What procedures are students doing during undergraduate surgical clerkship?

Many North American medical schools have removed didactic surgical teaching from the nonclinical years, and there has been a trend toward shortening surgical clerkships. Of concern is that this policy has led to a decrease in surgical exposure and a diminished interest in students pursuing a surgical career. We aimed to determine the effect of curricular change on practical experiences during surgical clerkship and to evaluate overall practical clinical exposure of students during surgical clerkship.

We collected validated experience logbooks completed before (1999-2001) and after (2001-2003) the curriculum change at the University of Alberta and converted them into electronic format. The study analyzed 10 procedures and 5 patient management situations. We assessed numbers of procedures performed and student performance on the Objective Structured Clinical Exam (OSCE) and Multiple-Choice Question (MCQ) examinations before and after the curriculum change. In addition, we completed an overall survey of all 4 classes (2000, 2001, 2002, 2003), measuring clinical exposure. We reviewed a total of 428 logbooks.

There were significant gaps in clinical exposure, which was demonstrated by more than 70% of students in each class failing to complete 8 of 15 procedures or managements at least once. No significant change in practical surgical exposure resulted from the curriculum change. The curriculum change did result in a decrease in end-of-rotation MCQ score performance, which was demonstrated by a 5% decrease in the class average after the curriculum change. Students' performance on ward evaluations and their OSCE scores were unaffected.

We were encouraged that a major change in how surgical education is delivered did not have a detrimental effect on subjective and objective evaluations of student performance. However, we are concerned that a considerable number of students appeared to have not performed several inpatient procedures. Further study is warranted to determine whether this is a common problem in other schools. There is a clear need at our school, and no doubt at others, to establish skills centres and other strategies to ensure that this component of medical education is appropriately and effectively taught.