A Mentorship-Based Preclinical
Elective Increases Exposure,
Confidence and Interest in Surgery
Patrick M. Mulvaney, BA1
Suma Sangisetty, MD1
Brian C. Drolet, MD1,2
Beth A. Ryder, MD, FACS1
William G. Cioffi, MD, FACS1
1Department
of Surgery, The Warren Alpert Medical
School of Brown University, Rhode Island Hospital
2Division of Plastic Surgery
Disclosures
• Financial support provided by the Rhode Island
Hospital Office of Graduate Medical Education for
SurveyMonkey® licensing
• Preliminary data from this study were presented as a
poster at the American College of Surgeons Clinical
Congress, October 2012
• No conflicts of interest
Outline
• Describe course rationale, programming and
structure
• Report results from student surveys
Rationale
• Health Research and Safety Agency predicts a shortage of over
20,000 general surgeons by 2020
• Exposure to surgery translates into favorable opinions of the
field (O’Herrin, 2003 and 2004; Naylor, 2010)
• Preclinical years viewed as a potential target for intervention
(Bland, 2003)
• Methods identified or utilized to improve interest:
•
•
•
•
Surgeons as anatomy lab instructors (Zaid, 2010)
Surgical skills workshops (Markovic, 2012)
Student-resident mentorship (Nguyen, 2006)
Structured course offering (Sammann, 2007)
Course Purpose and Goals
• Identify medical students interested in surgery
• Provide an opportunity for these students to explore
surgical interests through a structured course
• Maintain and enhance professional interest in
surgery through education and resident mentorship
Course Logistics
•
Started in the fall of 2012, 4th class is currently in session
•
12-week course, grading: pass/fail
•
Average enrollment: 8 students (range: 5-11)
•
Didactic
• 6 case modules led by BR, BD and SS
• 1 case presentation led by each student
•
Experiential
• 8 operative experiences
• 2 departmental conferences (Grand Rounds, M&M, etc.)
• 1 of each of the following: outpatient clinic, team rounds, skills session
(laparoscopic or suturing/knot tying)
Leadership Structure
Study Design
• IRB-approved, anonymous survey of students
• Administered to:
• Elective students before the course
• Elective students after the completion of all
requirements
• Non-elective M1 and M2 students at the Warren Alpert
Medical School of Brown University
• 29 multiple-choice questions on a five-point Likert
Scale in a self-administered electronic format
Results
• Elective (test) group: n=24 (100% response rate)
• General (control) cohort: n=147 (67% response rate)
• Overall course satisfaction: 4.8/5
• Significant difference (p<0.01) in most pre- vs. postcourse metrics aimed at assessing confidence,
exposures and perceptions of surgery
Composite Results
Post-intervention (n=24)
Pre-intervention (n=24)
Control (n=147)
4.38
Confidence in
surgical/clinical
experiences
2.83
2.68
4.39
Exposure to
surgery
2.40
2.32
4.21
Likelihood of
entering surgical
residency
3.72
2.68
4.25
4.17
Positive perception
of surgeons and
surgical career
3.47
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
(1= least through 5= most)
Exposure
How much exposure have you had with each of the following?
Pre- Intervention
1.81
Surgical rounds or call:
Post- Intervention
4.42
2.78
Operating Room
4.54
2.13
Surgical Residents
4.79
2.88
Surgical Attendings
3.88
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Student Reported Exposure: Five-point Likert response scale (1 - least to 5 - most exposure). Reported scores are the average from all
participants (N=24), the difference between pre- and post-intervention responses are statistically significant (p<0.01) for all questions.
5
Confidence
How confident are you with each of the following experiences?
Pre- Intervention
Post- Intervention
2.25
Participating while scrubbed
4.29
2.09
Independently scrubbing
4.42
2.88
Basic OR etiquette:
4.54
3.53
Observing in the OR
4.71
3.50
Approaching a surgical resident
4.46
3.13
Approaching a surgical attending
4.29
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Student Reported Confidence: Likert response scale (1 - least to 5 - most confident). Reported scores are the average from all participants
(N=24), the difference between pre- and post-intervention responses are statistically significant (p<0.01) for all questions.
5
Conclusions
• A preclinical elective centered around mentorship
can effectively improve exposure, confidence and
interest in surgical careers
• Effective course implementation requires:
•
•
•
•
Institutional support
Effective leadership
Dedicated resident-mentors
Motivated students
Future Work
• Continued improvement based on student feedback
• Evaluate course impact on:
• Clerkship performance
• Match rates
Thank you
Questions
References
•
Physician Shortage Spreads Across Specialty Lines. AAMC. (Accessed Aug. 8, 2012, at
https://www.aamc.org/newsroom/reporter/oct10/152090/physician_shortage_spreads_across_specialty_lines.html.)
•
Bland KI. The recruitment of medical students to careers in general surgery: emphasis on the first and second years of
medical education. Surgery 2003;134(3):409-13.
•
Markovic J, Peyser C, Cavoores T, Fletcher E, Peterson D, Shortell C. Impact of endovascular simulator training on vascular
surgery as a career choice in medical students. J Vasc Surg 2012;55(5):1515-21.
•
Naylor RA, Reisch JS, Valentine RJ. Do student perceptions of surgeons change during medical school? A longitudinal
analysis during a 4-year curriculum. Journal of the American College of Surgeons 2010;210(4):527-32.
•
Nguyen SQ, Divino CM. Surgical residents as medical student mentors. American journal of surgery 2007;193(1):90-3.
•
O'Herrin JK, Lewis BJ, Rikkers LF, Chen H. Why do students choose careers in surgery? The Journal of surgical research
2004;119(2):124-9.
•
O'Herrin JK, Lewis BJ, Rikkers LF, Chen H. Medical student operative experience correlates with a match to a categorical
surgical program. American journal of surgery 2003;186(2):125-8.
•
Sammann A, Tendick F, Ward D, Zaid H, O'Sullivan P, Ascher N. A surgical skills elective to expose preclinical medical
students to surgery. The Journal of surgical research 2007;142(2):287-94.
•
Zaid H, Ward D, Sammann A, Tendick F, Topp K, Maa J. Integrating Surgical Skills Into the Anatomy Laboratory. 2010;
158(1): 36-42