Burns teaching in UK medical schools: Is it enough?

PLAstic Surgery Teaching In the Undergraduate Curriculum of Medical Students-United Kingdom (PLASTICS-UK): A UK national collaborative survey of plastic surgery in the undergraduate medical curriculum

OBJECTIVE

To undertake a United Kingdom national medical student survey investigating undergraduate plastic surgery exposure and specialty perceptions.

BACKGROUND

Plastic surgery incorporates all anatomical regions, age groups and tissue types; clinical challenges vary from trauma and burns to congenital defects and cancer and although around 50% of the workload is trauma, it is often misperceived to revolve around cosmetic surgery.

METHOD

Following ethical approval, a national survey was conducted across 27 included UK medical schools (31/03/23-07/07/23). Trends were analysed, with comparisons made between surgical and non-surgical aspirants.

RESULTS

Data were included from 2513 students; 29.2% had surgical career aspirations. Students perceived plastic surgery as challenging, competitive, and impacting quality of life; however, most had no formal teaching (56.3%); merely 6.2% had clinical exposure and 30.4% had an undergraduate plastic surgery placement available. Breast reconstruction was the most frequently correctly identified surgery (91.8%), with head and neck cancer surgery the least (35.9%). Surgical aspirants were less likely to overestimate private practice (p < 0.001) but demonstrated greater self-confidence in plastic surgery understanding (p < 0.001) and their future ability to make plastic surgery referrals (p < 0.001), being more likely to pursue it (p < 0.001). Surgical aspirants were 17.3% more likely to obtain non-curricular plastic surgery experience (p < 0.001), and 5.6% more self-confident dressing basic wounds (p < 0.001).

CONCLUSION

A greater need for undergraduate plastic surgery teaching was determined. Significant heterogeneity across medical schools was identified. Formation of a national undergraduate plastic surgery curriculum, led by professional bodies, may tackle disparities among medical schools, improve accessibility and facilitate knowledge acquisition.

Undergraduate deficits in plastic surgery exposure and awareness of the specialty: a systematic review

INTRODUCTION

Plastic surgery is an important specialty that involves widespread medical knowledge, some of which is taught in undergraduate curricula. The General Medical Council provides a well-defined plastic surgery curriculum for postgraduate training. However, there is no consensus on the provision for undergraduates in this specialty, potentially giving rise to a deficit in undergraduate medical education and a suboptimal basis for plastic surgery postgraduate training. Our aim was to identify the gap in undergraduate plastic surgery teaching and to understand student perceptions of the specialty as well as any trialled interventions.

METHODS

A prospectively registered systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The MEDLINE®, Embase™, PubMed® and Google Scholar™ databases were searched for literature relating to undergraduate exposure to plastic surgery and relevant teaching interventions. Ten studies were included in this review, categorised into three main themes: exposure during medical school, determining factors and perceptions for pursuing a plastic surgery career, and teaching interventions.

RESULTS

Surveys assessing medical student perceptions indicate a significant deficit in exposure to plastic surgery in the undergraduate curriculum. Medical students' interest in the specialty is affected by multiple factors, including the amount of surgical exposure in medical school. Interventions to address the deficit mostly involve one-day courses.

CONCLUSIONS

Although the literature is currently limited, studies are needed to effectively assess the outcomes of plastic surgery teaching methods in undergraduate training. Moreover, there is a need for consensus around the provision of undergraduate teaching in plastic surgery. This should be reflected in the latest undergraduate curricula in medical education.

Emergency burn education: Evaluating a surgical simulation-based intervention

INTRODUCTION

Medical simulation has provided favorable outcomes in the improvement of clinical competence at both the undergraduate and postgraduate levels. The recall of information demonstrably increases when it has been taught in environments similar to the workplace. This study aimed to evaluate the role of a one-day burn simulation session in improving students' knowledge of burn management and interest in plastic surgery as a specialty.

METHOD

A one-day course was designed to deliver multiple lectures covering surgical topics such as the classification and management of burns, followed by a series of practical workshops. Participants were instructed to undergo a pre-course knowledge assessment and a survey focusing on interest in plastic surgery. Students were subsequently instructed to complete a post-course assessment and a survey of knowledge and confidence in managing burns as well as interest in plastic surgery both immediately and 6 weeks post-course.

RESULTS

The students' knowledge demonstrated a 54.2% increase in the post-course assessment (p < 0.01). 27% of participants (n = 14) participated in a 6-week post-course quiz. The knowledge assessment of these participants at 6 weeks post-course also demonstrated a sustained increase of 61.0% (p < 0.01). Interest in plastic surgery was increased by 31.4% post-course (p < 0.01). At 6 weeks post-course, a sustained increase of 14.7% was demonstrated in comparison to pre-course data (p = 0.03).

CONCLUSION

Simulation teaching provides good outcomes in both information retention and interest in plastic surgery as a specialty. Therefore, medical school curriculums may benefit from including burn simulations.

National evaluation of trauma teaching for students (NETTS)

Despite the shift towards consultant-led care, many patients with trauma are still seen by junior doctors. Previous research has demonstrated that junior doctors feel unprepared to work in acute care but there is a paucity of recent research in trauma specifically. Thus, a national study is required to investigate the current state of undergraduate trauma teaching and identify specific areas for improvement. Between August and September 2020, a 35-item structured questionnaire was distributed among doctors who graduated from UK medical schools within the last 4 years. The questionnaire retrospectively assessed their experience of trauma teaching at medical school and their confidence to diagnose and manage patients with trauma. 398 responses were recorded from graduates of 39 UK medical schools. With 79.6% reporting only 0-5 hours of bedside trauma teaching and 51.8% reporting less than 20 hours in Accident and Emergency, graduates reported that trauma teaching was deficient compared with other specialties (78.1%). The majority of graduates were not confident in the initial assessment (72.9%) of a patient with trauma and almost all felt that a short course in trauma would be useful (93.7%). 77.4% of students felt that online learning would be beneficial and 92.9% felt that simulation would be useful. There is lack of standardised undergraduate trauma teaching nationally; a formal undergraduate teaching to ensure that new graduates are competent in the management of trauma would be supported by students. It is likely that a blended learning approach, incorporating e-learning with traditional teaching and clinical experience would be well received.

Introducing the "SIMline"-A Simulation Course in the Management of Severe Burns as a Tool in Undergraduate Medical Education

Background: Management of burn injuries presents a complex and challenging situation for medical staff, especially for inexperienced young doctors. However, training on how to treat burn victims in the clinical setting is rarely taught in undergraduate medical classes. We have created the "SIMline", a simulation training program explicitly designed for coaching medical students in burn management. Methods: A total of 43 students participated in the "SIMline" course, which took place at the training facility at the Medical University of Graz, between 2018 and 2019. The course provided theoretical classes, practical exercises, and a full-scale care process simulation training. The learning progress of the students was monitored via a formative integrated test. Results: Students showed great progress throughout the course of the "SIMline" program, as their test scores improved by an average of 88%. The passing rate was 0% at the first exam (prior to course) as compared to 87% at the final exam, taken after the training. Conclusions: Comprehensive practical training programs in burn care are underrepresented in medical education. The "SIMline" course presents a novel and effective approach in training medical students in burn management. However, follow-up evaluation is necessary to confirm long-term educational benefits.

Impact of interprofessional in situ simulations on acute pediatric burn management: Combining technical and non-technical burn team skills

OBJECTIVE

This study aimed to evaluate the impact of interprofessional in situ simulations on the technical and non-technical skills of pediatric burn teams in acute burn management.

METHODS

This quasi-experimental study consisted of a one-group pre- and post-test design conducted in a pediatric burn center in Turkey. The sample consisted of nine interprofessional burn team members. Data collection tools consisted of the following: descriptive data form, burn technical skills checklists, simulation evaluation form, and Anesthesiologists' non-technical skills in Denmark rating form.

RESULTS

We found no statistically significant difference between the pre- and post-test scores for technical (p = 0.285) and non-technical skill (p = 0.180) scores. Burn team members evaluated the highest score in almost all criteria for in situ simulations.

CONCLUSION

The interprofessional in situ simulations did not improve the burn teams' acute burn management; however, according to a self-report, burn team members were satisfied with the interprofessional in situ simulation experiences and achieved their own gains.

Education in burns: Lessons from the past and objectives for the future

Burns are devastating to the individual and society, representing a huge biomedical burden. Improved education in burns has however ignited a revolution in high-income countries-burn mortality is reducing. Education in burns is far-reaching. For the purpose of this concise review, we focus on four categories: education of both (1) emergency and (2) specialist physicians, and the general population, both at a (3) societal and (4) individual level. Tragically, the global burns picture is bleak with burns representing a neglected but solvable health crisis. Ninety-five percent of burns occur in low-income countries, causing enormous suffering, death and disability. Here, we examine the literature detailing burn education with a focus on past lessons, current trends and future objectives. We have identified key educational objectives to revolutionise burn care on a global perspective. Now is the time to build on promising educational strides to reduce the global burns burden.