Letter re: Letter to the Editor: Reply to Srihari et al.

To the Editor

We sincerely thank Prahad et al for the interest in our work and for their thoughtful comments regarding our novel, resident-driven curriculum for medical students on the third-year surgical rotation. ¹ The Ask-a-Resident-Topic (ART) cards have indeed had a positive impact on students, in which standardized exam scores have increased following implementation, and, as our group has demonstrated in a previous study, subjectively improved camaraderie between students and residents while also increasing students’ perceived understanding of key general surgery topics. ²

The authors’ comments about the potential correlation between medical student interest in surgery as a career and improved exam scores is an interesting question; however, recent evidence has not shown that correlation to exist. ³ We applaud their preliminary analysis of recent National Resident Matching Program (NRMP) placement data from the University of North Carolina at Chapel Hill. It should be noted that the intervention and control cohorts in our analysis were based on the year in which the surgical rotation was completed rather than the year of graduation. With that, approximately 50% of our participants had not yet matched at the time of data analysis, thereby limiting our ability to compare outcomes based on NRMP placement. As the authors mention, many students at our institution also pursue gap years for continuing education or research, leading to potential crossover in student cohort classification. Additionally, although our data were blinded, future investigations evaluating stratified exam scores based on students’ interest in surgery or placement data would be useful to further address the authors’ hypothesis.

We also agree that a teaching modality, in which students and residents are able to interact more informally, may be mutually beneficial to all participants, including, if not especially for, medical students less interested in pursuing surgery as a career. Studying the potential effects of a similar curriculum in other specialties would be very informative. Clearly, there are many advantages to residents serving as teachers, ⁴ and ongoing development and evaluation of these curricula are required across specialties. Again, we unequivocally appreciate the support and interest in the ART cards and are eager to learn more about innovative teaching modalities at other institutions while expanding the use and evaluation of ART cards.