Abstract
Background
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.
Methods
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.
Results
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.
Conclusion
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.
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Acknowledgements
The authors would like to thank the following colleagues for participating at both Delphi Rounds and/or assisting during the adaptation process of the Delphi statements: Dan Beral, Consultant Colorectal Surgeon and Associate Director of Education (Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust); Ricky Harminder Bhogal, PhD, FRCS (The Royal Marsden Hospital; Institute of Cancer Research); Professor Richard Raymond Brady (Ulster University School of Medicine, Derry/Londonderry, United Kingdom); Antonia Durham-Hall, Consultant Colorectal Surgeon and Training Programme Director (Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust); Rina George, Consultant Colorectal Surgeon and Lead for National General Surgery Teaching Programme, (Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust); Mr Christian Macutkiewicz (Manchester University NHS Foundation Trust), President of the Association of Surgeons of Great Britain and Ireland; Professor Andrei Mihailescu, MD, MSc, PhD, AdE FRCS England, Consultant General/Emergency Surgeon (Tameside General Hospital, Tameside and Glossop Integrated Care NHS Foundation Trust); Harjeet Singh Narula, Consultant Colorectal Surgeon and Training Programme Director (Chesterfield Royal Hospital, United Kingdom); Mr Chetan Parmar (Department of Surgery, Whittington Hospital, London, UK; Department of Targeted Interventions, University College London, London, UK); Mr Adam Peckham-Cooper, BSc(Hons), MBChB, MD, FRCS, MTSTEd, Consultant Emergency General Surgeon (Leeds Institute of Emergency General Surgery, Leeds Teaching Hospitals NHS Trust); Mr Peter Adam Rees (Manchester University NHS Foundation Trust; The University of Manchester); Mr Paul Robinson, Consultant General Surgeon (University Hospital Southampton NHS Foundation Trust); Miss Chandeena Roshanlall (East Cheshire NHS Trust); Mr Christopher Thompson (Sandwell and West Birmingham Hospitals NHS Trust); Mr Manuk Wijeyaratne (Royal United Hospitals Bath NHS Foundation Trust); Mr Tim Wilson, Consultant Colorectal Surgeon and Honorary Clinical Lecturer (Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust and University of Sheffield); and Professor Lynda Wyld (University of Sheffield, United Kingdom).
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The primary researcher (ET) is a self-funded PhD student at the University of Sheffield, working as a clinical research fellow at Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust.
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Ethics approval has been obtained by the School of Medicine and Population Health Ethics Committee, University of Sheffield, United Kingdom (Reference Number 065891) and the study was conducted in accordance with the ethical principles of the Declaration of Helsinki. All authors have consented to publication of this manuscript. All acknowledged participants have provided their consent for their name to be in the acknowledgements section.
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Tokidis, E., Balasubramanian, S.P. & Vivekananda-Schmidt, P. Integrating evidence-based medicine into UK general surgical training: a modified Delphi consensus study. BMC Med Educ (2026). https://doi.org/10.1186/s12909-026-10187-w
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DOI: https://doi.org/10.1186/s12909-026-10187-w