Undergraduate Surgical Teaching Research Articles

201 The Surgical Hour: Improving the Surgical Footprint of Undergraduate Surgical Teaching

Abstract Aim To deliver an online surgical teaching programme for medical students to enhance undergraduate surgical education and evaluate its effectiveness. The drive was for increasing the surgical footprint in a curriculum surgeons felt lacked exposure during the COVID-19 pandemic. Method Surgical speakers across 9 different surgical specialties were recruited via email. Topics included basic surgical principles, common pathologies, the surgical portfolio and surgical innovation. The programme was advertised to students via social media and a newsletter. Quantitative and qualitative feedback was collected via attendee feedback forms. Attendees’ knowledge in topics covered before and after each lecture was measured via self-assessment using a 5-point Likert scale. A paired t-test was performed to measure pre- and post-session knowledge. Results 17 lectures were delivered between October 2021 and May 2022. 463 feedback forms were completed across the series by students across all years. Mean knowledge ratings improved after each session. 16/17 teaching sessions produced a statistically significant improvement in surgical knowledge (p<0.05). The most statistically significant improvement was seen following the acute abdomen lecture (p = 0.00) Vascular surgery showed an increase from 2.8 to 4 (p = 0.07). Common themes in written feedback were relevance to clinical practice, enthusiastic speakers, and exposure to content not otherwise taught in the curriculum. Conclusions Supplementary surgical series successfully address the demand for increased surgical teaching within the undergraduate curriculum. They improve insight into a career in surgery with exposure to positive role models, significant improvement in knowledge and practical advice on career development, empowering students to pursue surgery.

A review of UK undergraduate surgical curricula and teaching methods with an analysis of the university of Dundee (2011–2021)

• There is insufficient undergraduate surgical teaching in the UK. • Inconsistent teaching has led to severe shortfalls in many surgical specialties. • Simulation based learning has become an essential pillar of surgical education. • Studies typically measure subjective student-reported confidence in taught skills. • The university of Dundee runs successful BSS and theatre etiquette sessions. This review discussed the current state of undergraduate surgical education in UK medical schools with focus on changes over the previous decade (2011–2021). An analysis of theatre etiquette and basic surgical skills (BSS) courses from the University of Dundee undergraduate curriculum was also undertaken, with comparison to the literature. A PubMed search using the quire “(undergraduate) AND (medicine) AND (Surgical) AND (teaching) AND (UK)” returned 155 publications. These were screened for relevance to yield the 100 publications discussed in this review. Analysis of student feedback (2016 – 2019) was carried out for BSS and theatre etiquette courses. There exists a lack of consensus around the undergraduate curricula with extreme variation in teaching and clinical exposure by speciality and medical school. These are aided by the widespread adoption of simulation-based learning and non-technical skills teaching. Most teaching is conducted in transitional programmes to prepare students for surgical attachments with skills teaching focused on fourth- and fifth-year students. Scrubbing, gowning, gloving, and suturing are all often taught briefly and inconsistently with little follow up. A wide variety of novel techniques including near peer assisted, targeted basic surgical skills (BSS) courses and student opportunities, including mentorship and conferences have been found to be effective but are often limited to a single institution. Consensus amongst the existing literature highlights an urgent need for reform of surgical education to ensure patient safety and graduate competency. The University of Dundee runs a theatre etiquette and BSS courses which produces results which indicate a high degree in confidence subjective outcomes. There is a wealth of subjective and non-specific data with infrequent objective comparison between modern teaching modalities. The deficiency of undergraduate surgical teaching presents an opportunity to re-establish curricula using significantly more effective non-technical, near-peer, and simulation teaching modalities.

SP1.2.3 The SIMple Things: Using Simulation Models to Improve Junior and Undergraduate Surgical Teaching in a DGH

Abstract Aims Many clinical activities remain cancelled or uncertain in the COVID world. We established a Surgical Skills Club in our DGH, where students and juniors are rotated far from their home institution. We also aimed to improve our undergraduate teaching by incorporating new surgical Sim sessions. Methods We established a weekly Surgical Skills Club by trainees, and promoted this through MedEd to all juniors, students and ANPs. We used a combination of higher-fidelity models owned by the hospital and low fidelity models designed by ourselves such as lap-appendix and hernia. We utilised social media to share ideas. We recorded attendance and sought written feedback. We also set up dedicated simulation sessions as part of ongoing undergraduate teaching. Results Anonymous feedback was documented weekly via app/online. For skills club, 100% of attendees documented experience as “great” or “good” (options great, good, average, fair, poor). Attendance varied from 2–15 each week. The best attendance was a formalised session with consultant input. For undergraduate Sim, 100% of attendees rated experience as “great” or “good”. All attendees agreed Sim teaching improved their experience of surgery. 20% stated it made them consider a career in surgery. Conclusions Surgical simulation is an excellent tool for improving experience of general surgery especially in a COVID environment, and can widen access to surgical training by allowing juniors to explore their skills in a controlled, informal environment. Lap Skills gave students real-world confidence. A combination of low fidelity models provided the best experience showing that the barrier of cost can be broken.

388 The SIMple Things: Using Surgical Simulation to Improve Junior and Undergraduate Surgical Teaching in a Rural DGH

Abstract Aim Many clinical activities remain cancelled or uncertain in the COVID world. We established a Surgical Skills Club in our rural DGH, where students and juniors are rotated far from their home institution. We also aimed to improve our undergraduate teaching by incorporating new surgical Sim sessions. Method We established a weekly Surgical Skills Club by trainees, and promoted this through MedEd to all juniors, students and ANPs. We used a combination of higher-fidelity models owned by the hospital and low fidelity models designed by ourselves such as lap-appendix and hernia. We utilised social media to share ideas. We recorded attendance and sought written feedback. We also set up dedicated simulation sessions as part of ongoing undergraduate teaching. Results Anonymous feedback was documented weekly via app/online. For skills club, 100% of attendees documented experience as “great” or “good” (options great, good, average, fair, poor). Attendance varied from 2–15 each week. The best attendance was a formalised session with consultant input. For undergraduate Sim, 100% of attendees rated experience “great” or “good”. All attendees agreed Sim teaching improved their experience of surgery. 20% stated it made them consider a career in surgery. Conclusions Surgical simulation is an excellent tool for improving experience of general surgery especially in a COVID environment and can widen access to surgical training by allowing juniors to explore their skills in a controlled, informal environment. Lap Skills gave students real-world confidence. A combination of low fidelity models provided the best experience showing that the barrier of cost can be broken.

EP.TU.590Making the cut – Tailoring an undergraduate surgical teaching programme a QI project

Abstract Aims This project set out to improve the quality of surgical teaching for final year students on a DGH placement. A four-week programme was introduced and regular modification was undertaken through systematic gathering of feedback. The sessions developed were interactive question-based tutorials, suturing, and on-call simulation with common F1 scenarios. Methods Material was developed and piloted based on topics the facilitators felt were poorly taught as students. Feedback was gathered by questionnaire after each session comparing the student’s confidence before and after, along with suggestions for improvement. This process was repeated through all six rotations. Results A total of 95 questionnaires were completed. Average confidence increased from 52% to 77%. The programme was expanded based on suggestions to include orthopaedic examinations and plastic surgery. The tutor pool was increased to include more foundation doctors to ensure sustainable weekly delivery. Examples of how suggestions were implemented include: Conclusions The success of the teaching programme was evident through positive feedback and good student attendance. By playing to the strength of foundation trainees as recent graduates, the programme complemented content-based teaching from more senior colleagues with sessions targeting practical F1 skills and exam specific needs of students. Early piloting also meant ability to constantly adapt the programme to enhance its benefit to the students.

1496 Building Inclusivity and Diversity from our Foundations: A Cross-Sectional Study Identifying Barriers to Theatre Based Training for Foundation Doctors

Abstract Aim Theatre experience is a powerful factor enabling trainees to determine whether they possess the enthusiasm and aptitude to undertake a surgical career. Removing barriers to theatre learning should allow a more meritorious and diverse cohort of surgical trainees. Method An 18 -point open and closed question Likert scale survey was distributed to Foundation Doctors in three hospitals within the Northern Deanery. The survey was designed via focus group and literature review, ascertaining perceived levels of preparedness, acceptance, enjoyment, and barriers to theatre access. Results The survey dichotomized respondents (n = 54) into those who attended theatre (n = 40) and those who did not (n = 14). Of those attending 38% (n = 15) reported intimidation and 15% (n = 6) cited a cultural barrier to attendance. Of those who did not attend 79% (n = 11) were interested in surgery. These respondents predominantly reported concerns around prohibitive ward workload and unfamiliarity with protocols. Covid restricted surgical rotations for some. There was a statistically significant difference (p fishers exact test = 0.001) between 83% of respondents who felt welcomed by the surgeons compared to just 45% made to feel welcome by the wider theatre team. Only 20% (n = 11) of respondents felt prepared for theatre by medical school. 50% (n = 27) were confident with theatre protocols. Conclusions The study raises concerns around apprehension surrounding the theatre environment and ward workload which appear to impede access to theatre. Adequate undergraduate surgical teaching, appropriate induction and allocation of theatre time are crucial to improve safety, diversity of applicants, confidence for trainees and compliance within the team.

Surgical Skills Workshops Should Be a Part of the United Kingdom Undergraduate Medical Curriculum.

Introduction: Medical students across the United Kingdom (UK) report poor satisfaction with surgical teaching. The Surgical Skills Day (SSD) begins to address this by exposing medical students to surgery through an easily accessible one-day practical workshop. This study shows how the SSD encourages undergraduate engagement in surgery.Method: Feedback forms were emailed to attendees of the SSD and their anonymised responses were used to evaluate the SSD.Results: A total of 144 students attended the SSD across three years and the feedback response rate was 74% (n = 107). Key findings were that 100% of respondents (n = 107) would like the SSD to be an annual event, 79% (n = 83) were more inclined to pursue a surgical career following the event, and 97% (n = 103) would like to see practical surgical skills incorporated into the curriculum. The SSD was able to engage undergraduates with surgery through mentorship, practical skills, specialty exposure, and teaching of the General Medical Council (GMC) mandated skills.Conclusions: Undergraduate surgical teaching in the UK is insufficient. The student-led annual SSD showed improved engagement in practical surgical skills and increased enthusiasm for a surgical career. In light of this, the authors feel the SSD or similar event should be integrated into the UK medical school curriculum.

Increasing motivation and engagement in neurosurgery for medical students through practical simulation-based learning.

BackgroundSimulation-based learning (SBL) is an essential adjunct to modern surgical education. Our study aimed to evaluate the educational benefit and motivational impact of a pilot practical neurosurgical module.Materials and methods38 clinical medical students from several EU Medical Schools attended an international surgical course focused on teaching and learning basic surgical skills. We designed a pilot neurosurgical workshop instructing students to insert an intracranial pressure bolt using an ex vivo pig model. Each delegate was assessed by two consultant neurosurgeons using a validated assessment tool. Structured questionnaires were distributed on completion of the module.ResultsDelegate performance increased (p < 0.001) with no difference in performance improvement across year of study (p = 0.676) or medical school (p = 0.647). All delegates perceived this workshop as a potential addition to their education (median 5/5, IQR = 0), and indicated that the course provided motivational value towards a neurosurgical career (median 4/5, IQR = 1), with no difference seen between year of study or medical school (p > 0.05).ConclusionOur pilot neurosurgical workshop demonstrated the educational value of practical SBL learning for motivating students towards a surgical career. Homogeneous views across year of study and medical school underline the value of developing a unified strategy to develop and standardise undergraduate surgical teaching with a practical focus.

Undergraduate Surgical Teaching: Reflections by a Student-Led Surgical Society

Undergraduate Surgical Teaching: Reflections by a Student-Led Surgical Society

Has the Bachelor of Surgery Left Medical School?—A National Undergraduate Assessment

Nearly all trainee doctors would undertake a surgical placement in their clinical training; however, there is anecdotal evidence of variability in undergraduate surgical teaching across the UK. We set out to describe the provision of undergraduate surgery and report graduating students' opinions of aspects of this. We undertook a cross-sectional questionnaire of medical students graduating in 2014 from UK medical schools. An online electronic questionnaire was used to capture demographics, career intentions, and individual's undergraduate experience of surgery. A separate questionnaire was sent to medical schools to assess time devoted to surgical placements and how surgical sciences were taught and assessed. From 483 responses covering 31 UK medical schools, there were 328 completed student questionnaires. A third of respondents felt that teaching of surgical sciences was inadequate. Medical schools reported time allocated to surgical specialties ranging from 4 to 21 weeks (median 13 weeks). Among all, 1 medical school offered a basic surgical skills course and 1 medical school specifically assessed surgical-related skills. Overall, 65% of medical students felt prepared for a surgical foundation placement and 88% felt prepared for a medical foundation placement. In total, 78% felt ready to participate in an acute medicine on-call and 48% felt ready for emergency surgery on-call. There was a positive association between time dedicated to undergraduate surgery and reported preparedness for a foundation surgical job. UK medical students reported uniformly low rates of satisfaction with surgical science teaching. Students studying at medical schools with more time in the curriculum dedicated to surgery reported higher levels of preparedness for surgical foundation jobs. There were differences in the rates of perceived preparedness for surgical posts and for emergency surgery. There is a clear need to review undergraduate surgical provision to ensure that students are equipped for safe practice in junior surgical foundation jobs.

The surgical experience of current non-surgeons gained at medical school: a survey analysis with implications for teaching today's students.

BackgroundIt is unknown what aspects of undergraduate surgical curricula are useful for future non-surgeons. We aimed to define relevant, enduring learning achievements for this subgroup to enable student-centered teaching.MethodsAn online questionnaire using open ended questions was distributed to physicians of non-surgical specialties at the University Hospital of Tuebingen, Germany and its associated teaching hospitals. Participants were asked to describe knowledge and skills that endured from their surgical clerkship and which of these are used in daily practice. Textual responses were initially coded using content analysis and the frequency of recurrent categories was calculated.ResultsSixty-seven of 153 questionnaires were returned; participants belonged to six different non-surgical specialties and had received their training at 22 different medical schools. Sustaining learning achievements included basic skills (suturing and working under sterile conditions), learning about professionalism and appreciating working conditions in surgery. Two learning techniques were valued: witnessing of rare cases or complications and working autonomously.ConclusionIntegration of our findings in undergraduate surgical teaching may focus teaching on students’ interests and improve surgical teaching.

Undergraduate experience of surgical teaching and its influence and its influence on career choice

The purpose of this survey was to determine the views of final year medical students in Melbourne regarding both undergraduate surgical teaching and the students' career aspirations. A structured questionnaire was given to all final year medical students at Monash and Melbourne Universities in 2003. The questions dealt with the factors influencing graduating medical students, including theatre experience, encouragement/support from surgeons, presence of mentors, lifestyle factors and gender issues. The response rate was 61.2% (251/410). Of these, 50.6% were male, 32.3% declared an interest in surgical training with the remainder either uncertain (24%) or uninterested (44%). Male students were more likely to be interested in surgery. General surgery was the most popular field (69%), followed by plastic surgery (37%) and orthopaedic surgery (35%). Of respondents, 78% reported positive influences towards pursuing a surgical career during their undergraduate years, while 63% reported a negative experience. A total of 67% believed that the current curriculum is adequate and 43% that there is enough support/encouragement towards a surgical career. Only 44% of respondents reported that surgeons are approachable. Lifestyle and family factors were the most important career influence. In particular, 57% of female respondents felt discouraged from pursuing a surgical career and 99% of these women reported lifestyle/family factors as the main source of discouragement, with a further 72% identifying a lack of female role models. This survey highlights important issues in current undergraduate perception of surgical teaching and higher training. Issues that may encourage or discourage a graduating student to pursue a surgical career are identified.

Electronic learning can facilitate student performance in undergraduate surgical education: a prospective observational study

BackgroundOur institution recently introduced a novel internet accessible computer aided learning (iCAL) programme to complement existing surgical undergraduate teaching methods. On graduation of the first full cycle of undergraduate students to whom this resource was available we assessed the utility of this new teaching facility.MethodThe computer programme prospectively records usage of the system on an individual user basis. We evaluated the utilisation of the web-based programme and its impact on class ranking changes from an entry-test evaluation to an exit examination in surgery.Results74.4% of students were able to access iCAL from off-campus internet access. The majority of iCAL usage (64.6%) took place during working hours (08:00–18:00) with little usage on the weekend (21.1%). Working hours usage was positively associated with improvement in class rank (P = 0.025, n = 148) but out-of hours usage was not (P = 0.306). Usage during weekdays was associated with improved rank (P = 0.04), whereas weekend usage was not (P = 0.504). There were no significant differences in usage between genders (P = 0.3). Usage of the iCAL system was positively correlated with improvement in class rank from the entry to the exit examination (P = 0.046). Students with lower ranks on entry examination, were found to use the computer system more frequently (P = 0.01).ConclusionElectronic learning complements traditional teaching methods in undergraduate surgical teaching. Its is more frequently used by students achieving lower class ranking with traditional teaching methods, and this usage is associated with improvements in class ranking.

General Surgery as Education, Not Specialization

The topic I have chosen for the Presidential Address is controversial. I will present my point of view on the subject, which does not necessarily reflect the opinions of the other members of the Association. General surgery in crisis has been an increasingly repeated topic of discussion, but not many solutions to this discussion has been offered. There is no doubt, however, that general surgery should continue to be used as an effective coordinator of undergraduate surgical teaching, not withstanding departmental fragmentation. Over the years, general surgery has been providing core surgical training for many specialties’ residents. Snow1 has outlined this by saying, “The specialties of surgery, other than general surgery, continue to depend upon the discipline and specialty of general surgery for education, research and clinical practice.” Therefore, the discipline of general surgery has remained as the unifying force in surgery. Along this same line, Organ2 defined general surgery as the “gatekeepers” for surgical education, research, and patient care. Despite these eloquent declarations, general surgery has been losing its appeal as a career choice for students and residents alike, and moreover, it has been scrutinized by its nonsurgical colleagues and the public in general. In the United States, general surgery had its peak level of interest in 1981, when 12.1% of senior medical students selected general surgery as the first choice of specialty.3 In 1989, the interest level dropped to 10%, then down to 8% the following year, and to a low of 6.1% in the 2001 match program. Questionnaires were handed out to the students asking them to make a list of factors that were influential in their decision-making process.3 In the 1990s, students ranked the “type of patient problems encountered” as having the greatest influence in their decision of the specialty they wished to pursue. The second most influential factor was “clerkship” in the area, intellectual content of the specialty, or “challenging diagnostic problems.” The third most influential factor was “example of a physician to the specialty,” which was interpreted to be the “role model” that the student identified to. In the data extracted from the 1978 to 2001 medical student graduate questionnaire, all medical schools reported a large percentage of students (38.8%–57.8%) who were initially attracted to the specialty of general surgery and later changed their minds because of the following lifestyle issues4: unpredictable work hours, demands on time and effort, amount of stress, type of patient problems encountered, and the length of the residency program. In an analysis of contemporary trends in student selection of medical specialties by Bland and Isaacs,5 it was confirmed that perceived threats to lifestyle remained an important factor influencing the career choice of medical students. These issues may be among the most important because half of the medical students today are women, and lifestyle in a surgical program has been viewed as “especially difficult to combine with family life.” Program directors must address these issues in an attempt to attract top students. The surgery clerkship experience is also a major factor for students when deciding on a specialty. Polk6 has observed a 30% decrease in required clerkship experience in medical schools and students’ exposure to surgical sciences because of the shortening of requisite surgical rotations. In a recent Presidential Address, “Surgery, a Noble Profession in a Changing World,” Debas7 concluded that unless these trends are reversed (not only the declining number of students applying for surgical training but also the declining quality of training for those who do apply), “general surgery as specialty is threatened, and a future shortage of general surgeons is inevitable.” In addition, in America, the results of the 2001 general surgery national residency match program revealed an entirely unprecedented 7% unfilled first-year general surgery training positions.8 In an analysis9 of the data from the Canadian Residency Matching Service, the number of applicants listing general surgery as their first choice was 5.68% in 1996 and dropped to 4.25% by 2001. There are no official figures in Europe, but there is a consensus that general surgery is now becoming one of the least competitive surgical specialties. Another crucial deterrent in the pursuit of a career in general surgery may be the length of training period (residency programs of 5 or 6 years). Furthermore, quite often there maybe subsequent extensions to their training programs. It could be said that, in light of the current situation, general surgery has probably lost its personality as a specialty.

Undergraduate surgical teaching utilizing telemedicine.

To evaluate the concept of a new telemedicine orientated educational application by exposing junior medical students to surgical teaching via video-conferencing from the operating theatre and comparing this to the traditional method currently employed, which requires the presence of students in the operating room. To determine student satisfaction with this novel method and identify deficiencies associated with traditional surgical teaching. Students were connected by video-conferencing equipment 2 Mbit/s permanent virtual circuits that provided two-way picture and voice communication. Traditional tutoring involved students attending the operating theatre in set numbers. Video recordings were made during the telemedicine transmission for highlighting important factors relevant to the operative procedure. A questionnaire was used to assess the quality of time spent and information obtained by the students. Telemedicine centre and operating theatre, St Mary's Hospital, London. Junior clinical students. The median score for surgical teaching utilizing video-conferencing was 9 (scale 0-10) compared to 5 for traditional operating theatre surgical teaching. All 46 (100%) subjects indicated a willingness to return for the telemedicine influenced method of tutoring compared to 65% of students exposed to the conventional method. Our early experience with telemedicine assisted surgical teaching indicate high acceptance and satisfaction rates by clinical students. Further studies to evaluate the objective gain in knowledge associated with this method is required prior to its implementation in any future medical curriculum.

Undergraduate surgical teaching using telemedicine

Undergraduate surgical teaching using telemedicine