Use of Wikis and Evidence-Based Medicine in Surgical Practice

The translation of evidence-based medicine (EBM) to clinical practice requires training in literature searching and critical appraisal, which is particularly lacking in surgery. The demands of surgical residency coupled with the 80-hour work week make attendance at journal clubs suboptimal. Internet technology such as wikis, which are free user-friendly collaborative websites, may be a solution to improving resident participation in journal club-related activities, but their utility is highly dependent upon resident contributions and usage. We propose a pilot randomized trial of mandatory versus voluntary participation in a general surgery journal club wiki to verify its feasibility, sustainability, and impact on resident EBM skills as measured with a validated questionnaire. Secondary outcomes will include resident self-assessment of wiki usage and comfort with EBM skills and faculty-assessed resident application of these skills in weekly morbidity and mortality conferences. If the wiki is feasible and sustainable, then the project will be expanded to include other surgical disciplines and cohorts (i.e. students, fellows, other institutions, other medical disciplines) to ensure generalizability. If beneficial, wikis could not only improve resident EBM skills, but also have a halo effect on students and faculty, and ultimately wikis could improve patient care. The assembled multi-disciplinary and multi-institutional team has significant collective expertise in evidence-based medicine, medical education, library skills, and clinical trial design and analysis which are necessary for this project.