Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
Surgery. 2010 Oct;148(4):768-76; discussion 776-7. doi: 10.1016/j.surg.2010.07.022. Epub 2010 Aug 12.
Dedicated skills courses may help to prepare 4th-year medical students for surgical internships. The purpose of this study was to analyze the factors that influence the preparedness of 4th-year medical students planning a surgical career, and the role that our skills course plays in that preparedness.
A comprehensive skills course for senior medical students matching in a surgical specialty was conducted each spring from 2006 through 2009. Students were surveyed for background skills, clerkship experience, and skills confidence levels (1-5 Likert scale). Assessment included 5 suturing and knot-tying tasks pre- and postcourse and a written examination. Data are presented as mean values ± standard deviations; statistical analyses were by 2-tailed t test, linear regression, and analysis of variance.
Sixty-five 4th-year students were enrolled; most common specialties were general surgery (n = 22) and orthopedics (n = 16). Thirty-five students were elite musicians (n = 16) or athletes (n = 19) and 8 regular videogamers. Suturing task times improved significantly from pre- to postcourse for all 5 tasks (total task times pre, 805 ± 202 versus post, 627 ± 168 seconds [P < .0001]) as did confidence levels for 8 skills categories, including management of on-call problems (P < .05). Written final examination proficiency (score ≥70%) was achieved by 81% of students. Total night call experience 3rd year was 23.3 ± 10.7 nights (7.3 ± 4.3 surgical call) and 4th year 10.5 ± 7.4 nights (7.2 ± 6.8 surgical call). Precourse background variables significantly associated with outcome measures were athletics with precourse suturing and 1-handed knot tying (P < .05); general surgery specialty and instrument tying (P = .012); suturing confidence levels and precourse suturing and total task times (P = .024); and number of nonsurgical call nights with confidence in managing acute on-call problems (P = .028). No significant correlation was found between these variables and postcourse performance.
Completion of an accelerated skills course results in comparable levels of student performance postcourse across a variety of preclinical backgrounds and clerkship experiences.
专门的技能课程可能有助于为四年级医学生准备外科实习。本研究的目的是分析影响计划从事外科职业的四年级医学生准备情况的因素，以及我们的技能课程在其中的作用。
从 2006 年到 2009 年，每个春季都为匹配外科专业的高年级医学生开设了一门综合技能课程。学生们接受了背景技能、实习经验和技能信心水平（1-5 级李克特量表）的调查。评估包括课前和课后的 5 项缝合和打结任务以及书面考试。数据以平均值±标准偏差表示；统计分析采用双尾 t 检验、线性回归和方差分析。
共有 65 名四年级学生入学；最常见的专业是普通外科（n=22）和骨科（n=16）。35 名学生是优秀的音乐家（n=16）或运动员（n=19），8 名是普通电子游戏玩家。所有 5 项任务的缝合任务时间都从课前到课后显著改善（总任务时间课前 805±202 秒，课后 627±168 秒[P<0.0001]），包括处理值班问题在内的 8 项技能类别的信心水平也有所提高（P<0.05）。81%的学生在书面期末考试中达到了及格分数（≥70%）。三年级的总夜间值班经验为 23.3±10.7 个晚上（7.3±4.3 个手术值班），四年级为 10.5±7.4 个晚上（7.2±6.8 个手术值班）。课前背景变量与结果测量显著相关的是运动与课前缝合和单手打结（P<0.05）；外科专业和器械打结（P=0.012）；缝合信心水平与课前缝合和总任务时间（P=0.024）；非手术值班夜间次数与处理急性值班问题的信心（P=0.028）。在这些变量和课后表现之间没有发现显著的相关性。
完成加速技能课程可使具有各种临床前背景和实习经验的学生在课后达到相当水平的表现。
