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: We evaluated suturing skills performance and retention in senior medical students (MS4) at the beginning of their fourth year and 7 months later. MS4 students entering a surgery specialty were randomized to a proficiency-based suturing/knot-tying curriculum at the beginning of fourth year (Intervention, n = 11) versus no training (Control, n = 10). Time and technical proficiency (TP, proficiency ≥3) were assessed at baseline and 7 months. Performance was compared with past "Boot-Camp" MS4, categorical PGY-1 interns and PGY-2 residents. Data are mean ± SD. At baseline, Intervention and Control MS4 had similar total task times (848 ± 199 vs 845 ± 209 seconds) and TP scores (1.8 ± 0.15 vs 1.8 ± 0.3). At 7 months, Intervention MS4 total task times were faster (549 ± 80 vs 719 ± 151 seconds, P < .01) and mean TP scores greater (3.3 ± 0.6 vs 2.1 vs 0.4, P < .001) than Control MS4. Intervention MS4 also performed better at 7 months than Boot-Camp MS4 (662 ± 171 seconds and 2.6 ± 0.5, P < .04) and were similar to PGY-1 interns (601 ± 74 seconds, TP 2.7 ± 0.7 seconds) and end of PGY-2 residents (475 ± 81 seconds and 3.6 ± 0.3 seconds). A proficiency-based suturing and knot-tying curriculum taught early in the fourth year results in improved MS4 performance compared with no training or a traditional "boot camp" program.Surgery 10/2013; 154(4):823-30. DOI:10.1016/j.surg.2013.07.016 · 3.11 Impact Factor
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ABSTRACT: Simulation-based surgical skills training during preclinical education is a persistent challenge due to time constraints of trainees and instructors alike. Self-directed practice is resource-efficient and flexible; however, insight into technical proficiency among trainees is often lacking. The purpose of this study is to prospectively assess the accuracy of self-assessments among medical students learning basic surgical suturing. Over seven weekly practice sessions, preclinical medical students performed serial repetitions of a simulation-based suturing task under one-on-one observation by one of four trainers. Following each task repetition, self- and trainer-assessments (SA-TA) were performed using a 36-point weighted checklist of technical standards developed a priori by expert consensus. Upon study completion, agreement between SA and TA was measured using weighted Cohen's kappa coefficients. Twenty-nine medical students each performed a median of 25 suture task repetitions (IQR 21.5-28). Self-assessments tended to overestimate proficiency during the first tertile of practice attempts. Agreement between SA and TA improved with experience, such that the weighted kappa statistics for the two-handed and instrument ties were >0.81 after 18-21 task attempts. Inexperienced trainees frequently overestimate technical proficiency through self-assessments. However, this bias diminishes with repetitive practice. Only after trainees have attained the capacity to accurately self-assess can effective self-directed learning take place.Advances in Health Sciences Education 06/2014; 20(1). DOI:10.1007/s10459-014-9519-3 · 2.71 Impact Factor