General surgery versus specialty rotations: a new paradigm in surgery clerkships

Abstract

Background: The most common 3rd-year surgery clerkship uses general surgery services while limiting the involvement of subspecialty services. A novel surgery clerkship in which students were assigned to either general surgery or subspecialty services for the entire clerkship was tried at a large Midwestern medical school. The purpose of this study was to investigate the outcomes of clerks from subspecialty services and compare them with clerks from general surgery services.

Methods: Outcome measures included scores on the National Board of Medical Examiners Surgery Content Examination, faculty evaluation scores, and residency match results. A multivariate analysis of covariance compared National Board of Medical Examiners test scores and faculty evaluation ratings across service groups. United States Medical Licensing Examination Step 1 scores served as a covariate.

Results: Results showed significant differences between groups on faculty evaluation scores (F = 28.03; P <or= 0.001), while controlling for initial differences in academic performance. However, no differences were observed on examination score (F = 2.32, ns), or residency match results (chi(2) = 2.05, ns).

Conclusion: These findings inform surgical educators to consider a more prominent role of subspecialty surgery in teaching 3rd-year medical students. However, caution is advised to accommodate the difference in stringency observed between subspecialty and general surgery faculty in rating medical student performance. Faculty development in student evaluation for subspecialty surgical faculty is recommended.