Description and validation of a novel programme for theatre-based surgical education

Abstract

Context and setting The operating theatre (OT) is regarded by students as offering a poor environment for teaching because of its high-stakes nature and the passive role it imposes on the student. These difficulties have been well described, but no definitive solution has been offered. We have therefore developed a novel programme of theatre-based education and validated it in a population of medical students. Why the idea was necessary Our model of theatre education encourages the student to become an active participant in the overall surgical process. This differs from the traditional model, in which the OT is treated as a passive learning environment, which can hinder development and delay the acquisition of clinical skills. What was done Attitudes were assessed using a structured questionnaire (14 questions). This was administered to a sample of Year 4 students (n = 30), who had spent a year in clinical attachments. Responses were recorded using a 5-point Likert scale. Students were supplied with a logbook containing the learning objectives for five common surgical procedures, subdivided into pre-, intra- and postoperative tasks. The student would speak with and examine the patient before the operation and would study the relevant operative details and anatomy before entering the OT the next day. Postoperatively, the student would follow up the patient on the ward. The operative objectives were specific to each procedure, but generally entailed scrubbing in and observing the critical parts of the operation, such as the identification of Calot’s triangle in a laparoscopic cholecystectomy. The study was conducted in a Year 3 medical class who were just starting their clinical attachments. All students were given a lecture at the start of the year regarding the objectives of the surgical attachment. Students were alphabetically assigned into either a control or a study group (n = 32 in each). The control group performed their clinical attachments as normal, whereas the study group were given the logbook. The educational success of the intervention was measured using a true/false questionnaire (TFQ) consisting of 25 questions. The students’ subjective assessments of their experience were recorded using the same survey as in our preliminary study. Students were not told at the beginning of the study that there would be an evaluation, and both groups of students were tested 2 weeks after the completion of the surgical rotation. Evaluation of results and impact The mean Likert score of the Year 4 medical students, an indicator of student satisfaction, was poor, at 29.5 (range: 19–41). Mean Likert scores of the Year 3 students were 29.0 (range: 19–38) for students in the control group and 57.0 (range: 45–60) for students in the study group (p < 0.001). Median TFQ scores for the control and study groups were 58% and 88%, respectively (p < 0.005). This new approach to theatre education helps the student to develop a global appreciation of the surgical patient. Appropriate preoperative preparation and patient interaction help the student to develop links between clinical presentation, investigation, treatment and postoperative care. These links are generic and can be applied to different patients. The results of our study would indicate that this new approach is educationally sound and acceptable to students.