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Grady ZJ, Gallo LK, Lin HK, Magod BL, Coulthard SL, Flink BJ, Knauer EM, Winer JH, Papandria D, Pettitt BJ. From the Operating Room to Online: Medical Student Surgery Education in the Time of COVID-19. J Surg Res 2021; 270:145-150. [PMID: 34666220 PMCID: PMC8403665 DOI: 10.1016/j.jss.2021.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 07/18/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022]
Abstract
Background On March 17, 2020 the Association of American Medical Colleges recommended dismissal of medical students from clinical settings due to the COVID-19 pandemic. Third-year (M3) and fourth-year (M4) medical students were at home, M4s were interested in teaching, and residents and faculty had fewer clinical responsibilities due to elective surgery cancellations. To continue M3 access to education, we created a virtual surgery elective (VSE) that aimed to broaden students’ exposure to, and elicit interest in, general surgery (GS). Methods Faculty, surgical residents, and M4s collaborated to create a 2-wk VSE focusing on self-directed learning and direct interactions with surgery faculty. Each day was dedicated to a specific pathology commonly encountered in GS. A variety of teaching methods were employed including self-directed readings and videos, M4 peer lectures, case-based learning and operative video review with surgery faculty, and weekly surgical conferences. A VSE skills lab was also conducted to teach basic suturing and knot-tying. All lectures and skills labs were via Zoom videoconference (Zoom Video Communications Inc). A post-course anonymous survey sent to all participants assessed changes in their understanding of GS and their interest in GS and surgery overall. Results Fourteen M3s participated in this elective over two consecutive iterations. The survey response rate was 79%. Ninety-one percent of students believed the course met its learning objectives “well” or “very well.” Prior to the course, 27% reported a “good understanding” and 0% a “very good” understanding of GS. Post-course, 100% reported a “good” or “very good” understanding of GS, a statistically significant increase (P = 0.0003). Eighty-two percent reported increased interest in GS and 64% reported an increase in pursuing GS as a career. Conclusions As proof of concept, this online course successfully demonstrated virtual medical student education can increase student understanding of GS topics, increase interest in GS, and increase interest in careers in surgery. To broaden student exposure to GS, we plan to integrate archived portions of this course into the regular third-year surgery clerkship and these can also be used to introduce GS in the preclinical years.
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Affiliation(s)
| | | | - Heather K Lin
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Stacy L Coulthard
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Benjamin J Flink
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Eric M Knauer
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Joshua H Winer
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Dominic Papandria
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Barbara J Pettitt
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
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Nishii A, Burdine J, Matusko N, Wang T, De Roo A, Lussiez A, Sutzko DC, Minter R, Sandhu G. Identification of promotion and prevention associated surgeon behaviors in the operating room to facilitate resident self-regulated learning. Am J Surg 2020; 221:331-335. [PMID: 33729917 DOI: 10.1016/j.amjsurg.2020.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/24/2020] [Accepted: 10/18/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The regulatory focus theory (RFT) posits that people can pursue goals with a promotion or prevention focus. Greater alignment of RFT motivational styles between faculty and residents may enhance resident operative autonomy. This study establishes a set of faculty behaviors residents can identify to infer faculty motivational styles. METHODS 10 behaviors associated with promotion and prevention motivational styles were identified. General surgery residents rated faculty on how strongly they exhibit these behaviors. Faculty conducted a self-assessment of how strongly they exhibit these behaviors. RESULTS There is a positive correlation between resident and faculty ratings for the promotion-associated behaviors of "works quickly," "high energy," and "mostly provides broad oversight," and for the prevention-associated behaviors of "works slowly and deliberately," "quiet and calm," and "preference for vigilant strategies." CONCLUSION Residents can observe faculty operative behaviors to infer faculty motivational styles. Residents may use this knowledge to adjust to faculty motivational styles and enhance operative interactions.
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Affiliation(s)
- Akira Nishii
- University of Michigan, 500 S State St, Ann Arbor, MI, 48109, United States.
| | - Julie Burdine
- Department of Surgery, Michigan Medicine, 1500, E. Medical Center Dr, Ann Arbor, MI, United States.
| | - Niki Matusko
- Department of Surgery, Michigan Medicine, 1500, E. Medical Center Dr, Ann Arbor, MI, United States.
| | - Ton Wang
- Department of Surgery, Michigan Medicine, 1500, E. Medical Center Dr, Ann Arbor, MI, United States.
| | - Ana De Roo
- Department of Surgery, Michigan Medicine, 1500, E. Medical Center Dr, Ann Arbor, MI, United States.
| | - Alisha Lussiez
- Department of Surgery, Michigan Medicine, 1500, E. Medical Center Dr, Ann Arbor, MI, United States.
| | - Danielle C Sutzko
- Department of Surgery, University of Alabama at Birmingham School of Medicine, 1808 7th Avenue South, BDB 652, Birmingham, AL, 35294, United States.
| | - Rebecca Minter
- Department of Surgery, University of Wisconsin School of Medicine & Public Health, H4/710D Clinical Science Center, 600 Highland Avenue, Madison, WI, United States.
| | - Gurjit Sandhu
- Department of Surgery, Michigan Medicine, 1500, E. Medical Center Dr, Ann Arbor, MI, United States.
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Naylor KA, Torres KC. Translation of learning objectives in medical education using high-and low-fidelity simulation: Learners' perspectives. J Taibah Univ Med Sci 2020; 14:481-487. [PMID: 31908634 PMCID: PMC6940622 DOI: 10.1016/j.jtumed.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 12/04/2022] Open
Abstract
Objectives The mastering of learnt procedures by medical students is triggered by numerous elements, including the ability to understand educational goals for specific tasks. In this study, the authors investigated the processes for identifying learning objectives set forth by medical students and the possibility of the chosen simulation fidelity influencing this ability in Basic Clinical Skills and Elderly Medicine courses at the Medical University of Lublin. Methods A total of 121 medical students assessed the extent to which learning objectives were implemented in two courses with high- and low-fidelity simulation. Using an online survey with closed-ended questions, a list of learning objectives assigned to the courses was sent to participants. The authors evaluated how the courses were generally assessed in terms of their substantive value and general applicability. The Spearman rank correlation (Spearman's rho), χ2, and descriptive statistics were used for investigating research problems. Results Students correctly identified established learning objectives embedded in the courses and positively assessed both courses. Participants' affirmative opinions were related to the high substantive value of both courses. Conclusions Teachers and course creators could benefit from students' feedback about the clarity of learning objectives. The application of some of their ideas would promote a student-centred approach in medical simulation. This approach could be considered input for task selection and optimisation of learning.
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Affiliation(s)
- Katarzyna A Naylor
- Department of Didactics and Medical Simulation, Medical University of Lublin, Lublin, Poland
| | - Kamil C Torres
- Department of Didactics and Medical Simulation, Medical University of Lublin, Lublin, Poland
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4
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Affiliation(s)
- Douglas P Larsen
- Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
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Rausch N, Harendza S. Successful completion of clinical electives - Identification of significant factors of influence on self-organized learning during clinical electives with student focus groups. GMS J Med Educ 2018; 35:Doc39. [PMID: 30186949 PMCID: PMC6120151 DOI: 10.3205/zma001185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 05/29/2018] [Accepted: 06/12/2018] [Indexed: 06/08/2023]
Abstract
Background: The Medical Licensure Act prescribes a total of four months of clinical electives in which the medical students are to work in a self-organized manner in outpatient and inpatient care. Since no specific learning objectives or learning content are given and students come into contact with different structures of outpatient and inpatient care, the learning success in a clinical elective is often rather random. In order to make self-organized learning (SOL) in clinical electives as effective as possible, we identified factors in the area of inpatient care that have an influence on SOL and thus the learning success during a clinical elective. Methods: To investigate this question a qualitative and explorative approach was chosen. In 2015, a total of 21 students from semester 1 to 11 participated in six semi-structured focus group discussions at Hamburg Medical Faculty. In these, the students were asked about their experiences and expectations with regard to SOL in clinical electives. The interviews were transcribed literally and analyzed using Grounded Theory in parallel to further data collection. Results: Three main categories were identified, which had an impact on SOL in clinical electives, each with two sub-categories: People (elective students and physicians), learning itself (learning content and learning process) and the framework (local conditions and organizational structure). For example, elective students exhibiting openness and self-initiative as well as a good working atmosphere and few hierarchical structures were conducive to SOL, while shyness and lack of integration into the ward's medical team inhibited SOL. A mentor formally assigned to the student can promote SOL through guidance, supervision and the transfer of responsibility. Continuous feedback from mentors or peers promotes SOL. Framework conditions, such as a smooth administrative organization, also affect SOL, but elective students have limited influence over these. Conclusion: The creation of suitable framework conditions and considering the needs of the people involved in clinical electives and the requirements of learning itself are necessary steps in order to enable successful SOL during clinical electives. Suitable framework conditions could be compiled and widely disseminated on an empirical basis. Training for teachers and elective students on various aspects of clinical electives, from professional behavior to practical skills, could be a suitable preparatory measure to promote SOL in clinical electives and contribute to a better learning success of the elective students.
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Affiliation(s)
- Natalie Rausch
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany
| | - Sigrid Harendza
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany
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Leraas HJ, Cox ML, Bendersky VA, Sprinkle SS, Gilmore BF, Gunasingha RM, Tracy ET, Sudan R. Instituting a Surgical Skills Competition Increases Technical Performance of Surgical Clerkship Students Over Time. J Surg Educ 2018; 75:644-649. [PMID: 28988956 PMCID: PMC9757025 DOI: 10.1016/j.jsurg.2017.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/17/2017] [Accepted: 09/11/2017] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Surgical skills training varies greatly between institutions and is often left to students to approach independently. Although many studies have examined single interventions of skills training, no data currently exists about the implementation of surgical skills assessment as a component of the medical student surgical curriculum. We created a technical skills competition and evaluated its effect on student surgical skill development. METHODS Second-year medical students enrolled in the surgery clerkship voluntarily participated in a surgical skills competition consisting of knot tying, laparoscopic peg transfer, and laparoscopic pattern cut. Winning students were awarded dinner with the chair of surgery and a resident of their choice. Individual event times and combined times were recorded and compared for students who completed without disqualification. Disqualification included compromising cutting pattern, dropping a peg out of the field of vision, and incorrect knot tying technique. Timed performance was compared for 2 subsequent academic years using Mann-Whitney U test. RESULTS Overall, 175 students competed and 71 students met qualification criteria. When compared by academic year, 2015 to 2016 students (n = 34) performed better than 2014 to 2015 students (n = 37) in pattern cut (133s vs 167s, p = 0.040), peg transfer (66s vs 101s, p < 0.001), knot tying (28s vs 30s, p = 0.361), and combined time (232s vs 283s, p = 0.009). The best time for each academic year also improved (105s vs 110s). Fundamentals of Laparoscopic Surgery proficiency standards for examined tasks were achieved by 70% of winning students. CONCLUSIONS Implementation of an incentivized surgical skills competition improves student technical performance. Further research is needed regarding long-term benefits of surgical competitions for medical students.
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Affiliation(s)
| | - Morgan L Cox
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Shanna S Sprinkle
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Brian F Gilmore
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Elisabeth T Tracy
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ranjan Sudan
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Cho KK, Marjadi B, Langendyk V, Hu W. The self-regulated learning of medical students in the clinical environment - a scoping review. BMC Med Educ 2017; 17:112. [PMID: 28693468 PMCID: PMC5504849 DOI: 10.1186/s12909-017-0956-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 06/27/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND Self-regulated learning is the individual's ability to effectively use various strategies to reach their learning goals. We conducted this scoping review to explore what has been found regarding self-regulated learning in the clinical environment and how this was measured. METHODS Using Arksey and O'Malley's five-stage framework, we searched three medical and educational databases as well as Google Scholar for literature on the self-regulated learning of medical students in the clinical environment published between 1966 and February 2017. After results were screened and relevant studies were identified, the data was summarised and discursively reported. RESULTS The search resulted in 911 articles, with 14 articles included in the scoping review after the inclusion criteria was applied. Self-regulated learning was explored in these studies in various ways including qualitative, quantitative and mixed methods. Three major findings were found: 1) levels of self-regulated learning change in the clinical environment, 2) self-regulated learning is associated with academic achievement, success in clinical skills and mental health and 3) various factors can support self-regulated learning levels in medical students. CONCLUSIONS Most of articles exploring the self-regulated learning of medical students during the clinical years have been published in the last 5 years, suggesting a growing interest in the area. Future research could explore the self-regulated learning levels of medical students during the clinical years using a longitudinal approach or through the use of novel qualitative approaches.
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Affiliation(s)
- Kenneth K. Cho
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560 Australia
| | - Brahm Marjadi
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560 Australia
| | - Vicki Langendyk
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560 Australia
| | - Wendy Hu
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560 Australia
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