Early Hands-on Surgical Exposure: Outcomes of a Student-led Surgical Externship Program for Preclinical Students

Early surgical exposure may potentially influence medical students' decision to pursue a surgical career. At our urban, academic medical school, senior medical students developed a Surgical Externship Program (SEP) to provide first-years with hands-on OR experience. This program is a structured 1- to 2-week immersive experience in which first-year students scrubbed into operations, participated in rounds, and engaged with surgical teams under resident and attending supervision. This study evaluates the SEP's impact on surgical interest, OR confidence, and clinical exposure.

Academic tertiary care hospital.

First-year medical students.

First-year students participated in a 1- or 2-week SEP with pre- and postprogram surveys assessing surgical exposure, confidence, career perspectives, and interest. Students tracked procedures and skills via a Patient Encounter Log System (PELS). Data was analyzed via univariate analysis through a paired t-test.

A total of 28 first-year medical students participated in the SEP; 10 (36%) in the 1-week spring program and 18 (64%) in the 2-week summer program. One did not complete the postsurvey; thus, their presurvey was discarded for analysis. Most students (89%, n = 25) reported prior OR exposure, with 70.4% (n = 19) having <1 month of experience. Significant improvements were seen across all measures of operative and clinical confidence, including scrubbing in, suturing, and participating in rounds (p < 0.001). Perceptions of surgeons were high at baseline, with average Likert score above 4. Significant improvements were seen in views of surgeon work-life balance (p < 0.001) and encouragement of students to pursue a career in surgery (p = 0.011). In the postprogram survey, students reported a strong overall satisfaction (mean Likert score 4.70 ± 0.54) and likelihood of recommending the program to classmates (mean Likert score 4.74 ± 0.53). PELS data showed a documented 189 encounters by 24 students (median 6.5 encounters per student). This includes abdominal exams (n = 12), peripheral vascular exams (n = 5), staple/suture placement or removal (n = 16), nasogastric tube placement (n = 1), and Foley catheter placement (n = 2). On average, students completed 29.2% of the procedural requirements expected of third-year students during their general surgery clerkships.

Participation in the SEP was associated with significant improvements in students' confidence, operative exposure, and perceptions of surgery. Although participants entered the program with high baseline surgical interest, early immersive exposure may help reinforce career interest, foster mentorship, and support the recruitment and retention of talented students in general surgery.