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The Surgical Clerkship: A Contemporary Paradigm
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS Surgery students rotating at one hospital participated in weekly sessions on leadership/teamwork, while those at others sites did not. to test the programmatic effectiveness, all surgery students completed a well-accepted, validated, reliable teamwork survey at the beginning and the end of the 3-month rotation between 9/1/2010-4/1/2011 (TeamSTEPPS Teamwork Attitudes Questionnaire). Scores were compared for students receiving leadership/teamwork training and those who did not (SPSS). Results: 64 students completed pre-test and posttest surveys. 22 participated in the leadership/teamwork curriculum. Compared to students not receiving leadership/teamwork training, program participants had significantly better scores for Team Structure (p<.001), Situation Monitoring (p¼.045) and Communication (p¼.046) but not Mutual Support (p¼.249) or Team Leadership (p¼.307). Using a Likert-scale evaluation (1¼strongly disagree; 5¼strongly agree), leadership/teamwork students ranked the following statements: ‘‘valuable educational experience’’ (Mean score¼4.27), ‘‘.lead(s) to improvements in my patient care’’ (Mean Score¼3.95), ‘‘.lead(s) to improved performance as a medical student’’ (Mean Score¼4.36), and ‘‘.should be offered to medical students in the future’’ (Mean Score¼4.41). Conclusions: We developed a leadership/teamwork skills program that was perceived as valuable and relevant by medical students. Compared to students without teamwork training, students participating in the program had improved teamwork knowledge and attitudes at the end of each rotation.
19.7. The Surgical Clerkship: A Contemporary Paradigm. E. L. Bradley,1,2,3 A. B. Littles,1 L. J. Romrell1; 1Florida State University College of Medicine, Tallahassee, FL; 2Same, Tallahassee, FL; 3Same, Tallahassee, FL Introduction: Traditional Surgical clerkships have been composed of a mixture of hospitalized patients, daily resident interaction, periodic attending rounds, and assigned texts, often augmented by lectures. Recently, academic research has challenged the underpinnings of this traditional curriculum. Moreover, traditional clerkships do not necessarily mirror today’s surgical practice given its increasing short-stay and out-patient emphasis. Initiated in 2001, the allopathic Florida State University College of Medicine provided an opportunity to create a contemporary surgical curriculum, emphasizing learning rather than teaching. Methods: The eight week FSU surgical clerkship is a tutorial model. at each of our six regional campuses, students are assigned one-on-one to a carefully selected, board-certified community surgeon, responsible for daily in-patient and out-patient teaching. the academic spine for the rotation is provided by a central curriculum, containing defined objectives and competencies, administered during weekly meetings with the student by campus-specific surgical clerkship directors. Residents do not participate in student teaching, nor are lectures used. Students are free to choose from among suggested print materials or alternative learning sources. Patient contacts are entered into an electronic data collection system, capable of comparing both student and individual campus experiences. Evaluations of student performance are 360 degrees: by patients, staff, clerkship faculty, and clerkship directors. Results: to date, 456 students have graduated. No significant differences exist between campuses with respect to either the numbers or types of patients encountered. USMLE Step II CK and CS scores, or NBME Surgery Subject Examination scores (p>.05). Student satisfaction with the course is evidenced by exceptionally positive responses to the end-of-clerkship evaluations of both faculty and clerkship at each of the campuses, and by anonymous laudatory responses by graduating seniors to the AAMC GQ Survey. Overall, 23.3% of graduates have chosen some aspect of Surgery as a career. the community faculty retention rate exceeds 97%. Conclusions: 1) A quality clerkship experience in Surgery can be provided by a non-traditional community-based system, 2) the distributed campus model does not lead to inequality of learning opportunities or surgical experiences, 3) Both students and community faculty strongly support the tutorial model, 4) Student learning has been confirmed by national metrics.
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19.8. Clinical Experience Correlates With Surgical Examination Scores. Y. Vigneswaran, B. Gabryszak, C. Golner, L. Fogg, S. D. Bines, J. A. Myers; Rush University Medical Center, Chicago, IL Introduction: Medical schools worldwide continue to face the challenge to construct both a balanced curriculum between clinical experience, lectures, reading time and other activities and to find appropriate methods for clinical evaluation. Although most schools in the United States use the National Board of Medical Examiners (NBME) subject examinations as a method of at least partial assessment, there is still uncertainty of how well these examination scores correlate with clinical proficiency. Thus, we investigated which factors in a surgery clerkship curriculum have a positive impact on academic achievement on the NBME surgery subject examination. We hypothesized students with more free time for selfstudy outside of their clinical experience would achieve better scores on the objective NBME surgery subject examination. Methods: We performed a retrospective analysis of 83 third-year medical students at our institution that rotated on the 8 week core general surgery clerkship for the 2007-2008 academic year. During this academic year, reorganization of the clerkship allowed for analysis of four groups of students experiencing varying clinical volume: two groups with unequal clinical volumes and time for self-study during the first 6 months and two groups with equivalent clinical experiences during the last 6 months. Records of the United States Medical Licensing Examination (USMLE) Step 1 scores, NBME scores and essay examination scores in each set of groups were compared using single-factor analysis of variance testing. Additionally, to specifically characterize each service, student feedback for each surgical service was obtained evaluating the clinical course load, time allotted for self-study, time in lectures and teaching effectiveness. Results: Data from the first six months demonstrated NBME scores from the group with the heavier clinical loads and least time for self-study were statistically higher than the group with lighter clinical services and higher rated self-study time (p ¼ 0.036). the last six months, when the clerkship was rearranged to create two groups of equal clinical loads, there was no statistical difference of NBME scores between the groups (p ¼ 0.751). Baseline USMLE step 1 scores were not significantly different between the groups and no statistical difference was seen in the subjective essay examination scores. Conclusions: We found that students experiencing higher clinical volumes on surgical services, but less selfstudy time demonstrated statsically higher academic performance on objective evaluation, suggesting clinical experience may be of higher value than self-study and reading. Thus, as the structure of our training system adapts to abide by the duty hour restrictions for trainees, we must be conscientious that certain experiences on the floors and in the operating room are invaluable and cannot be substituted. 19.9. Attending Surgeons and Residents Underestimate Their Influence on Medical Students Entering Surgery. R. C. Quillin, T. A. Pritts, D. Hanseman, J. M. Collins, B. R. Davis, K. P. Athota, M. J. Edwards, A. D. Tevar; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH Introduction: Positive surgical role models have been demonstrated to influence medical students to pursue a career in surgery. However, the perception by the role model of their effectiveness has yet to be examined. in this study, we sought to evaluate the influence of surgical role models on medical student career choice and how these role models perceive themselves. Methods: A voluntary and anonymous survey was distributed to the following: (1) third year medical students at the end of their surgery clerkship, (2) applicants for a residency in general surgery, (3) general surgery residents and (4) attending surgery staff at a tertiary care university hospital during the 2010-2011 academic year. Statistical analysis was preformed using the chi-squared and Cochran–Mantel– Haenszel tests with a p-value < 0.5 being significant. Results: Responses were obtained from 127 (84%) medical students, 62 (86%) resident applicants, 29 (53%) general surgery residents, and 22 (31.4%) attending surgery staff. Medical students and the resident applicants agreed that faculty and residents play an important role in shaping the
19.7. The Surgical Clerkship: A Contemporary Paradigm. E. L. Bradley,1,2,3 A. B. Littles,1 L. J. Romrell1; 1Florida State University College of Medicine, Tallahassee, FL; 2Same, Tallahassee, FL; 3Same, Tallahassee, FL Introduction: Traditional Surgical clerkships have been composed of a mixture of hospitalized patients, daily resident interaction, periodic attending rounds, and assigned texts, often augmented by lectures. Recently, academic research has challenged the underpinnings of this traditional curriculum. Moreover, traditional clerkships do not necessarily mirror today’s surgical practice given its increasing short-stay and out-patient emphasis. Initiated in 2001, the allopathic Florida State University College of Medicine provided an opportunity to create a contemporary surgical curriculum, emphasizing learning rather than teaching. Methods: The eight week FSU surgical clerkship is a tutorial model. at each of our six regional campuses, students are assigned one-on-one to a carefully selected, board-certified community surgeon, responsible for daily in-patient and out-patient teaching. the academic spine for the rotation is provided by a central curriculum, containing defined objectives and competencies, administered during weekly meetings with the student by campus-specific surgical clerkship directors. Residents do not participate in student teaching, nor are lectures used. Students are free to choose from among suggested print materials or alternative learning sources. Patient contacts are entered into an electronic data collection system, capable of comparing both student and individual campus experiences. Evaluations of student performance are 360 degrees: by patients, staff, clerkship faculty, and clerkship directors. Results: to date, 456 students have graduated. No significant differences exist between campuses with respect to either the numbers or types of patients encountered. USMLE Step II CK and CS scores, or NBME Surgery Subject Examination scores (p>.05). Student satisfaction with the course is evidenced by exceptionally positive responses to the end-of-clerkship evaluations of both faculty and clerkship at each of the campuses, and by anonymous laudatory responses by graduating seniors to the AAMC GQ Survey. Overall, 23.3% of graduates have chosen some aspect of Surgery as a career. the community faculty retention rate exceeds 97%. Conclusions: 1) A quality clerkship experience in Surgery can be provided by a non-traditional community-based system, 2) the distributed campus model does not lead to inequality of learning opportunities or surgical experiences, 3) Both students and community faculty strongly support the tutorial model, 4) Student learning has been confirmed by national metrics.
221
19.8. Clinical Experience Correlates With Surgical Examination Scores. Y. Vigneswaran, B. Gabryszak, C. Golner, L. Fogg, S. D. Bines, J. A. Myers; Rush University Medical Center, Chicago, IL Introduction: Medical schools worldwide continue to face the challenge to construct both a balanced curriculum between clinical experience, lectures, reading time and other activities and to find appropriate methods for clinical evaluation. Although most schools in the United States use the National Board of Medical Examiners (NBME) subject examinations as a method of at least partial assessment, there is still uncertainty of how well these examination scores correlate with clinical proficiency. Thus, we investigated which factors in a surgery clerkship curriculum have a positive impact on academic achievement on the NBME surgery subject examination. We hypothesized students with more free time for selfstudy outside of their clinical experience would achieve better scores on the objective NBME surgery subject examination. Methods: We performed a retrospective analysis of 83 third-year medical students at our institution that rotated on the 8 week core general surgery clerkship for the 2007-2008 academic year. During this academic year, reorganization of the clerkship allowed for analysis of four groups of students experiencing varying clinical volume: two groups with unequal clinical volumes and time for self-study during the first 6 months and two groups with equivalent clinical experiences during the last 6 months. Records of the United States Medical Licensing Examination (USMLE) Step 1 scores, NBME scores and essay examination scores in each set of groups were compared using single-factor analysis of variance testing. Additionally, to specifically characterize each service, student feedback for each surgical service was obtained evaluating the clinical course load, time allotted for self-study, time in lectures and teaching effectiveness. Results: Data from the first six months demonstrated NBME scores from the group with the heavier clinical loads and least time for self-study were statistically higher than the group with lighter clinical services and higher rated self-study time (p ¼ 0.036). the last six months, when the clerkship was rearranged to create two groups of equal clinical loads, there was no statistical difference of NBME scores between the groups (p ¼ 0.751). Baseline USMLE step 1 scores were not significantly different between the groups and no statistical difference was seen in the subjective essay examination scores. Conclusions: We found that students experiencing higher clinical volumes on surgical services, but less selfstudy time demonstrated statsically higher academic performance on objective evaluation, suggesting clinical experience may be of higher value than self-study and reading. Thus, as the structure of our training system adapts to abide by the duty hour restrictions for trainees, we must be conscientious that certain experiences on the floors and in the operating room are invaluable and cannot be substituted. 19.9. Attending Surgeons and Residents Underestimate Their Influence on Medical Students Entering Surgery. R. C. Quillin, T. A. Pritts, D. Hanseman, J. M. Collins, B. R. Davis, K. P. Athota, M. J. Edwards, A. D. Tevar; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH Introduction: Positive surgical role models have been demonstrated to influence medical students to pursue a career in surgery. However, the perception by the role model of their effectiveness has yet to be examined. in this study, we sought to evaluate the influence of surgical role models on medical student career choice and how these role models perceive themselves. Methods: A voluntary and anonymous survey was distributed to the following: (1) third year medical students at the end of their surgery clerkship, (2) applicants for a residency in general surgery, (3) general surgery residents and (4) attending surgery staff at a tertiary care university hospital during the 2010-2011 academic year. Statistical analysis was preformed using the chi-squared and Cochran–Mantel– Haenszel tests with a p-value < 0.5 being significant. Results: Responses were obtained from 127 (84%) medical students, 62 (86%) resident applicants, 29 (53%) general surgery residents, and 22 (31.4%) attending surgery staff. Medical students and the resident applicants agreed that faculty and residents play an important role in shaping the