Third-year Surgery Clerkship Research Articles

Assessing the efficacy and feasibility of emotional intelligence and stress management training for medical students within their third-year surgery clerkship

BackgroundThis study aimed to evaluate the efficacy and feasibility of a cognitive fitness training (CFT) program on the development of emotional intelligence and stress management skills in medical students during their 3rd year surgery clerkship. MethodsMS3s (n ​= ​80) were randomized into a training or control group. The training group received CFT during their clerkship, the control group received online access afterwards. A cognitive fitness (CF) assessment was administered before and after the clerkship. ResultsThe training group demonstrated a significant improvement in cumulative assessment scores (126.4–146.5, p ​< ​0.0001) and most dimensions of CF assessment. Integration of the curriculum did not adversely impact performance on surgery NBME or surgery OSCE when compared to control (p ​> ​0.05). ConclusionsThe CFT provided to MS3s resulted in significant improvements in CF, including most subcategories. The CFT also did not have an adverse impact on academic performance indicating its feasibility within medical education curricula.

“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.

Implementation of a Surgical Problem-Based Learning Curriculum: A One-Year Single-Center Experience.

Problem-Based Learning (PBL) has become an integral part of medical student education for preclinical curricula, but few studies have evaluated the benefits of a PBL curriculum for clinical education. This study aims to assess the 1-year experience after implementing a resident-led PBL program for the third-year (MS3) surgery clerkship and compare students' self-reported preparedness following PBL sessions to traditional faculty-led lectures. Surgical faculty and residents developed a PBL curriculum to address common topics in surgical education. Pandemic requirements necessitated a switch from in-person to virtual sessions during the experience. Students enrolled in the MS3 surgical clerkship were asked to participate in a survey. Demographics and clerkship data were obtained. Quality of PBL and faculty-led lectures were assessed using a ten-point Likert scale, and standard statistical analyses were performed. During the study period, 165 students rotated through surgery, of which 129 (78%) responded to the survey (53% female, 59% white). PBLs were held in-person (53%), exclusively virtual (32%) or hybrid (15%) platforms. In-person PBLs were preferred to faculty-led lectures for preparing students for NBME examinations (6.9 vs 6.0), oral examinations (7.8 vs 6.3), and surgical cases (6.3 vs 5.8), all P < .001. Virtual PBLs were also preferred to lectures for preparing students for NBME examinations (6.8 vs 5.8, P < .001) and surgical cases (5.6 vs 4.8, P = .05). PBL is a valuable adjunct for medical student education. Resident-led PBLs were preferred to faculty-led lectures for preparing students for examinations and clerkship experiences and may be useful adjuncts to clinical education.

Surgical clerkship: Do examination scores correlate with clinical performance?

BackgroundThis study aims to determine if there are correlations between clinical performance and objective grading parameters for medical students in the third-year surgery clerkship. MethodsClerkship grades were compiled from 2016 to 2020. Performance on clinical rotations, NBME shelf exam, oral exam, and weekly quizzes were reviewed. Students were divided into quartiles (Q1-Q4) based on clinical performance. Standard statistical analysis was performed. ResultsThere were 625 students included in the study. Students in Q1+Q2 were more likely than those in Q3+Q4 to score in the top quartile on the shelf exam (29% vs. 19%, p = 0.002), oral exam (24% vs. 17%, p = 0.032), and quizzes (22% vs. 15%, p = 0.024). However, there was negligible correlation between clinical performance and performance on objective measures: shelf exam (R2 = 0.027, p < 0.001), oral exam (R2 = 0.021, p < 0.001), and weekly quizzes (R2 = 0.053, p = 0.092). ConclusionsClinical performance does not correlate with objective grading parameters for medical students in the third-year surgery clerkship.

From the Operating Room to Online: Medical Student Surgery Education in the Time of COVID-19

BackgroundOn March 17, 2020 the Association of American Medical Colleges recommended dismissal of medical students from clinical settings due to the COVID-19 pandemic. Third-year (M3) and fourth-year (M4) medical students were at home, M4s were interested in teaching, and residents and faculty had fewer clinical responsibilities due to elective surgery cancellations. To continue M3 access to education, we created a virtual surgery elective (VSE) that aimed to broaden students’ exposure to, and elicit interest in, general surgery (GS).MethodsFaculty, surgical residents, and M4s collaborated to create a 2-wk VSE focusing on self-directed learning and direct interactions with surgery faculty. Each day was dedicated to a specific pathology commonly encountered in GS. A variety of teaching methods were employed including self-directed readings and videos, M4 peer lectures, case-based learning and operative video review with surgery faculty, and weekly surgical conferences. A VSE skills lab was also conducted to teach basic suturing and knot-tying. All lectures and skills labs were via Zoom videoconference (Zoom Video Communications Inc). A post-course anonymous survey sent to all participants assessed changes in their understanding of GS and their interest in GS and surgery overall.ResultsFourteen M3s participated in this elective over two consecutive iterations. The survey response rate was 79%. Ninety-one percent of students believed the course met its learning objectives “well” or “very well.” Prior to the course, 27% reported a “good understanding” and 0% a “very good” understanding of GS. Post-course, 100% reported a “good” or “very good” understanding of GS, a statistically significant increase (P = 0.0003). Eighty-two percent reported increased interest in GS and 64% reported an increase in pursuing GS as a career.ConclusionsAs proof of concept, this online course successfully demonstrated virtual medical student education can increase student understanding of GS topics, increase interest in GS, and increase interest in careers in surgery. To broaden student exposure to GS, we plan to integrate archived portions of this course into the regular third-year surgery clerkship and these can also be used to introduce GS in the preclinical years.

A Novel Educational Tool to Improve Medical Student Knowledge Acquisition During Surgical Rotations.

The addition of a novel education tool helps students improve understanding of general surgery topics. However, the effect of the new tool on objective exam performance is unknown. A 10-item card of high-yield general surgery topics was implemented in the third-year surgery clerkship. Students reviewed these topics with general surgery residents. Scores from the National Board of Medical Examiners (NBME) surgery subject exam and Step 2 Clinical Knowledge (CK) board exam were compared among students who completed the Ask-a-Resident Topic card to a control group. Students who participated in the curriculum demonstrated significantly better scores on the NBME Surgery exam, t (236) = -2.56, P = .006. There was not a significant effect of the curriculum on Step 2 CK scores, although students who participated in the curriculum (M = 250.7, SD = 13.4) achieved higher scores than the control group (M = 247.8, SD = 14.2). The novel curriculum may improve objective student performance on standardized surgery exams.

Implicit Gender Bias in Third-Year Surgery Clerkship MSPE Narratives

To assess implicit gender bias in surgery clerkship evaluations of third-year medical students at a large, academic hospital in the Southeast. University of North Carolina at Chapel Hill School of Medicine has multiple branch campuses where students can complete their surgical clerkship including 1 large academic center, 1 hybrid academic and community-based practice, and 3 community-based hospitals. All residents and faculty evaluations of medical students who completed the surgery clerkship from March 1, 2018 to February 28, 2019 were analyzed. Evaluations were anonymized and names and pronouns were removed to mitigate evaluator bias. A word dictionary was created guided by previous literature and categorized descriptive adjectives into 4 categories: ability, grindstone, standout, and personality traits. Adjectives used to describe students, and references to the student using gendered pronouns or gender-fair language were coded and quantified as percentage of total evaluation word content. These percentages were compared between male and female students. A subsequent analysis was completed to assess the effects of gendered pronouns on linguistic patterns. A total of 583 evaluations from the surgery clerkship were available for 183 students (51.9% female, 48.1% male). When gender-fair language was used, there was no difference in the adjectives used to describe female and male students. Male evaluators were more likely to use female gendered pronouns compared to male gendered pronouns (3.1% vs 2.3%, p = 0.028). When gendered pronouns were present, evaluations of female students were more likely to contain grindstone adjectives but less likely to contain standout terms compared to evaluations of male students (4.4% vs 2.8%, p = 0.006; 0.6% vs 1.3%, p = 0.006). For students who have completed their surgical clerkship, the language patterns in evaluations differ between female students and male students. When the female pronoun was used, narratives contained more grindstone adjectives and fewer standout adjectives. Our results are consistent with previous literature and may be a manifestation of "othering" or a compensatory means of describing female students. This is potential manifestation of implicit gender bias.

Enhancing Medical Student Education and Combating Mistreatment During a Surgery Clerkship With a Novel Educational Tool: A Pilot Study

Medical education changes dramatically from preclinical to clinical years, and the learning environment becomes key as students strive to develop clinical competence and informed career decisions. This change becomes heightened on a surgical clerkship where student mistreatment is often perceived, and the fast-paced nature of surgery can result in limited resident-student interactions and time for examination preparation. To evaluate medical student and resident perception of educational strategies during a surgical clerkship and to determine whether the addition of a novel educational tool would increase satisfaction with the surgical clerkship on examination preparation and team dynamics. University of North Carolina at Chapel Hill, Department of Surgery. During the 2018-2019 academic year, a 10-item "Ask a Resident Topics" (ART) card of high yield general surgery topics was implemented as part of the third-year surgery clerkship curriculum. Students were asked to review a topic and then discuss it with a general surgery resident. They were expected to complete at least 6 of 10 topics by the end of the rotation for credit. At the end of the year, third-year medical students were administered a 23-item survey regarding their experience on the surgery clerkship and with the ART cards. Fourth-year medical students and those students at satellite sites who did not receive the ART cards were administered the same survey, minus specific questions about the ART card, and were used as a preintervention control. General surgery residents who participated in teaching were similarly surveyed. Of those students that completed the ART cards, 84% felt it improved their understanding of general surgery and were more likely to report the surgery clerkship prepared them well for the NBME examination compared to those who did not (Χ2 (1, N = 87) = 4.95, p = 0.03). They were also more likely to report residents were willing to discuss surgery topics with them (Χ2 (1, N = 87) = 2.77, p = 0.10). Seventy-three percent of students thought the card did not add undue stress to their clerkship. Sixty-three percent of all students felt they were a productive member of the surgery team, and this did not vary by intervention group (Χ2 (1, N = 87) = 0.03, p = 0.9). Students who completed the ART card were more likely to report being interested in surgery than those who did not (Χ2 (1, N = 87) = 4.20, p = 0.04). Hundred percent of residents surveyed felt the ART card provided value for themselves as a teacher and for the student as a learner. The ART card is mutually beneficial to both residents and medical students during the surgical clerkship. This tool is easy to implement, helps students improve their understanding of general surgery, increases camaraderie among the surgical team, and has a positive impact on students pursuing a career in surgery.

The PreOp Program: Intensive Preclinical Surgical Exposure is Associated With Increased Medical Student Surgical Interest and Competency

As medical students' interest in surgical fields wanes, we investigated the impact of a preclinical surgical exposure program on students' attitudes toward pursuing surgical careers. This is a prospective longitudinal study of PreOp, a preclinical rotation-based surgical exposure program for first-year medical students, from 2013 to 2017. Surveys assessed PreOp rotation quality, students' surgical interest, and students' self-reported preparedness for the surgical clerkship. Surgery clerkship grades were obtained as a measure of surgical competency and compared to class-wide peers. Match data was collected and compared to class-wide peers as well as historical norms. NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY; tertiary care center. Fifty-four PreOp students from 2013 to 2017. Fifty-four PreOp participants were recruited. After completing the PreOp program, 66.7% of PreOp students reported being very likely to apply into a surgical field compared to 29.4% when they started medical school. Ultimately, 71.4% of PreOp students versus 21.7% of non-PreOp class-wide peers matched into surgical fields (p < 0.001). From the preceding 5 match years before PreOp implementation, 21.4% of all students matched into surgical fields compared to 25.6% of all students after PreOp was started (p = 0.26). In terms of preparedness, 75% of PreOp students reported feeling more prepared for the third-year surgery clerkship than their non-PreOp peers after the second year of medical school. PreOp students were significantly more likely than non-PreOp class-wide peers to receive honors in the surgery clerkship when controlling for cumulative clerkship GPA (p = 0.012, adjusted odds ratio = 5.5 [95% confidence interval 1.5-22.1]). Hands-on preclinical surgical exposure was associated with student-reported increased surgical interest that was maintained longitudinally and reflected in significantly increased surgical matches relative to non-PreOp class-wide peers. This study uniquely demonstrates that participation in PreOp was also associated with increased self-reported surgical preparedness and significantly higher surgery clerkship grades relative to overall academic performance.

The Impact of Medical Student Burnout on Surgery Clerkship Performance

Increasing reports on resident burnout have resulted in efforts to improve trainee well-being. Medical student burnout, however, is not well understood. We set out to evaluate burnout among third-year medical students and explore its impact on clerkship performance. Analysis of prospectively-collected survey data from medical students on the third-year surgery clerkship was performed. Surveys included an institution-specific pre- and postclerkship survey, the 12-item Grit Scale, and the Maslach Burnout Inventory. University of Cincinnati College of Medicine. Between 2016 and 2017, 166 students completed the surgery clerkship and were asked to complete the surveys. Sixty-two students (37.4%) completed all surveys and were included in this study. Among the third-year medical student participants, there was no difference in burnout before vs after the clerkship (22.6% vs 17.7%, p = 0.41). Students with burnout had significantly lower grit scores (3.10 ± 0.66) compared to those without burnout (3.63 ± 0.50, p = 0.01). Linear regression analysis demonstrated that increasing grit was associated with decreasing emotional exhaustion (p = 0.01), decreasing depersonalization (p = 0.04), and increasing personal achievement (p = 0.03). Finally, 75% of students with resolution of burnout developed an interest in surgery, whereas all students who developed burnout after the clerkship had no interest in surgery (p = 0.03). Upon completion of the rotation, burnout was not associated with poorer quality of clerkship experience or decreased clerkship performance (p > 0.05 for each). Although traditionally considered a difficult rotation, we found no increase in medical student burnout following the surgery clerkship. Higher grit scores were associated with decreased burnout, though burnout did not have a negative impact on student experience or performance. Clerkships should continue to set high expectations and maximize educational opportunities without significant apprehension that it may have a negative impact on students.

Implementation of a flipped classroom approach to promote active learning in the third-year surgery clerkship

BackgroundConstructivist student-centered instructional models such as the flipped classroom (FC) have been shown to improve learning. MethodsA FC approach was implemented for the surgery clerkship. Data was collected in phase 1 to evaluate student learning and attitudes. Based on these results, questions for the phase 2 open-ended survey were developed to improve understanding of learner attitudes, and ascertain how well the FC aligns with constructivist principles. ResultsThere was no significant difference in shelf exam performance between the control and intervention groups. A majority of students agreed that they preferred the FC over lectures, and that their learning improved. Open-ended survey analysis demonstrated that the FC fostered self-directed, active learning, and that the in-class sessions facilitated application of concepts and deeper learning. Areas identified for improvement included better alignment with learning preferences through greater variety of pre-class learning options, improvement of podcast technical quality, and utilization of smaller in-class discussion groups. ConclusionsStudents had a positive perception of the FC. The FC supports self-directed and more active and deeper in-class learning.

Results of a Surgical Simulation Course Designed to Improve Surgery Clerkship Performance

During the 2015-2016 academic year, Rocky Vista University College of Osteopathic Medicine (RVUCOM) conducted a required 1-week surgical simulation course as the first week of students' 8-week surgical clerkship. This course was adapted from a pilot RVUCOM surgical simulation course and other surgical simulation courses identified in the literature. The objectives of this course were to teach surgical skills and clinical knowledge, aid students in adjusting to the stress of a surgical clerkship, and improve students' confidence and abilities during the clerkship. In all, 148 students participated in the surgical simulation course. Subjective assessment of this course included each student completing a daily standardized stress survey and student feedback surveys at the end of the course and at the end of the surgical clerkship. Objective assessment of this course compared precourse and postcourse tests of surgical knowledge and instrument identification, as well as comparison of NBME Surgery Subject Assessment percentile ranks of this class with 3 prior classes. Daily stress surveys indicated decreased stress on day 5 compared to day 1 (p < 0.01). Students' confidence level increased significantly on day 5 compared to day 1 (p < 0.01). Student feedback surveys demonstrated students' perception that surgical skills and clinical skills had been learned during the course and that the course improved their performance during the surgical clerkship. NBME Surgery Subject Assessment percentile rank improved significantly (p < 0.01) from a mean percentile rank of 36.94 for 3 previous classes to a mean percentile rank of 43.82 for the class who completed the simulation course. Surgical knowledge improved significantly (p < 0.001) from a pretest mean score of 47.02% to a posttest mean score of 55.14%. Surgical instrument identification improved significantly (p < 0.001) from a pretest mean of 13.81% to a posttest mean of 95.28%. The RVUCOM surgery simulation course significantly improved student performance academically and helped students acclimate to stress, increase their confidence level, and acquire surgical skills needed during the third-year surgery clerkship.

Using the ACMGE Milestones as a Handover Tool From Medical School to Surgery Residency

To map current medical school assessments for graduating students to the Accreditation Council for Graduate Medical Education (ACGME) milestones in general surgery, and to pass forward individual performance metrics on level 1 milestones to receiving residency programs. The study included 20 senior medical students who were accepted into surgery internship positions. Data from medical school performance assessments from the third-year surgery clerkship, fourth-year surgery rotations, fourth-year surgery boot camp, Clinical Competency Assessment Examination, and United States Medical Licensing Examination (USMLE) Step 1 and 2 examinations were used to map each student's competency assessments to the General Surgery Milestones based on a scoring system created and validated by independent assessors. This Milestones Assessment was then provided to each student's receiving program director. The study was conducted at the University of Michigan Medical School, in Ann Arbor, Michigan. Fourth-year medical students entering into surgical internship. Of 16 Accreditation Council for Graduate Medical Education (ACGME) General Surgery Milestones subcompetencies, 12 were able to be evaluated with current medical school assessments. Of the 20 students, 11 met criteria for all the level 1 milestones and 9 needed improvement in at least 1 domain. It was feasible to use medical school assessments to feed forward information about senior medical students on 12 of the 16 General Surgery Milestones subcompetency domains.

Medical Student Perceptions of Ethical Challenges during the Third-Year Surgery Clerkship

Medical Student Perceptions of Ethical Challenges during the Third-Year Surgery Clerkship

All for knots: evaluating the effectiveness of a proficiency-driven, simulation-based knot tying and suturing curriculum for medical students during their third-year surgery clerkship

BackgroundWe evaluated the effectiveness of implementing a proficiency-driven, simulation-based knot tying and suturing curriculum for medical students during their 3rd-year surgery clerkship. MethodsMedical students on the 3rd-year surgical clerkship completed a proficiency-driven, simulation-based knot tying and suturing curriculum consisting of 6 tasks. The effectiveness was evaluated by comparing the initial presession scores to the final postsession scores on an 8-item self-efficacy scale and evaluating pass rates on end of clerkship skills testing. A paired t test was used to analyze data. ResultsSixty-five students had matched preintervention and postintervention questionnaires for analysis. Pass rates approached 100% by the 3rd attempt on all tasks. Significant gains on all 8 items of the self-efficacy questionnaire from pretraining to post-training were noted. Timing of the general surgery rotation did not impact results. ConclusionsImplementation of a simulation-based training, proficiency-driven knot tying and suturing curriculum for 3rd-year medical students during the surgery clerkship is feasible and effective in improving student self-efficacy and objective proficiency toward performance of the tasks taught.

The Surgical Clerkship and Medical Student Performance in a Standardized Patient Case of Acute Cholecystitis

Although an Observed Structured Clinical Examination (OSCE) has been used to evaluate patient interaction and general knowledge competencies of third-year students during their required surgical clerkships, whether surgical clerkship experience predicts satisfactory performance with a surgical patient in an OSCE environment has not been investigated. We hypothesized that completion of the third-year surgery clerkship would improve student ability to diagnose acute cholecystitis and recognize the further need for hospital admission and treatment. An observational study design was used to determine student skills in evaluating a simulated surgical patient with abdominal pain from acute cholecystitis. The skills included key data gathering, physical examination, and information-sharing tasks. Tertiary care academic medical center. Performance was compared between a cohort of 101 medical students who had completed the third-year surgical clerkship and 72 who had not. A secondary analysis compared performance for 91 students who had completed their third-year clerkship in sites near the University of California, San Francisco School of Medicine, and 10 who did so at a regional campus geographically distant from the medical school. Of the 173 students who participated in the OSCE, only 42% correctly identified the diagnosis of acute cholecystitis, though 71% did suggest the possibility of a biliary process to the standardized patient. Most of the students who identified the condition as acute cholecystitis or gallbladder-related process had completed their third-year surgical clerkship (odds ratio [OR] = 3.26). Students who completed their surgical clerkship were also better able to recommend appropriate treatment for the patient (OR = 2.35), and recommend admission to the hospital or emergency department (OR = 2.00). Approximately one-third (35.3%) of all students documented a positive Murphy's sign, but only 6.4% identified the triad of leukocytosis, fever, and a Murphy's sign as diagnostic of acute cholecystitis and the need for surgical intervention. Student performance on the clinical examination did not differ depending on whether the students completed their clerkship at a Bay Area or regional hospital. Student recognition of the key physical examination and laboratory findings diagnostic of acute cholecystitis was low, but students were better able to recommend further treatment for a patient with acute cholecystitis after completing the third-year surgical clerkship. Our study reveals areas where surgical educators can improve medical student ability to accurately diagnose acute cholecystitis and evaluate acute abdominal processes.

Introduction of a fresh cadaver laboratory during the surgery clerkship improves emergency technical skills

BackgroundStudent acquisition of technical skills during the clinical years of medical school has been steadily declining. To address this issue, the authors instituted a fresh cadaver-based Emergency Surgical Skills Laboratory (ESSL). MethodsSixty-three medical students rotating through the third-year surgery clerkship participated in a 2-hour, fresh cadaver-based ESSL conducted during the first 2 days of the clerkship. The authors evaluated students utilizing both surgical skills and written examination before the ESSL and at 4 weeks post ESSL. ResultsStudents demonstrated a mean improvement of 64% (±11) (P < .001) and 38% (±17) (P < .001) in technical skills and clinical knowledge, respectively. When technical skills were compared between cohorts, there were no differences observed in both pre- and post-testing (P = .08). ConclusionsA fresh cadaver laboratory is an effective method to provide proficiency in emergency technical skills not acquired during the clinical years of medical school.

General Surgery Resident Remediation and Attrition

To determine the rates and predictors of remediation and attrition among general surgery residents. Eleven-year retrospective analysis of 348 categorical general surgery residents at 6 West Coast programs. Rates and predictors of remediation and attrition. Three hundred forty-eight categorical general surgery residents were included. One hundred seven residents (31%) required remediation, of which 27 were remediated more than once. Fifty-five residents (15.8%) left their programs, although only 2 were owing to failed remediation. Remediation was not a predictor of attrition (20% attrition for those remediated vs 15% who were not [P = .40]). Remediation was most frequently initiated owing to a deficiency in medical knowledge (74%). Remediation consisted of monthly meetings with faculty (79%), reading assignments (72%), required conferences (27%), therapy (12%), and repeating a clinical year (6.5%). On univariate analysis, predictors of remediation included receiving honors in the third-year surgery clerkship, United States Medical Licensing Examination (USMLE) step 1 and/or step 2, and American Board of Surgery In-Training Examination scores at postgraduate years 1 through 4. On multivariable regression analysis, remediation was associated with receiving honors in surgery (odds ratio, 1.9; P = .01) and USMLE step 1 score (odds ratio, 0.9; P = .02). On univariate analysis, the only predictor of attrition was the American Board of Surgery In-Training Examination score at the postgraduate year 3 level (P = .04). Almost one third of categorical general surgery residents required remediation during residency, which was most often owing to medical knowledge deficits. Lower USMLE step 1 scores were predictors of the need for remediation. Most remediated residents successfully completed the program. Given the high rates of remediation and the increased educational burden on clinical faculty, medical schools need to focus on better preparing students to enter surgical residency.

The University of Texas Medical School at Houston

The University of Texas Medical School at Houston

Ponce School of Medicine

Ponce School of Medicine