Medical student surgical proficiency and confidence on the core surgical clerkship

Abstract

We investigated how students’ surgical self-proficiency and self-confidence changed during the core surgical clerkship to better understand how students learn in the operating room (OR), which receives mixed reviews as a medical student learning environment. Student demographics, self-rated ability to perform a set of core proficiencies for a common operation, and self-confidence in the OR were assessed at three clinical sites at the beginning and end of the core surgical clerkship. Self-proficiency and self-confidence metrics were created with maximum scores of 72 and 45, respectively. Pre- and post-clerkship scores were compared and analyzed for associations with student demographics. 103 (89%) students completed the pre-clerkship survey and 74 (64%) completed the post-clerkship survey. Mean self-proficiency and confidence scores significantly increased by the end of the clerkship (p < 0.001). Before the clerkship, female students (n = 46) had lower mean proficiency (20.9 ± 7.6 vs. 28.3 ± 13.1, p = 0.001) and confidence (22.5 ± 5.1 vs. 27.5 ± 5.4, p < 0.001) scores, were less likely to feel comfortable in the OR [adjusted odds ratio (95% confidence interval) 0.19 (0.07–0.54)] and to view the OR as a supportive learning environment [0.18 (0.06–0.59)], and more likely to feel anxious [3.17 (1.33–7.53)]. No significant post-clerkship gender-based differences were observed. Students with more pre-clerkship surgical experiences had higher mean proficiency (29.5 ± 11.6 vs. 19.9 ± 9.4, p < 0.0001) and confidence (27.0 ± 6.0 vs. 22.9 ± 4.9, p = 0.0003) scores, as well as a higher likelihood of feeling comfortable in the OR [adjusted odds ratio (95% CI) 7.14 (2.53–20.14)] and a lower likelihood of feeling anxious [0.32 (0.10–0.98)]. Students’ self-rated proficiency and confidence increased significantly throughout the clerkship, though various factors such as gender and prior OR experience influence baseline levels and may represent important targets for intervention.