Thomas J Wade1, Karly Lorbeer1, Michael M Awad1, Julie Woodhouse1, Angela DeClue1, L Michael Brunt2. 1. Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO. 2. Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO. Electronic address: bruntm@wustl.edu.
Abstract
INTRODUCTION: We hypothesized that a proficiency-based curriculum administered early in the fourth year to senior medical students (MS4) would achieve outcomes comparable to a similar program administered during surgical internship. METHODS: MS4 (n = 18) entering any surgical specialty enrolled in a proficiency-based skills curriculum at the beginning of the fourth year that included suturing/knot-tying, on-call problems, laparoscopic, and other skills (urinary catheter, sterile prep/drape, IV placement, informed consent, electrosurgical use). Assessment was at 4-12 weeks after training by a modified Objective Structured Assessment of Technical Skills (OSATS). Suturing and knot tying tasks were assessed by time and OSATS technical proficiency (TP) scores (1 [novice], 3 [proficient], 5 [expert]). Outcomes were compared with PGY-1 residents who received similar training at the beginning of internship and assessment 4-12 weeks later. Data are presented as mean values ± standard deviation; statistical significance was assessed by Student's t test. RESULTS: Fifteen of 18 MS4 (83%) reached proficiency on all 15 tasks, and 2 others were proficient on all but 1 laparoscopic task. Compared with PGY-1s, MS4 were significantly faster for 3 of 5 suturing and tying tasks and total task time (547 ± 63 vs 637 ± 127 s; P < .05). Mean TP scores were similar for both groups (MS4, 3.4 ± 0.5 vs PGY-1, 3.1 ± .57; P = NS). MS4 OSATS scores were higher for IV placement, informed consent, and urinary catheter placement, but lower for prep and drape and for management of on-call problems. CONCLUSION: MS4 who participate in a proficiency-based curriculum taught early in the fourth year are able to meet proficiency targets in a high percentage of cases. This approach should better prepare MS4 for surgical internship.
INTRODUCTION: We hypothesized that a proficiency-based curriculum administered early in the fourth year to senior medical students (MS4) would achieve outcomes comparable to a similar program administered during surgical internship. METHODS:MS4 (n = 18) entering any surgical specialty enrolled in a proficiency-based skills curriculum at the beginning of the fourth year that included suturing/knot-tying, on-call problems, laparoscopic, and other skills (urinary catheter, sterile prep/drape, IV placement, informed consent, electrosurgical use). Assessment was at 4-12 weeks after training by a modified Objective Structured Assessment of Technical Skills (OSATS). Suturing and knot tying tasks were assessed by time and OSATS technical proficiency (TP) scores (1 [novice], 3 [proficient], 5 [expert]). Outcomes were compared with PGY-1 residents who received similar training at the beginning of internship and assessment 4-12 weeks later. Data are presented as mean values ± standard deviation; statistical significance was assessed by Student's t test. RESULTS: Fifteen of 18 MS4 (83%) reached proficiency on all 15 tasks, and 2 others were proficient on all but 1 laparoscopic task. Compared with PGY-1s, MS4 were significantly faster for 3 of 5 suturing and tying tasks and total task time (547 ± 63 vs 637 ± 127 s; P < .05). Mean TP scores were similar for both groups (MS4, 3.4 ± 0.5 vs PGY-1, 3.1 ± .57; P = NS). MS4 OSATS scores were higher for IV placement, informed consent, and urinary catheter placement, but lower for prep and drape and for management of on-call problems. CONCLUSION:MS4 who participate in a proficiency-based curriculum taught early in the fourth year are able to meet proficiency targets in a high percentage of cases. This approach should better prepare MS4 for surgical internship.
Authors: Swapnil D Kachare; Christina Kapsalis; Angelica Yun; Milind D Kachare; Jared Davis; Dexter Weeks; Joyce Jhang; Bradon J Wilhelmi; Morton L Kasdan Journal: Ann Med Surg (Lond) Date: 2020-05-30