Transition to Residency: The Successful Development and Implementation of a Nonclinical Elective in Perioperative Management

Abstract

Few medical school programs in Canada address challenges related to the significant increase in responsibility for patient care between medical school and residency. This is particularly important in surgery and anesthesia due to the high-acuity care required during the perioperative period. The purpose of this study was to develop and assess a program that would help students transition to surgical and anesthesia residencies, in terms of knowledge acquisition, clinical decision-making skills, and subjective preparedness. The authors developed a 1-week nonclinical Perioperative Management Elective for students matching to surgical or anesthesia residencies. Clinical decision-making training was incorporated using a simulated pager called the MedsOnCall Pager app. A study was conducted to evaluate knowledge acquisition and development of clinical decision-making skills in students completing the elective. A mixed-effects model analysis of the proportion of pages answered correctly during the elective was used as a marker of their progression. Students were asked to complete entry and exit questionnaires to provide subjective information regarding their elective experience. The study ran for 2 iterations of the elective in 2016 and 2017 at the University of Ottawa. A total of 20 University of Ottawa fourth-year medical students completed the elective. There was a significant increase in the proportion of correctly answered pages over the course of the elective week (p = 0.04). Results from entry and exit questionnaires revealed that students felt more knowledgeable, comfortable, and prepared for residency after completing the elective (p < 0.001). The Perioperative Management Elective has completed 2 successful iterations with confirmed knowledge acquisition and improved clinical decision-making skills among elective students. Participating students perceived that the experience was beneficial and fulfilled a gap in their medical school training. We believe that this elective framework could be employed by other schools to help graduating students' transition smoothly into residency.