Shipper Edward S, Miller Sarah E, Hasty Brittany N, Merrell Sylvia Bereknyei, Lin Dana T, Lau James N
Department of Surgery, Stanford University, Stanford Medical Center, Stanford, California.
Department of Surgery, Stanford University, Stanford Medical Center, Stanford, California.
J Surg Res. 2017 Nov;219:92-97. doi: 10.1016/j.jss.2017.05.105. Epub 2017 Jun 23.
Prior interventions to address declining interest in surgical careers have focused on creating early exposure and fostering mentorship at the preclinical medical student level. Navigating the surgical environment can be challenging, however, and preclinical students may be more likely to pursue a surgical career if they are given the tools to function optimally.
We designed a 10-wk technical and nontechnical skills curriculum to provide preclinical students with knowledge and skills necessary to successfully navigate the surgical learning environment, followed by placement in high-fidelity surgical simulations and scrubbing in on operative cases with attending surgeons. We administered pre-post surveys to assess student confidence levels in operative skills, self-perceptions of having a mentor, overall course efficacy, and interest in a career in surgery.
The overall response rates presurvey and postsurvey were 100% (30 of 30) and 93.3% (28 of 30), respectively. Confidence levels across all operative skills increased significantly after completing the course. Faculty mentorship increased significantly from 30.0% before to 61.5% after the course. Overall effectiveness of the course was 4.00 of 5 (4 = "very effective"), and although insignificant, overall interest in a career in surgery increased at the completion of the course from 3.77 (standard deviation = 1.01) to 4.17 (standard deviation = 0.94).
Our curriculum was effective in teaching the skills necessary to enjoy positive experiences in planned early exposure and mentorship activities. Further study is warranted to determine if this intervention leads to an increase in students who formally commit to a career in surgery.
以往为解决对外科职业兴趣下降问题所采取的干预措施，主要集中在临床前医学生阶段创造早期接触机会并促进指导关系。然而，融入外科环境可能具有挑战性，如果给临床前学生提供能使其最佳发挥作用的工具，他们可能更倾向于从事外科职业。
我们设计了一个为期10周的技术和非技术技能课程，为临床前学生提供成功融入外科学习环境所需的知识和技能，随后安排他们参与高保真外科模拟，并与主刀外科医生一起参与手术病例的刷手工作。我们进行了课前和课后调查，以评估学生在手术技能方面的信心水平、对拥有导师的自我认知、课程的整体效果以及对外科职业的兴趣。
课前和课后的总体回应率分别为100%（30人中的30人）和93.3%（30人中的28人）。完成课程后，所有手术技能的信心水平均显著提高。教师指导从课程前的30.0%显著增加到课程后的61.5%。课程的整体有效性为5分中的4.00分（4 =“非常有效”），虽然不显著，但对外科职业的整体兴趣在课程结束时从3.77（标准差 = 1.01）提高到了4.17（标准差 = 0.94）。
我们的课程有效地教授了在有计划的早期接触和指导活动中获得积极体验所需的技能。有必要进一步研究以确定这种干预措施是否会导致正式致力于从事外科职业的学生人数增加。
