Abstract
Objectives: Our objective is to highlight a few surgical practices that are not based on evidence but are still taught in surgical education, and to assess our experience with these practices. Design: We identified 3 practices (clamping of nasogastric tubes before removal, bowel preparation before elective colon resection, and elective sigmoid colectomy following 2 bouts of diverticulitis), identified the data supporting each practice, and administered a survey to faculty and residents at our institution. Setting: Wright State University Department of Surgery, Boonshoft School of Medicine, Dayton, Ohio. Participants: Twenty-one faculty and 35 residents responded to the survey. Results: No studies were found relating to clamping nasogastric tubes before removal. Seven faculty (33%) and 11 residents (31%) used this practice. Two faculty (10%) and 0 residents felt this was an evidence-based practice. Faculty were more likely to have reviewed the evidence (85% vs 40%, p < 0.001). Level 2 evidence has shown bowel preparation did not improve outcomes relating to anastomotic leak, wound infection, or septic complications in elective colon resection. Twenty faculty (95%) and 34 residents (97%) used this practice. Faculty were more likely to believe this to be evidence-based (85% vs 49%, p = 0.01). There has been no level 1 or 2 evidence showing that sigmoid colectomy following 2 bouts of diverticulitis improves morbidity or mortality. Fourteen faculty (70%) and 26 residents (76%) reported using this practice. Twelve faculty (60%) and 21 residents (60%) felt this was evidence-based. Conclusions: Frequent use of surgical practices without evidence support can create a misperception that such practices are evidence-based. Faculty are more likely to change a practice after obtaining continuing medical education, suggesting that residents may need validation by faculty practice of evidence-based procedures before incorporation into their clinical care.
Original language | English (US) |
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Pages (from-to) | 281-284 |
Number of pages | 4 |
Journal | Journal of surgical education |
Volume | 66 |
Issue number | 5 |
DOIs | |
State | Published - Sep 2009 |
Externally published | Yes |
Keywords
- Medical Knowledge
- Practice-Based Learning and Improvement
- Systems-Based Practice
- diverticulitis
- evidence-based medicine
- mechanical bowel preparation
- nasogastric tube
- surgical education