Elsevier

Surgery

Volume 148, Issue 4, October 2010, Pages 768-777
Surgery

Central Surgical Association
Do preclinical background and clerkship experiences impact skills performance in an accelerated internship preparation course for senior medical students?

Presented at the 119th Meeting of the Central Surgical Association, March 11, 2010, Chicago, Illinois.
https://doi.org/10.1016/j.surg.2010.07.022Get rights and content

Background

Dedicated skills courses may help to prepare 4th-year medical students for surgical internships. The purpose of this study was to analyze the factors that influence the preparedness of 4th-year medical students planning a surgical career, and the role that our skills course plays in that preparedness.

Methods

A comprehensive skills course for senior medical students matching in a surgical specialty was conducted each spring from 2006 through 2009. Students were surveyed for background skills, clerkship experience, and skills confidence levels (1–5 Likert scale). Assessment included 5 suturing and knot-tying tasks pre- and postcourse and a written examination. Data are presented as mean values ± standard deviations; statistical analyses were by 2-tailed t test, linear regression, and analysis of variance.

Results

Sixty-five 4th-year students were enrolled; most common specialties were general surgery (n = 22) and orthopedics (n = 16). Thirty-five students were elite musicians (n = 16) or athletes (n = 19) and 8 regular videogamers. Suturing task times improved significantly from pre- to postcourse for all 5 tasks (total task times pre, 805 ± 202 versus post, 627 ± 168 seconds [P < .0001]) as did confidence levels for 8 skills categories, including management of on-call problems (P < .05). Written final examination proficiency (score ≥70%) was achieved by 81% of students. Total night call experience 3rd year was 23.3 ± 10.7 nights (7.3 ± 4.3 surgical call) and 4th year 10.5 ± 7.4 nights (7.2 ± 6.8 surgical call). Precourse background variables significantly associated with outcome measures were athletics with precourse suturing and 1-handed knot tying (P < .05); general surgery specialty and instrument tying (P = .012); suturing confidence levels and precourse suturing and total task times (P = .024); and number of nonsurgical call nights with confidence in managing acute on-call problems (P = .028). No significant correlation was found between these variables and postcourse performance.

Conclusion

Completion of an accelerated skills course results in comparable levels of student performance postcourse across a variety of preclinical backgrounds and clerkship experiences.

Section snippets

Methods

A dedicated skills course entitled “Accelerated Skills Preparation for Surgical Internship” for 4th-year medical students matching to a surgical specialty was conducted from 2006 through 2009. The course was given as 7 once-weekly sessions lasting approximately 3 hours, as previously described.7 Each session consisted of a short didactic presentation followed by hands-on basic skills instruction and practice. The curriculum was designed to address perceived needs for students entering surgical

Results

Student demographics are shown in Table II. Sixty-five 4th-year medical students were enrolled (38 male, 27 female). Most common specialties were general surgery (n = 22) and orthopedics (n = 16). Thirty-five students were elite-level musicians (n = 16) or athletes (n = 19) and 8 were regular (several times/week) videogamers.

Objective assessment of skills performance showed a significant improvement in suturing and knot-tying task times from pre- to postcourse for all 5 tasks (Table III). The

Discussion

Despite pleas for more structure and organization,10, 11 the 4th year of medical school remains largely unstructured so that medical students can pursue electives in their specialties of interest.12 Although every medical school curriculum includes a core surgical block in the 3rd year, the skills exposure and skills set of students after their core clinical clerkships is often limited.13 The opportunity to perform procedures and the resultant hands-on experience acquired is heavily dependent

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Support for this course by a grant from the Washington University School of Medicine Innovations in Medical Student Education Program, and in part by education grant and equipment support from Ethicon Endosurgery, Ethicon Inc., Stryker Endoscopy, and Karl Storz Endoscopy. Dr Brunt has received honoraria for speaking/teaching from Ethicon Endosurgery and consulting from Stryker Endoscopy that are unrelated to the content of this article.

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