D. A. Machado-Aranda1, J. Cherry-Bukowiec1, K. To1, M. Englesbe2, L. M. Napolitano1, K. Raghavendran1 1University Of Michigan,Division Of Acute Care Surgery/Department Of Surgery,Ann Arbor, MI, USA 2University Of Michigan,Division Of Transplant Surgery/Department Of Surgery,Ann Arbor, MI, USA
Introduction: Declining medical student interest in surgical careers has been a worrisome trend in the last few years. A repetitive criticism in modern surgical education is the decreased value of educational experiences in the operative room. The unpredictable and intimidating atmosphere in the operating theater of Acute Care Surgery (ACS), including Trauma, Burns, Surgical Critical Care and Emergency Surgery Services, can lead to an poor perception among medical students, creating a negative experience that could divert talented students from choosing a career in ACS. However tools to evaluate teaching in the operating room remain poorly developed. We set out to interrogate this ACS operative perception in order to maximize its educational value and convert it into a positive experience.
Methods: Third-year medical students (M3) rotating through a four-week long course in ACS from the 2013-2014 academic years were the subject of this study. A tool (OR-card) was created to deconstruct the phases within the operative process (preoperative, intra-operative and postoperative debriefs) and capture potential areas of improvement.
Results: A total of 12 students were included in the initial sample. Close to 30 OR-cards were collected. All students (100%) correctly identified and named the operative procedure and its indication. However, only 66.6% could enumerate pertinent preoperative workup. Conversely, 83.3% could review principles of anatomy and physiology important for the operation, and 83.3% had a clear postoperative plan. Importantly, despite the unpredictable nature of ACS, only 16.6% of operations changed from the proposed surgery. Using an analogue scale where a “10” was exact to discussion and “1” was completely different from discussion, students' appreciation score was an 8.3 ± 2.4. Best memorable learning experiences were Anatomical Review (66.6%), Participation (50%), Individual Skill (50%) and Operative Surgical Principles (50%). Finally, the highest sources of information for students were residents (83.3%) followed by surgical attending (33.3%), whereas no traditional references were used (textbooks, peer-reviewed publications or atlases).
Conclusions: Despite the unscheduled nature of ACS operations, medical students were able to greatly follow through the different phases of the majority of emergency surgical interventions. Potential areas of improvement include understanding of pertinent preoperative workup, strengthening anatomical review, and inviting more participation within the intervention. Finally, attending surgeons should assume their critical role as teachers within the OR, as students are greatly depending on sources that are still in-training (residents).