Sweeney Brendan, Sadhwani Shaan, Marcinko Michael, Edwards Timothy, Brown Michael, Maurer Timothy, Ackerman Timothy
Department of Orthopaedic Surgery, UPMC Central PA, Harrisburg, Pennsylvania.
JB JS Open Access. 2025 Apr 14;10(2). doi: 10.2106/JBJS.OA.24.00163. eCollection 2025 Apr-Jun.
With the advent of virtual clerkships, the ability of medical students to be involved in direct patient care continues to be scrutinized. One such area that has come under scrutiny is the role medical students should play in the operating room. The major critiques brought up by OR staff and surgeons are potential increases in contamination rates and operative times. In this study, we hope to reveal that medical students do not significantly increase postoperative infections or operative times for total knee arthroplasty (TKA).
TKA cases were collected from 3 separate surgeons between 2021 and 2022. Operative times for TKA were compared when medical students were present and when students were not. The same was then done to compare the 2 groups for 30-day and 90-day emergency department (ED) visits and readmissions as well as 1-year deep/superficial infection rates.
Five hundred eighty-five cases met inclusion criteria. When averaging the operative times of the 3 surgeons with and without medical students, we found that medical student-assisted cases took 84.6 minutes and without students took 80.1 minutes (p value = 0.0056). Complication rates were higher in the student group (3.73% vs 11.67%, p-value = 0.004). When comparing infection rates, we found that there was a slight reduction in infection rate, 0.37% vs 0.63% with students present (student vs no student; p-value = 1.00).
This study appears to reassure hospital systems and operating room staff that medical students do not significantly alter infection rates in TKA. In addition, while they do extend operative times, on average, it was less than 5 minutes per case, which seems to be a reasonable amount of time to sacrifice in light of no increase to aggregate complications within 1 year.
随着虚拟临床实习的出现，医学生参与直接患者护理的能力仍在受到审视。手术室就是其中一个受到审视的领域。手术室工作人员和外科医生提出的主要批评是污染率和手术时间可能增加。在本研究中，我们希望揭示医学生不会显著增加全膝关节置换术（TKA）的术后感染率或手术时间。
收集了2021年至2022年间3位不同外科医生的TKA病例。比较了有医学生在场和无医学生在场时TKA的手术时间。然后对两组进行同样的比较，以对比30天和90天的急诊科就诊和再入院情况以及1年深部/浅表感染率。
585例病例符合纳入标准。在对3位外科医生有医学生和无医学生参与手术的平均手术时间进行比较时，我们发现有医学生协助的病例手术时间为84.6分钟，无医学生参与的为80.1分钟（p值 = 0.0056）。学生组的并发症发生率更高（3.73% 对11.67%，p值 = 0.004）。在比较感染率时，我们发现感染率略有降低，有医学生在场时为0.37%，无医学生在场时为0.63%（有医学生与无医学生；p值 = 1.00）。
本研究似乎让医院系统和手术室工作人员放心，医学生不会显著改变TKA的感染率。此外，虽然他们确实延长了手术时间，但平均每例不到5分钟，鉴于1年内总体并发症没有增加，这似乎是一个合理的牺牲时间量。
