title: A Learner-Created Virtual Patient Curriculum for Surgical Residents: Successes and Failures.
abstract: OBJECTIVE
  To determine the feasibility and effectiveness of a learner-created virtual patient (VP) curriculum for postgraduate year 2 surgical residents.
  
  
  METHODS
  Using a social-constructivist model of learning, we designed a learner-created VP curriculum to help postgraduate year 2 residents prepare for their in-training surgical examination. Each resident was assigned to create a VP curriculum based on the learning objectives for this examination, and VP cases were then disseminated to all residents for completion. To measure the learning effects of the curriculum, participants completed 2 simulated in-training examinations, both at the beginning and at the end of the intervention. Study participants also participated in a focus group and completed an online questionnaire about the perceived learning value of the curriculum.
  
  
  METHODS
  The study was conducted at the McGill University Health Centre, a tertiary care hospital in Montreal, Canada.
  
  
  METHODS
  In total, 24 residents from 7 surgical specialties completed both the pretest and posttest, as well as took part in the creation of a VP curriculum. Of those 24 residents, only 19 residents completed the cases created by their peers, with 7 completing greater than 50% of the cases and 12 completing less than 50%. In all 17 residents responded to the online questionnaire and 11 residents participated in the focus group.
  
  
  RESULTS
  The VP curriculum failed to improve scores from pretest (59.6%, standard deviation = 8.1) to posttest (55.4%, standard deviation = 6.6; p = 0.01) on the simulated in-training examination. Nonetheless, survey results demonstrated that most residents felt that creating a VP case (89%) and completing cases created by their peers (71%) had educational value. Overall, 71% preferred active participation in a curriculum to traditional didactic teaching. The focus group identified time-related constraints, concern about the quality of the peer-created cases, and questioning of the relationship between the curriculum and the Surgical Foundations examination as barriers to the success of the curriculum.
  
  
  CONCLUSIONS
  Despite the fact that a learner-created VP curriculum did not improve scores on a mock in training examination, residents viewed this intervention as a valuable educational experience. Although there were barriers to the implementation of a learner-created curriculum, it is nonetheless important to try and integrate pedagogical concepts into the instructional design of curricula for surgical residents.
authors.affiliation: Division of General Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada. Electronic address: katherine.mckendy@mail.mcgill.ca.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: McKendy
authors.affiliation: McGill Molson Medical Informatics, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Posel
authors.affiliation: Division of General Surgery, McGill University Health Centre, Montreal, Quebec, Canada; McGill Molson Medical Informatics, Montreal, Quebec, Canada; McGill Molson Medical Informatics, Montreal, Quebec, Canada.
authors.forename: David M
authors.initials: DM
authors.lastname: Fleiszer
authors.affiliation: Division of General Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Melina C
authors.initials: MC
authors.lastname: Vassiliou
mesh_terms: D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D004521:Educational Measurement; D017144:Focus Groups; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D016544:Patient Simulation; D016730:Program Development; D011792:Quebec
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; active learning; constructivism; curriculum design; surgical education; virtual patients