What procedures are students doing during undergraduate surgical clerkship?

BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSION: 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.