ORIGINAL REPORTS The Road Map to Better Knowledge? Care Pathways as an Educational Tool During Surgical Internship Abubakr Ahmed, MD,* Gaitri Sadadcharam, and Emmet Andrews, MD Department of Academic Surgery, University College Cork (UCC)/National University of Ireland (NUI), Cork University Hospital, Cork, Ireland INTRODUCTION: Changes in medical practice have promoted a culture of standardized care. Care pathways have been proven to raise the quality of clinical care. Their effect as an educational tool has not been evaluated to date. AIMS: To examine the educational role of care pathways in elective surgical admissions during surgical internship and the effect of their introduction on interns’ confidence in performing tasks. METHODS: A questionnaire survey was filled in by interns to determine their confidence in performing different tasks during elective surgical admission and postoperative care. Care pathways were then formulated for the commonest procedures within the Department of Colorectal Surgery. The same interns then repeated the same questionnaire after they were exposed to the care pathways. RESULTS: Thirty interns participated in the study with a 100% response rate. There was statistically significant improvement in tasks performed confidently in 20 out of 21 areas surveyed after the introduction of the care path- ways. The percentage of tasks performed with no con- fidence decreased from 25% to 1% (p o 0.001). CONCLUSION: Care pathways are an effective method to improve the efficiency and confidence of interns in different aspects of surgical care, thereby improving patient safety. They also function as a valuable educational tool to aid interns in the management of patients with complex surgical issues. ( J Surg 70:273-278. J C 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.) KEY WORDS: care pathways, education, elective surgical procedures COMPETENCIES: Patient Care, Practice-Based Learning and Improvement, Systems-Based Practice INTRODUCTION Medical practice around the world is moving towards standardized care to enable all health care providers to deliver consistent, safe, and optimal care to patients. 1 The integration of care pathways in health care services, especially in surgical practice, is essential for the delivery of consistent and reproducible care. 2 This should be placed in an appropriate timeframe, to help patients with specific conditions to progress safely through the clinical experience to positive outcomes. 3 Care pathways have been proposed as a way of encouraging the translation of national guide- lines into local protocols, which has resulted in their subsequent application to clinical practice. 4 They also provide a template for the systematic collection and extraction of clinical data for audit and promoting change in practice. 5 The degree to which they succeed in realizing this potential for improving patient care is still uncertain, but enough evidence exists in their favor to justify more widespread evaluation of their effect. Integrated care pathways—also known as coordinated care pathways or care maps—are task-oriented care plans that detail essential steps in the care of patients with a specific clinical problem and describe the patient’s expected clinical course. 6,7 They also provide a means of identifying the causes of clinical pitfalls before implementation of expected standards, i.e., the ‘‘missing link’’ in audit surveys. 5 It is believed that the primary method required to reorganize patient management is through the develop- ment and implementation of care pathways. 8 The internship year is a critical transitional period in a doctor’s career. There is often a discrepancy between the received medical education and the actual preparation for professional practice. 9 Many studies have described the anxiety during the internship year, with many strategies suggested to deal with this challenge. 10 The move of many colleges toward problem-based learning and transitional *Correspondence: Inquiries to Abubakr Ahmed, MSc, MD, Department of Academic Surgery, University College Cork (UCC)/National University of Ireland (NUI), Cork University Hospital, Cork, Ireland; fax: (353) 21-4901240; e-mail: dr.abubakr@ gmail.com Journal of Surgical Education  & 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved. 1931-7204/$30.00 http://dx.doi.org/10.1016/j.jsurg.2012.11.003 273