C. M. Freeman1, J. M. Sutton1, D. B. Pettigrew3, P. L. Jernigan1, E. F. Midura1, J. W. Kuethe1, B. R. Davis1,2, K. P. Athota1,2,3 1University Of Cincinnati,Department Of Surgery,Cincinnati, OH, USA 2University Of Cincinnati,Department Of Surgical Education,Cincinnati, OH, USA 3University Of Cincinnati,Department Of Medical Education,Cincinnati, OH, USA
Introduction: For the previous century, resulting from the Flexner Report, medical school curricula has consisted of two years of didactics followed by two years of clinical rotations. More recently, the Liaison Committee on Medical Education has mandated a more integrative approach to medical student education. While the value of incorporating clinical activities into the basic science educational years has been previously investigated, the efficacy of integrating basic science modules within the clinical rotations has not been well-studied.
Methods: We developed an intensive review course of anatomy via a laparoscopic perspective to reaffirm anatomical and spatial relationships initially taught during gross anatomy. Utilizing fresh, prosected cadavers, medical students entering the third year clerkships underwent a systematic review of anatomic landmarks of intra- and retro-peritoneal organs. Stations were designed to provide overview of the use of the laparoscope and to review abdominal, pelvic and retroperitoneal anatomy. Further discussion regarding differential diagnoses of various clinical scenarios was held to reinforce anatomic relationships of the organs within the abdomen. Medical student perceived interest, knowledge gain, comfort level with surgical instruments, pertinent anatomy and interaction with surgery attending and resident preceptors were assessed via voluntary survey at the conclusion of the session. Statistical analyses were performed using Fischer’s exact test.
Results: Thirty nine medical students participated in the surgical intersession prior to beginning core clerkships with the majority (90.6%) finding the gross anatomy sessions valuable. Twenty one students returned a detailed voluntary survey regarding their experience with the intersession. A significant improvement in the students’ understanding of anatomy relevant to gallbladder pathophysiology and laparoscopic anatomy was noted (66.7% felt uncomfortable with the topic before vs. 4.8% after the intersession, p <0.0001). Students also demonstrated a significant improvement in comfort with use of the laparoscope (4.8% before vs. 90.5% after, p <0.0001). Additionally, students demonstrated decreased sense of anxiety regarding their interaction with surgical attendings and residents after intersession (71.4% before vs. 28.6% after, p <0.01).
Conclusion: A focused intersession integrating pre-clinical knowledge of anatomy and pathophysiology prior to the medical student surgery clerkship can be used to reinforce clinically-relevant anatomic knowledge gained within the initial two years of medical school. The improved knowledge base and comfort with laparoscopic anatomy, use of the laparoscope, and improved interactions with surgery faculty and residents may translate to an enriched educational experience for medical students throughout their surgical clerkship.