Accelerated skills preparation and assessment for senior medical students entering surgical internship
ABSTRACT Skills training plays an increasing role in residency training. Few medical schools have skills courses for senior students entering surgical residency.
A skills course for 4(th)-year medical students matched in a surgical specialty was conducted in 2006 and 2007 during 7 weekly 3-hour sessions. Topics included suturing, knot tying, procedural skills (eg, chest tube insertion), laparoscopic skills, use of energy devices, and on-call management problems. Materials for outside practice were provided. Pre- and postcourse assessment of suturing skills was performed; laparoscopic skills were assessed postcourse using the Society of American Gastrointestinal and Endoscopic Surgeons' Fundamentals of Laparoscopic Surgery program. Students' perceived preparedness for internship was assessed by survey (1 to 5 Likert scale). Data are mean +/- SD and statistical analyses were performed.
Thirty-one 4(th)-year students were enrolled. Pre- versus postcourse surveys of 45 domains related to acute patient management and technical and procedural skills indicated an improved perception of preparedness for internship overall (mean pre versus post) for 28 questions (p < 0.05). Students rated course relevance as "highly useful" (4.8 +/- 0.5) and their ability to complete skills as "markedly improved" (4.5 +/- 0.6). Suturing and knot-tying skills showed substantial time improvement pre- versus postcourse for 4 of 5 tasks: simple interrupted suturing (283 +/- 73 versus 243 +/- 52 seconds), subcuticular suturing (385 +/- 132 versus 274 +/- 80 seconds), 1-handed knot tying (73 +/- 33 versus 58 +/- 22 seconds), and tying in a restricted space (54 +/- 18 versus 44 +/- 16 seconds) (p < 0.02). Only 2-handed knot tying did not change substantially (65 +/- 24 versus 59 +/- 24 seconds). Of 13 students who took the Fundamentals of Laparoscopic Surgery skills test, 5 passed all 5 components and 3 passed 4 of 5 components.
Skills instruction for senior students entering surgical internship results in a higher perception of preparedness and improved skills performance. Medical schools should consider integrating skills courses into the 4(th)-year curriculum to better prepare students for surgical residency.
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ABSTRACT: Background The accuracy of self-assessments has not been well-supported in the literature. This study was undertaken to examine the validity of medical students’ ratings of their proficiency during encounters with simulated patients and simulation devices. Methods Confidential self-assessments for 10 skills were collected from 195 students during a formal clinical skills assessment related to 3 cases at the end of a surgery clerkship. The cases required students to gather data from simulated patients and perform procedures such as rectal examinations, naso-gastric tube insertions, and suturing on bench simulation models. The patients were trained to assess student performance. Results There were significant differences between student self-assessments and simulated patient scores for general clinical skills as opposed to procedural skills. Students’ mean self-assessments in the data gathering and interpersonal skills were 2 to 6 percentage points higher than ratings of their proficiency by simulated patients. However, self-assessments on procedures were 5 to 8 points lower than patient ratings. The median correlation between self-assessments and patient ratings for general clinical skills such as data gathering and interpersonal skills was 0.08 (NS), whereas the median correlation between student and patient ratings in procedures was 0.22 (p<.01). Conclusions Third year medical students’ self-assessments for specific procedures are more valid than self-assessments of general clinical skills. Students are less confident in their procedural skills compared to general clinical skills. While self-assessments should not be used as the sole measure of performance in clinical simulations, self-assessments for specific procedures can provide supplemental information on proficiency.Journal of Surgical Research 10/2014; 193(2). DOI:10.1016/j.jss.2014.09.036 · 2.12 Impact Factor
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ABSTRACT: The transition from medical student to surgical intern is fraught with anxiety. We implemented a surgical intern survival skills curriculum to alleviate this through a series of lectures and interactive sessions. The purpose of this pilot study was to evaluate its effectiveness. This was a prospective observational pilot study of our surgical intern survival skills curriculum, the components of which included professionalism, medical documentation, pharmacy highlights, radiographic interpretations, nutrition, and mock clinical pages. The participants completed pre-course and post-course surveys to assess their confidence levels in the elements addressed using a 5-point Likert scale (1 = unsatisfactory, 5 = excellent). A P value of less than .05 was considered significant. In 2009, 8 interns participated in the surgical intern survival skills curriculum. Fifty percent were female and their mean age was 27.5 ± 1.5 years. Of 33 elements assessed, interns rated themselves as more confident in 27 upon completion of the course. The implementation of a surgical intern survival skills curriculum significantly improved the confidence levels of general surgery interns and seemed to ease the transition from medical student to surgical intern.American journal of surgery 12/2011; 202(6):713-8; discussion 718-9. DOI:10.1016/j.amjsurg.2011.06.049 · 2.41 Impact Factor
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ABSTRACT: Resident work-hour restrictions and a reduction in general surgery training have impacted urologic training. We sought to assess the educational needs of urology residents after preurology training in general surgery to compare self-reported outcomes to those of supervising faculty and to determine which aspects of preurology training have an impact on those needs. A survey was distributed electronically to urology residents and faculty of Accreditation Council for Graduate Medical Education (ACGME) residency programs. Residents evaluated 11 surgical skills with regard to their importance to subsequent urology training and their self-assessed proficiency with those skills. Faculty members evaluated the same skills with regard to their importance and their residents' proficiency with those skills. All individuals evaluated 11 general surgery rotations with regard to their importance to later urology training. The responses were analyzed using the paired Wilcoxon test, and faculty responses were compared with resident responses using the Fisher exact test and the χ(2)-test. Urologic surgery residency programs in the United States. There were 305 resident responses and 58 faculty responses. For each surgical skill, residents perceived skills as being more important than their self-assessed proficiency with those skills (p < 0.001). Resident and faculty assessments of surgical skills and of general surgery rotations were similar. More time spent in general surgery training was associated with increased self-assessed proficiency. No difference was found between resident and faculty assessment of global surgical skills (p = 0.76) or general surgery rotation importance (p = 0.87). A discrepancy was determined between urology residents' perceptions of the importance of surgical skills and their proficiency with those skills. The duration of general surgery training might have an impact on self-assessed skills proficiency. Concordance was demonstrated between resident and faculty perceptions of residents' surgical skills and of general surgery rotations.Journal of Surgical Education 09/2011; 68(5):341-6. DOI:10.1016/j.jsurg.2011.05.001 · 1.39 Impact Factor