Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
J Surg Educ. 2012 Jul-Aug;69(4):529-35. doi: 10.1016/j.jsurg.2012.04.010.
To prepare students pursuing surgical careers, we devised a senior subinternship curriculum supplement that focused on the acquisition of technical skills required of surgical residents. We hypothesized that more assertive students, those that accomplished more of the curriculum, would perform better on a technical skills Objective Structured Clinical Examination (OSCE).
Senior medical students rotating on their first general surgery subinternship were administered a 6-station OSCE on the first day of their subinternship and again during the final week of the month-long rotation. A self-directed, 38-task "scavenger hunt" representing common intern level clinical skills, procedures, and patient care activities was provided to each student.
The study was performed at Jefferson Medical College, a large, private medical school in Philadelphia, PA.
Forty-nine senior students completed surgical subinternships between July 2009 and September 2010, and participated both in the pre-/post-OSCEs and the scavenger hunt.
Students performed significantly better on the post-rotation OSCE than on the pre-rotation OSCE; 70.2% ± 8.1% vs. 60.4% ± 12.0%, p < 0.0001. Assertiveness scores from the "scavenger hunt" did not correlate with final OSCE scores (r = -0.328, p = 0.25), and were negatively correlated with the change between pre- and post-OSCE scores (r = -0.573, p < 0.04). Individual student assertiveness scores were determined by the number of tasks completed over the course of the rotation.
As surgical education becomes more streamlined with evolving work hour restrictions, medical school education is playing an increasingly pivotal role in preparing students for internship. In our study, individual assertiveness in completing structured self-directed learning tasks did not directly predict the acquisition of proficiency in technical skills. We feel assertiveness is overshadowed by other factors that may carry more weight in terms of technical skills acquisition. Further studies are required to delineate these factors and ultimately enhance technical skills acquisition during medical school.
为了培养从事外科职业的学生，我们设计了一个高级实习医师课程补充计划，重点是获取外科住院医师所需的技术技能。我们假设更果断的学生，即完成更多课程的学生，在技术技能客观结构化临床考试（OSCE）中表现会更好。
在第一个普通外科实习医师轮转的第一天和一个月轮转的最后一周，对接受高级实习医师轮转的医学生进行了 6 站 OSCE。每位学生都提供了一个自我指导的、代表常见实习水平的临床技能、程序和患者护理活动的 38 项任务“寻宝游戏”。
该研究在宾夕法尼亚州费城的一所大型私立医学院杰斐逊医学院进行。
49 名高年级学生在 2009 年 7 月至 2010 年 9 月期间完成了外科实习医师轮转，并参加了预/后 OSCE 和寻宝游戏。
学生在轮转后的 OSCE 中表现明显优于轮转前的 OSCE；70.2%±8.1%对 60.4%±12.0%，p<0.0001。“寻宝游戏”中的果断得分与最终 OSCE 得分无关（r=-0.328，p=0.25），与 OSCE 前后得分的变化呈负相关（r=-0.573，p<0.04）。学生的个人果断程度由轮转过程中完成的任务数量决定。
随着外科教育随着不断发展的工作时间限制变得更加精简，医学院教育在为学生准备实习方面发挥着越来越关键的作用。在我们的研究中，在完成结构化自我指导学习任务方面的个人果断性并没有直接预测技术技能的熟练程度。我们认为果断性被其他可能在技术技能获得方面更重要的因素所掩盖。需要进一步的研究来阐明这些因素，并最终在医学院期间提高技术技能的获得。
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