Effect of Community and Academic Surgical Rotation Sites on Medical Student Performance Outcomes and Career Choices

Standardized videos in addition to the surgical curriculum in Medical Education for surgical clerkships: a cohort study

BACKGROUND

Medical students are expected to translate the theoretical knowledge gained during their study to practical knowledge during the clerkships. A surgical educational platform with standardized videos may be the solution. However, the effects of a structured online video-based platform in addition to the standard curriculum on students' self-reported and tested surgical knowledge during the surgical clerkship must be assessed.

METHODS

Fourth-year medical students (n = 178) participated in a 6-week course of theoretical and practical training followed by a 10-week in-hospital clerkship in the Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands and 11 affiliated general hospitals. Ninety students followed the usual surgical curriculum (control group), followed by 88 students who were given voluntary access to a video-based surgical educational platform of Incision Academy (video group). At the start (T0) and end (T1) of the clerkship, both groups filled out a surgical knowledge test and a survey regarding their self-reported surgical knowledge and their access to available study sources. Supervisors were blinded and surveyed concerning students' performance and their acquired knowledge. We analyzed the data using paired and unpaired student t-tests and linear regression.

RESULTS

At the end of the clerkship, students in the video group indicated that they had better resources at their disposal than the control group for surgical procedures (p = 0.001). Furthermore, students in the video group showed a greater increase in self-reported surgical knowledge during their clerkship (p = 0.03) and in more objectively tested surgical knowledge (p < 0.001).

CONCLUSIONS

An online surgical educational platform with standardized videos is a valuable addition to the current surgical curriculum according to students and their supervisors. It improves their test scores and self-reported surgical knowledge. Students feel better prepared and more able to find the information necessary to complete the clerkship.

TRIAL REGISTRATION

Registry not necessary according to ICMJE guidelines.

Recruiting trainees to surgery in the United States and Canadian system - What strategies are effective?

BACKGROUND

There has been increasing concerns regarding the declining number of medical students entering surgical residencies. The aim of this study is to analyze strategies and outcomes to enhance recruitment to the surgical specialties.

METHODS

A systematic literature PRISMA-based search was performed. Study quality and bias were assessed. Meta-analysis was performed using DerSimonian Laird method.

RESULTS

Of 3288 unique titles identified, 73 studies met inclusion criteria. Median study unique sample size was 84 participants (range 15-910). Subjective interest was reported in 59 studies, while objective match rate was reported by only 21 studies. The cumulative odds of students interested in the studied specialty was 1.98 (95% CI 1.47-2.67, I² = 0%) and in any surgical specialty was 1.40 (95% 1.01-1.95, I² = 37%) after an intervention compared to baseline.

CONCLUSION

While studies show increased odds of "interested in" a surgical specialty, the results may be subject to high selective and confounding biases.

Preclinical Surgical Preparatory Course and the NRMP Match: Early Exposure and Surgical Recruitment a 10-Year Follow-Up

OBJECTIVE

Many medical students mentally commit to specialties prior to entering clerkships. This is why early preclinical interactions with surgical specialties, through mentorship and/or interest groups, increases the opportunity to nurture enthusiasm for surgery. In 2007, a course providing preclinical medical students with introductory surgical skills training and preparation for the surgical environment ("SURG205") was established at our institution. The course underwent a major revision in 2016, increasing intraoperative mentorship by matching students to surgical attendings and requiring students to scrub into operative cases together. We anticipate that the positive surgical experiences created by the course will lead to further development and enhancement of student interest in surgical specialties-interest that we hypothesized would reflect in their National Resident Matching Program (NRMP) Match outcomes.

DESIGN

NRMP results from 2010 to 2019 were cross-referenced with a database of students who participated in the SURG205 course from 2007 to 2016. With this, we examined the correlation between student participation in SURG205 and surgical specialty match. Descriptive statistics were used to review the trends of the NRMP results, and Pearson's correlation was used to determine the relationship and its significance.

SETTING

This study was conducted in a single private medical school in California.

PARTICIPANTS

Specialties considered "surgical" included: General Surgery, integrated programs-such as Plastic, Thoracic, or Vascular surgery, Obstetrics and Gynecology, Orthopedic Surgery, Otolaryngology, Neurosurgery, and Urology. All other specialties were considered nonsurgical. Students identified as having participated in SURG205 and who then also took part in the NRMP.

RESULTS

Seven hundred eighty students underwent the Match process from 2010 to 2019. 144 (18.5%) of these students participated in SURG205 between 2007 and 2016. Each Match class ranged in size from 62 to 91 (median = 77.5, IQR = 14.5) students. (Table 1) Two-hundred and nineteen students (28.1%) matched into a surgical specialty, of which 34 (15.5%) selected general surgery. From 2010 to 2019 the rate of students who matched into surgical specialties averaged 28.1% per year with a slight nonstatistically significantly increasing trend over that time period R² = 0.30 (p = 0.09; Fig. 1). There was a significant increase in trend in proportion of students who took the course and matched into any specialty between 2010 and 2019 (R² = 0.85, p = 0.0002; Fig. 2). And, there was a statistically significant positive relationship between students taking the course and matching into a surgical specialty (R² = 0.63, p = 0.01; Fig. 3).

CONCLUSION

Our results highlight the increasing tendency of students who pursue surgical specialties having previously participated in this early exposure courses. Not only is student interest created and encouraged through positive mentorship experiences, but that interest may be associated with increases in application rates and eventual match into the specialty. General surgery training programs might consider these trends when designing courses to ease transitions into first-year residency positions-such as fourth-year surgical boot camps, surgical procedure-based anatomy courses, and mentorship frameworks. This information further justifies the cost and time commitment required to administer these programs for students.

A Tale of Two Campuses? An Analysis of Two Affiliated Medical School Campuses With Different Match Rates in General Surgery

OBJECTIVE

The purpose of this study was to compare factors that contribute to increased match rates into general surgery.

DESIGN

Survey study.

SETTING

University of Kansas School of Medicine Campuses.

PARTICIPANTS

A survey assessing experiences and perceptions during their surgical clerkship was sent to graduating medical students from a single university with a hybrid (academic-affiliated community-based) campus, and an academic campus. Specific questions were asked with regard to residents and attendings, procedural experiences, perceived lifestyle, and general interest in surgery before and after clerkship.

RESULTS

The match rate into general surgery was significantly higher on the hybrid campus (14.7% vs 4.0%, p = 0.215). Factors that were positively correlated with interest in surgery included interactions with attendings (0.86) and residents (0.63), time spent in the OR (0.77), participation in the OR (0.62), and complexity of cases (0.61). Students on the hybrid campus spent more weeks on general surgery services (6 vs 4, p < 0.001). More students from the hybrid campus were "Not interested at all" in surgery prior to their surgery clerkship (26.5% vs 16.0). Significantly more academic students indicated they were "Not interested at all" in surgery after their surgery clerkship (52.0 vs 17.6%), while more students on the hybrid campus indicated they were "extremely interested" (29.4 vs 12.0%, p = 0.005) after their surgery clerkship.

CONCLUSION

The rate of students matching into general surgery between the 2 campuses are different, with the hybrid campus having nearly 4 times the rate of students matching into general surgery. Programs may be able to increase their match rate by allowing students more opportunities to participate in the operating room, spending more time on a general surgery service, and by ensuring that medical students are included as members of the surgical team.