The development of physician confidence during surgical and medical internship

BACKGROUND: While much research has addressed physician competency, the development of confidence has not been studied. We sought to identify which elements of internship residents feel most contributed to building their confidence. METHODS: By anonymous survey, University of Pennsylvania residents rated 104 internship elements for contribution to building physician confidence and reported their subjective confidence during and since internship. RESULTS: Two hundred ten residents in 18 specialties participated. Detailed ratings for all 104 elements are provided. Generally, independent decision-making items and good back-up support were equally highly valued, as was developing work efficiency. Poorly valued items included high patient loads, long hours, and abusive interactions. Surgical and medical residents agreed. Mean confidence increased during internship from 12 to 32 (1-100 scale) but remained in the 50s during residency for most specialties. CONCLUSIONS: Faculty should make informed, deliberate attempts to provide those elements identified as most fostering the development of physician confidence.     

A mentorship-based preclinical elective increases exposure,confidence, and interest in surgery

Background

The predicted shortage of surgeons is of growing concern with declining medical student interest in surgical careers. We hypothesized that earlier exposure to operative experiences and the establishment of resident mentors through a preclinical elective would enhance student confidence and interest in surgery.

Methods

We developed a preclinical elective in surgery, which served as an organized curriculum for junior medical students to experience surgery through a paired resident-mentorship model. We assessed student exposure and confidence with clinical activities before and after the elective (N = 24, 100% response rate). We compared these students with a cohort of peers not enrolled in the elective (N = 147, 67% response rate).

Results

We found significantly improved confidence (2.8 vs 4.4) and clinical exposure (2.4 vs 4.3) before versus after the elective, with precourse scores equal to matched peers.

Conclusions

This elective incorporates elements that have been shown to positively influence student decision making in surgical career choice. The mentorship model promotes residents as educators, whereas the elective provides a means for early identification of students interested in surgery.     

Paediatric surgery: trends in UK surgical trainees' operative experience

Aim

This study assesses the effects of the reconfiguration of postgraduate surgical training and changes to work patterns through legislation within UK on the operative experience of trainees completing specialty training in paediatric surgery.

Methods

Data were collected from the consolidation record of operative experience submitted by every candidate sitting the Intercollegiate Specialty Board Examination in Paediatric Surgery in UK from 1996 through 2004. A number of index procedures were chosen as surrogates of the overall operative experience and underwent detailed analysis. These comprised operations performed in the following categories: Neonatal Surgery, General Paediatric Surgery, Paediatric Urology, Paediatric Oncology, and Emergency Paediatric Surgery.

Results

Sixty-three sets of data comprising 12,866 operations were ultimately identified as being suitable for analysis. The average number of operations performed annually by trainees increased over the study period as did the number in each of the operative categories. The number of operations performed with senior assistance or supervision increased over this period by an average of 12.5%. This trend was also evident in emergency surgery where the average number of sample procedures performed by trainees increased by 28% over the study period.

Conclusion

In 1995, reforms to the training grade within UK reduced the time spent in specialist training from a previously unregulated period to 72 months of higher surgical training. Subsequent directives in response to health and safety legislation have further abbreviated the length of time spent at the workplace, initially to 72 hours and more recently to 58 hours per week. This combination has been generally perceived throughout the surgical community as prejudicial to acquisition of clinical and operative competence. This study, however, fails to endorse this perception and suggests to the contrary that perhaps through increased delegation, the volume of training operations is being preserved and that operative training is now better supervised than ever before.     

医学生营养知识-态度-行为现状调查分析

目的调查某医学院校医学生营养知识-态度-行为（KAP）现状,为针对性对其进行营养教育和干预提供依据,增强医学生日后在医疗工作中的营养治疗意识。方法采用分层随机抽样的方法,对某医学院校800名医学生的KAP现状进行调查分析。结果医学生中女性的营养知识（K）、态度（A）、行为（P）得分及KAP总分均高于男生,差异有统计学意义（,分别为2．272,2．035,2．435,3．096,均P〈0．05）;高年级医学生K、A得分及KAP总分优于低年级学生（f分别为6．017,2．018,4．441,均P〈0．05）,不同年级学生间P得分差异无统计学意义（t=0．153,P=0．2265）;城市生源地间学生K、A得分及KAP总分高于农村生源学生（f分别为2．138,11．561,2．800,均P〈0．05）,不同生源地问学生P得分差异无统计学意义（t=0．061,P=0．0585）;营养知识与吃零食、在外就餐和每天吃早餐的食用行为存在相关性（P〈0．05）,营养态度与每天吃早餐的行为存在相关性（火0．05）。结论医学生营养知识缺乏,营养行为较差,但营养态度较为积极,应加强对医学生尤其是男生、低年级、农村学生的营养教育。     

A CRASH course in procedural skills improves medical students' self-assessment of proficiency, confidence, and anxiety

BACKGROUND: Medical students enter the clinical education years with minimal exposure to procedural skills. This study aims to determine the effect of a pre-clinical skills course on students' ratings of proficiency, confidence, and anxiety levels. METHODS: An elective pre-clinical course in procedural skills was given to medical students prior to clinical rotations. Self-assessment of proficiency, confidence, and anxiety in performing these skills was made prior to and on completion of the course. RESULTS: Course participants reported low proficiency and confidence, and high anxiety regarding performing procedural skills. Following the course, there was significant improvement in self-assessed proficiency, confidence, and anxiety. There were no gender differences in responses. CONCLUSIONS: Medical students entering clinical rotations have poor self-assessment of proficiency, low confidence, and high anxiety regarding procedural skills. A concentrated course in procedural skills significantly improved students' assessment of their proficiency, confidence, and anxiety levels.     

Effective retention of primary survey skills by medical students after participation in an expanded Trauma Evaluation and Management course

BACKGROUND: The Trauma Evaluation and Management (TEAM) module orients medical students to the initial assessment of an injured patient. At the Medical College of Wisconsin, a course based on expanded TEAM (eTEAM) was developed for junior medical students. This study determined whether eTEAM improved the ability to perform and retain primary survey skills. METHODS: Objective Structured Clinical Examination methodology was used to compare 2 groups of senior medical students 1 year after receiving either a 2-hour lecture or eTEAM. RESULTS: Students receiving eTEAM performed the primary survey much better than those receiving lecture alone. The overall Objective Structured Clinical Examination scores did not differ between groups. CONCLUSIONS: Medical students participating in eTEAM retained the ability to perform a primary survey in proper sequence 1 year later better than students receiving the information in lecture format only.     

Laparoscopy as an educational and recruiting tool

BACKGROUND: General surgeons can supplement traditional gross anatomy instruction by using laparoscopy to provide clinical correlations. Early, positive interaction with surgeons may stimulate student interest in this field. METHODS: Basic laparoscopy was performed on fresh cadavers for first year medical students in gross anatomy over 2 consecutive years. Surgical residents reviewed anatomy of the abdomen, and students manipulated intra-abdominal organs using laparoscopic instruments. Students completed pre- and post-demonstration questionnaires that were compared independently. RESULTS: More than 95% of responding students agreed the demonstration enhanced their understanding of abdominal anatomy. Regardless of planned area of specialization, students felt the demonstration reinforced the clinical relevance of gross anatomy. Among students already anticipating surgical careers, 88.2% said the demonstration increased their interest in general surgery; this was significantly higher than among those intending careers in internal medicine (27.3%) or other fields (23.5%; P < .0001). CONCLUSIONS: Cadaver-based laparoscopy demonstrations by general surgeons supplement didactic sessions and enhance learning in gross anatomy. Furthermore, such demonstrations may stimulate student interest in general surgery at an early point in their medical education, particularly in those already interested in a surgical career.     

The impact of medical student interest in surgery on clerkship performance and career choice

BackgroundInterest in surgery has declined for two decades. This study aimed to evaluate the impact of one’s interest in surgery on career choice.MethodsStudents who completed the surgical clerkship (2016–2017) were invited to complete surveys assessing rotation experience, learning style, burnout, and grit. Students were grouped according to interest or no interest in surgery after the clerkship.ResultsSurveys were completed by 62 students of whom 51.6% reported an interest in surgery. No minority students expressed interest compared with Caucasian (51.1%) and Asian (71.4%) students (p = 0.02). Disinterested students had higher emotional exhaustion (EE, 20 vs 25, p = 0.03). There was no difference in clerkship grade between groups (86.3% vs 85.3%, p = 0.56). Students who matched into surgery had lower EE and higher grit.ConclusionsInterest in surgery was not associated with improved clerkship performance. Disinterested students had higher EE, suggesting interest may play a role in adapting to clerkship challenges.     

Training general surgery residents in pediatric surgery: educational value vs time and cost

Background

This study evaluated the educational value of pediatric surgery rotations, the likelihood of performing pediatric operations upon completing general surgery (GS) residency, and time and cost of training GS residents in pediatric surgery.

Methods

A survey was administered to GS residents that evaluated the pediatric surgery rotation and anticipated practice intentions. A retrospective analysis (2005-2006) of operative times for unilateral inguinal hernia repair, bilateral inguinal hernia repair, and umbilical hernia repair was also performed. Procedure times were compared for operations performed by a pediatric surgeon with and without GS residents. Cost analysis was based on time differences.

Results

General surgery residents (n = 19) considered the pediatric surgery rotation to have high educational value (4.7 ± 0.6 of 5) with extensive teaching (4.6 ± 0.7) and operative experience (4.4 ± 0.8). Residents listed pediatric surgery exposure, operative technique, and observed work ethic as most valuable. Upon graduation, residents expect to perform pediatric operations 2 to 3 times annually. Thirty-seven percent of residents felt competent to perform appendectomy (patients >5 years), 32% appendectomy (3-5 years), 21% gastrostomy (>1 year), and 11% inguinal herniorrhaphy (>1 year). Operative times and costs were significantly higher in operative procedures performed with a GS resident.

Conclusion

General surgery residents considered pediatric surgery as a valuable educational experience. Residents anticipate performing pediatric operations a few times annually. Training GS residents in pediatric surgery increased operative time and cost. This information may be useful in determining the appropriate setting for resident education as well as budget planning for pediatric surgical practices.     

Differences in operative self-assessment between male and female plastic surgery residents: A survey of 8,149 cases

BackgroundPrevious studies show female residents tend to underrate and male residents to overrate their own performance. We sought to determine if plastic surgery resident trainee self-evaluations differ by resident sex.MethodsWe extracted Operative Entrustability Assessment (OEA) data for plastic surgery programs from MileMarker?, a program capable of storing assessment data for CPT-coded procedures. Complete OEAs contain a trainee self-assessment and attending surgeon assessment. We used simple statistics and linear regression to assess differences, stratifying by trainee sex and post-graduate year (PGY).ResultsWe analyzed 8149 OEAs from 3 training programs representing 64 residents (25% female) and 51 attendings. Compared to attending assessments, both male and female residents significantly underrated their performance during PGY1. However, during PGY2-6 male residents’ self-evaluations were significantly higher and female residents’ self-evaluations significantly lower than their attending evaluations.ConclusionsResults demonstrated female plastic surgery residents underestimated and male residents overestimated their performance. Further studies are needed to determine reasons for these differences.     

Upcoming female preponderance within surgery residents and the association of sex with the surgical career choice in the new millennium: results from a national survey in France

Background

Women are increasingly entering the medical studies. We aim to investigate surgical residents' career decision making among surgical residents and to assess the presence of women.

Methods

An “electronic questionnaire” of self-assessment was distributed to the 2,500 current French surgical residents. Items analyzed included population characteristics, demographics, educational experiences, and choice of career.

Results

There was a response rate of 31.2% (n = 779). The male/female ratio was 1.1 with 370 women (47.5%). The mean age was 28 ± 2 years. All surgical specialties were represented. Sex was significantly associated with the choice of surgical specialty (P < .05). Female residents had a shorter working time per week than male residents (P < .001). Sex was significantly linked with future career plans as female residents expected to work in a public hospital (P = .005) and as male residents expected to work in private practice (P = .001).

Conclusions

Female surgical residents are more populous than ever among surgical residents. Sex appears to be linked with where and how the residents expect to work in the future.     

Development and decay of procedural skills in surgery: A systematic review of the effectiveness of simulation-based medical education interventions

ContextChanges to surgical training programmes in the UK has led to a reduction in theatre time for trainees, and an increasing reliance on simulation to provide procedural experience. Whilst simulation offers opportunity for repetitive practice, the effectiveness of simulation as an educational intervention for developing procedural surgical skills is unclear.MethodsA systematic literature review was undertaken to retrieve all studies describing simulation-based medical education (SBME) interventions for the development of procedural surgical skills using the MEDLINE, PsycINFO, CINAHL, EMBASE and PUBMED databases. Studies measuring skill retention or demonstrating transferability of skills for improving patient outcomes were included in the review.ResultsSBME is superior to no training and can lead to improvement in procedural surgical skills, such that skills transfer from simulated environments into theatre. SBME results in minimal skill degradation after 2 weeks, although more significant decay results after >90 days. Many studies recruited <10 participants, used a variety of methods and were restricted to endoscopic surgical techniques. All studies did not compare interventions with non-SBME teaching methods for developing procedural surgical skills. No studies compared the curriculum design of different surgical training programmes.ConclusionsSBME interventions are effective for developing procedural skills in surgery. SBME interventions are also effective for preventing the decay of procedural surgical skills. Although no studies demonstrate non-inferiority of SBME interventions compared to time in theatre developing skills, SBME interventions do enable the transfer of skills into theatre, and the potential for improving patient outcomes.