Accelerated Skills Preparation and Assessment for Senior Medical Students Entering Surgical Internship

ArticleinJournal of the American College of Surgeons 206(5):897-904; discussion 904-7 · June 2008with15 Reads
DOI: 10.1016/j.jamcollsurg.2007.12.018 · Source: PubMed
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.
    • "Numerous medical schools programs have acknowledged this transition point and devised different training programs. Simulation-based curriculum was often chosen for its increasingly recognized efficacy and for its superior ethical approach[3, 4], and had demonstrated benefit in several locally based studies[5][6][7][8] . Based on this experience, the Israeli National Internship Committee in collaboration with the Medical School Deans' Association and the Ministry of Health, have decided to approach the critical transition point of internship on a national level and initiate a national, pre-internship " boot-camp " . "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction The transition for being a medical student to a full functioning intern is accompanied by considerable stress and sense of unpreparedness. Simulation based workshops were previously reported to be effective in improving the readiness of interns and residents to their daily needed skills but only few programs were implemented on a large scale. Methods A nationally endorsed and mandated pre-internship simulation based workshop is reported. We hypothesized that this intervention will have a meaningful and sustained impact on trainees' perception of their readiness to internship with regard to patient safety and quality of care skills. Main outcome measure was the workshop’s contribution to professional training in general and to critical skills and error prevention in particular, as perceived by participants. Results Between 2004 and 2011, 85 workshops were conducted for a total of 4,172 trainees. Eight-hundred and six of the 2,700 participants approached by e-mail, returned feedback evaluation forms, which were analyzed. Eighty five percent of trainees perceived the workshop as an essential component of their professional training, and 87% agreed it should be mandatory. These ratings peaked during internship and were generally sustained 3 years following the workshop. Contribution to emergency care skills was especially highly ranked (83%). Conclusion Implementation of a mandatory, simulation-based, pre-internship workshop on a national scale made a significant perceived impact on interns and residents. The sustained impact should encourage adopting this approach to facilitate the student to doctor transition.
    Full-text · Article · Mar 2016
    • "Although shadowing an intern can also be useful, it relies on chance occurrences. The use7,9,11,12 These studies have often used self-reported confidence as their primary *Last full week of work. "
    [Show abstract] [Hide abstract] ABSTRACT: The transition from student to intern can be challenging. The "August" or "July effect" describes increased errors and reduced patient safety during this transition. The study objectives were to develop, pilot, and evaluate clinical performance after an immersive simulation course for incoming interns. Graduating students were recruited for a 1-week immersive simulation course. Controls received no simulation training. Primary outcome (at baseline, and 1 and 6 months) was clinical performance on Objective Structured Clinical Examinations (OSCE) of clinical procedures and surgical technical skills. Secondary outcomes were self-reported confidence and clinical procedure logbook data. Nineteen students were recruited. Sixteen completed the 6-month follow-up, 10 in the intervention group and 6 in the control group. No differences were demonstrated between interventions and controls at baseline (OSCE [median, 66 vs 78; P = .181], technical skills [48 vs 52.5; P = .381], and confidence [101 vs 96; P = .368]). Interventions outperformed controls at 1 month (OSCE [111 vs 82; P = .001], technical skills [78.5 vs 63; P = .030], and confidence [142 vs 119; P < .001]), and 6 months (OSCE [107 vs 93; P = .007], technical skills [92.5 vs 69; P = .044], and confidence [148 vs 129; P = .022]). No differences were observed in numbers of clinical procedures performed at 1 (P = .958), 4 (P = .093), or 6 months (P = .713). The immersive simulation course objectively improved subjects' clinical skills, technical skills, and confidence. Despite similar clinical experience as controls, the intervention group's improved performance persisted at 6 months follow-up. This feasible and effective intervention to ease transition from student to intern could reduce errors and enhance patient safety. Copyright © 2015 Elsevier Inc. All rights reserved.
    Full-text · Article · Jan 2015
    • "Trainee doctor necessity to select the importance treatment for save patient from coma. In emergency department, numerous cases there and trainee doctor extra responsibility the practice than thinking because the matter occurs in unexpectedly (Brunt et al., 2008; Naylor et al., 2010). An accident, fever, cancer and many more type of sickness occur in emergency of department. "
    [Show abstract] [Hide abstract] ABSTRACT: This research conducted at Hospital Pakar Sultanah Fatimah, Johor. The purpose of this research is identifying the level of clinical skill and trainee doctor achievement in medical learning experimentation. Besides that, researcher will identify either the clinical supervision as a moderator or non-moderator. The data collected shown the researcher getting 98 of questionnaire returned. The researcher have been done do pilot study and the alpha cronbach finding is high. Next, the researcher analyse output through descriptive statistics (mean, frequency and percentage) and inferential statistic (pearson correlation and hierarchical regression. The output shown the level of clinical skills and knowledge used and the achievement of experimentation learning is high. The correlation analysis shown there are low positive correlation between clinical skills use with experimentation learning achievement. However, based on output the relationship is not influences by the supervision clinical moderator. The output shown the first hypothesis is accepted and second hypothesis was rejected. © 2015 Mediterranean Journal of Social Sciences. All rights received.
    Article · Jan 2015
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