Cloyd Jordan, Holtzman Daniel, O'Sullivan Patricia, Sammann Amanda, Tendick Frank, Ascher Nancy
School of Medicine, University of California, San Francisco, California 94122, USA.
J Surg Educ. 2008 Jul-Aug;65(4):275-82. doi: 10.1016/j.jsurg.2008.04.002.
Despite the importance of preclerkship experiences, surgical education has essentially remained confined to the third-year operating room experience. According to experience-based learning theory, the acquisition of new clinical knowledge is a dynamic process of social enculturation and professional identity development that requires active participation, clinical applicability, and direct interaction with doctors and other members of the medical team. In conjunction with a previously described surgical skills elective, we created a new clinical elective in which preclerkship medical students were assigned a surgical mentor and invited into the operating room to assist in surgeries.
The elective paired 36 first-year students with 24 surgeons and instructed students to participate in at least 2 surgeries over the 3-month elective period. Students, surgeons, and operating room nurses filled out questionnaires after each surgery.
Although 6 students failed to enter the operating room, 30 students scrubbed and gowned for a total of 62 procedures during the elective period. Although most students reported the operating room to be a comfortable learning environment in which they were actively included, students consistently underrated their performance and contribution to the surgical team compared with the surgeons' and nurses' ratings. With 75% of students who reported using a previously learned surgical skill during each surgery, this elective succeeded in allowing preclerkship medical students the opportunity to participate actively in the operating room.
Early surgical exposure is critical for attracting student interest in careers in surgery. We believe that these early clinical experiences, combined with strong mentorship from the surgical faculty, will eventually lead to greater success during clerkships and greater interest in surgery as a career.
尽管临床实习前的经历很重要，但外科教育基本上仍局限于三年级的手术室实习。根据基于经验的学习理论，获取新的临床知识是一个社会文化融入和职业身份发展的动态过程，需要积极参与、临床适用性以及与医生和医疗团队其他成员的直接互动。结合之前描述的外科技能选修课，我们创建了一门新的临床选修课，让临床实习前的医学生与一名外科导师配对，并邀请他们进入手术室协助手术。
该选修课将36名一年级学生与24名外科医生配对，并指导学生在为期3个月的选修期间至少参与2台手术。学生、外科医生和手术室护士在每次手术后填写问卷。
尽管有6名学生未能进入手术室，但在选修期间，有30名学生进行了刷手和穿手术衣准备，总共参与了62台手术。尽管大多数学生报告说手术室是一个舒适的学习环境，他们能积极参与其中，但与外科医生和护士的评价相比，学生们一直低估自己在手术团队中的表现和贡献。75%的学生报告说在每次手术中都使用了之前学到的外科技能，这门选修课成功地让临床实习前的医学生有机会在手术室中积极参与。
早期接触外科手术对于吸引学生对外科职业的兴趣至关重要。我们相信，这些早期临床经验，加上外科教员的有力指导，最终将导致在临床实习期间取得更大的成功，并对外科职业产生更大的兴趣。
