Surgery Clerkship Research Articles

Needs assessment for enhancing pediatric clerkship readiness

BackgroundMany students report feeling inadequately prepared for their clinical experiences in pediatrics. There is striking variability on how pediatric clinical skills are taught in pre-clerkship curricula.MethodsWe asked students who completed their clerkships in pediatrics, family medicine, surgery, obstetrics-gynecology and internal medicine to rate their pre-clinical training in preparing them for each clerkship, specifically asking about medical knowledge, communication, and physical exam skills. Based on these results, we surveyed pediatric clerkship and clinical skills course directors at North American medical schools to describe the competence students should have in the pediatric physical exam prior to their pediatric clerkship.ResultsClose to 1/3 of students reported not feeling adequately prepared for their pediatrics, obstetrics-gynecology, or surgery clerkship. Students felt less prepared to perform pediatric physical exam skills compared to physical exam skills in all other clerkships. Pediatric clerkship directors and clinical skills course directors felt students should have knowledge of and some ability to perform a wide spectrum of physical exam skills on children. There were no differences between the two groups except that clinical skills educators identified a slightly higher expected competence for development assessment skills compared to pediatric clerkship directors.ConclusionsAs medical schools undergo cycles of curricular reform, it may be beneficial to integrate more pre-clerkship exposure to pediatric topics and skills. Further exploration and collaboration establishing how and when to incorporate this learning could serve as a starting point for curricular improvements, with evaluation of effects on student experience and performance. A challenge is identifying infants and children for physical exam skills practice.

Real-Time Student Feedback on the Surgical Learning Environment: Use of a Mobile Application

Improvements to the medical student surgical learning environment are limited by lack of granular data and recall bias on end-of-clerkship evaluations. The purpose of this study was to identify specific areas for intervention using a novel real-time mobile application. An application was designed to obtain real-time feedback from medical students regarding the learning environment on their surgical clerkship. Thematic analysis of student experiences was performed at the conclusion of 4 consecutive 12-week rotation blocks. Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts. Fifty-four medical students at a single institution were asked to participate during their primary clerkship experience. Students submitted 365 responses over 48 weeks. Multiple themes emerged which were dichotomized into positive and negative emotions centered on specific student priorities. Approximately half of responses were associated with positive emotions (52.9%) and half with negative emotions (47.1%). Student priorities included the desire to feel included in the surgical team (resulting in feeling engaged/ignored), to have a positive relationship with members of the team (perceiving kind/rude interactions), to witness compassionate patient care (observing empathy/disrespect for patients), to have a well-planned surgical rotation (experiencing organization/disorganization within teams), and to feel that student well-being is prioritized (reporting opportunities/disregard for student wellness). A novel, user-friendly mobile application identified several areas to improve the experience and engagement of students on their surgery clerkship. Allowing clerkship directors and other educational leaders to collect longitudinal data in real time may allow for more targeted, timely improvements to the medical student surgical learning environment.

Surgical Education: Disparities in Education May Impact the Quality and Likelihood of Completion of Training.

Female surgical trainees experience bias that begins at the preclinical stages of medical school, extending into their surgery clerkships, and then into their residency training. There are important implications in terms of training opportunities and career advancement, mentorship, sponsorship, and ultimately burnout. Childbearing and lactation also impact the experiences and perceptions of female trainees who have children. There are limited interventions that have improved the experience of women in surgical training. Mentorship appears to play an important role in ameliorating some of the negative consequences of the training environment and improving outcomes for women surgeons.

Improving Medical Student Anatomy Knowledge and Confidence for the Breast Surgical Oncology Rotation.

The anatomy curriculum has undergone considerable reductions in class time, resulting in decreased student anatomical knowledge retention and confidence during their surgical rotations. To counter this deficit in anatomy knowledge, a clinical anatomy mentorship program (CAMP) was developed by fourth-year medical student leaders and staff mentors in a near-peer teaching fashion prior to the surgical clerkship. This study analyzed the impact this program had on third-year medical students (MS3s) self-assessed anatomical knowledge and confidence in the operating room on the Breast Surgical Oncology rotation after this near-peer program. A single-center prospective survey study was performed at an academic medical center. Pre- and post-program surveys were administered to all students who participated in the CAMP and rotated on the breast surgical oncology (BSO) service during the surgery clerkship rotation. A control group of individuals who did not rotate on the CAMP was established, and this group was administered a retrospective survey. A 5-point Likert scale was used to assess surgical anatomy knowledge, confidence in the operating room, and comfort in assisting in the operating room. Control group versus post-CAMP intervention group and pre- versus post-CAMP intervention groups survey results were compared using the Student's t-test with a p-value of <0.05 statistically significant. All CAMP students rated their surgical anatomy knowledge (p < 0.01), confidence in the operating room (p < 0.01), and comfort in assisting in the operating room (p < 0.01) as greater than those who did not participate in the program. Additionally, the program improved the ability of third-year medical students to prepare for operating room cases going into their third-year breast surgical oncology clerkship (p < 0.03). This near-peer surgical education model appears to be an effective way to prepare third-year medical students for the breast surgical oncology rotation during the surgery clerkship by improving anatomic knowledge and student confidence. The program can serve as a template for medical students, surgical clerkship directors, and other faculty interested in efficiently expanding surgical anatomy at their institution.

Improvisation to combat sexual harassment on the wards.

In the spring of 2021, medical students at the University of Geneva, Switzerland, conducted a survey amongst their peers concerning sexual harassment during the clinical clerkships. The survey collected multiple testimonies of sexual harassment that occurred during their clinical rotations. These results inspired an awareness campaign against sexual harassment. Knowing that the impact of sexual harassment includes physical and psychological repercussions, burnout, career change and avoidance of learning opportunities, the medical school created a sexual harassment awareness course for medical students before beginning their clinical rotations. Due to the sensitive nature of the subject matter, we decided to use actual testimonies of the campaign as part of the teaching strategy. We sought to create an active learning exercise that would stimulate students to reflect deeply on prevention and response strategies with the purpose of removing students from the role of victim or passive witness. In collaboration with an improvisational theatre troupe, Impro-Impact, we created the course using the extended parallel process model (EPPM) as our conceptual framework.1 This model purports that if one believes that a threat is harmful and that they are at risk, while at the same time they believe in the effectiveness of solutions and have the confidence to practice them, they are more likely to take protective action to avoid or reduce the threat. The course was constructed in five parts: (1) a brief theoretical introduction, (2) a performance depicting the day in the life of a female medical student who experiences sexual harassment on the first day of her surgery clerkship, (3) students formed small groups to debrief the scenarios and to brainstorm potential responses as a victim and as a bystander, (4) the scenes were replayed by the actors using the suggestions of the students, and (5) the course concluded with a presentation of available resources. Feedback from the medical students showed that our initial objective of increasing awareness was attained, but in addition, we learned that this course was able to empower students to speak up about their own experiences, to question the status quo and to give students enough agency to react in these uncomfortable situations. In the first clinical rotation following the course, students in the surgery rotation were able to come forward about incidents of sexual harassment, allowing the medical school to intervene on their behalf. Students were also vocal about the necessity to train faculty in order to bring about a culture change. Two multiple-choice questions asking students to decide upon next steps in a sexual harassment vignette were included in the final exam. Surprisingly, responses to the questions showed that students did not identify medical school faculty as an important resource. Future work will need to focus on ways to increase student confidence in the medical school's response to sexual harassment. The course will occur annually and there are now plans to create similar courses for medical school faculty and other faculties associated with the university. Pauline Hämmerli, Lygia Pavitt and Nadia M. Bajwa designed, constructed, implemented and evaluated the project. Nadia M. Bajwa wrote the draft manuscript. Pauline Hämmerli and Lygia Pavitt revised the manuscript.

Oral 'Board Style' Examination for Surgery Clerkship.

Evaluating medical students during surgical clerkships relies on multifactorial methods of evaluation. Clinical evaluations, combined with standardized multiple-choice exams, are often the foundation of evaluation highlighting the challenge of combining subjective and objective measurements. Oral board exams are standard amongst medical certification and employ an additional element to evaluate students more holistically. Course evaluations from years that incorporated an oral board exam were compared to a year that omitted the exam. We found course satisfaction was higher in the years that included the oral exam (3.25 /5) than years without the oral board exam (3/ 5). The oral exam adds a novel element to the evaluation of a medical student that allows for a comprehensive understanding of a student's fund of knowledge and helps prepare them for future board certifications. Because students have an opportunity to demonstrate knowledge in a standard, more comprehensive format, they have higher satisfaction with the course.

"LEARN", a novel teaching method for Chinese clinical clerkship: A cross-sectional study.

Despite the clerkship being crucial in the training of a future doctor, no widely accepted education model has been proposed. This study devised a new model for clinical clerkship rotations, titled "LEARN" for Lecture, English-video, Advisor, Real-case and Notion, and evaluated whether the LEARN model is appropriate for medical education in China. A cross-sectional study was performed among 101 fourth-year students from the Xiangya School of Medicine during an Orthopaedic Surgery clerkship rotation in the Third Xiangya Hospital. They were divided into seven groups and took clerkship based on the LEARN model. A questionnaire was collected at the conclusion to measure learning outcomes. The LEARN model was highly accepted with the acceptance of five sessions being 95.92% (94/98), 93.88% (92/98), 96.98% (97/98), 100% (98/98) and 96.94% (95/98). The outcomes of two genders were comparable, whereas a difference was observed in the test score among groups (group 3 scored 93.93 ± 5.20, higher than others). Quantitative analysis showed that positive correlations existed in participation in the Notion (Notion means students' case discussion) section with leadership (r = 0.84, 95% CI: 0.72-0.94, p < 0.001), participation in the Real-case section with leadership (r = 0.66, 95% CI: 0.50-0.80, p < 0.001), participation in the Real-case section with mastery of inquiring skills (r = 0.57, 95% CI: 0.40-0.71, p < 0.001) and participation in the Notion section with mastery of physical examination skills (r = 0.56, 95% CI: 0.40-0.69, p < 0.001). Further qualitative analysis demonstrated that high-level participation in the English-video section indicated better outcomes in mastery of inquiring (p < 0.01), physical examination (p < 0.001), film reading (p < 0.01) and clinical reasoning (p < 0.01) skills. Our results support the LEARN model is a promising method for medical clerkship in China. Further research involving more participants and more meticulous design is planned to test its efficacy. For refinement, educators may try to promote students' participation in the English-video session.

Career Choice Disclosure and Clerkship Grades Among Orthopaedic Residency Applicants

Objective Medical student clerkship evaluations are susceptible to preceptor bias. Students interested in orthopaedics may choose not to disclose their career path during clerkships to avoid bias. The purpose of this study was to identify factors that may lead to grading bias, including career choice disclosure, among medical students interested in a career in orthopaedic surgery. Design A cross-sectional survey was performed by distributing an anonymous electronic survey. Respondents were asked if they disclosed an interest in orthopaedic surgery during core clerkships and whether or not they believed it impacted their grade. The relationship between demographic variables including age, gender, race, ethnicity, and geographical location were also collected and compared. Setting Multiple institutions in different geographic locations in the US. Participants Medical students in orthopaedic interest groups or those who completed an orthopaedic surgery rotation. Results Of 149 responses, 90 (60.1%) of students chose to disclose an interest in orthopaedics during all clerkships. Over 50% of students were able to achieve honors in core clerkships except for OB/Gyn (41/112, 36.6% honors) and emergency medicine (17/59, 28.8% honors). On average, 7.9% of students believed disclosure had a negative impact on their grade, but in internal medicine and OB/Gyn, those that disclosed were able to achieve honors more often than those that did not. Males (38/50, 76%) were given honors more often than females (11/24, 45.8%) in their surgery clerkship and those that identified as “other” race (1/6, 16.7%) achieved fewer honors in surgery and pediatrics compared to White, Black, Asian, Indian, and Hispanic students (48/68, 70.6%). Conclusion Some students believe disclosing an interest in orthopaedics may negatively impact their grade, but the opposite may be true. Other potential areas of bias include gender and race. More research is needed to improve the clerkship evaluation process given an increasingly competitive application process.

A 5-Year Update and Comparison of Factors Related to the Sex Diversity of Orthopaedic Residency Programs in the United States.

The American Medical Association Fellowship and Residency Electronic Interactive Database was used to identify all allopathic orthopaedic surgery residency programs during the 2021 to 2022 academic year. The number of female residents and interns; the number of female faculty, professors, and associate professors; and the number of women in leadership positions were compared with data from the academic year 2016 to 2017. Continuous data were analyzed with independent t-tests, and significance was set at p < 0.05. A total of 696 female residents (19.2%) were identified from 3,624 orthopaedic residents, an increase from 13.5% in 2016. Programs in the top quartile of female residents had 3 times the number of female residents per program when compared to other quartiles and almost double the number of female interns per program. Programs in the top quartile of female residents had a significantly greater number of female faculty per program than the lower quartiles; 5.76 vs. 4.18. Compared with 2016 to 2017, there were significant increases in female faculty per program from 2.77 to 4.54 along with female full professors from 0.274 to 0.694. These increases contribute to the overall growth in the number of women in leadership positions per program over the past 5 years to 1.01 from 0.35 (p < 0.001). In the past 5 years, the percentage of female residents has increased from 13.5% to 19.2%. Furthermore, women make up 22.1% of interns. Orthopaedic surgery residency programs with higher percentages of female faculty had higher numbers of female residents. By encouraging programs to promote female representation within leadership and residents, we may continue to see the gap in orthopaedic sex diversity close. III.

The White Coat Ceremony: Welcome to the Medical Profession.

We have written about a number of the transitions, or 'lurches,' that most of us in medicine encounter as we move through the various stages of education and training in our profession. Some of our prior musings have addressed the transition into a Surgery Clerkship or a Surgery externship in the third or fourth years of medical school, respectively, as well as transitions into internship, the senior years of a Surgery residency, and a new job after completing Thoracic Surgery training. [Tribble: 2019, 2021, 2018, 2021, 2022].

The high five: a novel assessment tool for medical student-driven feedback for residents on surgery clerkships

The high five: a novel assessment tool for medical student-driven feedback for residents on surgery clerkships

Surgery Clerkship Directors' Perceptions of the COVID-19 Pandemic's Impact on Medical Student Education.

This study assessed the national impact of the coronavirus disease 2019 (COVID-19) pandemic on the education of medical students assigned to surgery clerkship rotations, as reported by surgery clerkship directors (CDs). In the spring of 2020 and 2021, the authors surveyed 164 CDs from 144 Liaison Committee on Medical Education-accredited US medical schools about their views of the pandemic's impact on the surgery clerkship curriculum, students' experiences, outcomes, and institutional responses. Overall survey response rates, calculated as number of respondents/number of surveyed, were 44.5% (73 of 164) and 50.6% (83 of 164) for the spring 2020 and 2021 surveys, respectively. Nearly all CDs (more than 95%) pivoted to virtual platforms and solutions. Most returned to some form of in-person learning by winter 2020, and prepandemic status by spring 2021 (46%, 38 of 83). Students' progression to the next year was delayed by 12% (9 of 73), and preparation was negatively impacted by 45% (37 of 83). Despite these data, CDs perceived students' interest in surgical careers was not significantly affected (89% vs 77.0%, p = 0.09). During the 1-year study, the proportion of CDs reporting a severe negative impact on the curriculum dropped significantly (p < 0.0001) for most parameters assessed except summative evaluations (40.3% vs 45.7%, p = 0.53). CDs (n = 83) also noted the pandemic's positive impact with respect to virtual patient encounters (21.7%), didactics (16.9%), student test performance (16.9%), continuous personal learning (14.5%), engagement in the clerkship (9.6%), and student interest in surgery as a career (7.2%). During the pandemic, the severe negative impact on student educational programs lessened, and novel virtual curricular solutions emerged. Student interest in surgery as a career was sustained. Measures of student competency and effectiveness of new curriculum, including telehealth, remain areas for future investigation.

The impact of preclinical clerkship in general surgery on medical students' attitude to a surgical career.

With the advent of a new program for postgraduate medical students in 2004, the number of applicants choosing surgical careers in Japan has been declining. We conducted this study to evaluate the impact of preclinical clerkship and how it affects students' attitudes toward a surgical career. The subjects of our study were fifth-year medical students who participated in a clinical clerkship in general surgery in our department between April 2021 and March 2022. We conducted pre- and post-preclinical clerkship surveys to assess the perceived image of surgeons and the impact of clerkship on surgical career interest. Among 132 medical students (77 men and 55 women) who rotated through preclinical clerkship in our department, 125 participated in the survey and 66% expressed interest in a surgical career. In the post-clerkship survey, an increased interest in a surgical career was expressed by 79% of the students; notably, including those who initially expressed interest. Approximately 77% of students were satisfied with the practical skill training they received. Engaging medical students early in surgical experience through a preclinical clerkship for general surgery appears to promote their interest in a surgical career.

Impact of the surgery clerkship on medical students’ situational interest in surgery

Impact of the surgery clerkship on medical students’ situational interest in surgery

A prosection-based surgical anatomy training session that improves medical student anatomical knowledge and confidence on the surgery clerkship

A prosection-based surgical anatomy training session that improves medical student anatomical knowledge and confidence on the surgery clerkship

Deconstructing the roadmap to surgical residency: a national survey of residents illuminates factors associated with recruitment success as well as applicants' needs and beliefs.

As applications increase and residency becomes more competitive, applicants and programs will be challenged by increased demands on recruitment, metric assessment, and rank determination. Studies have investigated program opinions; however, this survey sought to illuminate the process from an applicant's perspective. An anonymous survey was distributed to past or current surgery residents nationwide using social media and program director emails. Regression analyses were performed to assess factors correlating with percentage of programs which offered the applicant an interview. There were 223 respondents who applied to an average of 61 programs (± 40) with 16 (± 11) interviews offered. Applicants believed that programs were most interested in (1) personality, (2) letter of recommendation (LOR) writers, and (3) medical school reputation. Top factors considered by applicants in ranking were resident culture, location, program reputation, and autonomy. Bivariate analysis found factors that decreased percent of interview invites to be Asian race, whereas factors that increased interview invites included age, year of match, surgery clerkship grade, medicine clerkship grade, AOA status, honor surgery rotation, gold humanism (GHHS) status, phone call for interview made, and step scores (all p < 0.05). AOA status, step scores, honor surgery rotation, year of match, and Asian race remained significant after multivariate analysis. National surveys illuminate how applicants approach the application process and what programs and applicants appear to value. This information provides insight and guidance to candidates and programs as the process of matching becomes more challenging with surging application numbers, changes in testing parameters and virtual interviews. The online version contains supplementary material available at 10.1007/s44186-022-00070-9.

Evaluating the Implementation of a Medical Student’s Handoff Curriculum During the Surgery Clerkship

IntroductionEarly introduction to essential communication skills is important. We sought to determine if a handoff curriculum (HC) would improve confidence, decrease anxiety, and increase participation in clinical handoffs during the surgical clerkship. MethodsA multi-center prospective cohort study was performed at two medical schools. Training in the intervention group (HC) consisted of a didactic lecture, video review, and practice session. Students completed a pre-clerkship knowledge test and confidence/anxiety/handoff experience questionnaire pre- and post-clerkship. ResultsThere were no significant differences in pre-clerkship handoff experiences between institutions except having previously witnessed a verbal handoff (School A 96.4% versus School B 76.2%, P = 0.01). While there were no significant differences in post-clerkship confidence or anxiety, HC students were significantly more involved with written sign-outs (52.9% versus 18.2%, P = 0.02) and verbal handoffs (29.4% versus 4.6%, P = 0.03). ConclusionsMedical students exposed to handoff training shared similar confidence and anxiety scores compared to those that were not, however, they were more involved in handoff experiences during their surgical clerkship. Early introduction to handoff skills may encourage greater participation during subsequent clinical experiences.

Assessing Success of Implementation of the Stop the Bleed Curriculum in Surgical Clerkships

INTRODUCTION: Stop The Bleed (STB) is a national curriculum developed by the American College of Surgeons that teaches how to address life-threatening bleeding events via interactive, in-person sessions. Research has demonstrated that medical students are effective STB instructors but has not described implementation of student instruction. This study aims to assess implementation of the STB curriculum in one institution’s surgery clerkship. METHODS: The curriculum was administered by medical students during surgery clerkship orientations over two years. Participants completed pre- and post-tests to assess comprehension. Barriers and facilitators to implementation were considered using the Consolidated Framework for Implementation Research (CFIR) from the field of Implementation Science, which includes domains for the internal and external environment, intervention characteristics, individual characteristics, and the process of implementation. RESULTS: The most notable facilitators to implementation were using existing validated material, faculty champions, and clinical examples relevant to medical students in the intervention. In total, 221 students completed the pre- and post-tests, an approximately 85% response rate. The mean pre- and post-test scores were 66.3 ± 20.1% and 89.7 ± 8.4% respectively. Paired t-tests of overall scores demonstrated a significant improvement between pre- and post-test scores (p < 0.001). ANOVA and paired t-tests across all 4 questionnaire subdomains demonstrated significant improvement (p < 0.001). CONCLUSION: Improvement in pre- and post-test scores demonstrate effective implementation of the STB curriculum into the surgery clerkship. Applying tools for systematically evaluating implementation strategies, such as the CFIR, can improve the likelihood of integrating curricular change in undergraduate medical education.

“See One, Do One, Perceive One”: Analyzing the Role of the Third-Year Surgery Clerkship on Students’ Perceptions of Surgeons and Their Lifestyles Amidst the COVID-19 Pandemic

INTRODUCTION: Long hours, poor work-life balance, pessimism, and cynicism are the notorious perceptions of surgeons thought to be held by medical students. The impact that the third-year surgery clerkship has on these perceptions has been discussed, but it’s unclear whether changes to the clinical environments due to COVID-19 hamper such impacts. We sought to provide updated analysis on this common question. METHODS: Identical survey questions were given to third-year medical students before and after their surgery clerkship. Students were asked whether they strongly agreed, agreed, neither agreed nor disagreed, disagreed, or strongly disagreed with multiple statements about surgeons. A p-value <0.05 was considered statistically significant. RESULTS: 91 students responded to the pre-clerkship survey (82.7% response rate) and 34 students to the post-clerkship survey (38.6% response rate). Compared to pre-clerkship responses, post-clerkship responses demonstrated a significant increase in the percentage of students who believe that surgeons are good teachers (p = 0.00092), respect medical students (p=0.00326) encourage students to pursue surgery (p = 0.0114) and are compassionate physicians (p = 0.00429), and a significant decrease in the percentage of students who believe that surgeons are mean (p = 0.0394) or pessimistic (p = 0.0161). There was no change seen with respect to students’ perceptions of surgeons’ workload (p = 0.304)/lifestyle (p = 0.0796), reputation (p = 0.0873)/respect received (p = 0.750), contentment with career choice (p = 0.268) or respect for other physicians (p = 0.151). CONCLUSION: The third-year surgery clerkship appeared to have improved students’ perception of surgeons’ personality traits and role as educators but did not appear to affect students’ perceptions of surgeons’ lifestyle, inter-personal traits, or reputation.

Medical Student Preparation for Surgery: Students’ Usage of Educational Resources in the Digital Age

INTRODUCTION: Medical students today have access to myriad information sources, of varying quality and reliability. We hypothesized that students commonly use non-peer-reviewed online resources to prepare for surgical cases. METHODS: From September to December 2021, a cross-sectional survey of students who had completed their surgery clerkships was administered at three medical schools. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to identify factors associated with use of non-peer-reviewed resources. RESULTS: A majority (74%) of the 122 respondents spent <1 hour/day studying for surgical cases; 42% and 43% of students devoted most of their study time to reviewing anatomy and operative steps, respectively. The most used study resources were YouTube (29%), high-yield review books (29%) and digital textbooks (21%). Eighty-four percent of students used non-peer-reviewed sources, including Wikipedia, YouTube, Google images and podcasts, at least sometimes; 30% used a non-peer-reviewed source as their primary study material. Students who spent ≤1 hour/day on case preparation were more likely to use a non-peer-reviewed source as their primary study resource (OR 3.3 95% CI: 1.1-9.7), than those who spent >1 hour/day. Ninety-eight percent of students reported knowing what constitutes a peer-reviewed source, and 86% believe that Wikipedia is not a peer-reviewed source. CONCLUSION: These data suggest that medical students do not prioritize peer-reviewed resources when selecting study materials. Furthermore, the accessibility of non-peer-reviewed resources may be attractive to students who prioritize efficiency. Surgical educators should focus on identifying high-quality online resources and educating medical students on how to interpret the reliability of available information.Figure