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Moya-Mendez ME, Thornton S, Rhodin KE, Gao Q, Leraas HJ, Vatsaas CJ. Longitudinal Integrated Clerkships and Undergraduate Surgical Education: A Scoping Review and Gap Analysis. J Surg Educ 2024; 81:367-372. [PMID: 38272748 DOI: 10.1016/j.jsurg.2023.12.005] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/23/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Longitudinal integrated clerkships (LICs) are an increasingly popular approach to medical student clinical education, and the literature describing them is expanding. Despite this, there is a lack of understanding for how surgery didactics and skills are currently taught as a part of the LIC curriculum. DESIGN We conducted a scoping literature review in July 2022 using terms related to LIC and surgical education. Abstract and full-length text screening followed. Data extraction was completed in August 2022. Articles published in English, focused on LIC students, and discussed any element of LIC curriculum surgical education was included. SETTING Scoping literature review. PARTICIPANTS A total of 282 studies describing LICs were identified from the scoping literature review. After applying inclusion and exclusion criteria, 37 (13%) studies describing some element of surgical education were included. RESULTS Of these 37 studies, the majority did not delve into pertinent details related to students' surgery experience, expectations, and surgical skills accomplishments. Four studies (11%) reported on the outpatient surgical experience, such as minimum required time that students were expected to be in the clinic, and 8 studies (22%) described the inpatient and operating room exposure. Only 1 study (3%) described the surgical floor management of surgical patients, including tasks like documentation and wound care, and 3 studies (8%) reported formal assessment of surgical skills, such as suturing technique. CONCLUSIONS Our study highlights the paucity LIC literature examining the relationship between this curricular innovation and the unique needs of medical students on a surgical clerkship. Surgeon educators should embrace the opportunity to contribute LIC curriculum development and subsequent investigation into how this modality interfaces with the learning objectives of undergraduate surgical education. A formal description of essential curriculum components for all surgical LIC programs is needed to ensure appropriate surgical education across the varied LIC models.
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Affiliation(s)
| | - Steven Thornton
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Kristen E Rhodin
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Qimeng Gao
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Harold J Leraas
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
| | - Cory J Vatsaas
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
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O'Sullivan L, Kagabo W, Prasad N, Laporte D, Aiyer A. Racial and Ethnic Bias in Medical School Clinical Grading: A Review. J Surg Educ 2023; 80:806-816. [PMID: 37019709 DOI: 10.1016/j.jsurg.2023.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/26/2023] [Accepted: 03/17/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Improving diversity in healthcare is a widely recognized national goal. The diversity of medical student matriculants has increased, yet this trend is not seen in the composition of competitive residency programs. In this review, we examine racial and ethnic disparities in medical student grading during clinical years and explore the consequences of how this may exclude minority students from accessing competitive residency positions. DESIGN Following PRISMA guidelines, we searched PubMed, Embase, Scopus, and ERIC databases using variations of the terms "race," "ethnicity," "clerkship," "rotation," "grade," "evaluation", or "shelf exam." Of 391 references found using the criteria, 29 were related to clinical grading and race/ethnicity and included in the review. The GRADE criteria were used to determine the quality of evidence. SETTING Johns Hopkins School of Medicine, Baltimore MD. RESULTS Five studies examining a total of 107,687 students from up to 113 different schools found racial minority students receive significantly fewer Honors grades in core clerkships compared to White students. Three studies examining 94,814 medical student evaluations from up to 130 different schools found significant disparities in the wording of written clerkship evaluations based on race and/or ethnicity. CONCLUSIONS A large body of evidence suggests the presence of racial bias in subjective clinical grading and written clerkship evaluations of medical students. Grading disparities can disadvantage minority students when applying to competitive residency programs and may contribute to a lack of diversity in these fields. As low minority representation has a negative impact on patient care and research advancement, strategies to resolve this issue must be further explored.
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Affiliation(s)
- Lucy O'Sullivan
- Johns Hopkins Orthopedics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Whitney Kagabo
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
| | - Niyathi Prasad
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
| | - Dawn Laporte
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
| | - Amiethab Aiyer
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
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Sideris M, Hanrahan J, Tsoulfas G, Theodoulou I, Dhaif F, Papalois V, Papagrigoriadis S, Velmahos G, Turner P, Papalois A. Developing a novel international undergraduate surgical masterclass during a financial crisis: our 4-year experience. Postgrad Med J 2018. [PMID: 29519810 DOI: 10.1136/postgradmedj-2017-135479] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Essential Skills in the Management of Surgical Cases (ESMSC) is a novel 3-day international undergraduate surgical masterclass. Its current curriculum (Cores integrated for Research-Ci4R) is built on a tetracore, multiclustered architecture combining high-fidelity and low-fidelity simulation-based learning (SBL), with applied and basic science case-based workshops, and non-technical skills modules. We aimed to report our experience in setting up ESMSC during the global financial crisis. METHODS We report the evolution of our curriculum's methodology and summarised the research outcomes related to the objective performance improvement of delegates, the educational environment of the course and the use of mixed-fidelity SBL. Feedback from the last three series of the course was prospectively collected and analysed using univariate statistics on IBM SPSS V.23. RESULTS 311 medical students across the European Union (EU) were selected from a competitive pool of 1280 applicants during seven series of the course between 2014 and 2017. During this period, curriculum 14 s evolved to the final Ci4R version, which integrates a tetracore structure combining 32 stations of in vivo, ex vivo and dry lab SBL with small group teaching workshops. Ci4R was positively perceived across different educational background students (p>0.05 for any comparison). CONCLUSIONS ESMSC is considered an innovative and effective multidisciplinary teaching model by delegates, where it improves delegates objective performance in basic surgical skills. Our experience demonstrates provision of high-quality and free surgical education during a financial crisis, which evolved through a dynamic feedback mechanism. The prospective recording and subsequent analysis of curriculum evolution provides a blueprint to direct development of effective surgical education courses that can be adapted to local needs.
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Affiliation(s)
- Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, London, UK
| | - John Hanrahan
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Georgios Tsoulfas
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Iakovos Theodoulou
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Fatema Dhaif
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | - George Velmahos
- Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Harvard Medical School, Boston, Maryland, USA
| | - Patricia Turner
- American College of Surgeons, Chicago, Illinois, USA.,Department of Surgery, Section of General Surgery, The University of Chicago, Chicago, Illinois, USA
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Dhaif F, Paparoidamis G, Sideris M, Hanrahan J, Georgopoulou EM, Tsagkaraki I, Staikoglou N, Saeed F, Michail T, Tzavelas A, Kenanidis E, Potoupnis M, Tsiridis E, Papalois A. The Role of Anxiety in Simulation-Based Dexterity and Overall Performance: Does It Really Matter? J INVEST SURG 2017; 32:164-169. [PMID: 29286827 DOI: 10.1080/08941939.2017.1387624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Essential Skills in the Management of Surgical Cases (ESMSC) is an international undergraduate surgical masterclass which combines ex vivo, dry lab and high fidelity in vivo simulation-based learning (SBL). It consists of 32 stations of skills-based learning, including open reduction internal fixation (ORIF) of fractures. Current literature suggests early involvement in skills-based learning at the undergraduate level is vital. AIMS To compare students' dexterity and skills-based performance with demographic and educational background parameters. METHODS 112 medical students from European Union countries including the United Kingdom, Germany, Greece, Cyprus, Germany, and Bulgaria were selected from a competitive pool of candidates to attend the course. Students undertook ORIF in an ex vivo swine model, and in a simulated fracture on a bamboo rod. Skills-based performance was assessed by two consultant surgeons with validated direct observation of procedural skills (DOPS) forms. Anxiety was self-assessed using the Westside Anxiety Scale prior to the ORIF stations. Dexterity was measured with the O'Connor tweezer dexterity test. RESULTS Female students had significantly higher dexterity scores (median difference 7, p =.003). Right-handed students achieved higher dexterity than left-handed students (median difference 7, p =.043). There was no difference in students' performance across different medical schools, and across year groups (p <.05 for any correlation). Self-reported anxiety was not correlated with high fidelity skills-based performance (r = 0.032, p =.74). CONCLUSION Anxiety does not seem to play a significant role in Simulation Skills-Based learning. Undergraduate surgical curricula should incorporate SBL-based modules to enhance practical skills learning and motivate future orthopedic surgeons.
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Affiliation(s)
| | | | | | | | | | | | | | - Ferha Saeed
- e Newham University Hospital, Bartshealth NHS Trust , London , UK
| | | | | | | | | | | | - Apostolos Papalois
- e Newham University Hospital, Bartshealth NHS Trust , London , UK.,f Experimental Research Centre ELPEN , Athens , Greece
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Sideris M, Papalois A, Theodoraki K, Dimitropoulos I, Johnson EO, Georgopoulou EM, Staikoglou N, Paparoidamis G, Pantelidis P, Tsagkaraki I, Karamaroudis S, Potoupnis ME, Tsiridis E, Dedeilias P, Papagrigoriadis S, Papalois V, Zografos G, Triantafyllou A, Tsoulfas G. Promoting Undergraduate Surgical Education: Current Evidence and Students' Views on ESMSC International Wet Lab Course. J INVEST SURG 2016; 30:71-77. [PMID: 27611894 DOI: 10.1080/08941939.2016.1220652] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Undergraduate Surgical Education is becoming an essential element in the training of the future generation of safe and efficient surgeons. Essential Skills in the Management of Surgical Cases (ESMSC), is an international, joint applied surgical science and simulation-based learning wet lab course. METHODS We performed a review of the existing literature on the topic of undergraduate surgical education. Following that, we analyzed the feedback questionnaire received 480 from 2 recent series of ESMSC courses (May 2015, n = 49 and November 2015, n = 40), in order to evaluate European Union students' (UK, Germany, Greece) views on the ESMSC course, as well as on the undergraduate surgical education. Results Using a 10 point graded scale, the overall ESMSC concept was positively evaluated, with a mean score of 9.41 ± 0.72 (range: 8-10) and 8.94 ± 1.1 (range: 7-10). The majority of delegates from both series [9.86 ± 0.43 (range: 8-10) and 9.58 ± 0.91 (range: 6-10), respectively] believed that ESMSC should be incorporated in the undergraduate surgical curriculum. Comparison of responses from the UK to the Greek Medical Student, as well as the findings from the third and fourth year versus the fifth and sixth year Medical Students, revealed no statistically significant differences pertaining to any of the questions (p > 0.05). CONCLUSIONS Current evidence in the literature supports the enhancement of surgical education through the systematic use of various modalities that provide Simulation-Based Training (SBT) hands-on experience, starting from the early undergraduate level. The findings of the present study are in agreement with these previous reports.
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Affiliation(s)
- Michail Sideris
- a NIHR Academic Clinical Fellow ST1 level , The London Deanery, Queen Mary's University London (QMUL) , London , UK , Lead of the ESMSC Project
| | - Apostolos Papalois
- b Equal Contribution with 1st Author, Director of the Experimental Research Centre ELPEN , Lead of the ESMSC Project
| | | | - Ioannis Dimitropoulos
- d Consultant in Diabetes and Endocrine Medicine , Plymouth Hospitals NHS Foundation Trust
| | - Elizabeth O Johnson
- e Associate Professor of Anatomy , National and Kapodistrian University of Athens
| | | | | | | | | | | | | | - Michael E Potoupnis
- h Assistant Professor of Orthopedic Surgery , Aristotle University of Thessaloniki (AUTH)
| | - Eleftherios Tsiridis
- i Associate Professor of Orthopedic Surgery , Aristotle University of Thessaloniki (AUTH)
| | | | - Savvas Papagrigoriadis
- k Consultant Colorectal Surgeon , King's College Hospital NHS Foundation Trust, Senior Clinical Lecturer in Surgery, King's College London , London , UK
| | - Vassilios Papalois
- l Consultant Transplant Surgeon , Hammersmith Hospital, London, UK, Professor of Surgery , Imperial College , London , UK
| | - Georgios Zografos
- m Professor of Surgery, Vice Rector , University of Athens, Director of 1st Surgical Department , Hippocratio General Hospital, Athens , Greece
| | | | - Georgios Tsoulfas
- o Assistant Professor of Surgery , Aristotle University of Thessaloniki (AUTH)
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