Integrating evidence-based medicine into UK general surgical training: a modified Delphi consensus study

Abstract

Recent research has highlighted inconsistent teaching and application of Evidence-Based Medicine (EBM) within General Surgery. Existing international EBM competency frameworks are not tailored to the specific requirements of surgical training, and no specialty-specific curriculum currently exists. This study seeks to establish the stakeholder-agreed competency foundations that could inform future curricular refinements. A modified Delphi study was conducted electronically with surgical educators involved in postgraduate General Surgery training. Participants rated their agreement to 21 adapted statements using a five-point Likert scale and provided commentary. Consensus was pre-defined as ≥ 75% agreement. Quantitative findings were summarised using percentage agreement, medians, and interquartile ranges; qualitative commentary was retained verbatim after round 1 and analysed thematically after round 2 when the study concluded. Thirty-six and twenty-one panellists completed rounds 1 and 2 respectively. Consensus was reached on key EBM competencies including question formulation, evidence retrieval, critical appraisal, and application of evidence in clinical decisions; and on preferred teaching approaches. Qualitative feedback emphasised the value of EBM while identifying feasibility, supervisory capacity, and resource constraints. One statement proposing assessment of EBM through existing Workplace-Based Assessments did not reach consensus across the two rounds. Response stability, supported by panel diversity, consistency and the 58.3% retention rate informed the decision not to proceed to a third round. The study establishes consensus on core EBM competencies for General Surgery. These findings provide a stakeholder-informed foundation for curriculum development and highlight assessment through workplace-based mechanisms as an area that requires further evaluation.