A Mentorship-Based Surgery Clerkship: A Prospective Study Investigating Student Satisfaction

BACKGROUND

Interest in general surgery has steadily decreased among medical students due to negative perceptions of surgeons, a lack of meaningful clerkship involvement, and inadequate mentorship. We implemented a novel mentorship-based surgery clerkship (MBSC) in which each student was matched with a resident mentor with the goals of enhancing student learning experience, meaningfulness, and interest in surgery. We hypothesized that students participating in the MBSC would report increased confidence in surgical competencies, exposure to surgical faculty, and positive perception of surgery, with no detriment to clerkship grades.

METHODS

Mentors were instructed to provide the following when asked by the student: (1) weekly feedback; (2) personalized goals; (3) daily cases; (4) specific videos; (5) presentation subjects; (6) operating room skills coaching. A 5-point Likert Scale survey was distributed to the students pre and post clerkship, and median differences in Likert Scale Score pre and post mentorship were compared between mentored and control groups using the unpaired Wilcoxon's test. This was a two-arm, nonrandomized trial comparing traditional curriculum with the mentored program.

RESULTS

The total sample size was n = 84. When comparing mentored to control, Wilcoxon's analysis showed greater post clerkship increases in confidence in operating room etiquette (P = 0.03), participating in rounds (P = 0.02), and suturing (P < 0.01). There were greater increases in perceived surgeon compassion (P = 0.04), respectfulness (P < 0.01), and teaching ability (P < 0.01). Median scores for meaningfulness overall (P = 0.01) and as measured as a feeling of positively impacting a patient (P = 0.02) were also increased when comparing mentored to control. More students were encouraged by a surgeon to pursue surgery (P = 0.01) and consider a surgery career themselves (P = 0.02).

CONCLUSIONS

An MBSC increases meaningfulness, confidence, skills, and exposure in various surgical competencies. Compared to nonmentored students, MBSC students have more positive perceptions of surgeons and are more likely to pursue surgery.

Augmented 360° Three-Dimensional Virtual Reality for Enhanced Student Training and Education in Neurosurgery

OBJECTIVE

This prospective study assesses the acceptance and usefulness of augmented 360° virtual reality (VR) videos for early student education and preparation in the field of neurosurgery.

METHODS

Thirty-five third-year medical students participated. Augmented 360° VR videos depicting three neurosurgical procedures (lumbar discectomy, brain metastasis resection, clipping of an aneurysm) were presented during elective seminars. Multiple questionnaires were employed to evaluate conceptual and technical aspects of the videos. The analysis utilized ordinal logistic regression to identify crucial factors contributing to the learning experience of the videos.

RESULTS

The videos were consistently rated as good to very good in quality, providing detailed demonstrations of intraoperative anatomy and surgical workflow. Students found the videos highly useful for their learning and preparation for surgical placements, and they strongly supported the establishment of a VR lounge for additional self-directed learning. Notably, 81% reported an increased interest in neurosurgery, and 47% acknowledged the potential influence of the videos on their future choice of specialization. Factors associated with a positive impact on students' interest and learning experience included high technical quality and comprehensive explanations of the surgical steps.

CONCLUSIONS

This study demonstrated the high acceptance of augmented 360° VR videos as a valuable tool for early student education in neurosurgery. While hands-on training remains indispensable, these videos promote conceptual knowledge, ignite interest in neurosurgery, and provide a much-needed orientation within the operating room. The incorporation of detailed explanations throughout the surgeries with augmentation using superimposed elements, offers distinct advantages over simply observing live surgeries.

Gauging the effects of COVID-related changes to the medical student surgical clerkship experience: a mixed-methods study

Purpose

This study sought to understand the medical student experience on the restructured surgical clerkship during the COVID-era to provide guidance for future scenarios affecting student participation in clinical activities.

Methods

Medical students completing an anonymous 70-question survey at the conclusion of their surgical clerkship from June 2019 to October 2020 were divided into 2 cohorts: students completing their clerkship prior to March 2020 and after June 2020. Quantitative assessment was performed to evaluate the clerkship performance and perceptions. Resulting findings were used to construct an interview guide and conduct semi-structured interviews.

Results

Fifty-nine medical students rotated through the surgical clerkship prior to COVID and 23 during the COVID-era. No differences in perception of the surgical clerkship, participation in essential activities, or shelf examination scores were found. Students completing their clerkship during the COVID-era reported a lower perception of interaction and professional relationships with attending and resident surgeons (p = 0.03). Qualitatively, students completing their clerkship during the COVID-era struggled to balance clinical experiences with personal wellness and noted that building relationships with faculty was substantially more difficult.

Conclusions

There does not appear to be a difference in the level of participation in essential clerkship activities nor a diminished perception of learning between students completing their surgical clerkship before or during the pandemic. However, there does appear to be a difference in the relationships formed between students and attending surgeons. Altered didactic structures and apprenticeship-type rotations may help mitigate such effects.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44186-022-00015-2.

The Influence of an Acting or Subintern on Third-Year Medical School Surgery Clerkship Students

BACKGROUND

Previous reports demonstrated a positive relationship between the surgical clerkship and student likelihood of pursuing a surgical career, but no studies have examined the influence a peer has on comfort during a surgical clerkship. We hypothesized that a fourth-year acting intern (AI) would positively impact third-year medical students' experience during their surgical clerkship.

METHODS

All third-year medical students at our institution who completed their surgical clerkship in 2019 were surveyed regarding the preclerkship and postclerkship perceptions.

RESULTS

Of the 110 students surveyed, 52 responded (47.3% response rate), and 25 students (48.1%) reported having an AI during their clerkship rotation, and 27 did not (51.9%). Presence of an AI had no significant effect on the postclerkship perception of surgery, likelihood of pursuing general surgery, or comfort in the OR. Analysis of all responses demonstrated the surgery clerkship had no significant impact on students' perception of surgery or likelihood of pursuing general surgery but did statistically increase students' comfort in the OR.

CONCLUSIONS

The results of this study suggest that AI presence did not significantly influence a student's clerkship experience or comfort in the OR. Further studies are needed to determine what, if any effect, an AI could have on third-year clerkship students.

Integrating a Novel Global Surgery and Health Inequity Course to the Surgical Clerkship

OBJECTIVE

Medical students report growing interest in health inequity and global surgery, subjects not currently integrated to their core curriculum. Currently, fundamental tenets of global surgical inequity are only available to students on an elective basis or in special interest groups. Therefore, an hour-long course with emphasis on global surgery was developed for third-year medical students. The aim of this study was to examine student response to this pilot course and to establish whether course content was applicable to clinical rotations.

DESIGN

A 1-hour structured curriculum was delivered to third-year medical students (MS3s) during the 2-day orientation phase of each rotation of an 8-week surgery clerkship from August 2018 to May 2019. The course targeted approximately 30 students per session in the preclinical orientation at Rutgers-New Jersey Medical School. Upon completion of the 8-week clerkship rotation, a paper survey was administered to evaluate student's exposure to previous content, attitudes toward global health, interest and engagement in course materials, and applicability of learned course content to local environments.

SETTING

Rutgers-New Jersey Medical School, an urban medical school located in Newark, New Jersey.

PARTICIPANTS

A total of 191 students attended the global surgery and health equity course; 146 participants participated in the postcourse survey.

RESULTS

When asked about baseline interest in global or public health, the majority (51%) were extremely interested or very interested. Nearly all participants found the course to be valuable (94%). When asked which educational modality was preferred, 23% of participants favored the traditional lecture component and 29% favored case-based discussions. Nearly half (48%) the respondents found both modalities to be valuable. Fifty students (34% of respondents) reported encounters with patients affected by barriers in access to surgical care during their clerkships.

CONCLUSIONS

Medical students responded favorably to this health inequity and global surgery pilot course and requested supplemental lectures. Additionally, course content was applicable to local clinical experiences. Therefore, 1 modality of integrating global surgery to the established curriculum is under the framework of health inequity and social determinants of health during surgical clerkships. This study demonstrates that meaningful inclusion of global surgery and health inequity can be implemented within the existing curricular structure.

Midclerkship feedback in the surgical clerkship: the "Professionalism, Reporting, Interpreting, Managing, Educating, and Procedural Skills" application utilizing learner self-assessment

BACKGROUND

The Liaison Committee on Medical Education requires midclerkship formative (low stakes) feedback to students regarding their clinical skills. Student self-assessment is not commonly incorporated into this evaluation. We sought to determine the feasibility of collecting and comparing student self-assessment with that of their preceptors using an iPad application. These student self-ratings and preceptor ratings are jointly created and reviewed as part of a face-to-face midclerkship feedback session.

METHODS

Using our iPad application for Professionalism, Reporting, Interpreting, Managing, Educating, and Procedural Skills ("PRIMES"), students answer 6 questions based on their self-assessment of performance at midclerkship. Each skill is rated on a 3-point scale (beginning, competent, and strong) with specific behavioral anchors. The faculty preceptors then complete the same PRIMES form during the face-to-face meeting. The application displays a comparison of the 2 sets of ratings, facilitating a discussion to determine individualized learning objectives for the second half of the clerkship.

RESULTS

A total of 209 student-preceptor pairs completed PRIMES ratings. On average, student-preceptor ratings were in agreement for 38% of the time. Agreement between students and preceptors was highest for Professionalism (70%) and lowest for Procedural Skills (22%). On average, 60% of student-preceptor ratings did not agree. Students rated themselves lower than preceptors 52% of the time, while only 8% of students rated themselves higher than their preceptors' ratings (this difference is significant at the P value <.05 level).

CONCLUSIONS

This study demonstrates the value of using the PRIMES framework to incorporate surgery clerkship students' self-assessment into formative face-to-face midclerkship feedback sessions with their preceptors with the goal to improve performance during the second half of the clerkship.

A night float week in a surgical clerkship improves student team cohesion

BACKGROUND

We hypothesize that night float rotations in the third-year surgical clerkship improve student learning and perceptions of team cohesion.

METHODS

A 1-week night float (NF) system was implemented during the 2013 to 2014 academic year for students. Each student completed 1 week of NF with the Trauma/Emergency General Surgery service. The Perceived Cohesion Scale survey was prospectively administered and National Board of Medical Examiners academic performance retrospectively reviewed.

RESULTS

We surveyed 70 medical students, 37 traditional call and 33 NF students, with 91% response rate. Perception of team cohesion increased significantly, without perceived loss of educational benefit. Examination scores increased significantly comparing pre- and postintervention groups, with this trend continuing in the following academic year.

CONCLUSIONS

A week-long student NF experience significantly improved perception of team cohesion and standardized examination results. A dedicated period of NF during the surgical clerkship may improve its overall educational value.

The impact of visiting student electives on surgical Match outcomes

BACKGROUND

Residency applicants commonly complete visiting student electives (VSEs) hoping to increase their odds of matching at host institutions. Existing evidence on Match outcomes for applicants who complete VSEs is limited. As VSEs involve monetary and opportunity costs to students and administrators, data on their utility are vital for student well-being, preparedness for residency, and, ultimately, success in the Match. We investigated the utilization and impact of VSEs for all applicants. We hypothesized that completion of VSEs would increase the likelihood of matching at a host institution.

MATERIALS AND METHODS

A retrospective review was conducted of academic records and National Resident Matching Program outcomes for the graduates of one institution and visiting students to that institution over the course of 7 y.

RESULTS

Utilization of VSEs varied significantly among specialties. Across all specialties and in general surgery, applicants were more likely to match into host programs than others. The size of the effect of VSEs on outcomes varied by specialty. Host programs were applicants' top choice for residency in 48% of cases.

CONCLUSIONS

Completion of VSEs may give surgical applicants increased control over Match outcomes. Our findings may assist future students in strategic decision making when determining whether and where to use VSEs.