The perceptions and attitudes of medical students towards trauma and orthopaedic teaching: a cross-sectional study

Obstetrics and gynecology patients' perceptions about bedside teaching at a Saudi teaching hospital

BACKGROUND

Bedside teaching (BST) is a crucial component of medical education. It entails the interaction of students with patients in outpatient clinics and inpatient wards under the supervision of their tutors in order to improve the clinical skills of the students and, ultimately, patient outcomes. This teaching relies heavily on patients' willingness and cooperation. The aim of this study was to assess the perception of Obstetrics and Gynecology (OB/GYN) patients regarding the presence and participation of medical students in BST.

MATERIALS AND METHODS

A cross-sectional survey was conducted among OB/GYN patients at the outpatient clinics and inpatient wards at King Fahd Hospital of the University (KFHU) in Al-Khobar from January 1 to April 30, 2023. Data were collected online through the Google Drive survey tool using a validated and pilot tested questionnaire. Data were analyzed utilizing SPSS version 26.0. Chi-squared test was employed to test for association between two categorical variables. Multiple logistic regression model was used to determine variables associated with positive attitudes.

RESULTS

A total of 507 patients completed online questionnaire. A highly positive patients' attitude was observed toward the presence and participation of medical students during BST with a mean score of 81.8 ± 10.4. The acceptance rates were higher for female students compared to male students (91.9% vs 61.7%) and for senior doctors compared to junior doctors (89.9% vs 58.9%). Patients who came to the outpatient clinics were also more likely to accept students' presence than those who went to hospital wards. Age, marital status, and previous clinic visits were positively associated with the acceptance level of the presence and involvement of medical students in BST without a significant difference.

CONCLUSION

In general, patients had a good perception of medical students' engagement in their care and that the gender of the medical students/doctors and clinical setting could affect this perception. Raising patients' awareness of their valuable role in male medical students' and doctors' education should be raised, as this will increase their acceptance during BST.

Early Exposure to Orthopaedic Surgery

INTRODUCTION

Disparities in early orthopaedic experiences among medical students prompt a critical examination of factors influencing the availability and nature of these exposures. While the current body of literature underscores the significance of early surgical exposure and mentorship in medical education, a notable gap exists in investigating early orthopaedic exposure and its specific impact on students from diverse backgrounds.

METHODS

A 16-item questionnaire, approved by our institutional review board, was administered to fourth-year medical students (MS4) and first-year orthopaedic residents (PGY-1) across U.S. orthopaedic surgery programs during the 2022-2023 application cycle. The questionnaire assessed participants' initial orthopaedic exposures and factors influencing interest in the field. Two-proportion Z-test analyses were conducted to analyze the data, and thematic analysis was used to assess qualitative data involving free-response questions.

RESULTS

Out of 72 total respondents, the study revealed that 83% of respondents encountered orthopaedics before medical school, with initial exposures stemming from various sources such as familial connections (28%), athletics (17%), and high school or college exposures (15%), including shadowing, athletics participation, and occupation-related exposure. Disparities were observed in the availability of orthopaedic mentors and early exposure opportunities between demographic groups. Statistical analyses highlighted significant differences in access to mentors who reflected students' identities between male and non-male participants (70% vs. 39%, p=0.02) and between white and non-white participants (69% vs. 36%, p=0.02). White participants were also more likely to first interact with a surgeon who treated them or their family members than non-white participants (35% vs 7%, p=0.04). Non-white participants were more likely than white participants to come by their first orthopaedic opportunity by searching for it independently (21% vs. 4%, p=0.03). Family and friend connections in orthopaedics were found to be influential in motivating students to pursue orthopaedics, with 40% of respondents indicating personal connections in medicine and 12% reporting family members who are orthopaedic surgeons. Research experiences were identified as important contributors to students' initial interest and motivation to ultimately pursue orthopaedics, especially those with diverse backgrounds.

CONCLUSION

The findings underscore the importance of early orthopaedic exposures in shaping students' interest in the field, highlighting the need for more immersive pre-clinical year opportunities and enhanced mentorship programs. Addressing disparities in mentorship access and early exposure opportunities requires systemic changes and increased support for underrepresented minorities in orthopaedics. Initiatives like mentorship programs and research opportunities can help bridge gaps in access to early orthopaedic experiences. Medical schools should prioritise targeted early access to orthopaedic exposures for all students, regardless of background. This initiative aims to promote inclusivity and cultivate a more diverse orthopaedic workforce capable of meeting the evolving healthcare needs of society.

Factors influencing medical students' decision to pursue a career in obstetrics and gynaecology

INTRODUCTION

The career intentions of medical students can exert influence on service provision and medical staffing in the health services. It is vital for a specialty's development and sustainability that it has a constant stream of trainees into it annually. An appreciation of how a specialty is viewed by medical students can be used as an opportunity for early intervention in order to improve perception of the specialty and reduce future workforce problems, such as retention and attrition within obstetrics and gynaecology (O&G). We aimed to analyse positive and negative factors of the specialty of O&G as perceived by medical students in order to gain insight into changes that need to be made to improve recruitment and retention into the specialty.

METHODS

A 70-item structured questionnaire consisting of demographic information and 5-point Likert scale questions relating to O&G was administered to final year medical students in the Republic of Ireland. Data were analysed with descriptive statistics, logistic regression, and odds ratios as appropriate.

RESULTS

Of 195 medical students approached, 134 completed the questionnaire, a response rate of 68.7%. The majority were female (55.2%, n = 74) and 76.1% of respondents (n = 102) were Direct Entry Medicine students, with the remainder Graduate Entry Medicine students. 30.8% (n = 41) of students who responded scored 6 or more on a 10-point Likert scale when asked about their likelihood of considering a career in O&G. Students' clerkship experience factored heavily into their perception of the specialty and was more likely to be positive if they experienced direct consultant engagement and the opportunity for hands-on experience. Lifestyle factors, litigation and media were found to be deterrents to considering the specialty after graduation.

CONCLUSIONS

This study demonstrates the importance of good clerkship experience in fostering an interest amongst undergraduates in O&G. Educators and those working within the specialty should showcase the strengths of the specialty during undergraduate education, and work on ameliorating deterrents to ultimately provide a structured approach to improving recruitment into O&G.

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.

Surgical videos on the internet: Is this a reliable pedagogical tool in residency training?

INTRODUCTION

Several open access platforms are currently available to help facilitate this online learning; however, whether the platforms are generalized or specialized, peers do not evaluate videos, and they may teach unverified techniques. The purpose of this study was to compare the quality of each website's content using a specific measurement, analyzing the pedagogical quality of Femoroacetabular impingement (FAI) arthroscopic videos on YouTube versus VuMedi.

METHODS

A prospective study analyzing 20 arthroscopy videos of arthroscopic FAI surgery on two hosting platforms online: 10 on the generalist platform YouTube and 10 on a specialized platform VuMedi.

RESULTS

The average length of the YouTube videos was 503 ± 355.02 s (198-1430). The average number of views for the YouTube videos was 56,114.6 ± 116,832.61 (1149-383,694). The average length of the VuMedi videos was 797.5 ± 522.5 s (185-1927). The average number of views for the VuMedi video was 10,404.7 ± 10,071.2 (1625-37,115) The average LAP-VEGaS scores of the YouTube and VuMedi videos were 8.2 ± 3.47 (3-15) and 11.95 ± 2.64 (6-15), respectively (p < 0.0005).

DISCUSSION

The use of a specialized website makes it possible to obtain educational videos of better quality. Health professionals need to be aware of this when using it as a resource for learning. Therefore, it should be in the interest of educational institutions to participate in the sharing of videos on this platform or to create their own platform to improve the quality of the information provided and the overall pedagogical experience.

LEVEL OF EVIDENCE

II.

Undergraduate education of trauma and orthopaedic surgery in the UK

Aims

Evidence exists of a consistent decline in the value and time that medical schools place upon their undergraduate orthopaedic placements. This limited exposure to trauma and orthopaedics (T&O) during medical school will be the only experience in the speciality for the majority of doctors. This review aims to provide an overview of undergraduate orthopaedic training in the UK.

Methods

This review summarizes the relevant literature from the last 20 years in the UK. Articles were selected from database searches using MEDLINE, EMBASE, ERIC, Cochrane, and Web of Science. A total of 16 papers met the inclusion criteria.

Results

The length of exposure to T&O is declining; the mean total placement duration of two to three weeks is significantly less than the four- to six-week minimum advised by most relevant sources. The main teaching methods described in the literature included didactic lectures, bedside teaching, and small group case-based discussions. Students preferred interactive, blended learning teaching styles over didactic methods. This improvement in satisfaction was reflected in improvements in student assessment scores. However, studies failed to assess competencies in clinical skills and examinations, which is consistent with the opinions of UK foundation year doctors, approximately 40% of whom report a “poor” understanding of orthopaedics. Furthermore, the majority of UK doctors are not exposed to orthopaedics at the postgraduate level, which only serves to amplify the disparity between junior and generalist knowledge, and the standards expected by senior colleagues and professional bodies.

Conclusion

There is a deficit in undergraduate orthopaedic training within the UK which has only worsened in the last 20 years, leaving medical students and foundation doctors with a potentially significant lack of orthopaedic knowledge.

Cite this article: Bone Jt Open 2022;3(7):549–556.

A Cross-Sectional Study of Undergraduate Teaching of Trauma and Orthopaedics in the UK and the Relationship Between Medical Schools and Interest in Trauma and Orthopaedics as a Career

INTRODUCTION

Adequate exposure and teaching of Trauma and Orthopaedics (T&O) to medical students is fundamental in order to obtain sufficient knowledge and sustain their interest in T&O as a career. The primary aim is to assess the exposure and delivery of T&O at all medical schools in the UK. The secondary aim is to determine whether there are any associations between attending a particular medical school and having a strong interest in pursuing a career in T&O.

METHODS

To explore the primary aim, all 33 UK medical schools were investigated in the study, by means of a questionnaire distributed to medical students. This did not include 'new' medical schools, defined as those established from 2014 onwards. To investigate the secondary aim of exploring associations between students' and alumni's medical schools and their interest in T&O as a career, British Orthopaedic Training Association (BOTA) members were reviewed, using the General Medical Council register to identify the universities from which members had graduated. The authors have made the assumption that membership of BOTA signified an interest in T&O as a career.

RESULTS

Results were obtained for all 33 medical schools. The mean total teaching time specifically for T&O throughout medical school was 18 days, ranging from 3 to 60 days in total. 118 BOTA members were reviewed. No member of BOTA in the study had attended medical school in Keele, Liverpool, Plymouth or Lancashire. These universities taught below the national average number of days in T&O.

DISUCSSION

There is a large national variance in the number of compulsory teaching days provided for T&O. The authors advocate medical schools to aim for at least the national average in duration of T&O of 18 days.

A Virtual Curriculum to Prepare Medical Students to Achieve Accreditation Council for Graduate Medical Education Level-1 Milestones in Orthopaedic Surgery

As a part of the American healthcare system's response to the Coronavirus Disease 2019 (COVID-19) global pandemic, the Association of American Medical Colleges recommended that medical schools temporarily remove students from clinical settings and transition to an entirely online learning environment. This posed an unprecedented challenge to students in the clinical years of their medical education. To address this unexpected shift, we modified an in-person workshop to teach orthopaedic trauma basics to 5-week virtual course for third year medical students from several schools in New Jersey and Pennsylvania. We focused on moving students toward the Level-1 milestones for basic fracture care with a combination of weekly lectures and virtual interactive small group sessions, all conducted via WebEx and proctored by an orthopaedic attending or resident. The course was well received by students. Participation in the course was completely voluntary and did not count for credit at any institution. The course was valuable to students because the students who registered chose to fully complete the 5-week course and no student missed more than one small group session. On a postcourse survey, 100% of students said they would be highly likely to recommend the course to a future student, and the average rating for educational value of the course was 4.98 of 5. Given the current limitations in clinical education because of the COVID-19 pandemic, our course provides a reasonable alternative to clinical experience and prepares students with the knowledge and many of the skills that are required to succeed as orthopaedic interns. Furthermore, the success of our course this year suggests that similar programing may be a useful adjunct to clinical experiences even when it is safe to return to more traditional medical school scheduling.

Patient outlook on bedside teaching in a medical school

Objective

Bedside teaching is an important element of training undergraduate and postgraduate medical students to attain clinical skills. The perceptions of patients about bedside teaching vary significantly based on their understanding of the educational climate in hospitals. This study aimed to evaluate the views of diverse groups of patients on bedside teaching and the degree of involvement of medical students in their clinical decision-making processes.

Methods

This was a cross-sectional study conducted among patients admitted to various departments of a tertiary care hospital. A total of 200 patients were surveyed by students using a questionnaire, which covered their knowledge, views, and expectations with respect to medical students in hospital settings and bedside teaching.

Results

The majority (83.5%) of patients surveyed felt that the students made the hospital environment more comfortable and friendly. Male patients chose to permit students' involvement more than female patients. Among the female patients, teens, young adults, and unmarried women were more positive towards students' direct participation in their physical examinations. Health concerns and stress were issues for adults and older patients, whereas privacy and confidentiality concerned the younger age group. Patients admitted to the obstetrics and gynaecology wards were more likely to reject student involvement in hospital procedures than patients in other departments.

Conclusion

Most of the patients had a markedly positive attitude towards bedside teaching. Alternative methods of teaching can be implemented in situations where patients feel uncomfortable with students' involvement during their hospital stay.

Current State of Undergraduate Trauma and Orthopaedics Training in United Kingdom: A Survey-based Study of Undergraduate Teaching Experience and Subjective Clinical Competence in Final-year Medical Students

OBJECTIVE

To assess the quality and duration of trauma and orthopedics (T&O) training in medical schools in United Kingdom (UK), and to evaluate final-year students' self-perceived level of competence in essential T&O skills.

DESIGN

This was a survey-based study of final-year medical students that attended 1-day undergraduate T&O courses held between Feb'17 and Feb'19. Outcome measures were duration and perceived quality of undergraduate T&O placements, students' self-rated competence in essential T&O skills, and impact of teaching methods on their subjective future competence.

SETTING

Four courses held at education centers in 3 different locations in UK (London, Nottingham, and Leeds) PARTICIPANTS: All 414 course attendees from 13 UK medical schools completed the questionnaire.

RESULTS

19.3% of students had not experienced a placement in T&O. Mean duration of T&O placements was 2.5 weeks. 37.4% described their training as "poor". Majority of students attended 1-5 sessions of: lectures (50.5%), small group teaching (58.7%), trauma meetings (58.7%), clinics (65.7%), and theatres (72.5%). Lowest competency scores were reported in management of T&O emergencies, fracture management, and interpretation of T&O radiographs. Self-rated competence in essential T&O skills was significantly higher in students with previous experience of a T&O placement (p < 0.05). There was a strongly positive correlation between small group teaching attendance and perceived competence in management of T&O patients in different clinical settings (p < 0.001).

CONCLUSIONS

Medical schools in UK are currently failing to adequately train medical graduates to manage T&O patients, with students reporting low competency scores in all basic T&O skills. To mitigate the current situation, a minimum duration of a T&O placement for all students must be implemented nationally. Educational boards and medical schools must work in collaboration to improve the delivery of undergraduate T&O curriculum, the structure of the clinical T&O placement, and efficacy of the commonly encountered learning environments.