The Surgical Clerkship: A Contemporary Paradigm

Abstract

Introduction: Traditional Surgical clerkships have been composed of a mixture of hospitalized patients, daily resident interaction, periodic attending rounds, and assigned texts, often augmented by lectures. Recently, academic research has challenged the underpinnings of this traditional curriculum. Moreover, traditional clerkships do not necessarily mirror today's surgical practice given its increasing short-stay and out-patient emphasis. Initiated in 2001, the allopathic Florida State University College of Medicine provided an opportunity to create a contemporary surgical curriculum, emphasizing learning rather than teaching. Methods: The eight week FSU surgical clerkship is a tutorial model. at each of our six regional campuses, students are assigned one-on-one to a carefully selected, board-certified community surgeon, responsible for daily in-patient and out-patient teaching. the academic spine for the rotation is provided by a central curriculum, containing defined objectives and competencies, administered during weekly meetings with the student by campus-specific surgical clerkship directors. Residents do not participate in student teaching, nor are lectures used. Students are free to choose from among suggested print materials or alternative learning sources. Patient contacts are entered into an electronic data collection system, capable of comparing both student and individual campus experiences. Evaluations of student performance are 360 degrees: by patients, staff, clerkship faculty, and clerkship directors. Results: to date, 456 students have graduated. No significant differences exist between campuses with respect to either the numbers or types of patients encountered. USMLE Step II CK and CS scores, or NBME Surgery Subject Examination scores (p>.05). Student satisfaction with the course is evidenced by exceptionally positive responses to the end-of-clerkship evaluations of both faculty and clerkship at each of the campuses, and by anonymous laudatory responses by graduating seniors to the AAMC GQ Survey. Overall, 23.3% of graduates have chosen some aspect of Surgery as a career. the community faculty retention rate exceeds 97%. Conclusions: 1) A quality clerkship experience in Surgery can be provided by a non-traditional community-based system, 2) the distributed campus model does not lead to inequality of learning opportunities or surgical experiences, 3) Both students and community faculty strongly support the tutorial model, 4) Student learning has been confirmed by national metrics.