Attendings' and residents' teaching role and students' overall rating of clinical clerkships

Medical student experience in surgery influences their career choices: a systematic review of the literature

OBJECTIVES

Student experiences during surgical rotations may dictate interest in future surgical careers. The objective of this study was to systematically examine the effect of surgical experience (SE) on student attitudes toward surgical careers and also to identify variables influencing the educational value of SE.

METHODS

A systematic review of the available literature was conducted by 2 independent researchers searching Medline, EMBASE, Google Scholar, and Cochrane databases, in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses recommendations. Studies assessing SE during the students' surgical rotations were identified. The quality of the included studies was assessed using a validated quality index. Factors affecting student surgical rotation experience and perceptions of surgical careers were recorded.

RESULTS

Overall, 204 studies were identified; 20 unique studies met the inclusion criteria with a median cohort size of 169 (interquartile range: 107-262) respondents. Most were cross-sectional surveys (n = 16/20) and administered to clinical students (n = 16/20). All studies investigating the effect of SE on career choices (n = 8) found that positive experiences during the surgical placement were associated with an increased interest in surgical careers. The operating theater experience was identified as a defining feature of overall SE. Involvement in operative procedures, a welcoming environment, and avoidance of syncopal events positively influenced the SE, particularly in those who actively sought educational opportunities. Study limitations included single-center and single-year cohort designs (70%) with the use of nonvalidated research tools (95%).

CONCLUSIONS

A systematic review of the literature highlights a number of factors associated with a positive surgical rotation, which may lead to more students deciding to pursue a career in surgery. Understanding the factors that contribute to these decisions through multicenter studies using validated research tools may lead to more effective surgical rotations, ultimately improving the delivery of the surgical education.

Challenges of multisite surgical teaching programs: a review of surgery clerkship

OBJECTIVE

As the enrollment in medical schools increases, the need for affiliated sites to participate in clerkship teaching will continue. The aim of this literature review was to provide a summary of measures that have been used to compare the training in affiliated community hospital sites with the tertiary teaching hospitals.

METHODS

An extensive literature search was conducted using PubMed, MEDLINE, and EMBASE. A total of 386 articles were identified, of which 20 were found to be relevant to this topic. The references of those articles were also consulted and were included in the preparation of this manuscript when deemed appropriate.

RESULTS

A significant difference does not seem to exist in either written examination or clinical performance evaluations among medical students who receive training at either tertiary care teaching hospitals or affiliated community hospital sites. Positive role models are important in influencing the choice of a surgical career, regardless of where clerkship training takes place.

CONCLUSIONS

Although more research is merited in this area, the current evidence suggests that affiliated sites are comparable in their ability to train medical students during their surgical clerkship.

Multiple variables influence the educational value of surgical clerkship sites

BACKGROUND

Students' satisfaction with the educational quality of a surgical clerkship is influenced by their experiences at assigned clinical sites. We sought to identify key variables perceived by students to be associated with educationally valued clerkship sites.

METHODS

Between 1998 and 2002, third-year medical students completed a surgery site survey for each of the 2 sites on which they rotated during their required 2-month surgery rotation, representing a total of 16 sites. Students rated each site using a Likert scale on 8 educational variables as well as the overall educational value of the site. Students recorded the hours per week of direct instructional contact with attendings and, in the 2001/2002 academic year, provided narrative comments regarding site-specific strengths and weaknesses. The relationship between site variables and overall educational value across all sites was examined by stepwise multiple regression analysis. Content analysis of narrative responses was performed to surface major strengths and weaknesses associated with site-specific educational value.

RESULTS

From 1,377 completed surveys, representing an 87% completion rate, a statistically significant relationship was identified between sites' overall educational value and 6 variables. The most significant variables were as follows: "direct instructional contact with attendings in the operating room" and "quality of house staff teaching" (accounted for 33% and 13% of the total variance in educational value, respectively). Content analysis from 359 narrative responses, representing a 92% response rate, revealed 5 major categories, with operating room experience receiving the most "strength" comments (28.8%).

CONCLUSIONS

Specific variables influencing the perceived educational quality of clerkship sites can be identified. The single largest influence emerging independently from both the quantitative and qualitative analyses was the students' experiences in the operating room. Emphasis on the educational experience in the operating room should be a priority when seeking to improve the educational value of clerkship sites.

The reliability of an instrument for identifying and quantifying surgeons' teaching in the operating room

BACKGROUND

The operating room is an important teaching venue where surgical residents develop their operative skills and clinical judgement. The purpose of this study was to establish reliability for an observation instrument designed to quantify surgeons' teaching behaviors in the operating room.

METHODS

An instrument was developed to identify operating room teaching behaviors in four categories: informing, questioning, responding, and setting tone. Two trained observers coded videotaped operations. Cronbach's alpha was used to estimate the instrument's internal consistency, and criterion-related reliability was established through an interobserver agreement level (IOA).

RESULTS

Results for each of the teaching behavior categories were as follows: informing (IOA = 86%, alpha = +0.978); questioning (IOA = 97%, alpha = +0.966); responding (IOA = 93%, alpha = +0.97); setting tone (IOA = 97%, alpha = +0.882).

CONCLUSIONS

This instrument is reliable in identifying and quantifying surgeons' teaching behaviors in the operating room. Identifying teaching behaviors will be valuable to describing and enhancing teaching in the operating room.

The changing health care system. A research agenda for medical education

The volatility in the U.S. health care system due to unprecedented changes in its organization, financing, and delivery, coupled with a growing physician surplus in certain areas, suggests the need for a research agenda to investigate the impact of these forces on the educational programs of medical schools. This article discusses the potential impact of trends in the health care environment on the following key aspects of undergraduate medical education: admissions, faculty, curriculum, and educational outcomes. A representative set of research questions intended to stimulate inquiry and guide empirical studies in each of the four domains is proposed.

Students' satisfaction and perceptions of attending physicians' and residents' teaching role

BACKGROUND

Changes in the health care system imply that fewer patients will be admitted to hospitals and attending physicians will be devoting more time to clinical activities with less time for student education.

METHODS

Surveys of third-year students were conducted for 5 consecutive years at Jefferson Medical College at the end of the required 6-week surgical clerkship at the university hospital or at one of the eight affiliates.

RESULTS

The numbers of new inpatients and outpatients encountered by students were not significantly related to students' overall satisfaction. The ratings of teaching rounds and conferences were significant predictors of satisfaction with the clerkship, as were the ratings of residents' teaching.

CONCLUSIONS

As medical education shifts to ambulatory settings, didactic teaching such as rounds and conferences should be maintained and efforts to enhance the teaching skills of residents should be encouraged.