SOURCE is proud to be a world leader in the area of evidence-based surgery (EBS). An exciting project is underway that serves SOURCE’s goals to increase awareness of the importance of evidence-based surgery among surgeons and to increase the dissemination of surgical outcomes research findings. This project is the evidence-based surgery article series.

The aims of the series are to:

• Introduce members of the surgical community to the concepts of evidence-based surgery
• Pique surgeons’ interest in using an evidence-based approach in clinical practice
• Reinforce the need for surgeons to get involved in surgical research

It is a recognised problem in surgical circles that randomized trials are more difficult to perform in surgery than medicine, thus, most of the clinical research published in surgery is low-level evidence. Both the volume of high-quality clinical research in surgery and the uptake of research that is published are hampered by the fact that many surgeons have not developed the tools or the “know-how” to critically appraise evidence. This series will facilitate transfer of these skills to the surgical community.

Members of SOURCE from various subspecialties are producing articles modelled on, and supported by, the successful, world-renowned Evidence Based Medicine Journal of the American Medical Association (JAMA) article series, led by Drs. Cook, Guyatt and Sackett from the Department of Health Research Methods, Evidence and Impact (HEI), McMaster University. Many surgeons are still unfamiliar with the JAMA series, partially because of its publication in a medical rather than a surgical journal and also because the articles are focused around case scenarios, which have all been medical rather than surgical problems. The SOURCE series articles are focused around a surgical clinical scenario with the appropriate methodology reviewed and discussed as it applies to using research in surgical practice. To date, manuscripts have been published in the areas of therapy, diagnosis, economic analysis, volume outcomes, literature searches and systematic overviews, with practical examples drawn from the fields of head and neck, thoracic, orthopedics, plastic and general surgery.

Published in Canadian Journal of Surgery:

• Archibald S, Bhandari M, Thoma A. Users’ guides to the surgical literature: how to use an article about a diagnostic test. Can J Surg 2001; Vol 44(1): 17-23. Corrections for this article found in Vol 44(6): 467.
• Urschel J, Tandan V, Miller J, Goldsmith C. Users’ guide to evidence-based surgery: how to use an article evaluating surgical interventions. Can J Surg 2001; Vol 44(2): 95-100.
• Thoma A, Tandan V, Sprague S. Users’ guide to the surgical literature: how to use an article on economic analysis. Can J Surg 2001; Vol 44(5): 347-54.
• Hong D, Tandan V, Goldsmith C, Simunovic M. Users’ guide to the surgical literature: how to use an article reporting population-based volume-outcome relationships in surgery. Can J Surg 2002; Vol 45(2): 109-15.
• Birch D, Eady A, Robertson D, De Pauw S, Tandan V. Users’ guide to the surgical literature: how to perform a literature search. Can J Surg 2003; Vol 46(2): 136-41.
• Bhandari M, Devereaux PJ, Montori V, Cinà C, Tandan V, Guyatt GH. Users’ guide to the surgical literature: How to use a systematic literature review and meta-analysis. Can J Surg 2004, 47(1); 60-7.
• Thoma A, Farrokhyar F, Bhandari M, Tandan V. Users’ guide to the surgical literature: how to assess a randomized controlled trial in surgery. Can J Surg 2004; Vol 47(3): 200-8.
• Birch D, Goldsmith GH, Tandan V. Users’ guide to the surgical literature: Self audit and practice appraisal for surgeons. Can J Surg 2005; 48(1): 57-62.
• Mastracci TM, Thoma A, Farrokhyar F, Tandan VR, Cina CS. Users’ guide to the surgical literature: how to use a decision analysis. Can J Surg 2007; 50(5): 403-409.
• Thoma A, Cornacchi SD, Lovrics PJ, Goldsmith CH. Users’ guide to the surgical literature: how to assess an article on health-related quality of life. Can J Surg 2008; 51(3): 215-224.
• Cadeddu M, Farrokhyar F, Thoma A, Haines T, Garnett A, Goldsmith CH. Users’ guide to the surgical literature: how to assess power and sample size. Can J Surg 2008; 51(6):476-82.
• Hansebout R, Cornacchi SD, Haines T, Goldsmith CH. Users’ guide to the surgical literature: how to use an article on prognosis. Can J Surg 2009; 52(4):328-36.
• Dijkman B, Kooistra B, Bhandari M. Users’ guide to the surgical literature: how to work with a subgroup analysis. Can J Surg Accepted for publication Feb 2009.

Free copies of the articles are available from the Canadian Medical Association.

SOURCE has developed an interactive evidence-based surgery (EBS) workshop based on the Users’ Guides series. The workshop consists of small group tutorials lead by surgeons and researchers with formal training in healthcare research methodology. The workshops have been designed as an interactive forum where learners have the opportunity to ask questions and work together as a group.

Upon completion of the workshop, participants will have an understanding of evidence based surgery and its importance in day-to-day practice. Participants will be taught how to:

1. Define clinical problems and perform literature searches in order to identify the best evidence from surgical literature
2. Accurately interpret and evaluate this evidence
3. Apply this research evidence to clinical situations.

SOURCE held its first EBS workshop at the 5th Annual SOURCE Research Retreat in February 2001. The second EBS workshop was held at an international venue – as the opening plenary session for the 37th Congress of the International College of Surgeons (ICS) (Orlando, Florida, USA) in July 2001. The ICS Congress Continuing Education Committee gave our workshop proposal an expedited review and was excited to have EBS as the opening (plenary) session for the conference. This workshop was also successful. All of our participants gave our opening didactic session, small group sessions and tutors high praise in their written evaluations. SOURCE also held an EBS workshop for its members at the 6th Annual SOURCE Research Retreat held in February 2003. Our EBS workshop was also accepted as a postgraduate course at the Canadian Surgery Forum on September 19, 2002. This conference is sponsored by the Canadian Association of General Surgeons (CAGS) and is attended by general surgeons from across Canada (community and rural surgeons, as well as academic), providing national exposure for our workshop. SOURCE EBS tutors also tutored a half-day EBS workshop on the topic of economic analysis at the “Current Practices in Urology” Conference held February 7, 2004 in Quebec City.

SOURCE also held a series of nine EBS workshops over 2002-04 as part of the core curriculum for the McMaster University surgical residents. We recently held EBS workshops for the faculty in the Department of Surgery at McMaster on the topics of economic analysis (November 29, 2006), randomized controlled trials in surgery (May 9, 2007), health-related quality of life (January 10, 2008) and on the topic of systematic reviews and meta-analyses (February 11, 2009).

Our evidence-based surgery workshops are designed to provide participants with hands-on experience of the health research methodology, including defining a research question, literature searching and developing a clear, answerable clinical research question. During these small group, problem-solving, interactive sessions participants learn to critically appraise specific research study design surgical articles and learn whether or not you should apply their findings to your patients.

The workshop topics are presented in a way that mirror the research process trajectory. A few examples of the topics reviewed during our past workshops include, but are not limited to:

• Randomized Controlled Trials
• Power and Sample Size
• Systematic Review and Metaanalysis
• Diagnosis
• Health-Related Quality of Life
• Case Series and Case Reports
• Clinical Practice Guideline

• Newswire (Canada)
• British Medical Journal
• Canadian Institute for Health Information
• Royal College of Physicians and Surgeons of Canada
• Canadian Medical Association
• Health Canada
• International Clinical Epidemiology Network
• PubMed of National Library of Medicine
• Statistics Canada
• Canadian Society of Plastic Surgeons