Protected block curriculum enhances learning during general surgery residency training

Arch Surg. 2009 Feb;144(2):160-6. doi: 10.1001/archsurg.2008.558.


Background: Changes in medical education require a rethinking of our training paradigm. We implemented a protected block curriculum for postgraduate year (PGY)-1 and PGY-2 surgery residents.

Hypothesis: A protected block curriculum promotes adult learning consistent with the 6 competencies.

Design: Prospective static-group comparison with pretesting and posttesting.

Setting: Medical College of Wisconsin, Milwaukee.

Participants: Eight university-based surgical residents (curriculum group) and 8 residents who did not participate in the curriculum (control group).

Main outcome measures: The curriculum occurs during protected time away from clinical activity. Predefined learning objectives and competencies were identified for PGY-1 and PGY-2 residents. Multiple choice examinations were administered to assess knowledge. The first 3 tests of the year in the PGY-2 curriculum were also given to the PGY-3 and PGY-4 and -5 residents for comparison with curriculum residents. In-training examination scores of control and curriculum residents were compared. Surgical and communication skills were assessed using checklist assessment forms. Curriculum residents evaluated the content and delivery.

Results: Pretest and posttest results demonstrated acquisition of knowledge with improved aggregated mean scores from 57.5% to 71.4% for PGY-1 residents and 58.6% to 72.6% for PGY-2 residents. The average curriculum test results were 76.7% for curriculum residents, 56.9% for control residents, and 57.3% for all residents. The 2-year average in-training scores were 71.2% for curriculum and 60.3% for control residents. Assessments demonstrated improvements in communication and surgical skills.

Conclusions: A protected block curriculum enhanced surgical residents' learning compared with a traditional model. Improvement in medical knowledge was easiest to measure, but performance in other Accreditation Council for Graduate Medical Education competency areas also demonstrated improvement.

MeSH terms

  • Adult
  • Clinical Competence
  • Communication
  • Curriculum*
  • General Surgery / education*
  • Humans
  • Internship and Residency / organization & administration*
  • Learning
  • Models, Educational*