Department of Psychology, Counseling, United Arab Emirates University, Al-Ain, United Arab Emirates.
J Surg Educ. 2012 Jul-Aug;69(4):544-9. doi: 10.1016/j.jsurg.2012.04.005.
Literature suggests declining interest in General Surgery (GS) and other surgical specialties, with fewer Canadian medical residency applicants identifying a surgical specialty as their first choice. Although perceptions of surgical careers may begin before enrollment in clerkship, clerkship itself provides the most concentrated environment for perceptions to evolve. Most students develop perceptions about specialties during their clinical clerkships. This study examines the immediate impact of GS clerkship on student attitudes toward GS as a career, and on preferences towards GS compared with other specialties.
A pre-post design involved 61 McMaster clinical clerks. Two instruments were used to collect data from students over the course of clerkship (2008-2009). Paired comparison (PC) compared ranking of career choices before and after clerkship. Semantic differential (SD) measured attitudes toward GS and variables that may have affected attitudes before and after clerkship. Analyses used SPSS 16.0 (SPSS Inc., Chicago, IL).
Clerks ranked preferences for GS changed substantially after clerkship, moving from the 10th to the 5th position compared with other specialties. Ranks of surgical subspecialties also changed, though GS demonstrated the largest improvement. SD results were consistent with PC, showing improved attitudes after rotation, with differences both statistically and practically significant (t = 3.81, p < 0.000, effect size = 0.23). Results indicated that attitudes toward all areas related to GS clerkship (attending physicians, surgical residents, ward nurses, scrub nurses, workload, knowledge achieved, technical skills acquired) improved significantly except attitude toward technical skills acquired.
Clinical clerkship at McMaster was a positive experience and significantly enhanced preferences towards GS and attitudes towards GS as a career. Medical schools should foster positive interaction between clinical clerks and staff (including attending surgeons and nurses), ensure that teaching hospital staff provide a positive experience for clerks, and should provide opportunities to learn basic technical skills during GS clerkship.
文献表明，人们对普通外科（GS）和其他外科专业的兴趣正在下降，越来越少的加拿大医学住院医师申请人将外科专业作为他们的首选。尽管对外科职业的看法可能在入学前就开始了，但实习本身提供了最集中的环境，让这些看法得以发展。大多数学生在临床实习期间对专业有了看法。本研究考察了 GS 实习对学生对 GS 作为职业的态度的直接影响，以及与其他专业相比对 GS 的偏好。
采用前后设计，共纳入 61 名麦克马斯特临床实习医师。在实习期间，使用两种工具从学生那里收集数据（2008-2009 年）。配对比较（PC）比较实习前后职业选择的排名。语义差异（SD）测量实习前后与 GS 相关的态度和可能影响态度的变量。使用 SPSS 16.0（SPSS Inc.，芝加哥，IL）进行分析。
实习后，实习医生对 GS 的偏好排名从第 10 位大幅上升至第 5 位，超过了其他专业。外科亚专业的排名也发生了变化，尽管 GS 的改善幅度最大。SD 结果与 PC 一致，显示出轮转后的态度有所改善，差异在统计学和实际意义上均具有显著性（t=3.81，p<0.000，效应量=0.23）。结果表明，除了对获得技术技能的态度外，与 GS 实习相关的所有领域的态度（主治医生、外科住院医生、病房护士、洗手护士、工作量、获得的知识、获得的技术技能）都有显著改善。
麦克马斯特的临床实习是一次积极的体验，显著增强了学生对 GS 的偏好以及对 GS 作为职业的态度。医学院应促进临床实习医生与工作人员（包括主治外科医生和护士）之间的积极互动，确保教学医院的工作人员为实习医生提供积极的体验，并应为实习医生提供在 GS 实习期间学习基本技术技能的机会。
