Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Duke University School of Medicine, Durham, North Carolina.
J Surg Res. 2020 Sep;253:214-223. doi: 10.1016/j.jss.2020.03.058. Epub 2020 May 4.
Underinsured and uninsured surgical-oncology patients are at higher risk of perioperative morbidity and mortality. Curricular innovation is needed to train medical students to work with this vulnerable population. We describe the implementation of and early educational outcomes from a student-initiated pilot program aimed at improving medical student insight into health disparities in surgery.
MATERIALS/METHODS: First-year medical students participated in a dual didactic and perioperative-liaison experience over a 10-month period. Didactic sessions included surgical-skills training and faculty-led lectures on financial toxicity and management of surgical-oncology patients. Students were partnered with uninsured and Medicaid patients receiving surgical-oncology care and worked with these patients by providing appointment reminders, clarifying perioperative instructions, and accompanying patients to surgery and clinic appointments. Students' interest in surgery and self-reported comfort in 15 Association of American Medical Colleges core competencies were assessed with preparticipation and postparticipation surveys using a 5-point Likert scale.
Twenty-four first-year students were paired with 14 surgical-oncology patients during the 2017-2018 academic year. Sixteen students (66.7%) completed both preprogram and postprogram surveys. Five students (31.3%) became "More Interested" in surgery, whereas 11 (68.8%) reported "Similar Interest or No Change." Half of the students (n = 8) felt more prepared for their surgery clerkship after participating. Median self-reported comfort improved in 7/15 competencies including Oral Communication and Ethical Responsibility. All students reported being "Somewhat" or "Extremely Satisfied" with the program.
We demonstrate that an innovative program to expose preclinical medical students to challenges faced by financially and socially vulnerable surgical-oncology patients is feasible and may increase students' clinical preparedness and interest in surgery.
保险不足和没有保险的外科肿瘤患者在围手术期发病率和死亡率方面风险更高。需要课程创新来培训医学生，使其能够与这一弱势群体合作。我们描述了一个由学生发起的试点项目的实施情况及其早期教育成果，该项目旨在提高医学生对手术中健康差异的认识。
材料/方法：一年级医学生在 10 个月的时间内参加了双重理论和围手术期联络经验。理论课程包括外科技能培训和由教员领导的关于财务毒性和外科肿瘤患者管理的讲座。学生与接受外科肿瘤治疗的无保险和医疗补助患者配对，并通过提供预约提醒、澄清围手术期说明以及陪同患者进行手术和诊所预约来为这些患者提供帮助。使用 5 分李克特量表，通过参与前和参与后调查，评估学生对手术的兴趣和自我报告的在 15 项美国医学协会核心能力方面的舒适度。
在 2017-2018 学年，24 名一年级学生与 14 名外科肿瘤患者配对。16 名学生（66.7%）完成了参与前和参与后调查。5 名学生（31.3%）“对手术更感兴趣”，而 11 名学生（68.8%）表示“兴趣相似或无变化”。一半的学生（n=8）表示参与后对手术实习更有准备。在包括口头沟通和道德责任在内的 7/15 项能力中，自我报告的舒适度中位数有所提高。所有学生都报告对该项目“有些”或“非常满意”。
我们证明，让医学生接触经济和社会上处于不利地位的外科肿瘤患者所面临的挑战的创新项目是可行的，并且可能会提高学生的临床准备程度和对手术的兴趣。
