Evaluating Operative Exposure for Medical Students in the Era of Virtual Learning: A Single-Institution Experience

Abstract

Introduction

Training at a tertiary center offers clerkship students the opportunity to rotate through a wide range of surgical specialties that may not be otherwise available. At our institution, students rotate through general surgery for 3 out of 9 weeks, with the remainder offering electives. As a result, students may have limited experience with core general surgery cases which are necessary to complete by the end of the clerkship to demonstrate competency. In efforts to standardize clinical training, students must log 11 core general surgery cases either in the operating room or modules via Wise-MD. Wise-MD is used in place of participating in the operating room when students do not have the opportunity to see certain cases during their surgical rotation. The purpose of the study is to ascertain what proportion of third year medical students experience core general surgery cases in the operating room versus Wise-MD, providing insight into ways to improve the surgical clerkship.

Methods

Clerkship students recorded whether surgical cases are completed via Wise-MD or experienced in the operating room. Forms submitted by students who completed surgical clerkship between January 2018 to September 2022 were analyzed. For each core surgical case (anorectal, appendicitis, bowel obstruction, breast cancer, cholecystitis, colon cancer, diverticulitis, inguinal hernia, lung cancer, skin cancer, and trauma) students were stratified based on their reported experience. The proportion of Wise-MD versus operating room cases was calculated.

Results

Between January 2018 and September 2022 a total of 411 students submitted completed case logs. Among all surgical cases, 60% were experienced by students in the operating room. The surgical cases with the highest proportion of operating room experience included appendicitis (78%), cholecystitis (85%), inguinal hernia (79%), and trauma (76%). The surgical cases with the lowest proportion of operating room experience included lung cancer (34%) and skin cancer (44%).

Conclusion

Despite enforcing a general surgery block, about 40% of students are not experiencing most “bread and butter” surgical cases. Clerkship directors should be mindful about the distribution of medical students among surgical teams as this may affect which cases are observed. Moreover, the opportunity for surgical electives may influence general surgery exposure.