Contribution of final-year medical students to operation room performance—economical and educational implications

Abstract

The so-called "practical year" is the last part of medical students' education in Germany. Without being paid, final-year medical students have to work for 1year under supervision in academic teaching hospitals. It is mandatory for every student to rotate to a surgical department for 4months. The aim of the present study was to assess the working time contribution of final-year medical students on operation room performance at the surgical department of a university hospital. Over an 8-year period, purely surgical times of 24,214 operations in 2,792days were analyzed with special regard to final-year medical students' participation rate. Students' cumulative workload in the operating room was compared to that of surgical residents. Mean participation rate of final-year medical students was 47.8%, being higher in elective surgery than in emergency surgery (53.9% vs. 24.7%; p < 0.001). When students participated in operations, mean daily cumulative working time of student's cohort was 10.3 ± 0.12h. Daily cumulative workload of medical students in the operating room strongly correlated with both medical doctors' cumulative workload (r (2) = 0.573) and daily workload of the team (r (2) = 0.740, p < 0.001 each). Final-year medical students assisted significantly more often in time-consuming operations. Final-year medical students contribute significantly to surgical operation room performance, similarly but less intensively than residents. Employment of students may counterbalance staff shortage in operating rooms. Therefore, it is likely that the German health care system relies on unpaid medical students to minimize the total cost of surgery. According to the extent of workload accomplished by final-year medical students, a remuneration of the "practical year" seems reasonable.