Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA.
Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA.
J Am Coll Surg. 2020 Jun;230(6):957-964. doi: 10.1016/j.jamcollsurg.2020.03.033. Epub 2020 Apr 18.
Medical students increasingly report not feeling meaningfully involved during surgical clerkships. Preceptorship and mentorship through longitudinal experiences ameliorate this problem. A preceptorship model was introduced into the surgery clerkship at our institution to increase contact and improve relationships between students and faculty.
The preceptorship model was introduced at select sites in 2017. In contrast to the standard structure in which students are assigned to cases and clinics as needed, preceptorship students are assigned to attending surgeons and follow the surgeons' schedules for the rotation. Student performance data, including final grades, clinical evaluations, and shelf examination scores, were collected for clerkship students from May 2017 to November 2018. Formative and summative evaluations for each student were collected. Qualitative content analysis was used to explore evaluations for themes.
Two hundred and seventy-four students completed the clerkship during the study period; 41 experienced a preceptorship model. There was no difference in student performance across clerkship structures. Summative and formative evaluations for preceptorship students were longer than for traditional students (137 words vs 78 words; p < 0.0001 and 46 words vs 16 words, p = 0.03 respectively). Preceptorship student evaluations contained higher-quality feedback relating to clerkship objectives than those of traditional students. Preceptorship comments also contained more frequent mentions of response to feedback.
A preceptorship model was successfully implemented on the third-year surgical clerkship at our institution. Although there was no difference between top performers on either clerkship structure, preceptorship students received written evaluations with better feedback as a result of their direct relationship with faculty. Strategies such as this, which improve student-faculty relationships, will be needed as programs find new ways to assess residency applicants.
越来越多的医学生报告说，在外科实习期间没有感受到有意义的参与。通过长期的实习和指导可以改善这个问题。我们学院的外科实习引入了导师制模式，以增加学生和教师之间的接触并改善他们之间的关系。
导师制模式于 2017 年在部分基地引入。与学生根据需要分配病例和临床科室的标准结构不同，导师制学生被分配给主治医生，并按照主治医生的轮转时间表进行轮转。从 2017 年 5 月到 2018 年 11 月，我们为实习学生收集了包括最终成绩、临床评估和笔试成绩在内的实习学生表现数据。为每位学生收集了形成性和总结性评估。采用定性内容分析方法探索评估主题。
在研究期间，有 274 名学生完成了实习，其中 41 名学生经历了导师制模式。两种实习结构的学生表现没有差异。导师制学生的总结性和形成性评估比传统学生更长（137 字与 78 字；p < 0.0001 和 46 字与 16 字；p = 0.03）。导师制学生的评估比传统学生的评估更能提供与实习目标相关的高质量反馈。导师制的评价也更频繁地提到对反馈的回应。
我们成功地在我们学院的三年级外科实习中实施了导师制模式。尽管两种实习结构的优秀学生之间没有差异，但由于与教师的直接关系，导师制学生获得了更好的反馈。随着项目寻找评估住院医师申请人的新方法，像这样可以改善学生与教师关系的策略将是必要的。
