共查询到20条相似文献,搜索用时 31 毫秒
1.
Kathryn M. Tchorz S. Bruce Binder Mary T. White Larry W. Lawhorne Deborah M. Bentley Elizabeth A. Delaney Jerome Borchers Melanie Miller Linda M. Barney Margaret M. Dunn Kenneth W. Rundell Thavm Thambipillai Randy J. Woods Ronald J. Markert Priti P. Parikh Mary C. McCarthy 《The Journal of surgical research》2013
Background
In 2000, the Liaison Committee on Medical Education required that all medical schools provide experiential training in end-of-life care. To adhere to this mandate and advance the professional development of medical students, experiential training in communication skills at the end-of-life was introduced into the third-year surgical clerkship curriculum at Wright State University Boonshoft School of Medicine.Materials and methods
In the 2007–08 academic year, 97 third-year medical students completed six standardized end-of-life care patient scenarios commonly encountered during the third-year surgical clerkship. Goals and objectives were outlined for each scenario, and attending surgeons graded student performances and provided formative feedback.Results
All 97 students, 57.7% female and average age 25.6 ± 2.04 y, had passing scores on the scenarios: (1) Adult Hospice, (2) Pediatric Hospice, (3) Do Not Resuscitate, (4) Dyspnea Management/Informed Consent, (5) Treatment Goals and Prognosis, and (6) Family Conference. Scenario scores did not differ by gender or age, but students completing the clerkship in the first half of the year scored higher on total score for the six scenarios (92.8% ± 4.8% versus 90.5% ± 5.0%, P = 0.024).Conclusions
Early training in end-of-life communication is feasible during the surgical clerkship in the third-year of medical school. Of all the scenarios, “Conducting a Family Conference” proved to be the most challenging. 相似文献2.
Nikki Tocco Melissa Brunsvold Loay Kabbani Jules Lin Brent Stansfield Dean Mueller Rebecca M. Minter 《American journal of surgery》2013
Background
An operative anatomy course was developed within the construct of a surgical internship preparatory curriculum. This course provided fourth-year medical students matching into a surgical residency the opportunity to perform intern-level procedures on cadavers under the guidance of surgical faculty members.Methods
Senior medical students performed intern-level procedures on cadavers with the assistance of faculty surgeons. Students' confidence, anxiety, and procedural knowledge were evaluated both preoperatively and postoperatively. Preoperative and postoperative data were compared both collectively and based on individual procedures.Results
Student confidence and procedural knowledge significantly increased and anxiety significantly decreased when preoperative and postoperative data were compared (P < .05). Students reported moderate to significant improvement in their ability to perform a variety of surgical tasks.Conclusions
The consistent improvement in confidence, knowledge, and anxiety justifies further development of an operative anatomy course, with future assessment of the impact on performance in surgical residency. 相似文献3.
Charity C. Glass Robert D. Acton Patrice G. Blair Andre R. Campbell Ellen S. Deutsch Daniel B. Jones Kathleen R. Liscum Ajit K. Sachdeva Daniel J. Scott Stephen C. Yang 《American journal of surgery》2014
Background
Simulation can enhance learning effectiveness, efficiency, and patient safety and is engaging for learners.Methods
A survey was conducted of surgical clerkship directors nationally and medical students at 5 medical schools to rank and stratify simulation-based educational topics. Students applying to surgery were compared with others using Wilcoxon's rank-sum tests.Results
Seventy-three of 163 clerkship directors (45%) and 231 of 872 students (26.5%) completed the survey. Of students, 28.6% were applying for surgical residency training. Clerkship directors and students generally agreed on the importance and timing of specific educational topics. Clerkship directors tended to rank basic skills, such as examination skills, higher than medical students. Students ranked procedural skills, such as lumbar puncture, more highly than clerkship directors.Conclusions
Surgery clerkship directors and 4th-year medical students agree substantially about the content of a simulation-based curriculum, although 4th-year medical students recommended that some topics be taught earlier than the clerkship directors recommended. Students planning to apply to surgical residencies did not differ significantly in their scoring from students pursuing nonsurgical specialties. 相似文献4.
Keith Wirth Bethany Malone Kaylene Barrera Warren D. Widmann Christopher Turner Aliu Sanni 《American journal of surgery》2014
Background
The aim of this study was to investigate a novel resident education model that turns the traditional surgical hierarchy upside down, termed a “reverse” peer-assisted learning curriculum.Methods
Thirty surgical topics were randomized between medical students and chief residents on each clinical team, with 1 topic being presented briefly during morning rounds. An exam evaluating junior residents' knowledge of these topics was administered before and after 1 month of presentations. A questionnaire was distributed to evaluate the junior residents' perceptions of this teaching model.Results
Thirty-four residents participated. There was a significant improvement in the mean examination score (54 vs 74, P < .05). No significant difference was noted in the mean score differentials of topics presented by either the medical students or the chief resident (21 vs 18, P = .22). More than 80% of the residents responded positively about the effectiveness of this exercise and agreed that they would like to see this model used on other services.Conclusions
This study confirms the hypothesis that medical students can teach surgical topics to junior residents at least as effectively as their chief residents. 相似文献5.
Ira L. Leeds Lee A. Hugar Barbara J. Pettitt Jahnavi Srinivasan Viraj A. Master 《American journal of surgery》2013
Background
Concerns about international training experiences in medical school curricula include the effect on student learning. We studied the educational effect of an international elective integrated into a traditional third-year (M3) surgical clerkship.Methods
A 1-week surgical elective in Haiti was available to M3 students during the conventional 8-week surgical clerkship each year for the 4 academic years 2008 to 2011. The authors collected student and surgeon perceptions of the elective using a mixed-methods web-based survey. Statistical analysis compared the academic performance of participating M3s relative to nonparticipating peers.Results
Twenty-eight (100%) students (41 trip weeks) and 3 (75%) surgeons responded. Twenty-five (89%) students believed the elective provided appropriate clinical training. Surgeon responses were consistent with students' reported perceptions.Strengths included unique clinical experiences and close interactions with faculty. Criticisms included recurring overwhelming clinical responsibilities and lack of local provider involvement.Academic performance of participants versus nonparticipants in the same clerkship term were statistically insignificant.Conclusions
This study demonstrates the feasibility of integrating global health experiences into traditional medical student clinical curricula. The effects on less tangible attributes such as leadership skills, fostering teamwork, and cultural competency require future investigation. 相似文献6.
Joseph Drosdeck Ellen CarraroMark Arnold MD Kyle PerryAlan Harzman MD Rollin NagelLynnsay Sinclair BA Peter Muscarella MD 《The Journal of surgical research》2013
Background
Medical students desire to become proficient in surgical techniques and believe their acquisition is important. However, the operating room is a challenging learning environment. Small group procedural workshops can improve confidence, participation, and performance. The use of fresh animal tissues has been rated highly among students and improves their surgical technique. Greater exposure to surgical procedures and staff could positively influence students' interest in surgical careers. We hypothesized that a porcine “wet lab” course for third year medical students would improve their surgical skills.Methods
Two skills labs were conducted for third year medical students during surgery clerkships in the fall of 2011. The students' surgical skills were first evaluated in the operating room across nine dimensions. Next, the students performed the following procedures during the skills lab: (1) laparotomy; (2) small bowel resection; (3) splenectomy; (4) partial hepatectomy; (5) cholecystectomy; (6) interrupted abdominal wall closure; (7) running abdominal wall closure; and (8) skin closure. After the skills lab, the students were re-evaluated in the operating room across the same nine dimensions. Student feedback was also recorded. Fifty-one participants provided pre- and post-lab data for use in the final analysis.Results
The mean scores for all nine surgical skills improved significantly after participation in the skills lab (P ≤ 0.002). Cumulative post-test scores also showed significant improvement (P = 0.002). Finally, the student feedback was largely positive.Conclusions
The surgical skills of third year medical students improved significantly after participation in a porcine wet lab, and the students rated the experience as highly educational. Integration into the surgery clerkship curriculum would promote surgical skill proficiency and could elicit interest in surgical careers. 相似文献7.
Shaun C. Daly Rebecca A. Deal Daniel E. Rinewalt Amanda B. Francescatti Minh B. Luu Keith W. Millikan Mary C. Anderson Jonathan A. Myers 《American journal of surgery》2014
Background
The purpose of our study was to determine the predictive impact of individual academic measures for the matriculation of senior medical students into a general surgery residency.Methods
Academic records were evaluated for third-year medical students (n = 781) at a single institution between 2004 and 2011. Cohorts were defined by student matriculation into either a general surgery residency program (n = 58) or a non–general surgery residency program (n = 723). Multivariate logistic regression was performed to evaluate independently significant academic measures.Results
Clinical evaluation raw scores were predictive of general surgery matriculation (P = .014). In addition, multivariate modeling showed lower United States Medical Licensing Examination Step 1 scores to be independently associated with matriculation into general surgery (P = .007).Conclusions
Superior clinical aptitude is independently associated with general surgical matriculation. This is in contrast to the negative correlation United States Medical Licensing Examination Step 1 scores have on general surgery matriculation. Recognizing this, surgical clerkship directors can offer opportunities for continued surgical education to students showing high clinical aptitude, increasing their likelihood of surgical matriculation. 相似文献8.
Ralph C. Quillin III Timothy A. Pritts Amit D. Tevar Dennis J. Hanseman Michael J. Edwards Bradley R. Davis 《The Journal of surgical research》2013
Purpose
The perceptions and expectations of students on the surgery clerkship were evaluated and compared with those of surgical residents and faculty.Methods
A voluntary and anonymous survey was distributed to third year medical students, general surgery residents, and surgery faculty. Statistical analysis was performed using the χ2 and Cochran-Mantel-Haenszel tests (P value <0.05 was significant).Results
Medical students, surgery residents and faculty largely agreed on student responsibilities during morning rounds. However, more students (96.9%) than residents (86.2%) and faculty (77.3%) believed they should be writing progress notes, and fewer students (85%) than residents (100%) and faculty (95.5%) thought they should be taught during morning rounds (P < 0.01 and P = 0.04, respectively). The expected and actual educational experience on the surgical clerkship was similar. The amount of instruction provided each week by residents and faculty was similar to the amount expected by students; each group believed that surgical residents were good educators. Students, residents, and faculty agreed on many essential skills for a student to learn by the clerkship’s end; however, more students (85.8%) than residents (58.6%) and faculty (68.2%) viewed identifying surgical complications as an essential skill (P < 0.01).Conclusions
Overall, the expectations of the medical students, surgical residents, and surgical faculty on the surgery clerkship were well matched. However, there were some instances where the students thought they should be more involved in patient care than did the residents and the faculty. It is important for surgical educators to be aware of these discrepancies to fully maximize the educational experience of medical students. 相似文献9.
Brian C. Drolet Suma Sangisetty Patrick M. Mulvaney Beth A. Ryder William G. Cioffi 《American journal of surgery》2014
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. 相似文献10.
David T. Hughes Stephen J. ForestRosangela Foitl B.S. Edward Chao M.D. 《American journal of surgery》2014
Background
Medical students often site their ability to excel at technical tasks as justification for choosing surgery as a career path. We sought to investigate how medical students' dexterity skills and past experiences correlated with suturing performance.Methods
Sixty-four 3rd-year medical students were surveyed about previous experiences that involved manual dexterity. Technical skills were then measured using a validated test of manual dexterity and subcuticular closure of a pig's foot incision. Spearman's rank correlation coefficients determined correlation between variables.Results
Previous experiences, self-assessment of dexterity, prior suturing, and current interest in surgery did not significantly correlate with manual dexterity or suturing skill scores. Innate manual dexterity score was the only significant correlating factor to suture skill score (Spearman's rank correlation coefficient = .336; P = .007).Conclusions
Innate manual dexterity skills are predictive of initial surgical suturing performance regardless of past student experiences. Interventions aimed at improving early surgical technique should be optimally focused on dexterity training. 相似文献11.
Chris M. Reid Dennis Y. Kim Jess Mandel Alan Smith Vishal Bansal 《The Journal of surgical research》2014
Background
Evaluation of medical students during the surgical clerkship is controversial. Performance is often based on subjective scoring, whereas objective knowledge is based on written examinations. Whether these measures correspond or are relevant to assess student performance is unknown. We hypothesized that student evaluations correlate with performance on the National Board Of Medical Examiners (NBME) examination.Methods
Data were collected from the 2011–2012 academic year. Medical students underwent a ward evaluation using a seven-point Likert scale assessing six educational competencies. Students also undertook the NBME examination, where performance was recorded as a percentile score adjusted to national standards.Results
A total of 129 medical students were studied. Scores on the NBME ranged from the 52nd to the 96th percentile with an average in the 75th percentile (±9). Clerkship scores ranged from 3.2–7.0 with a mean of 5.7 (±0.8). There was a strong positive association between higher NBME scores and higher clerkship evaluations shown by a Pearson correlation coefficient of 0.47 (P < 0.001). Students clustered with below average ward evaluations (3.0–4.0) were in the 69.5th percentile of NBME scores, whereas students clustered with above average ward evaluations (6.0–7.0) were in the 79.2th percentile (P < 0.001).Conclusions
A strong positive relationship exists between subjective ward evaluations and NBME performance. These data may afford some confidence to surgical faculty and surgical resident ability to accurately evaluate medical students during clinical clerkships. Understanding factors in student performance may help in improving the surgical clerkship experience. 相似文献12.
Benjamin M. Martin Timothy P. Love Jahnavi Srinivasan Jyotirmay Sharma Barbara Pettitt Cinnamon Sullivan John Pattaras Viraj A. Master Luke P. Brewster 《The Journal of surgical research》2014
Background
The field of global health is rapidly expanding in many medical centers across the US. As a result, medical students have increasing opportunities to incorporate global health experiences (GHEs) into their medical education. Ethics is a critical component of global health curricula, yet little literature exists to direct the further development of didactic training. Therefore, we sought to define ethical encounters experienced by medical students participating in short-term surgical GHEs and create a framework for the design of ethics curriculum specific to global surgery.Materials and methods
Emory University Departments of Surgery, Urology, and Anesthesia, in partnership with the non-profit organization Project Medishare, have taken annual humanitarian surgical trips to Hinche, Haiti. All medical students returning from the trips in 2011 and 2012 received a 35-question survey to assess demographic data, extent of prior ethics education, frequency of exposure and situational confidence to ethical subject matter, as well as ethical conflicts involved in surgical GHEs. The same comparative data were also collected for domestic clinical clerkships.Results
Seventeen out of 21 medical students completed the survey. Nearly all (88.3%) students had previous formal ethics training as an undergraduate or in medical school. Ethical issues were commonly encountered during domestic clinical encounters and volunteerism. However, students reported enhanced exposure to the professional obligation of surgeons (P = 0.025) and truth-telling/surgeon–patient relationships (P = 0.044) during surgical volunteerism. Despite increased exposure, situational confidence did not change.Conclusions
Ethical issues are commonly confronted during GHEs in surgery and differ from domestic clinical encounters. Healthcare ethics curriculum should be designed to meet the needs of medical students involved in global health. 相似文献13.
Rebekah A. Naylor M.D. Lisa A. Hollett R.N. M.A. R. James Valentine M.D. Ian C. Mitchell M.D. Monet W. Bowling M.D. A. Moe Ma M.D. Sean P. Dineen M.D. Brandon R. Bruns M.D. Daniel J. Scott M.D. 《American journal of surgery》2009,198(2):277-282
Background
The purpose of this study was to determine whether third-year medical students can become proficient in open technical skills through simulation laboratory training.Methods
A total of 204 students participated in a structured curriculum including bladder catheterization, breast examination, and knot-tying. Proficiency was documented using global rating scales and validated, objective, model-based metrics.Results
For catheterization and breast examination, all trainees showed proficiency, and self-rated comfort increased in more than 90%. For knot-tying, 83% completed the curriculum; 57% and 44% of trainees showed proficiency for 2- and 1-handed tasks, respectively. Objective performance scores improved significantly for 2- and 1-handed knot-tying (62.9-94.4 and 49.2-89.6, respectively; P < .001) and comfort rating also increased (28%-91% and 19%-80%, respectively; P < .001).Conclusions
Objective scores and trainee self-ratings suggest that this structured curriculum using simulator training allows junior medical students to achieve proficiency in basic surgical skills. 相似文献14.
Austin B. George Abbie Schuster Stephen D. Helmer Rachel M. Drake Beryl Silkey Therese E. Cusick Jacqueline S. Osland Alex D. Ammar 《American journal of surgery》2014,208(6):1040-1046
Background
Some medical school training consists of oral examinations.Methods
We conducted a 9-year review of third-year medical student examinations including oral examinations, National Board of Medical Examiners Surgery Subject Examination (SSE, ie, shelf), and United States Medical Licensing Examinations Step 1 and Step 2.Results
Step 1 showed a moderate to strong association with Period 1 orals (Somers' D = .297, P < .001), but not Period 2 orals (Somers' D = .048, P = .053). Period 1 orals (percentage) had a strong association with SSE (Somers' D = .356, P < .001) and Step 2 (Somers' D = .368, P < .001). Period 2 orals (pass/fail) suggested a positive, but not statistically significant, association with SSE (Somers' D = .334, P = .085) and Step 2 (Somers' D = .370, P = .055). Step 1 shows a strong association with SSE (Somers' D = .490, P < .001). SSE showed a strong association with Step 2 (Somers' D = .506, P < .001).Conclusions
Orals can be used to identify students who may have difficulty passing the SSE. Step 1 can be used to identify students at risk of poor performance on the SSE, and SSE can be used to identify students at risk for poor performance on Step 2. 相似文献15.
Hilary C. McCrary Jonida Krate Christine E. Savilo Melissa H. Tran Hang T. Ho William J. Adamas-Rappaport Rebecca K. Viscusi 《American journal of surgery》2016,212(5):1020-1025
Background
The aim of our study was to determine if a fresh cadaver model is a viable method for teaching ultrasound (US)-guided breast biopsy of palpable breast lesions.Methods
Third-year medical students were assessed both preinstruction and postinstruction on their ability to perform US-guided needle aspiration or biopsy of artificially created masses using a 10-item checklist.Results
Forty-one third-year medical students completed the cadaver laboratory as part of the surgery clerkship. Eight items on the checklist were found to be significantly different between pre-testing and post-testing. The mean preinstruction score was 2.4, whereas the mean postinstruction score was 7.10 (P < .001).Conclusions
Fresh cadaver models have been widely used in medical education. However, there are few fresh cadaver models that provide instruction on procedures done in the outpatient setting. Our model was found to be an effective method for the instruction of US-guided breast biopsy among medical students. 相似文献16.
Adam C. Frischknecht Margaret L. Boehler Cathy J. Schwind Melissa E. Brunsvold Larry D. Gruppen Michael J. Brenner Linnea S. Hauge 《American journal of surgery》2014
Background
This study evaluated a simulated pages curriculum that was developed to assess communication and clinical decision making in medical students and interns.Methods
A curriculum consisting of 14 simulated pages was administered across 5 institutions to 150 senior medical students. A 3-case subset was administered to interns who did not participate in the curriculum. Six expert surgeons identified critical fails and set passing scores for case-specific assessments using the Graphical Hofstee Method.Results
Participants in the curriculum demonstrated superior clinical decision making compared with non-participants across all cases scenarios (P < .01). Average medical student scores for clinical decision making were 46.9%. Global ratings averaged 6.0 for communication and 5.2 for patient care. Passing rates averaged 46%.Conclusions
Participation in a mock page curriculum improved performance. The performance of participants based on expert standards set for simulated page performance highlight the need for innovative approaches to improve interns' preparedness to take calls. 相似文献17.
Mark S. Hochberg Jessica BilligRussell S. Berman M.D. Adina L. KaletSondra R. Zabar M.D. Jaclyn R. FoxH. Leon Pachter M.D. 《American journal of surgery》2014
Background
When surgeons decide to become surgeons has important implications. If the decision is made prior to or early in medical school, surgical education can be more focused on surgical diseases and resident skills.Methods
To determine when surgeons – compared with their nonsurgical colleagues – decide on their medical path, residents in surgery, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, and emergency medicine were surveyed. Timing of residency choice, demographic data, personal goals, and reason for residency choice were queried.Results
A total of 234 residents responded (53 surgical residents). Sixty-two percent of surgeons reported that they were “fairly certain” of surgery before medical school, 13% decided during their preclinical years, and 25% decided during their clerkship years. This compares with an aggregate 40%, 7%, and 54%, respectively, for the other 5 residency specialties. These differences were statistically significant (P = .001). When the 234 residents were asked about their primary motivation for choosing their field, 51% pointed to expected job satisfaction and 44% to intellectual curiosity, and only 3% mentioned lifestyle, prestige, or income.Conclusions
General surgery residents decide on surgery earlier than residents in other programs. This may be advantageous, resulting in fast-tracking of these medical students in acquiring surgical knowledge, undertaking surgical research, and early identification for surgical residency programs. Surgical training in the era of the 80-hour work week could be enhanced if medical students bring much deeper knowledge of surgery to their first day of residency. 相似文献18.
Background
Midclerkship self-evaluations (MCSEs) require students to reflect on their knowledge, skills, and behaviors. We hypothesized that MCSEs would be consistent with supervisor midpoint evaluations during a surgical clerkship.Methods
MCSEs of 153 students who completed our surgery clerkship in 2 academic years were compared with supervisor midclerkship evaluations. The quantitative domains of the MCSE and supervisor evaluation were compared for accuracy. Identified areas of strengths and weakness were evaluated for thematic consistency.Results
Student MCSE scoring was accurate across evaluated domains most of the time; when students were inaccurate, they tended to underrate themselves. Students and supervisors most often identified cognitive skills as areas for improvement and noncognitive skills predominated as student strengths.Conclusions
Medical students can accurately identify their strengths and weaknesses in the context of an MCSE. Based on these findings, knowledge acquisition and application by medical students in the clinical setting should be emphasized in undergraduate medical education. 相似文献19.
Iliana Harrysson Louise HullNick Sevdalis Ph.D. Ara DarziRajesh Aggarwal M.D. Ph.D. M.A. F.R.C.S. 《American journal of surgery》2014
Background
The implementation of duty-hour restrictions and a heightened awareness of patient safety has changed resident education and training. A new focus has been placed on high-yield training programs and simulation training has naturally grown to fill this need.Methods
This article discusses the development of a training framework, knowledge, skills, and attitudes, and the design of a surgical simulation curriculum. Five residents were recruited for a pilot study of the curriculum.Results
A successful framework for curriculum development was implemented using laparoscopic cholecystectomy as the example. The curriculum consisted of classroom and virtual reality simulation training and was completed in 3.1 to 4.8 hours.Conclusions
The current curricula that have been developed for surgical education cover the breadth of a surgical residency well. This curriculum went beyond these curricula and developed a structured framework for surgical training, a method that can be applied to any procedure. 相似文献20.
Amanda KohlbrennerRachel Dirks Ph.D. James DavisMary Wolfe M.D. Christina Maser 《American journal of surgery》2016,211(6):1164-1168