Cutting Through Expectations: Single Institutional Insights from Students, Residents, and Faculty on the Third-Year Surgical Clerkship
Poster #: 012
Session/Time: A
Author:
Ryan Mancoll, BS
Mentor:
Alexa Shaw, MD
Research Type: Educational
Abstract
INTRODUCTION:
With the changing culture within surgical education, specifically within the clerkship phase secondary to implications of Step 1 being pass/fail and shifting pressure on shelf exams and clerkship grades, there seems to be fundamental differences between students' expectations compared to residents and faculty. Surgical clerkships are known to have a demanding workload. This can place stress on students, limit study time compared to other rotations, and ultimately lead to discrepancies between expectations and the realities of the clinical environment. The purpose of this study is to perform a multilevel assessment of the learning environment and expectations during the third-year surgery clerkship.
METHODS:
Recruitment was done at institutional meetings for students, residents, and faculty using a QR code. All surveying was done using RedCap. Participants were assigned into a group: medical students, residents, or attendings and received the corresponding survey. Quantitative data analysis was done using JMP 18, and thematic analysis of qualitative data was done in a staged reflective fashion in NVivo 12. Two investigators completed the analysis after the initial codes were made.
RESULTS:
100 participants completed the survey, comprised of 67 medical students, 23 residents, and 12 attending surgeons. Quantitative analysis revealed descriptive and inferential trends in the questions proposed to participants. In terms of work hours and call expectations, a significant difference existed in the expectations of duty hours during clerkship (p = .0335), with attendings expecting more than residents and residents expecting more than students. The number of call shifts followed the same trend, with attendings having a mean (STD) of 4.25(1.49) and students reporting a mean (STD) of 2.63(1.3), with residents in the middle (p = .0003). This trend was reversed when asked about hours spent studying while not on duty, with students expecting the most (p = .0142). When asked how faculty view teaching students, most students saw themselves as inconveniences and faculty would rather have them on the team. Faculty inversely mirrored this, and residents fell in the middle. (p < .0001), (p < .0001). Qualitatively, reflective thematic analysis revealed many themes with homogeneity, but also descriptive differences. When asked, what are the responsibilities of medical students on the floor, or what contributes to actual education, residents thought floor procedures should involve students, but students and attendings barely contributed. All groups felt that rounding and post-op care would contribute to education.
DISCUSSION:
Our results describe not only the expectations that these groups have in terms of surgical clerkship but also show key positional discrepancies are being seen in surgical education. This study allows clerkship directors to set expectations upfront to each group and hopefully align the clerkship for a better experience.
With the changing culture within surgical education, specifically within the clerkship phase secondary to implications of Step 1 being pass/fail and shifting pressure on shelf exams and clerkship grades, there seems to be fundamental differences between students' expectations compared to residents and faculty. Surgical clerkships are known to have a demanding workload. This can place stress on students, limit study time compared to other rotations, and ultimately lead to discrepancies between expectations and the realities of the clinical environment. The purpose of this study is to perform a multilevel assessment of the learning environment and expectations during the third-year surgery clerkship.
METHODS:
Recruitment was done at institutional meetings for students, residents, and faculty using a QR code. All surveying was done using RedCap. Participants were assigned into a group: medical students, residents, or attendings and received the corresponding survey. Quantitative data analysis was done using JMP 18, and thematic analysis of qualitative data was done in a staged reflective fashion in NVivo 12. Two investigators completed the analysis after the initial codes were made.
RESULTS:
100 participants completed the survey, comprised of 67 medical students, 23 residents, and 12 attending surgeons. Quantitative analysis revealed descriptive and inferential trends in the questions proposed to participants. In terms of work hours and call expectations, a significant difference existed in the expectations of duty hours during clerkship (p = .0335), with attendings expecting more than residents and residents expecting more than students. The number of call shifts followed the same trend, with attendings having a mean (STD) of 4.25(1.49) and students reporting a mean (STD) of 2.63(1.3), with residents in the middle (p = .0003). This trend was reversed when asked about hours spent studying while not on duty, with students expecting the most (p = .0142). When asked how faculty view teaching students, most students saw themselves as inconveniences and faculty would rather have them on the team. Faculty inversely mirrored this, and residents fell in the middle. (p < .0001), (p < .0001). Qualitatively, reflective thematic analysis revealed many themes with homogeneity, but also descriptive differences. When asked, what are the responsibilities of medical students on the floor, or what contributes to actual education, residents thought floor procedures should involve students, but students and attendings barely contributed. All groups felt that rounding and post-op care would contribute to education.
DISCUSSION:
Our results describe not only the expectations that these groups have in terms of surgical clerkship but also show key positional discrepancies are being seen in surgical education. This study allows clerkship directors to set expectations upfront to each group and hopefully align the clerkship for a better experience.