Third-year Surgical Clerkship Research Articles

Do student and faculty expectations differ during the third-year surgical clerkship?

Do student and faculty expectations differ during the third-year surgical clerkship?

Intimidating Attendings: The Importance of Near-Peer Instruction and Mentoring During Third-Year Surgical Clerkship

Intimidating Attendings: The Importance of Near-Peer Instruction and Mentoring During Third-Year Surgical Clerkship

Exploring the Influence of Gender on Surgical Clerkship Grades and Test Scores: A Single Institution, Multisite Comparison

General surgery remains a male-dominated specialty. Women constitute 54% of medical students at the University of Washington, but only 3.4% of full professors within the Department of Surgery. Many believe surgical attrition and "the leaky pipeline" starts during medical school clerkships, but the exact deterrents remain undefined. This study examined the impact of gender on grading during the third-year surgical clerkship. Retrospective analysis of confidential final clerkship grades, examination scores and subjective clerkship grades was conducted. These were compared by gender, time period, and type of clerkship site. Chi-square analyses were performed. Clerkship sites across multiple academic (n = 6) and nonacademic (n = 14) locations. All third-year medical students undergoing a core surgical clerkship over 2 time periods-2007 to 2010 (period 1) and 2016 to 2019 (period 2)-were included. There were 539 medical students in period 1 and 792 in period 2. The percentage of women was stable over time (52.0% vs 54.2%, p = 0.43). Final clerkship grades of Honors increased significantly from period 1 to 2 (22.3% vs 44.3%, p < 0.0001) and was similarly distributed by gender (women: 21.4% vs 48.0%, p < 0.0001; men 23.2% vs 39.9%, p < 0.0001). Honors on examinations remained stable over time and did not differ by gender. Women earned more final clerkship honors than men at academic sites in period 2 (48.4% vs 30.9%, p < 0.001). This finding was not identified in period 1, nor at nonacademic sites. There was a significant increase in surgical clerkship honors over the past decade, independent of gender. Women attained more clinical and final clerkship honors than men and similar exam grades as time progressed, suggesting that gender bias in the subjective grading of women at this institution does not directly contribute to the loss of talented women as they progress from medical student to faculty within the department, with said gender imbalance not related to clerkship evaluations.

Medical Student Education During COVID-19: Electronic Education Does Not Decrease Examination Scores.

During the COVID-19 emergency, medical students were mandated to remain home, creating challenges to providing education remotely for third-year clinical rotations. This study aims to assess student reception and investigate objective outcomes to determine if online learning is a suitable alternative. Medical students enrolled in the third-year surgical clerkship during COVID-19 were asked to participate in a survey. 19 of 27 (70%) students participated. Content, faculty-led lectures, and resident-led problem-based learning (PBL) sessions were assessed using a ten-point Likert scale. National Board of Medical Examiners (NBME) examination, weekly quiz, and oral examination scores were compared to previous years. Student t-tests compared the groups. The median age was 25years. Comparing in-person to electronic sessions, there was no difference in effectiveness of faculty sessions preparing students for NBME (6.2 vs. 6.7, P = .46) or oral examinations (6.4 vs. 6.8, P = .58); there was also no difference in resident-led PBL sessions preparing students for NBME (7.2 vs. 7.2, P = .92) or oral examinations (7.4 vs. 7.6, P = .74). Comparing this group to students from the previous academic year, there was no difference in weekly quiz (85.3 vs. 87.8, P = .13), oral examination (89.8 vs. 93.9, P = .07), or NBME examination (75.3 vs. 77.4, P = .33) scores. Surgical medical didactic education can effectively be conducted remotely through faculty-led lectures and resident-led PBL sessions. Students did not have a preference between in-person and electronic content in preparation for examinations. As scores did not change, electronic education may be adequate for preparing students for examinations in times of crisis such as COVID-19.

Evaluation of a Preceptorship Model on Third-Year General Surgery Clerkship

Medical students increasingly report not feeling meaningfully involved during surgical clerkships. Preceptorship and mentorship through longitudinal experiences ameliorate this problem. A preceptorship model was introduced into the surgery clerkship at our institution to increase contact and improve relationships between students and faculty. The preceptorship model was introduced at select sites in 2017. In contrast to the standard structure in which students are assigned to cases and clinics as needed, preceptorship students are assigned to attending surgeons and follow the surgeons' schedules for the rotation. Student performance data, including final grades, clinical evaluations, and shelf examination scores, were collected for clerkship students from May 2017 to November 2018. Formative and summative evaluations for each student were collected. Qualitative content analysis was used to explore evaluations for themes. Two hundred and seventy-four students completed the clerkship during the study period; 41 experienced a preceptorship model. There was no difference in student performance across clerkship structures. Summative and formative evaluations for preceptorship students were longer than for traditional students (137 words vs 78 words; p < 0.0001 and 46 words vs 16 words, p= 0.03 respectively). Preceptorship student evaluations contained higher-quality feedback relating to clerkship objectives than those of traditional students. Preceptorship comments also contained more frequent mentions of response to feedback. A preceptorship model was successfully implemented on the third-year surgical clerkship at our institution. Although there was no difference between top performers on either clerkship structure, preceptorship students received written evaluations with better feedback as a result of their direct relationship with faculty. Strategies such as this, which improve student-faculty relationships, will be needed as programs find new ways to assess residency applicants.

Curricular Innovation in the Surgery Clerkship: Can Assessment Methods Influence Development of Critical Thinking and Clinical Skills?

Although key clinical skills have been defined in the Core Entrustable Professional Activities, there is a need to improve medical school curricula with standardized training opportunities and assessments of these skills. Thus, we aimed to develop an innovative curriculum that emphasized critical thinking and clinical skills. We hypothesized that we would be able to observe measurable improvement on assessments of students' critical thinking and clinical skills after the implementation of the new curriculum. Prospective, Quasi-Experimental study with the use of historical controls. This study took place through the third-year surgical clerkship at the University of Texas Medical Branch at the Galveston, Houston, and Austin, Texas, locations. A total of 214 students taking the third-year surgical clerkship for the first time during the periods of interest were included. Although the students with traditional curriculum improved 9.5% on a short answer exam from preclerkship to postclerkship completion, the students with new curriculum improved by 40%. Students under the new curriculum performed significantly better on the Objective Structured Clinical Exam; however, their shelf scores were lower. Under this new curriculum and grading system, we demonstrated that students can be incentivized to improve critical thinking and clinical skills, but this needs to be balanced with knowledge-based incentives.

Evaluation of Feedback Systems for the Third-Year Surgical Clerkship

To compare faculty-to-student feedback rates from 2 different data sets: direct observation cards (direct evidence) and end-of-clerkship questionnaires (ECQs, secondary student reporting). We as authors hypothesized that direct evidence from observation cards would yield higher rates of feedback, compared with student-reported ECQs. Data were gathered from 2 consecutive medical classes of the third-year surgical clerkship. Data were analyzed retrospectively. Subjects and authors were blinded during data collection and analysis. University of Michigan Medical School (UMMS) and University of Michigan Health System (UMHS). UMHS is an academic tertiary care center, located in Ann Arbor, Michigan. Data were gathered from all third-year medical students completing the surgical clerkship from 2012 to 2014. Data were available for 309 students, compared to 313 students who graduated from UMMS during that time. Directly measured rates of feedback showed higher rates of midclerkship feedback (95.43% vs 83.57%, p < 0.05), feedback on an observed history-taking (97.62% vs 84.87%, p < 0.05), and feedback on an observed physical examination (99.67% vs 79.71%, p < 0.05), when compared with the ECQ. These data suggest that solely using ECQs to assess feedback rates may be inadequate. The use of multiple methods to assess feedback may therefore be a prudent choice for surgical clerkships.

A night float week in a surgical clerkship improves student team cohesion

BackgroundWe hypothesize that night float rotations in the third-year surgical clerkship improve student learning and perceptions of team cohesion. MethodsA 1-week night float (NF) system was implemented during the 2013 to 2014 academic year for students. Each student completed 1 week of NF with the Trauma/Emergency General Surgery service. The Perceived Cohesion Scale survey was prospectively administered and National Board of Medical Examiners academic performance retrospectively reviewed. ResultsWe surveyed 70 medical students, 37 traditional call and 33 NF students, with 91% response rate. Perception of team cohesion increased significantly, without perceived loss of educational benefit. Examination scores increased significantly comparing pre- and postintervention groups, with this trend continuing in the following academic year. ConclusionsA week-long student NF experience significantly improved perception of team cohesion and standardized examination results. A dedicated period of NF during the surgical clerkship may improve its overall educational value.

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.

Palliative and end-of-life care training during the surgical clerkship

BackgroundIn 2000, the Liaison Committee on Medical Education required that all medical schools provide experiential training in end-of-life care. To adhere to this mandate and advance the professional development of medical students, experiential training in communication skills at the end-of-life was introduced into the third-year surgical clerkship curriculum at Wright State University Boonshoft School of Medicine. Materials and methodsIn the 2007–08 academic year, 97 third-year medical students completed six standardized end-of-life care patient scenarios commonly encountered during the third-year surgical clerkship. Goals and objectives were outlined for each scenario, and attending surgeons graded student performances and provided formative feedback. ResultsAll 97 students, 57.7% female and average age 25.6 ± 2.04 y, had passing scores on the scenarios: (1) Adult Hospice, (2) Pediatric Hospice, (3) Do Not Resuscitate, (4) Dyspnea Management/Informed Consent, (5) Treatment Goals and Prognosis, and (6) Family Conference. Scenario scores did not differ by gender or age, but students completing the clerkship in the first half of the year scored higher on total score for the six scenarios (92.8% ± 4.8% versus 90.5% ± 5.0%, P = 0.024). ConclusionsEarly training in end-of-life communication is feasible during the surgical clerkship in the third-year of medical school. Of all the scenarios, “Conducting a Family Conference” proved to be the most challenging.

International surgical clerkship rotation: perceptions and academic performance

BackgroundConcerns about international training experiences in medical school curricula include the effect on student learning. We studied the educational effect of an international elective integrated into a traditional third-year (M3) surgical clerkship. MethodsA 1-week surgical elective in Haiti was available to M3 students during the conventional 8-week surgical clerkship each year for the 4 academic years 2008 to 2011. The authors collected student and surgeon perceptions of the elective using a mixed-methods web-based survey. Statistical analysis compared the academic performance of participating M3s relative to nonparticipating peers. ResultsTwenty-eight (100%) students (41 trip weeks) and 3 (75%) surgeons responded. Twenty-five (89%) students believed the elective provided appropriate clinical training. Surgeon responses were consistent with students' reported perceptions.Strengths included unique clinical experiences and close interactions with faculty. Criticisms included recurring overwhelming clinical responsibilities and lack of local provider involvement.Academic performance of participants versus nonparticipants in the same clerkship term were statistically insignificant. ConclusionsThis study demonstrates the feasibility of integrating global health experiences into traditional medical student clinical curricula. The effects on less tangible attributes such as leadership skills, fostering teamwork, and cultural competency require future investigation.

Surgical Interest and Surgical Match for Third-Year Students: Results of a Prospective Multivariate Longitudinal Cohort Study

Numerous factors have been linked to surgical career choice, including the quality of third-year surgical clerkship. The vast majority of studies also selectively evaluate one or only a few variables that link to surgical career choice, so relative impact cannot be assessed. This study simultaneously evaluates the majority of variables linked to surgical career choice in previous research so that the relative contributions of each of these variables with respect to surgical career choice can be determined. Surveys before, during, and after the third-year surgical clerkship included student demographics, background, and values (eg, importance of money, controllable lifestyle), and student reactions to the third-year surgical clerkship. The dependent variables in this study included interest in surgery at the beginning and end of the clerkship and matching into a surgical residency. Both univariate and multivariate analyses generally supported findings in the literature, but the strengths of these associations reported previously might not have been accurate. In this study, the surgical resident match odds ratio for students starting the clerkship already knowing they wanted to be a surgeon was 22.46; the next highest associations were 4.65 and 3.37, which corresponded to earlier exposure to a surgical specialty and earlier exposure to general surgery, respectively. Differences in career choice for general surgeons and surgical specialists were also explored. Although the experience of the clerkship is related to career choice, the largest impact of the clerkship is for those already interested in a surgical career. Interest in a surgical career largely develops before the third-year clerkship. Implications of the results for recruiting greater numbers of students into surgical careers are discussed.

Use of Breast Simulators Compared with Standardized Patients in Teaching the Clinical Breast Examination to Medical Students

Simulators have replaced some standardized patients in medical student teaching, and their use seems to decrease anxiety related to the clinical breast examination (CBE). We compared learning the CBE on a breast palpation simulator with learning on a standardized patient with respect to skill acquisition and comfort level. At Penn State College of Medicine, the class of 2008 (historical control group, n = 113) learned the CBE on a standardized patient, whereas the class of 2009 (experimental group, n = 131) learned on the breast palpation simulator. We used measures of the process (conducting the CBE) and measures of the outcome (examination scores and detection of abnormal findings). During their third-year surgical clerkship, students in both groups completed a questionnaire reporting the number of CBEs performed and confidence in performing the CBE. The students then performed an observed examination on the simulator, and the number of positive findings detected was recorded. The mean number of positive findings was compared between groups, and an economic analysis was conducted. The experimental group had a significantly higher mean examination score than the historical control. In subgroups, this difference was significant for those who reported performing 0-5 clinical examinations but for not those who had performed >6 examinations. On individual items, the experimental group scored significantly higher in examining for neck nodes, nipple retraction, skin changes, and axillary evaluation. The 2 groups did not differ significantly in the mean number of positive findings detected or in ratings of comfort level. Medical students who learned the CBE on breast palpation simulators performed as well or better than those who learned on standardized patients; however, a subgroup analysis revealed that the benefit was limited to students with less clinical experience.

Medical Student Surgery Elective in Rural Haiti: A Novel Approach to Satisfying Clerkship Requirements While Providing Surgical Care to an Underserved Population

The addition of global health programs to medical school training results in graduates with enhanced clinical skills and increased sensitivity to cost issues. Funding from U.S. medical schools has been unable to meet student demand, and therefore it is often a critical limiting factor to the lack of development of these programs. We describe an alternative approach for global health surgical training for medical students. Emory University medical students and faculty, in collaboration with Project Medishare for Haiti, planned, raised funds, and executed a successful short-term surgical camp to supplement available surgical services in rural Haiti. Learning objectives that satisfied Emory University School of Medicine surgery clerkship requirements were crafted, and third-year students received medical school credit for the trip. In the absence of house staff and placed in an under-resourced, foreign clinical environment, the surgical elective described here succeeded in meeting learning objectives for a typical third-year surgical clerkship. Objectives were met through a determined effort to ensure that home institution requirements were aligned properly with learning activities while students were abroad and through a close collaboration between medical students, faculty members, and the administration. Emory University's international surgery elective for medical students demonstrates that opportunities for supervised, independent student-learning and global health service can be integrated into a traditional surgical clerkship. These opportunities can be organized to meet the requirements and expectations for third-year surgery clerkships at other medical colleges. This work also identifies how such trips can be planned and executed in a manner that does not burden strained academic budgets with further demands on resources.

Student Perceptions of Medical Errors: Incorporating an Explicit Professionalism Curriculum in the Third-Year Surgery Clerkship

Among medical educators, there is a universal call for curricula that emphasize development of character, compassion, and integrity. A unique challenge to the development of such curricula is the lack of tools with which to assess student progress. To these ends, we created a curriculum designed to inculcate the values of the surgical profession alongside both fact-based and skill-based learning within the triad of medical school education. Our purposes were 1) the acknowledgment of student fears regarding committing medical errors during their third-year surgical clerkship and 2) the design of curricular content aimed toward a more comprehensive understanding of professionalism using medical error as a paradigm. Third-year clerks on the surgical service were assigned readings, participated in formalized discussions regarding medical errors and ethics, and were required to complete questionnaires that contained open-ended questions pertaining to their concerns, observations, and reactions toward any perceived or actual medical errors they encountered during the third-year surgical clerkship. Questionnaires were analyzed according to themes contained within the students' responses. Most students expressed an initial fear of committing primarily technical medical errors and subsequently causing harm to patients. The dilemma as to whether to speak up against a superior regarding unaddressed medical errors appeared as a frequent theme among the students. New prerotation and postrotation questionnaires have been designed to allow for both quantitative and qualitative analysis of the students' understanding of the gravity of varying types of medical errors and how they relate to medical professionalism.

Narrative Medicine in Surgical Education

Narrative medicine is a patient-centered approach to the practice of medicine that rescues the patients' stories and integrates what is important to them into decisions regarding their health care. Our hypothesis is that narrative understanding enhances the patient-provider relationship and contributes to optimizing patient care. We propose to use written narrative reflection to capture and measure the general competencies of systems-based practice, practice-based learning, communication skills, and professionalism. DEVELOPMENT/METHODS: The development of this narrative-based project is based on a pilot study that we conducted at our institution with third-year surgical clerkship students. In the pilot, students produced in-depth narrative write-ups on a patient they had had the opportunity to "know." We plan a similar approach for surgical resident education. After a brief discussion of narrative medicine during our scheduled didactic conference, the residents are asked to initiate a written narrative reflection on a patient of their choosing. The narratives will be collected 1 week later. Our plan is to repeat this assessment quarterly so that 4 narratives will be generated annually from internship through the chief resident year. The narratives will be analyzed for content and recurring themes that capture the resident's communication skills, professionalism, as well as self-critique (practice-based learning) and value attributed to health-care teams (systems-based practice). After completion of the narratives, a 5-point Likert response survey will be given to the residents to assess their experience and the perceived value of written reflection. The written narratives will become part of the resident's ongoing portfolio. IMPLEMENTATION/EXPERIENCE TO DATE: Feedback from the medical student pilot study was favorable. When asked in a follow-up questionnaire, most students reported the experience to be valuable and recommended the use of narrative reflection in medical education. To assess the feasibility of this approach in surgical residency, we introduced the concept of narrative reflection to our residents during surgery grand rounds. Thirty-three narratives were collected 1 week later. CONCLUSION/NEXT STEPS: This preliminary experience suggests that acquisition of resident-authored narrative reflection is feasible during surgical residency. Use of this narrative-based approach in surgical resident education has the potential to capture and measure the general competencies of systems-based practice, practice-based learning, communication skills, and professionalism.

Reliability and Usefulness of Clinical Encounter Cards for a Third-Year Surgical Clerkship

Third-year medical students (MS3) were given clinical encounter cards (CECs) to stimulate feedback during their surgery clerkship. This study analyzes the feedback given on their clinical performance using CECs. Two hundred one students enrolled in the 12-week surgery clerkship were given CECs. Each card contained the chief focus of the encounter, which was rated on a six-point Likert scale. The CECs were analyzed to determine if they provided reliable formative information, identified marginal performances, and identified differences between raters, settings, rotations, and aspects of clinical performance evaluated. Seven thousand three hundred eight CECs were submitted from 201 students. The CECs were completed most often (65%) in the inpatient setting. Technical skills were evaluated on 49% of CECs, history/physical examinations on 40%, and case presentations on 30%. There were comments written on half of the CECs and 89% of these were strictly positive. Women (52.8%) and faculty (63.3%) were more likely to provide written comments. The students were most likely to seek feedback from the interns and faculty who gave significantly higher ratings. The Cronbach-alpha reliability coefficient was 0.69, based on 12 raters per student. There was a significant positive correlation (P < 0.05) between the CEC composite rating and the clinical performance rating (r = 0.356), NBME score (r = 0.258), and the final grade (r = 0.250). The implementation of CECs in a surgery clerkship provided a large quantity of positive feedback. The quality was limited because there were minimal recommendations for improvement and they were a poor predictor of overall clinical performance.

18: Student quality of life decline during third-year surgical clerkship

Introduction: Choosing surgery as a career is declining among U.S. medical students. The 8-week third-year surgery clerkship at our institution can be an intense learning experience, and we hypothesized that participation in the clerkship may negatively impact student quality-of-life to the point of dissuading students from choosing a surgical career. We began a study in 2005 to address this hypothesis, and our quality-of-life findings are presented here. Methods: At orientation (baseline), students were asked to complete a survey that measured quality-of-life on an 84-point scale, and depression on a 40-point scale. The quality-of-life scale was composed of select questions from the Medical Outcome Study, and the depression scale was composed of a subset of questions from the Beck Depression Inventory. Students were also asked the typical number of hours they slept per night. On Week 6 of the clerkship, students were surveyed on the same quality-of -life and depression scales, and asked average hours of sleep per night for the previous week. Results: From June 2005 through June 2006, 93 of 121 students agreed to participate in the study, representing a response rate of 77%. Forty-five students were women (48.39%), and the average age was 26.09 (sd 2.85). Mean quality-of-life at baseline was 56.43 (n=93, sd=11.36) and at Week 6 was 50.79 (n=92, sd=10.35) representing a statistically significant average decline of 5.63 points (n=92, 95% CI=3.21-8.06). Mean depression at baseline was 35.31 (n=93, sd=3.94) and at Week 6 was 34.83 (n=93, sd=3.59), representing a non-significant average decline of 0.48 points (n=93, 95% CI -0.24-1.21). Mean sleep at baseline was 6.34 hrs/night (n=92, sd=0.91) and at Week 6 was 5.70 hrs/night (n=91, sd=1.30), representing a statistically significant average decline of 0.64 hrs/night (n=90, 95% CI 0.36-0.93). Conclusion: In the first year of our study, quality-of-life and sleep declined significantly in third-year medical students from orientation to week 6 of their surgery clerkship. Depression level, however, did not change significantly during this time period. We look forward to assessing whether the magnitude of this decline in quality-of-life predicts students avoiding a future career in surgery.

Medical student concerns and fears before their third-year surgical clerkship

Background This study describes the personal concerns of third-year medical students beginning their surgical clerkship. To assess these needs, we studied the expectations, interests, and concerns of beginning surgical clerks. Methods Beginning surgical clerks during the 2002–2003 academic year were invited to respond to a written survey. Responses were categorized into domains of interest and domains of concern. Analysis controlled for prior surgical experience, interest in a surgical career, and academic term. Results The response rate was 83%. Students were most curious about surgical practice, technical skills, and issues of lifestyle/balance among surgeons. Students were most concerned about fatigue, long hours, potential mental abuse, and poor performance. Differences between groups are described. Conclusions Beginning surgical clerks have questions and concerns about topics often not addressed in the curriculum or syllabus. This study suggests the nature of improvements that could assist the inexperienced student in creating a positive clerkship experience and guiding their choice of career.

Objective assessment of videoconferenced lectures in a surgical clerkship

Background A challenge to the practice of third-year clerkship rotations at remote locations is the maintenance of equivalent didactic lectures, especially in subspecialty components. There has been little objective assessment of the results of videoconference lectures on medical student clerkship education. Methods Third-year surgical clerkship students, randomly assigned to a 4-week rotation 75 miles from the medical school, received subspecialty lectures by interactive teleconference via an ISDN line at 128 kb/s. Weekly quiz results (% correct) of students who received videoconference lectures were compared with students receiving conventional lectures, and were analyzed by 2-tailed t tests for equality of means. Results A mean of 12 students were tested per quiz (range, 5–21 students) after videoconference lectures, and 98 students were tested after conventional lectures (range, 41–146 students). The mean quiz score of students receiving video lectures was 70.5% (range, 65.4% to 73.6%); and after conventional lectures the mean quiz score was 71.4% (range, 69.5% to 76.8%). There were no significant differences in the mean scores of the individual quizzes ( P = .16–.92) or between the totals ( P = .65). Conclusions Telemedicine, using interactive videoconferencing, is an effective method for didactic lectures in a surgical clerkship. This technology allows students to receive interactive lectures at distant clinical sites and limit their travel.