Sustained Supervised Practice on a Coronary Anastomosis Simulator Increases Medical Student Interest in Surgery, Unsupervised Practice Does Not

Use of Simulation Resources for Underrepresented in Medicine Youth Engagement: A National Survey of Academic Anesthesiology Programs With Specified Diversity, Equity, and Inclusion Positions

Background The utilization of simulation resources can be an effective strategy to offer early medical exposure to underrepresented in medicine (URiM) youth populations, with the objective of promoting diversity in the field of medicine. Currently, it is unclear what proportion of academic anesthesiology programs with simulation centers utilize these resources for community engagement events. Methodology A survey was created using REDCap® and distributed via email to 38 anesthesiologists from 30 departments in the United States holding a leadership position dedicated to advancing diversity, equity, and inclusion. The survey assessed whether their programs had conducted community engagement events for URiM students, what simulation resources were available at their program, and which of these resources they had used at any community engagement events. Additionally, we assessed program characteristics such as region, academic versus community practice, and urban versus rural locations. Survey responses were collected between March and April 2023. Results We received responses from 15 of the 30 institutions sampled for an institutional response rate of 50%. The majority of respondents (86.7%) reported holding community engagement events. Most respondents reported a wide variety of simulation resources available, including 11 (73.3%) having access to full simulation centers. However, only three (27.3%) of the 11 with full simulation centers reported utilizing them for community events. Conclusions Despite the potential benefits of using simulation resources for community engagement events, our results suggest that academic anesthesiology departments may not commonly utilize simulation centers to provide URiM youth with exposure to the field of medicine. Anesthesiology departments with access to simulation resources are in a unique position to be leaders in advancing diversity in medicine by increasing URiM youth interest in medicine as a career through simulation-based exposure.

Medical Students' Attitudes Towards Cardiothoracic Surgery in the United Kingdom: A Cross-Sectional Survey of 1675 Students

OBJECTIVES

The objectives of this study were the following: (i) assess interest levels in cardiothoracic surgery (CTS) among UK-based medical students, (ii) identify potential motivators and barriers to pursuing CTS training, (iii) explore the influence of gender on interest in CTS in greater depth.

METHODS

Medical students from all year groups across UK medical schools were invited to participate in a cross-sectional, national online survey. Responses were collected from 02/12/2019 to 08/12/2019.

RESULTS

1675 medical students from 31 UK medical schools responded, with an estimated 5.3% response rate. Of the respondents, 33.7% respondents reported having exposure to CTS, primarily through their medical school or through extracurricular activities (48.4% and 38.8%, respectively). When assessing interest in CTS, 31.4% were interested in undertaking a career in CTS, with a larger proportion of students expressing interest with no exposure to CTS than those with exposure. However, interest in pursuing CTS decreased with exposure as medical students transitioned from pre-clinical to clinical stages. Additionally, male participants were more interested in seeking a CTS post than their female counterparts (38% vs. 27.6%). The length of training (p = 0.0009) and competitive nature (p < 0.0001) of gaining a CTS post were the primary deterring factor for female participants, compared to their male counterparts.

CONCLUSIONS

This study shows the importance of quality of exposure and its impact on students' interests in pursuing a career in CTS. The negative relationship between exposure and interest in CTS can be associated with the realisation of the challenges that come with pursuing CTS.

How to prepare for academic leadership: scientific training curriculum

Thoracic surgery has evolved into an independent discipline out of general surgery practice over the past decades. The development of the field of thoracic surgery was generated from surgeons being motivated to move this field forward by constant analysis and critical appraisal and review of current practice, as well as identification of new research approaches as the pool and generator of innovation. For this purpose, scientific skills are needed that are currently not covered during the surgical training. In the present overview, we will try to summarize important factors for an academic career, although none of these recommendations are validated and also not realistic to be uniquely applied to every geographical setting. Several key factors will be described being necessary for pursuing basic science, translational, and clinical research as a surgeon scientist introducing “from bench to bedside” research ideas into clinic and “from bedside to bench” bringing important clinical problems back to the lab.

Evaluating the Impact of Medical Student Inclusion Into Hands-On Surgical Simulation in Congenital Heart Surgery

OBJECTIVE

Over the last decade medical students' interest in pursuing surgery as a career has declined. This is more apparent in high-specialized specialities such as congenital heart surgery (CHS). Early hands-on simulation has shown to have a positive impact on medical students' interest in pursuing surgery, however, its incorporation into medical school curricula is lacking. This study aimed to evaluate the impact of incorporating medical students as surgical assistants during the Hands On Surgical Training course in CHS.

METHODS

Local preclinical medical students were invited to participate as surgical assistants during the 5th annual Hands On Surgical Training course in CHS. Among those who responded to the invitation, students were randomly selected and allocated to assist a congenital heart surgeon. All selected students attended an assistants' session prior to the course to familiarize themselves with assisting and to practice basic surgical skills. At the end of both courses students completed a questionnaire based on Likert 5-point scale to evaluate the courses' usefulness.

RESULTS

Fifteen medical students completed the questionnaires. All reported a beginner level of understanding of congenital heart disease. All students were highly satisfied with using 3D-printed models to help their understanding of congenital heart disease (4.80 ± 0.41) and agreed that the sessions improved their assisting skills (4.93 ± 0.26). All expressed a desire to attend similar sessions in the future and agreed that surgical simulation inclusion into medical school curricula would enhance learning (5.00 ± 0.00). Interest in pursuing a career in CHS increased from 33% (5) to 87% (13) by the end of the course.

CONCLUSIONS

Integration of preclinical medical students into surgical simulation increases interest in pursuing highly specialised surgical specialities such as CHS. Early exposure and the incorporation of such simulation programs into medical school curricula will likely improve surgical skill acquisition and may enable students to be better informed when selecting future career choices.

Clinical Exposure to Cardiothoracic Surgery for Medical Students and General Surgery Residents

BACKGROUND

The introduction of integrated 6-year cardiothoracic surgery (CTS) residency programs has shifted recruitment efforts to encompass not only general surgery (GS) residents, but also medical students.

OBJECTIVE

The aim of this paper is to assess medical student and GS resident clinical exposure to CTS.

DESIGN

Data from the Association of American Medical Colleges Visiting Student Application Service and the Accreditation Council for Graduate Medical Education Case Log Reports were collected from 2010 to 2017 and 2010 to 2018, respectively. The data extracted included medical students who applied and received an offer for elective rotations and the cases performed as a GS resident.

RESULTS

A mean of 95 ± 28.5 medical students applied for CTS rotations annually and the applicants for CTS rotations increased by an average of 11.8% per year. However, significantly less students received an offer compared to other specialties (53.4% CTS vs 74.1% GS, 79.3% plastic surgery, 86.3% urology, 85.7% otolaryngology, 88.6% neurological surgery, and 89.6% orthopedic surgery) (p < 0.001). GS residents performed a mean of 39.3 ± 0.8 CTS procedures during residency: 32.9 ± 1.0 performed as a junior resident and 6.3 ± 0.7 as a chief resident. Out of all CTS procedures, 7.3% were cardiac procedures, with rates increasing from 5.6% to 8.4% during the study period (p = 0.001).

CONCLUSIONS

Elective rotation opportunities in CTS are high in demand for medical students while GS residents receive limited CTS exposure, especially cardiac cases. Increasing clinical opportunities in both groups will aid in recruiting young talent to the field.

Medical student perceptions of a career in cardiothoracic surgery: Results of an institutional survey

OBJECTIVES

Recruiting medical students to cardiothoracic surgery is critical given new training paradigms and projected cardiothoracic surgeon shortages. This study characterizes current perceptions and exposure to cardiothoracic surgery among all levels of medical students.

METHODS

Currently active medical students at all levels at a US allopathic medical school were sent an invitation to complete an online survey. Baseline demographics, medical specialty interest, interest and exposure to cardiac surgery specifically, and awareness of procedures performed by cardiothoracic surgeons were evaluated. Five-point Likert scales were used to evaluate attitudes toward facets of the field of cardiothoracic surgery. Only complete surveys over the 4-week enrollment period were used for analysis.

RESULTS

There were 126 surveys (22%) completed during the study period. Interest in cardiothoracic surgery at any point was indicated by 37% of students, but only 13% indicated an interest at the time of the survey. Interest among first-year students was greater than all other classes (30% vs <15%, P = .02). Lifestyle factors and personal attributes of cardiothoracic surgeons were noted as negative factors influencing cardiothoracic surgery perception, whereas intellectual challenge and clinical impact were cited as positive factors. Increasing interaction with faculty/residents and simulation experiences were factors noted to increase interest in the field.

CONCLUSIONS

Although medical students report early interest in cardiothoracic surgery because of intellectual stimulation and patient care attributes, lack of early exposure and perceived poor lifestyle negatively affect interest in the field. Early interaction between students and cardiothoracic faculty/trainees along with early exposure opportunities may increase recruitment.

Evaluation of a simulation-based mini-elective on medical student interest in cardiac surgery

BACKGROUND

Integrated cardiothoracic (CT) surgery training programs are an increasingly popular pathway to train CT surgeons. Identifying and engaging medical students early is important to generate interest and ensure highly qualified applicants are aware of opportunities provided by a career in CT surgery.

METHODS

An optional CT surgery "mini-elective" was developed for preclinical medical students consisting of five 2-hour sessions covering major procedures in cardiac surgery. Each session had an inital 1 hour lecture immediatly followed by a hands on simulation component. Sessions were taught by CT surgery faculty and residents. A precourse and postcourse survey was administered to identify interest in and awareness of the field of CT surgery.

RESULTS

There were 22 students enrolled in the course who provided precourse surveys, while 21 provided postcourse surveys. CT surgery was a career consideration for 95.4% of students who took the mini-elective. nine percent of the students who had either scrubbed or observed a CT case precourse, increased to 33.3% postcourse (P = .11). With regards to mentorship, 23.8% felt they could easily find a mentor in CT surgery precourse, increasing to 66.7% postcourse (P = .01). Eighty-one percent of students reported that the mini-elective significantly increased their CT knowledge over the standard cardiovascular curriculum, and 100% of those completing the course were "extremely satisfied" with the experience.

CONCLUSIONS

A CT surgery mini-elective increased awareness and interest in the field among preclinical medical students. Longitudinal exposure and mentorship provided in programs such as this will be key to the continued recruitment of high-quality medical students to the field.

Simulation-Based Learning Strategies to Teach Undergraduate Students Basic Surgical Skills: A Systematic Review

OBJECTIVE

We aimed to identify and critically appraise all literature surrounding simulation-based learning (SBL) courses, to assess their relevance as tools for undergraduate surgical education, and create a design framework targeted at standardizing future SBL.

METHODS

We performed a systematic review of the literature using a specific keyword strategy to search at MEDLINE database.

RESULTS

Of the 2371 potentially eligible titles, 472 were shortlisted and only 40 explored active interventions in undergraduate medical education. Of those, 20 were conducted in the United States, 9 in Europe and 11 in the rest of the world. Nineteen studies assessed the effectiveness of SBL by comparing students' attributes before and after interventions, 1 study assessed a new tool of surgical assessment and 16 studies evaluated SBL courses from the students' perspectives. Of those 40 studies, 12 used dry laboratory, 7 wet laboratory, 12 mixed, and 9 cadaveric SBL interventions. The extent to which positive results were obtained from dry, wet, mixed, and cadaveric laboratories were 75%, 57%, 92%, and 100%, respectively. Consequently, the SBL design framework was devised, providing a foundation upon which future SBL interventions can be designed such that learning outcomes are optimized.

CONCLUSIONS

SBL is an important step in surgical education, investing in a safer and more efficient generation of surgeons. Standardization of these efforts can be accelerated with SBL design framework, a comprehensive guide to designing future interventions for basic surgical training at the undergraduate level.

Can specialized surgical simulation influence resident career choice?

OBJECTIVE

Our institution began Advanced Trauma Operative Management (ATOM) simulation course in 2007 for senior residents with the aim of increasing opportunities for surgical trainees to gain operative trauma experience. The aim of our study was to evaluate the effect of the ATOM simulation course on residents' choice of trauma as a career as demonstrated by entrance into surgical critical care (SCC) fellowships.

DESIGN

Retrospective study of institutional data on graduating residents from 2002 to 2015. Residents were divided into pre-ATOM (2002-08) and post- (institution of) ATOM (2009-15) cohorts. The percentage of residents entering SCC fellowships was then compared among cohorts as well as to national trends.

RESULTS

Nationally the pre-ATOM group had 7057 graduating general surgery (GS) residents (847 SCC) and post-ATOM had 7581 graduating GS residents (1268 SCC). Locally the pre-ATOM group consisted of 40 graduating GS residents (1 SCC) and while the post-ATOM cohort had 51 graduating GS residents (9 SCC). The number of SCC fellows increased by 4.7% nationally and 15.7% institutionally between the two study groups. The increased interest in SCC was more than could be accounted for by national trends.

CONCLUSIONS

Interest in a career in trauma was increased among residents graduating from this single institution after instituting ATOM as part of the educational curriculum.

Factors influencing US medical students' decision to pursue surgery

BACKGROUND

Interest and applications to surgery have steadily decreased over recent years in the United States. The goal of this review is to collect the current literature regarding US medical students' experience in surgery and factors influencing their intention to pursue surgery as a career. We hypothesize that multiple factors influence US medical students' career choice in surgery.

METHODS

Six electronic databases (PubMed, SCOPUS, Web of Science, Education Resources Information Center, Embase, and PsycINFO) were searched. The inclusion criteria were studies published after the new century related to factors influencing surgical career choice among US medical students. Factors influencing US medical student surgical career decision-making were recorded. A quality index score was given to each article selected to minimize risk of bias.

RESULTS

We identified 38 relevant articles of more than 1000 nonduplicated titles. The factors influencing medical student decision for a surgical career were categorized into five domains: mentorship and role model (n = 12), experience (clerkship n = 9, stereotype n = 4), timing of exposure (n = 9), personal (lifestyle n = 8, gender n = 6, finance n = 3), and others (n = 2).

CONCLUSIONS

This comprehensive systemic review identifies mentorship, experience in surgery, stereotypes, timing of exposure, and personal factors to be major determinants in medical students' decisions to pursue surgery. These represent areas that can be improved to attract applicants to general surgery residencies. Surgical faculty and residents can have a positive influence on medical students' decisions to pursue surgery as a career. Early introduction to the field of surgery, as well as recruitment strategies during the preclinical and clinical years of medical school can increase students' interest in a surgical career.

Inspiring the next generation of Cardiothoracic Surgeons: an easily reproducible, sustainable event increases UK undergraduate interest in the specialty

There is believed to be declining interest in cardiothoracic surgical careers among UK medical students. Relative lack of undergraduate exposure to the specialty compared with other surgical specialties may be partly responsible. Using pre- and postintervention analysis, we assessed the ability of a student-led extracurricular engagement event to increase undergraduate interest in the specialty. Fifty-four students attended and 50 (93%) participated in the study. Of the total, 32% of delegates had identified a cardiothoracic mentor, with only 8 and 4% exposed to cardiac and thoracic surgery, respectively, compared with 50% exposed to other surgical specialties. Self-reported understanding of cardiothoracic training increased from 20 to 80% (P < 0.001) after the 1-day event; 77% of delegates reported increased interest in the specialty. We demonstrate that it is possible to provide a free-to-user event that increases engagement using a student-led design. Similar events could increase interest in the specialty and may improve recruitment rates. Current levels of cardiothoracic exposure are very low among UK students.

Incorporating three-dimensional printing into a simulation-based congenital heart disease and critical care training curriculum for resident physicians

OBJECTIVE

Although simulation-based education is now commonly utilized in medicine, its use in the instruction of congenital heart disease remains limited. The objective of this study is to evaluate whether heart models created with three-dimensional printing technology can be effectively incorporated into a simulation-based congenital heart disease and critical care training curriculum for pediatric resident physicians.

DESIGN

Utilizing heart models created with a three-dimensional printer, pediatric residents participated in a 60-minute simulation seminar with three consecutive components: (1) didactic instruction on ventricular septal defect anatomy; (2) didactic/simulation-based instruction on echocardiographic imaging of ventricular septal defects and anatomical teaching/operative simulation of ventricular septal defect repair; (3) simulation-based instruction on postoperative critical care management of ventricular septal defects.

SETTING

Academic, free-standing, children's hospital with quaternary care referrals.

PARTICIPANTS

Twenty-three pediatric resident physicians.

OUTCOME MEASURES

Subjective, Likert-type questionnaires assessing knowledge acquisition, knowledge reporting, and structural conceptualization of ventricular septal defects.

RESULTS

Three-dimensional printing technology was successfully utilized to create heart models of five common ventricular septal defect subtypes. After using these models in a simulation-based curriculum, pediatric residents were found to have improvement in the areas of knowledge acquisition (P = .0082), knowledge reporting (P = .01), and structural conceptualization (P < .0001) of ventricular septal defects, as well as improvement in the ability to describe and manage postoperative complications in ventricular septal defect patients in the critical care setting.

CONCLUSIONS

The utilization of three-dimensional printing in a simulation-based congenital heart disease and critical care training curriculum is feasible and improves pediatric resident physicians' understanding of a common congenital heart abnormality.

Practice improves performance on a coronary anastomosis simulator, attending surgeon supervision does not

OBJECTIVES

Enthusiasm for simulation early in cardiothoracic surgery training is growing, yet evidence demonstrating its utility is limited. We examined the effect of supervised and unsupervised training on coronary anastomosis performance in a randomized trial among medical students.

METHODS

Forty-five medical students were recruited for this single-blinded, randomized controlled trial using a low-fidelity simulator. After viewing an instructional video, all participants attempted an anastomosis. Subsequently, the participants were randomized to 1 of 3 groups: control (n = 15), unsupervised training (n = 15), or supervised training with a cardiothoracic surgeon or fellow (n = 15). Both the supervised and unsupervised groups practiced for 1 hour per week. After 4 weeks, the participants repeated the anastomosis. All pre- and posttraining performances were videotaped and rated independently by 3 cardiothoracic surgeons blinded to the randomization. All raters scored 13 assessment items on a 1 to 5 (low-high) scale along with an overall pass/fail rating.

RESULTS

After the training period, all 3 groups showed significant improvements in composite scores (control: +0.52 ± 0.69 [P = .014], unsupervised: +1.05 ± 0.48 [P < .001], and supervised: +1.10 ± 0.84 [P < .001]). Compared with control group, both supervised (P = .005) and unsupervised trainees (P = .005) demonstrated a significant improvement. Between the supervised and unsupervised groups there were no statistically significant differences in composite scores.

CONCLUSIONS

Practice on low-fidelity simulators enabled trainees to improve on a broad range of skills; however, the additional effect of attending-level supervision is limited. In an era of increasing staff surgeon responsibilities, unsupervised practice may be sufficient for inexperienced trainees.

Utilizing Three-Dimensional Printing Technology to Assess the Feasibility of High-Fidelity Synthetic Ventricular Septal Defect Models for Simulation in Medical Education

Background:

The current educational approach for teaching congenital heart disease (CHD) anatomy to students involves instructional tools and techniques that have significant limitations. This study sought to assess the feasibility of utilizing present-day three-dimensional (3D) printing technology to create high-fidelity synthetic heart models with ventricular septal defect (VSD) lesions and applying these models to a novel, simulation-based educational curriculum for premedical and medical students.

Methods:

Archived, de-identified magnetic resonance images of five common VSD subtypes were obtained. These cardiac images were then segmented and built into 3D computer-aided design models using Mimics Innovation Suite software. An Objet500 Connex 3D printer was subsequently utilized to print a high-fidelity heart model for each VSD subtype. Next, a simulation-based educational curriculum using these heart models was developed and implemented in the instruction of 29 premedical and medical students. Assessment of this curriculum was undertaken with Likert-type questionnaires.

Results:

High-fidelity VSD models were successfully created utilizing magnetic resonance imaging data and 3D printing. Following instruction with these high-fidelity models, all students reported significant improvement in knowledge acquisition ( P < .0001), knowledge reporting ( P < .0001), and structural conceptualization ( P < .0001) of VSDs.

Conclusions:

It is feasible to use present-day 3D printing technology to create high-fidelity heart models with complex intracardiac defects. Furthermore, this tool forms the foundation for an innovative, simulation-based educational approach to teach students about CHD and creates a novel opportunity to stimulate their interest in this field.