Role of surgical residents in undergraduate surgical education.

OBJECTIVES: To identify the role and impact of surgical residents on the various activities of a senior (4th year) surgical clerkship, and to explore students' perceptions of differences between the teaching behaviours of attending physicians and residents. DESIGN: A survey by questionnaire. SETTING: McGill University, Montreal. METHOD: A 67-item questionnaire was administered to fourth-year medical students at the end of their 8-week surgical clerkship. Analysis of the data was performed using the Wilcoxon signed-rank test, Dunn's multiple comparison test and mean average. MAIN OUTCOME MEASURES: Overall satisfaction with the clerkship, teaching behaviours and teaching of clinical skills and basic principles. RESULTS: Overall satisfaction with the clerkship was 6.31 out of 10. Surgical residents were perceived as being significantly more active than the attending staff in 14 out of 15 teaching behaviours. They were also seen as important in teaching certain clinical skills such as suturing, assisting in the operating room and managing emergency situations. They also contributed significantly to teaching the basic principles of surgery such as infections, surgical bleeding and fluid and electrolytes. On a 10-point scale, students felt that more learning was achieved by independent reading, tutorials and residents' teaching than by other teaching modalities, including attending physicians' and nurses' teaching. CONCLUSIONS: Medical students perceive surgical residents as being significantly more active in their education process than the attending staff. Residents appear to be responsible for teaching various technical and patient management skills necessary for patient care. Along with independent reading and tutorials, resident teaching contributes a significant portion of the medical student's acquisition of knowledge and appears to contribute to the students' choice of surgery as a career.     

A needs assessment of surgical residents as teachers.

OBJECTIVE: To determine the needs of surgical residents as teachers of clinical clerks. DESIGN: A needs assessment survey. SETTING: Department of Surgery, University of Toronto. PARTICIPANTS: Clinical clerks and surgical residents and staff surgeons. METHODS: Three stakeholder groups were defined: staff surgeons, surgical residents and clinical clerks. Focus-group sessions using the nominal group technique identified key issues from the perspectives of clerks and residents. Resulting information was used to develop needs assessment surveys, which were administered to 170 clinical clerks and 190 surgical residents. Faculty viewpoints were assessed with semi-structured interviews. Triangulation of these 3 data sources provided a balanced approach to identifying the needs of surgical residents as teachers. RESULTS: Response rates were 64% for clinical clerks and 66% for surgical residents. Five staff surgeons were interviewed. Consensus was noted among the stakeholder groups regarding the importance of staff surgeon role modelling and feedback, resident attitude, time management, knowledge of clerks' formal learning objectives, and appropriate times and locations for teaching. Discrepancies included a significant difference in opinion regarding the residents' capacity to address clerks' individual learning needs and to foster good team relationships. Residents indicated that they did not receive regular feedback regarding their teaching and that staff did not place an emphasis on their teaching role. CONCLUSIONS: This study has, from a multi-source perspective, assessed the needs of surgical residents as teachers. These needs include enhancing residents' education regarding how and what to teach medical students on a surgical rotation, and a need for staff surgeons to increase feedback to residents regarding their teaching.     

Urological needs assessment for primary care practice: implications for undergraduate medical education

PURPOSE: The majority of graduating medical students will become primary care physicians. We discuss what urological topics primary care physicians need to know, proficiency in urological skills of primary care physicians and undergraduate urological curriculum recommendations that would serve the needs of primary care physicians. MATERIALS AND METHODS: A written survey instrument was mailed to all 452 family practice residency directors in the United States. Subjects rated how well family practice physicians need to know urological topics and how proficient they must be in urological skills. RESULTS: A total of 329 responses were received (response rate 73%). Respondents indicated that they need to know urinary tract infection, sexually transmitted disease, epididymitis, benign prostatic hyperplasia diagnosis, hematuria and erectile dysfunction diagnosis very well. They indicated a greater need to know diagnostics than staging or management of prostate, bladder, renal or testis cancer (p <0.05). Among diagnostics respondents indicated that generalists should be highly proficient in urinalysis interpretation. Proficiency was ranked greater for interpretations of semen analysis than excretory urogram, abdominal computerized tomography or magnetic resonance imaging, or renal ultrasound (p <0.05). Proficiency in catheter insertion and circumcision was ranked highly, and vasectomy was ranked moderately. CONCLUSIONS: Primary care physicians need to know and be proficient in many urological topics and skills. They need to know diagnostics better than staging and management information, and urological infectious topics better than urological cancers. They need to be proficient in physical examination, urinalysis interpretation, catheter insertion, circumcision and vasectomy. Undergraduate medical education should reflect these needs.     

An assessment of surgical education

A review of the dramatic changes in society, science and medicine that have affected the time we have available for education of students and residents. Reference is made to distance learning, educational efficiency and mental practice as concepts that may aid educators in the quest to provide the public with well trained surgeons. Surgical educators are urged to look outside of traditional models of teaching and evaluating for tools that have been successfully used by industry or business.     

The role of the community teaching hospital in surgical undergraduate education

BACKGROUND: Significant changes in surgical practice have resulted in a reexamination of surgical undergraduate education. The increasing emphasis toward ambulatory procedures positions the community hospital as an excellent alternative site for surgical education. This study compares the quality of one medical school's surgical education at a principal teaching hospital to that of affiliated teaching hospitals. METHODS: Surgical undergraduate education offered through four programs was evaluated for 1993 to 1997. Students' performance was objectively rated by the National Board Examination in surgery, an oral examination, and a clinical appraisal. A subjective appraisal was determined via students' clerkship evaluation. RESULTS: There was a significant difference (P <0.01) in National Board Examination scores and clerkship evaluations that favored some affiliated teaching hospitals over the principal teaching hospital. CONCLUSION: The quality of surgical undergraduate education, documented by objective testing and subjective perception, indicated that the education obtained at the affiliated hospitals was at least equivalent to the principal teaching hospital.