Developing purposeful observation during early clinical exposure in anesthesiology: a cluster-randomized study

Early clinical exposure allows undergraduate medical students to encounter authentic clinical practice, but novice learners may not know what to observe or how to interpret complex clinical events. This challenge is particularly relevant in anesthesiology, where many professional activities are embedded in perioperative workflow and are not immediately visible to beginners. This study examined whether a structured perioperative observation model was associated with improved learning objective clarity and self-reported purposeful observation during early anesthesiology clinical exposure.

This prospective cluster-randomized educational study included 154 s-year undergraduate medical students from 12 clerkship groups. Six groups were assigned to a conventional lecture-observation-question-and-answer clerkship, and six groups were assigned to a structured perioperative observation model organized according to the Bridge-in, Objectives, Pre-assessment, Participatory learning, Post-assessment, and Summary (BOPPPS) framework. The primary outcome was the post-clerkship score for learning objective clarity and self-reported purposeful observation ability. Secondary outcomes included anesthesia-related awareness, knowledge test scores, post-clerkship learning experience, and open-ended feedback. A linear mixed-effects model was used to account for clerkship group clustering.

Seventy-six students were assigned to the conventional group and 78 to the structured observation group. Academic track distribution differed between groups, while other baseline characteristics were comparable. The structured observation group had a higher primary outcome score than the conventional group (22.55 ± 1.17 vs. 16.74 ± 1.36, P < 0.001). The association remained significant after adjustment for age, sex, academic track, prior operating room exposure, and baseline interest in anesthesiology. The structured group also showed greater gains in anesthesia-related awareness and knowledge and higher post-clerkship learning experience scores. Findings were consistent across academic track and prior operating room exposure strata.

Structured perioperative observation was associated with higher learning objective clarity and self-reported purposeful observation during early anesthesiology clinical exposure. By guiding students to observe perioperative workflow, anesthesiologists' responsibilities, patient safety, and team collaboration, this model may help novice medical students transform passive clinical exposure into more goal-directed learning.