A Novel Approach to Teaching Surgical Skills to Medical Students Using an Ex Vivo Animal Training Model

Objectives

Traditional surgical teaching is influenced by restrictive factors, such as financial pressures and ethical constraints. The teaching of surgical skills during a medical school education seems not to be robust enough at present, possibly resulting in stressful circumstance for surgical novices. However, the authors are convinced that practical training is fundamental for preparing medical students optimally for challenges in the operating theater and have, therefore, examined a novel method of teaching basic surgical skills to medical students.

Methods

A total of 20 medical students received surgical skill training, which included theoretical lessons, working with ex vivo pig training models, and active participation in the operating theater. All the trainees took written tests and were rated in an Objective Structured Clinical Examination. Before and after training, the students completed a self-assessment form involving the choice of the correct surgical indication and the performance of surgical procedures.

Results

The students’ performance in the written examination and in the Objective Structured Clinical Examination increased significantly after training (p ≤ 0.001). Furthermore, the evaluation of the self-assessment form revealed significant improvements in all categories (p ≤ 0.001).

Conclusions

Our surgical training method appears to improve the surgical abilities of medical students and to increase their self-confidence with respect to surgical procedures. Therefore, the authors recommend the integration of this method into the medical school curriculum to prepare medical students well for surgical challenges.

Introduction

Historically, surgery has been one of most prestigious and competitive disciplines for medical students.¹ In this context, surgical skill training plays a decisive role to prepare novices adequately for the challenges of the operating theater. Traditional surgical teaching includes the acquisition of foundational surgical knowledge via lectures and books and, subsequently, the application of this knowledge in the operating theater.² Thereby, the teaching and education of surgical skills in the operating theater has followed an apprenticeship format, by which surgical residents have learned to operate by assisting qualified surgeons and successively performing components of the operation independently.³ However, current financial pressure and budgetary constraints of medical centers do not afford an appropriate time of training for either medical students or residents in the operating theater.⁴ Furthermore, diseases are generally more complex today than in the past, whereby a high degree of the physician’s attention is required. Thus, over the last few years, ethical constraints and concerns over the safety of patients being operated upon by students and residents with a lack of surgical experience have been raised.5, 6

Growing pressure and difficult working conditions in surgical specialties also cause dissatisfaction among young residents. A lack of technical skill training during medical studies combined with the high expectations of new residents in the operating theater might reduce self-confidence of students and increase their insecurity with regard to surgical procedures. Especially in Europe, only two-thirds of surgery residents asked in a survey carried out by von Websky et al.⁷ were satisfied with their current working situation, dissatisfaction arising mostly because of a lack of training facilities, such as the availability of a structured training curriculum or training courses. Possible consequences are evident in Germany. A lack of well-trained surgeons can be observed at German hospitals,⁸ as can a dearth of trainees in surgical subspecialties at German medical schools.⁹

Therefore, the teaching of procedural skills in the early stages of a medical degree might develop long-term effectiveness in basic skills and competence and should increase the confidence of students and young residents, thereby improving their proficiency.¹⁰

Responses to these aforementioned challenges include new approaches to surgical education based on learning and the practice of basic skills on models and simulators, with the aim of preparing trainees for surgical procedures.4, 11, 12 The training of basic surgical skills occurs outside the operating theater until automaticity in basic skills is achieved.¹³ Subsequently, after the mastering of basic surgical procedures, trainees can enter the operating theater with a focus on more complex surgical procedures.

Thus, the aim of our project has been to examine a novel method of teaching basic surgical skills and to improve the surgical abilities of medical students and their self-confidence with regard to surgical procedures. An integral part of our new teaching approach has been to concentrate mainly on practical work using animal models, such as pig heads and, subsequently, active participation in the operating theater.