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Ann Thorac Surg 2001;71:339
© 2001 The Society of Thoracic Surgeons
a Department of Thoracic Surgery, Johns Hopkins Hospital, Osler 624, 600 N Wolfe St, Baltimore, MD 21287-5674, USA
In this paper by Urschel and colleagues, the authors evaluate the rate of change of knowledge in general thoracic surgery to extrapolate recommendations regarding thoracic residency education. Specifically, the authors cite two contrasting teaching techniques—traditional, based on "fundamental knowledge," and evidenced-based learning. The paper is very timely as our specialty is currently in the process of both standardizing our thoracic surgical residency curriculum and making it widely available through the Internet.
The authors selected the lead articles in The Annals of Thoracic Surgery over a 33-year period (1965 to 1997), abstracted them into a summary form, and had them reviewed by 6 thoracic surgeons who rated the topics on their current validity. The format of this study is essentially the same as that used by Hall and Platell [1] who previously evaluated the evolution of general surgical knowledge. The methods do not specify who generates the summary statements. The authors found that the absolute change in validity scores changed only slightly over the 33-year study period. They conclude that because the rate of change of knowleldge is slow, continued use of traditional thoracic surgical teaching methods is justified.
These conclusions must be viewed wth the following reservations. The first concerns the study’s methodology. The authors selected The Annals for their database because it is a journal that "broadly serves the need of the thoracic surgical community." However, the competitive selection process and the high quality of papers that are published in The Annals might select for work that would be more likely to stand the test of time. In addition, a 33-year study period is really quite short when evaluating historical trends. This particular period (1965 to 1997) was a time when thoracic surgery was largely dominated by cardiac surgery and may not be representative of the overall rate of change of knowledge in thoracic surgery. The authors assume that the rate of change of knowledge is constant or linear. Historically, it seems more likely that change occurs gradually for periods of time punctuated by rapid changes secondary to new techniques, products, and technology. Perhaps the authors have only identified a plateau period in thoracic surgical knowledge. The second reservation concerns the authors’ implied bias in favor of traditional teaching methods. This is reflected in their descriptions of the two teaching methods. Traditional methods are based on "existing surgical dogma, personal experience, recommendations of surgical authorities, and thoughtful application of surgical basic sciences." In contrast, evidence-based teaching has "devalued the acquisition of fundamental medical knowledge." I do not agree with the authors’ assessment that traditional and evidence-based teaching are separate and unrelated methods. In my opinion, evidence-based teaching provides a methodology by which traditional knowledge and experience in thoracic surgery can adapt and evolve in response to changes influencing clinical practice.
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