.7 vs 4.1 ± 0.9 and 4.0 ± 1.2 vs 3.5 ± 1.0, p < 0.05). Interns operated more on the MDB than on the USOS and were more focused on breast resections, lymph node dissections, and port placements than on the traditional surgical rotation or USOS.


CONCLUSIONS
The MDB incorporates multidisciplinary care into a unique, disease-specific, and educationally focused rotation. It is highly rated and affords a greater opportunity for DP than either the USOS or TCR. DP is strongly associated with mastery learning and this novel rotation structure could maximize intern education in the era of limited work hours.
Department of Surgery, Oregon Health and Science University, Portland, Oregon. Electronic address: cookmac@ohsu.edu.
Mackenzie R
MR
Cook
Department of Surgery, Oregon Health and Science University, Portland, Oregon.
Amanda N
AN
Graff-Baker
Department of Surgery, Oregon Health and Science University, Portland, Oregon.
Alexis M
AM
Moren
Department of Surgery, Oregon Health and Science University, Portland, Oregon.
Sarah
S
Brown
Department of Surgery, Oregon Health and Science University, Portland, Oregon.
Kelly A
KA
Fair
Department of Surgery, Oregon Health and Science University, Portland, Oregon.
Laszlo N
LN
Kiraly
Compass Oncology, Portland, Oregon.
Violeta Tammy
VT
De La Melena
Department of Surgery, Oregon Health and Science University, Portland, Oregon.
SuEllen J
SJ
Pommier
Department of Surgery, Oregon Health and Science University, Portland, Oregon.
Karen E
KE
Deveney
D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D009922:Oregon; D013043:Specialties, Surgical / Q000193:education*
Interpersonal and Communication Skills; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; autonomy; breast neoplasms; general surgery; graduate medical education; surgery residency training