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Junior trainees and medical students cannot be expected to understand what they
necessarily need to know about a specific area of medicine or surgical discipline. It
therefore must fall to the expert educators to determine the baseline needs of these
novice groups of learners. Considering the educational needs of junior trainees may
necessitate the utilization of the Delphi technique to determine the content of the
curriculum.
The Delphi technique is a structured communication process or method which
was originally developed as a systematic interactive forecasting method which
relies on a panel of experts [ 6 ]. It is designed as a group communication process
which aims to achieve a convergence of opinion on a specific real-world issue. It has
been applied to various aspects of educational program development including sur-
gical training programs. Surgical experts review and suggest materials that they
consider critical to the comprehensive training of specific surgical trainees. A facili-
tator, often one of the key surgical experts, provides anonymous summaries of the
expert’s feedback and reasons for their judgments during the process. Thus, experts
are encouraged to revise their earlier contributions in light of the replies and sugges-
tions of other expert members of the panel. During this deliberative process, the
range of suggestions and decisions on educational content will decrease, and the
group will converge toward an agreed consensus. It is important that these same
experts determine not only the content of the curriculum but delineate what is
expected performance or proficiency levels and identify specific errors or unaccept-
able performance and how this should be remediated.
More advanced learners such as senior residents, fellows, and postgraduate sur-
geons should be included in the needs assessment process of curriculum develop-
ment. In this way the specific educational needs of these learners can be identified
and addressed in the development process. Input from these groups can be solicited
with survey questionnaires, small group discussions, and from curriculum evaluation
of existing educational programs or courses. Addressing the specific educational
needs of these more advanced groups of learners will ensure that they will be fully
engaged in the curriculum and complete the learning material or skills training.
Residency training programs themselves may identify specific educational needs
for their residents and tailor their training programs accordingly. Continual feed-
back from residents will assist in creating a relevant educational curriculum and
identify specific areas within the learning program that may require special atten-
tion or new learning material. Finally the public and patients can provide a valuable
mechanism for creating curriculum revision or change. It is this area of educational
need that results in the development of best practice statements and guidelines by
organizations such as the American Urological Association (AUA) [ 7 ]. However,
patient survey feedback on resident encounters in the hospital or outpatient setting
can give valuable information to educators and help address specific educational
needs, particularly pertaining to nontechnical skills such as communication and
professionalism.
Less resource intensive options for teaching may allow for equally effective learn-
ing by the learners and actually stimulate them to become more active self-directed
learners. As an example, a cadaveric hands-on, robotic surgery teaching laboratory
E.M. McDougall and B. Schwartz