A needs assessment study of undergraduate surgical education

Abstract

Background: There is compelling evidence to suggest that undergraduate surgical education may fail to provide appropriate instruction in basic surgical principles and skills.

Methods: We completed a descriptive, cross-sectional survey of stakeholder groups (surgeon educators and recent medical school graduates) to assess the perceived relevance and learning for surgical principles, surgical skills, teaching environments and teaching interventions.

Results: Graduates returned 123 surveys, and surgeons returned 55 surveys (response rates: graduates 46%, surgeons 45%). Both graduates and surgeons considered 8 of 10 surgical principles highly relevant to current medical practice. Despite this, the surgical clerkship seemed to enable proficiency in far fewer principles (graduates: 3, surgeons: 5). Graduates believed that each of the 15 basic surgical skills is relevant to current medical practice, whereas surgeons indicated that more invasive skills (i.e., central venous lines, thoracentesis) are much less relevant. Graduates and surgeons indicated that medical students will achieve proficiency in only 3 basic skills areas as a result of the surgical clerkship. Graduates and surgeons considered each surgical specialty relevant and effective in undergraduate surgical education. According to graduates and surgeons, the most effective teaching environments are outpatient settings (emergency department, outpatient clinics). Graduates and surgeons ranked resident teaching as the most effective teaching intervention, and traditional interventions (grand rounds, formal rounds) and electronic resources (computer-assisted learning, web-based learning) were ranked the least effective.

Conclusions: In this study, we assessed the learning needs of contemporary medical students in surgery. The results suggest that respondent graduate students and surgeons believe that the level of proficiency achieved in surgical principles and basic skills through undergraduate surgical educations is much less than anticipated. Outpatient settings and resident teaching are believed to provide the most effective teaching for medical students. Information from this study has important implications for Canadian undergraduate surgery programs and curricula.

FIG. 1. Perceived learning and relevance of surgical principles according to graduates (n = 120) (A) and surgeon educators (n = 47) (B). Likert scale anchors for learning: 1: learned poorly, 3: became proficient, 5: excelled. Likert scale anchors for relevance: 1: irrelevant, 3: relevant, 5: extremely relevant.

FIG. 2. Perceived learning and relevance of basic surgical skills according to graduates (n = 120) (A) and surgeon educators (n = 36) (B). Likert scale anchors for learning: 1: learned poorly, 3: became proficient, 5: excelled. Likert scale anchors for relevance: 1: irrelevant, 3: relevant, 5: extremely relevant. ABG = arterial blood gas; CVL = central venous line; I/D = incision and drainage; IV = intravenous; NG = nasogastric.

FIG.3. Educational impact and relevance of surgical specialties according to graduates (n = 120) (A) and surgeon educators (n = 30) (B). Likert scale anchors for impact: 1: does not help, 3: usually helps, 5: extremely effective. Likert scale anchors for relevance: 1: never, 3: occasionally, 5: always. ENT = ear, nose, throat; Ortho = orthopedics; Neuro = neurosurgery; Peds = pediatrics.

FIG. 4. Effectiveness and relevance of teaching environments according to graduates (n = 120) (A) and surgeon educators (n = 44) (B). Likert scale anchors for effectiveness: 1: did not learn, 3: usually effective, 5: extremely effective. Likert scale anchors for relevance: 1: never, 3: occasionally, 5: always. ER = emergency room; OR = operating room.

FIG. 5. Effectiveness and relevance of teaching interventions according to graduates (n = 120) (A) and surgeon educators (n = 42) (B). Likert scale anchors for effectiveness: 1: did not learn, 3: usually effective, 5: extremely effective. Likert scale anchors for relevance: 1: never, 3: occasionally, 5: always.