Does academic advancement impact teaching performance of surgical faculty?

The operating theatre as a classroom: a literature review of medical student learning in the theatre environment

OBJECTIVES

We set out to review the published literature relating to the educational experiences of medical students in the operating theatre.  In particular, we wished to deduce from the current evidence what challenges are posed to student learning in this environment, and how they may be overcome.

METHODS

National Library of Medicine and Google Scholar databases were searched from 1990-2018, using search terms 'Operating Theatre,' OR 'Operating Theater,' OR 'Operating Room' AND 'Medical Students.' Title and abstract review of 679 papers were performed.  Full-text English language papers about the learning or satisfaction of medical students in the theatre environment were included.  Papers exploring the experiences of residents/trainees rather than medical students were excluded.  A total of 36 papers were eligible for inclusion.  Thematic analysis was conducted on these papers.

RESULTS

A number of common themes were identified.  Throughout the literature, medical students describe a lack of clear learning objectives, fear, anxiety, feelings of humiliation and intimidation, lack of visualisation and lack of opportunity for participation as barriers to their satisfaction with theatre placements and to their subjective learning.

CONCLUSIONS

Obstacles identified by students as deleterious to their experiences in the operating theatre are remarkably reproducible across a number of research studies in different populations.  Areas to address by both individual educators and curriculum designers include fostering a culture of inclusion in theatre, setting explicit, achievable learning goals for students in this environment and making a concerted effort to prepare students for the theatre setting.

Needs Assessment for an American College of Surgeons Certificate in Applied Surgical Education Leadership (CASEL)

OBJECTIVE

Surgeon educators in departments of surgery play key roles in leading and advancing surgical education. Their activities include ensuring sound curricula and evaluation systems, monitoring education resources, overseeing faculty development, and providing mentorship. For more than 25 years, the American College of Surgeons (ACS) has offered a comprehensive "Surgeons as Educators" (SAE) course to address fundamental topics in surgical education. This study aims to identify future career needs of SAE graduates to inform the development of an American College of Surgeons Certificate in Applied Surgical Education Leadership program.

DESIGN

An IRB exempt, anonymous electronic survey was developed to determine educational roles, career aspirations, and needs of SAE Graduates.

SETTING AND PARTICIPANTS

Participants included all 763 1993-2016 SAE graduates.

RESULTS

One hundred and thirty-five responses were received from 600 (22.5%) graduates with valid email addresses. Sixty (45%) respondents completed the SAE Course > 5 years prior to the study (M5YRS) and 75 (55%) within the last 5 years (L5YRS). L5YRS respondents were less likely to be full professors (8% vs. 44%) or to serve as program directors (32% vs. 57%), and more likely to be associate program directors (25% vs. 17%) or clerkship directors (40% vs. 18%). High percentages of both L5YRS and M5YRS reported not pursuing additional educational opportunities post-SAE due to time and fiscal constraints. One-fifth of respondents were unaware of additional opportunities and 19% of M5YRS versus 6% of L5YRS stated that existing programs did not meet their needs. Overall improving skills as educational leaders, developing faculty development programs, and conducting educational research were noted as priorities for future development. Differences were observed between the L5YRS and M5YRS groups. The dominant preferences for course format were full-time face-to-face (41%) or a combination of full-time face-to-face with online modules (24%). The most important considerations in deciding to pursue a certificate course were course content, and interest in advancing career and time constraints.

CONCLUSIONS

An SAE graduate survey has confirmed the need for additional formal training in surgical education leadership in order to permit surgeon educators meet the demands of the changing landscape of surgical education. The needs of early career faculty may differ from those of more senior surgeon educators.

The effects of tenure and promotion on surgeon productivity

BACKGROUND

Studies investigating the impact of promotion and tenure on surgeon productivity are lacking. The aim of this study is to elucidate the relationship of promotion and tenure to surgeon productivity.

METHODS

We reviewed data for the Department of Surgery at our institution. Relative value units (RVUs) billed per year, publications per year, and grant funding per year were used to assess productivity from 2010 to 2016. We analyzed tenure-track (TT) and non-tenure-track (NT) surgeons and compared the productivity within these groups by rank: assistant professor (ASST), associate professor (ASSOC), and full professor (FULL). Kruskal-Wallis and Mann-Whitney U tests were used to assess significance and relationships between the groups.

RESULTS

A TT faculty was promoted if they produced more research, with the highest publication rates in TT FULL. TT faculty publishing rates increased from ASST to ASSOC (1 versus 2, P = 0.006) and from ASSOC to FULL (2 versus 4, P < 0.001). There were no differences in the low publication rates among NT ranks. Grant funding was also highest at the TT FULL level. The clinical production (RVUs) was highest between TT ASSOC and NT FULL. TT faculty increased productivity between ASST and ASSOC (7023 versus 8384, P = 0.001) and decreased between ASSOC and FULL (8384 versus 6877, P < 0.001). Among NT faculty, RVUs were stagnant between ASST and ASSOC levels (4877 versus 6313, P = 0.312) and increased between ASSOC and FULL levels (6313 versus 8975, P < 0.001).

CONCLUSIONS

Tenure and nontenure pathways appear to appropriately incentivize surgical faculty over the course of their advancement. TT FULL has the highest research production and grant funding, whereas NT FULL has the highest clinical production.

Preparing faculty for the future: AAVMC members' perceptions of professional development needs

Our purpose in this study was to determine professional development needs of faculty in the Association of American Veterinary Medical Colleges' (AAVMC's) member institutions, including those needs associated with current and emerging issues and leadership development. The survey asked respondents to report their level of job satisfaction and their perceptions of professional development as they related to support and resources, teaching, research, career planning, and administration. Five hundred and sixty-five individuals from 49 member institutions responded to an online professional development needs survey. We found that job satisfaction was associated with a variety of workplace variables correlated with academic rank, with those of higher academic rank expressing greater levels of satisfaction. Respondents with tenure also expressed generally higher levels of satisfaction. Most of the respondents expressed interest in learning more about topics related to teaching (e.g., effective questioning, giving feedback, principles of learning and motivation), research (e.g., research design, writing grants), career planning (e.g., mentoring, time management), and administration (e.g., fostering innovation, enhancing productivity, improving the work environment). Just more than half of the respondents indicated moderate to high interest in an AAVMC multi-phase leadership training program. The study suggests topics for which AAVMC should provide professional development opportunities either at existing meetings or through new programming. The study also suggests directions for individual institutions as they seek to implement professional development activities at the local level.

Students' perception of the characteristics of effective bedside teachers

BACKGROUND AND METHODS

To determine a student perspective of the characteristics of ideal bedside teachers, a 25-item questionnaire was administered to 84 final-year medical students. The items were constructed to check for two domains of 'Communication' and of 'Demographics'. The former included behaviours such as providing constructive feedback, respecting patient confidentiality and encouraging critical thinking, while the latter included characteristics such as gender, academic rank and language skills.

RESULTS

The students identified the characteristics in the 'Communication' domain as being far more important determinants of ideal bedside teaching than the 'Demographics' domain. Factor analysis showed that of the questions designed to determine communication all but one loaded unequivocally into a single factor, while the demographics were best described by two additional factors. Both these factors represented teacher properties that were difficult or impossible for the teacher to modify, while those in the communication domain were all amenable to change.

CONCLUSIONS

These results are consistent with data from the literature on the broader aspects of clinical teaching, and imply that the ideal bedside teaching experience from the perspective of the students is heavily influenced by teacher behaviours than that can be modified.

Effective Surgical Residents Strongly Influence Medical Students to Pursue Surgical Careers

BACKGROUND

There is a paucity of data about the influence of surgical residents on the career choices of medical students. We hypothesized that medical students exposed to effective surgical residents would be more likely to pursue careers in surgery.

STUDY DESIGN

From 1998 to 2003, 108 surgical residents were evaluated by medical students rotating on the third-year clerkship. Residents were scored on a 4-point scale (1 = outstanding to 4 = poor). The career choices of all medical students were also tabulated.

RESULTS

We examined 2,632 evaluations on 108 residents. Medical students who eventually pursued surgical residency training were exposed to surgical residents who were more effective clinical teachers, role models, and overall residents. In addition, medical students exposed to the highest-rated residents were more likely to pursue surgical residency training compared with students exposed to the least effective residents (12% versus 4.9%, p = 0.022).

CONCLUSIONS

These data suggest that surgical residents who are effective educators and mentors influence medical students to pursue surgical careers. Efforts to provide more leadership and teaching workshops to surgical residents may not only create better future surgeon educators, but may also increase the number of students pursuing surgical training.