Test-Only Learning via Virtual Patients to Improve Surgical Illness Scripts of Preclinical Medical Students as a Preparation for Clinical Clerkships: An Experimental Study.

OBJECTIVE: The aim was to determine whether preclinical medical students can develop their illness scripts to a level comparable to that of clerkship students through test-only learning using repeated formative online testlets. METHODS: In this experimental study, participants were 52 preclinical and 53 clinical medical students. The intervention group consisted of preclinical medical students, and the control group consisted of clinical medical students. The intervention group responded to online testlets containing feedback, an innovative formative assessment method called ContExtended Questions, on general surgery for 8 days by spending no more than 30 minutes each day. The control group completed the general surgery clerkship. The performances were assessed using 20 Key-Feature Question items. The intervention group was assessed twice: immediately after the intervention (the immediate test), and again 1 month later (the delayed test). The control group was assessed once, immediately after the clerkship. All performance tests were identical. RESULTS: The preclinical students had a significantly higher mean score on the immediate test (83.1 ± 9.6) compared to the clinical students (75.4 ± 8.9), P < .001. The effect size (Cohen's d) was .83. However, the mean score in the delayed test (76.9 ± 13.6) was not significantly different from clinical students' mean score (75.4 ± 8.9), P > .05. CONCLUSIONS: Test-only learning as a spaced repetition of online formative testlets is effective in preparing preclinical medical students to the clinical clerkship. Through using this approach in preclinical period, they can prepare themselves for the clinical environment to optimize the benefits derived from clerkships.

Evaluating The Role of ChatGPT as a Study Aid in Medical Education in Surgery.

OBJECTIVE: Our aim was to assess how ChatGPT compares to Google search in assisting medical students during their surgery clerkships. DESIGN: We conducted a crossover study where participants were asked to complete 2 standardized assessments on different general surgery topics before and after they used either Google search or ChatGPT. SETTING: The study was conducted at the Perelman School of Medicine at the University of Pennsylvania (PSOM) in Philadelphia, Pennsylvania. PARTICIPANTS: 19 third-year medical students participated in our study. RESULTS: The baseline (preintervention) performance of participants on both quizzes did not differ between the Google search and ChatGPT groups (p = 0.728). Students overall performed better postintervention and the difference in test scores was statistically significant for both the Google group (p < 0.001) and the ChatGPT group (p = 0.01). The mean percent increase in test scores pre- and postintervention was higher in the Google group at 11% vs. 10% in the ChatGPT group, but this difference was not statistically significant (p = 0.87). Similarly, there was no statistically significant difference in postintervention scores on both assessments between the 2 groups (p = 0.508). Postassessment surveys revealed that all students (100%) have known about ChatGPT before, and 47% have previously used it for various purposes. On a scale of 1 to 10 with 1 being the lowest and 10 being the highest, the feasibility of ChatGPT and its usefulness in finding answers were rated as 8.4 and 6.6 on average, respectively. When asked to rate the likelihood of using ChatGPT in their surgery rotation, the answers ranged between 1 and 3 ("Unlikely" 47%), 4 to 6 ("intermediate" 26%), and 7 to 10 ("likely" 26%). CONCLUSION: Our results show that even though ChatGPT was comparable to Google search in finding answers pertaining to surgery questions, many students were reluctant to use ChatGPT for learning purposes during their surgery clerkship.

Medical student perceptions of assessments of clinical reasoning in a general surgery clerkship.

BACKGROUND: Components factoring into general surgery clerkship grades vary by institution, and while evaluators attempt to remain unbiased when evaluating medical student performance, subjectivity and implicit bias remain an issue. Our institution recently implemented a case-based structured oral examination to provide the general surgery clerkship director objective insight into students' clinical reasoning skills. We hypothesized that medical students believe this exam, along with graded clinical documentation and the Observed Standardized Clinical Encounter (OSCE), are fair assessments and increase students' awareness of their clinical reasoning skills. METHODS: A survey was sent to third-year medical students in the classes of 2023 and 2024 at our institution who had completed their general surgery clerkship. Students rated five grading assessments (i.e., preceptor evaluations, the oral examination, clinical documentation, the OSCE, and the shelf exam) on fairness and the ability of the assessment to give them insight into their clinical reasoning on a five-point Likert scale 1-5 (with 1 = Strongly Agree, 5 = Strongly Disagree). RESULTS: One hundred and ten of 162 (67.9%) students responded to the survey. The shelf examination was the most highly regarded assessment tool followed by the oral examination. Seventy-three percent agreed or strongly agreed that the oral exam was a fair assessment, and 80% agreed or strongly agreed that it gave them insight into their clinical reasoning skills. Alternatively, only 41.8% of students agreed or strongly agreed that preceptor evaluations were fair assessments and 42.7% agreed or strongly agreed that it gave them insight into their clinical reasoning. CONCLUSIONS: Third-year medical students on a general surgery clerkship favor the shelf examination and a case-based oral examination over other assessment tools regarding fairness and perception of their clinical reasoning. This type of examination can provide general surgery clerkship directors with additional objective data to assess medical students more fairly and improve students' clinical reasoning.

Evaluating Medical Students' Perceptions of Patient-Led Transplant Surgery Education 1-2 Years Later.

INTRODUCTION: Medical students value the opportunity to learn from patients as a supplement to traditional faculty-led education; however, long-term follow-up to understand the educational impact of these experiences is lacking. We surveyed medical students who conducted non-medical virtual encounters with transplant recipients or living donors to understand the impact on students' patient care approach after 1-2 y. METHODS: Students who completed their surgery clerkship from July 2020 to September 2021 were surveyed about this nonmedical patient encounter in January 2023. Quantitative and qualitative survey data were analyzed using descriptive statistics and inductive thematic analysis, respectively. RESULTS: Of the 27 respondents (46% response rate), 44.4% completed the experience 1 y ago and 55.6% completed the experience 2 y ago. Nearly all respondents (96.3%) agreed that this experience was an effective way to learn about organ donation and transplantation and that learning from patients was beneficial to their development as a doctor. Over 50% felt this experience changed how they provide care to patients. Qualitatively, students reported that this activity cultivated their empathy for patients, provided unique insight into patients' illness experiences, and enhanced their understanding of the longitudinal patient-surgeon relationship. CONCLUSIONS: Utilizing patients as teachers in transplant surgery not only taught medical students more about organ donation and transplantation but also built empathy and highlighted unique, non-clinical aspects of the patient experience that persisted over time. This is one of the first studies to evaluate patient-led teaching of this type over a year later and assess its unique influence on medical student development.

Longitudinal Integrated Clerkships and Undergraduate Surgical Education: A Scoping Review and Gap Analysis.

OBJECTIVE: Longitudinal integrated clerkships (LICs) are an increasingly popular approach to medical student clinical education, and the literature describing them is expanding. Despite this, there is a lack of understanding for how surgery didactics and skills are currently taught as a part of the LIC curriculum. DESIGN: We conducted a scoping literature review in July 2022 using terms related to LIC and surgical education. Abstract and full-length text screening followed. Data extraction was completed in August 2022. Articles published in English, focused on LIC students, and discussed any element of LIC curriculum surgical education was included. SETTING: Scoping literature review. PARTICIPANTS: A total of 282 studies describing LICs were identified from the scoping literature review. After applying inclusion and exclusion criteria, 37 (13%) studies describing some element of surgical education were included. RESULTS: Of these 37 studies, the majority did not delve into pertinent details related to students' surgery experience, expectations, and surgical skills accomplishments. Four studies (11%) reported on the outpatient surgical experience, such as minimum required time that students were expected to be in the clinic, and 8 studies (22%) described the inpatient and operating room exposure. Only 1 study (3%) described the surgical floor management of surgical patients, including tasks like documentation and wound care, and 3 studies (8%) reported formal assessment of surgical skills, such as suturing technique. CONCLUSIONS: Our study highlights the paucity LIC literature examining the relationship between this curricular innovation and the unique needs of medical students on a surgical clerkship. Surgeon educators should embrace the opportunity to contribute LIC curriculum development and subsequent investigation into how this modality interfaces with the learning objectives of undergraduate surgical education. A formal description of essential curriculum components for all surgical LIC programs is needed to ensure appropriate surgical education across the varied LIC models.

Medical Student Perceptions of Academic Surgery: Rose-Colored Glasses or Jaded Prism?

OBJECTIVE: Stereotypes of surgeons are pervasive and play a role in medical students' decisions about pursuing a surgical career. This study aimed to determine: (1) how medical students' perceptions of surgery and surgeons changed following exposure to surgery during clerkship rotations; and (2) if gender and racial/ethnic identification played a role in this process. DESIGN, SETTING, AND PARTICIPANTS: In this mixed-method study, clerkship students at one U.S. medical school were asked to anonymously contribute words and phrases that they associated with surgery to an online "word cloud" at the beginning and end of their 12-week surgery clerkship. In addition, an end-of-year, anonymous survey of their perceptions was administered and analyzed using a Grounded Theory approach. RESULTS: Of 154 students invited to complete the online survey, analysis of 24 completed surveys suggested that students believe surgical culture to be toxic, with unfriendly attitudes, strict hierarchy, and lack of work-life balance. Analysis of 678 Word Cloud responses, however, indicated that the frequency of complimentary responses increased following surgery clerkships (25% vs 36%; z = -3.26; p = 0.001), while the proportion of responses describing surgery/surgeons as male-dominated, egotistical, and scary decreased (5% vs 1%, z = 2.86, p = 0.004; 9% vs 4%, z = 2.78, p = 0.005; 3% vs 0.3%, z = 2.56, p = 0.011, respectively). The association between surgeons and being White disappeared entirely. Female students were more likely than male students to state that their perceptions did not change following exposure (40% vs 0%; z = 2.19; p = 0.029). CONCLUSIONS: With exposure to surgery, students' preconceived notions may be positively influenced. However, students continue to hold negative perceptions, and this effect may be stratified by gender identification. Institutions should work to address these perceptions in pre-clerkship years to attract a more diverse pool of future surgeons.

Neurosurgery Clerkships in United States Medical Schools: A Survey of Doctor of Medicine-Granting and Doctor of Osteopathic Medicine-Granting Schools.

OBJECTIVE: Exposure to neurosurgery is important for knowledge of neurosurgical conditions that physicians may encounter. The current status of neurosurgery nonsubinternship clerkships in the United States is unknown; this study determined the availability and format of non-subinternship neurosurgery clerkships in DO (Doctor of Osteopathic Medicine)-granting and MD (Doctor of Medicine)-granting U.S. medical schools. METHODS: Association of American Medical Colleges and American Association of Colleges of Osteopathic Medicine websites were used to obtain contact information for all U.S. medical schools. Respondents were asked whether their school offered a non-subinternship neurosurgery clerkship, if it was required, clerkship length, and whether the clerkship was embedded in another clerkship. Nonsubinternship clerkships/electives/selectives were defined as an exploratory neurosurgery rotation. For nonresponding schools, data were collected from school websites. RESULTS: Data were obtained for 180/199 U.S. medical schools; 142 (79%) provided neurosurgery non-subinternships, including 125/150 (83.3%) MD-granting and 17/30 (57%) DO-granting schools. Four MD-granting schools (2.8%) required the clerkship; 87/142 (61%) offered a stand-alone clerkship, 34/142 (24%) an embedded clerkship, and 21/142 (15%) offered both. In total, 200 clerkships were offered across 142 schools. Most were either >1-2 weeks or >3-4 weeks (69/200, 35% and 89/200, 45%, respectively). CONCLUSIONS: Most U.S. medical schools provide elective neurosurgery non-subinternships. Fewer, although still a majority, of DO-granting schools offer a neurosurgery non-subinternship compared with MD-granting schools.

Predictors of Excellent Urology Residents at the Time of the Urology Match.

OBJECTIVE: To update our experience and report on features predictive of high-quality urology residents at the time of the urology match, because data predicting which medical students will mature into excellent urology residents are sparse. METHODS: We reviewed our experience with 84 urology residents who graduated from 2006 to 2023. Residents were independently scored 1-10 based on overall quality by the current and former Program Director. Discrepant scoring by >2 was resolved by an independent review. Associations of features from the medical student application with an excellent score (defined as 8-10) were evaluated with logistic regression. RESULTS: Discrepant scoring >2 was noted in only 5 (6%) residents. Among the 84 residents, the median overall score was 7 (range 1-10) and 36 (43%) residents had an excellent score of 8-10. Univariably, higher USMLE step II score (P = .03), election to alpha omega alpha (P = .004), no negative interview comments (P = .002), honors in OB/Gyn (P = .048) and psychiatry clerkships (P = .04), and honors in all core clinical clerkships (P < .001) were significantly associated with an excellent score. In a multivariable model, no negative interview comments (P = .003) and honors in all core clinical clerkships (P = .001) were independently associated with an excellent score (c-index 0.76). There were several notable features (sex, letters of recommendation, USMLE step I, externship at our institution, surgery clerkship grade, and rank list) that were not significantly associated with excellent residents. CONCLUSION: We demonstrate features associated with excellent urology residents, most notably no negative interview comments and an honors grade in all core clinical clerkships.

A Mentorship-Based Surgery Clerkship: A Prospective Study Investigating Student Satisfaction.

BACKGROUND: Interest in general surgery has steadily decreased among medical students due to negative perceptions of surgeons, a lack of meaningful clerkship involvement, and inadequate mentorship. We implemented a novel mentorship-based surgery clerkship (MBSC) in which each student was matched with a resident mentor with the goals of enhancing student learning experience, meaningfulness, and interest in surgery. We hypothesized that students participating in the MBSC would report increased confidence in surgical competencies, exposure to surgical faculty, and positive perception of surgery, with no detriment to clerkship grades. METHODS: Mentors were instructed to provide the following when asked by the student: (1) weekly feedback; (2) personalized goals; (3) daily cases; (4) specific videos; (5) presentation subjects; (6) operating room skills coaching. A 5-point Likert Scale survey was distributed to the students pre and post clerkship, and median differences in Likert Scale Score pre and post mentorship were compared between mentored and control groups using the unpaired Wilcoxon's test. This was a two-arm, nonrandomized trial comparing traditional curriculum with the mentored program. RESULTS: The total sample size was n = 84. When comparing mentored to control, Wilcoxon's analysis showed greater post clerkship increases in confidence in operating room etiquette (P = 0.03), participating in rounds (P = 0.02), and suturing (P < 0.01). There were greater increases in perceived surgeon compassion (P = 0.04), respectfulness (P < 0.01), and teaching ability (P < 0.01). Median scores for meaningfulness overall (P = 0.01) and as measured as a feeling of positively impacting a patient (P = 0.02) were also increased when comparing mentored to control. More students were encouraged by a surgeon to pursue surgery (P = 0.01) and consider a surgery career themselves (P = 0.02). CONCLUSIONS: An MBSC increases meaningfulness, confidence, skills, and exposure in various surgical competencies. Compared to nonmentored students, MBSC students have more positive perceptions of surgeons and are more likely to pursue surgery.

Teaching Sideways: Implementing a Peer-Led Medical Student Orientation Bootcamp and Survival Guide for Internal Medicine Clerkship.

OBJECTIVES: Transitioning from classroom learning to clerkships presents a challenge for medical students because there is often sparse preparation material on how to effectively contribute to the medical team as a clerkship student. Although some medical schools have implemented transition-to-clerkship sessions, they often are led by faculty and lack the practical and contemporary guidance from students who have recently completed clerkships themselves. METHODS: Using a sideways mentorship approach, we implemented a 1-hour near-peer Internal Medicine (IM) clerkship orientation bootcamp at our medical school and wrote an accompanying survival guide to teach students how to function as part of a medical team and to increase the transparency of student expectations and evaluations during the clerkship. The 1-hour session covered the following core topics: clerkship logistics, how to gather/present clinical information, a resident/student question-and-answer panel, and how to contribute to the medical team. A postclerkship medical student and second-year IM resident conducted the bootcamp for four student cohorts (105 students total) during the January to December 2022 clerkship year before the IM rotation of each cohort. After the bootcamp, students received a copy of the survival guide to solidify concepts covered in the session. RESULTS: A preclerkship survey included questions to assess student confidence in 10 core IM clerkship domains pre- and postbootcamp. Both pre- and postclerkship surveys asked students to provide feedback on bootcamp strengths and weaknesses. Wilcoxon signed rank tests revealed a significant increase in postbootcamp student confidence rating for all 10 clerkship domains in the early clerkship cohort and in the late clerkship cohort for all of the domains, except finding clinical reference resources (P = 0.15). The bootcamp had the largest effect size (r) on student confidence in both early and late clerkship cohorts for the following clerkship domains: familiarity with IM clerkship evaluation (early: r = 0.61, P < 0.001; late: r = 0.56, P = 0.002), identification of ways to contribute to the medical team (early: r = 0.58, P < 0.001; late: r = 0.63, P < 0.001), and prerounding/chart checking (early r = 0.52, P < 0.001; late: r = 0.55, P = 0.001). The percentage of students rating the helpfulness of both the bootcamp and survival guide as a 3 to 5 on a 5-point Likert scale in the postclerkship survey was highest for the following domains: being familiar with the structure of a subjective, objective, assessment, and plan presentation (88% and 97%), prerounding/chart checking (82% and 95%), writing progress notes (82% and 92%), and identifying ways to contribute to the medical team (82% and 95%). Students commented that the main strengths of the bootcamp included its specific tips on synthesizing and presenting clinical information and its transparency about student expectations and experiences. CONCLUSIONS: A structured student-led bootcamp can increase clerkship preparation in core domains. The bootcamp is now part of mandatory clerkship didactics at our medical school, given its success during the 2022 clerkship year, and its content is continuing to be expanded upon by postclerkship students and residents. In addition, the format of the bootcamp also is being adapted to other clerkships, including surgery and obstetrics/gynecology.

When I Don't see me, Am I seen? Race and student perception of the surgery clerkship.

INTRODUCTION: Increasing interest in general surgery from students who are Under-Represented in Medicine (URiM) is imperative to advancing diversity, equity, and inclusion efforts. We examined medical student third year surgery clerkship evaluations quantitatively and qualitatively to understand the experiences of URiM and non-URiM learners at our institution. METHODS: Evaluations from 235 graduated medical students between the years of 2019 and 2021 were analyzed. T-tests were used to compare numerical data. Free-text comments were qualitatively analyzed using inductive thematic analysis by two independent reviewers with conflicts resolved by a third. RESULTS: Evaluations were completed by 214 non-URiM students (91.1 â€‹%) and 21 (8.9 â€‹%) URiM students. There were no significant differences between URiM and non-URiM students in ratings of faculty and resident teaching. When asked whether residents were positive role models for patient care, non-URiM students were more likely than URiM students to agree (3.284 vs. 2.864, p â€‹= â€‹0.040). When asked whether they considered faculty to be positive role models, non- URM students were also more likely to answer affirmatively than URiM students (3.394 vs. 2.909 p â€‹= â€‹0.013). Qualitative comments were similar between the two groups. When asked what the strengths of the clerkship were, the most commonly evoked theme was "interactions with team" with subthemes of "team integration" "feeling valued" and positive "faculty" or "resident" interactions. "Operative experience" was the second most commonly evoked strength of the clerkship. The most common criticisms of the clerkship involved "negative interactions with team" with subthemes of "not prioritized above other learners" and "ignored." Negative "academic experience" was the next most commonly evoked weakness, with an affiliated theme of "lack of teaching." CONCLUSIONS: URiM students are less likely than non-URiM students to see surgical residents and faculty as positive role models. Integrating medical students into the team, taking time to teach, and allowing students to feel valued in their roles improves the clerkship experience for trainees and can contribute to recruitment efforts.

Surgical Residents as Clerkship Scholars May Improve Student Perception of the Surgery Clerkship.

INTRODUCTION: The surgical clerkship is a formative experience in the medical school curriculum and can leave a lasting impression on students' perception of surgery. Given the historical negative stereotypes of surgeons, the clerkship represents an opportunity to impact students in a meaningful way. METHODS: Our institution developed a program in which research residents can serve as junior clerkship coordinators and educators; working closely with medical students on their surgery clerkship. At the end of their clerkship, students were administered a survey with Likert-scale and free text responses regarding satisfaction with the rotation, lectures, feedback, and value of the clerkship. Student survey results were compared before (2015-2016) and after (2017-2019) the implementation of the scholar program with nonparametric statistical analysis and qualitative text analysis. RESULTS: A total of 413 students responded to the survey with no significant difference in response rate by term (P = 0.88). We found no statistical difference with respect to overall course perception (92.3% versus 91.2%, P = 0.84), but a statistically significant difference was noted for the clarity of the provided written clerkship materials (80.3% versus 91.3%, P = 0.02) and usefulness of the feedback (57.5% versus 78.7%, P = 0.01). Qualitative analysis demonstrated an overall positive shift in perception of the clerkship, improvement in the course materials, and organization. CONCLUSIONS: The scholar program was overall well received by the students with improvements in certain aspects of the clerkship: organization, feedback, and course materials. This program represents a potential strategy to improve certain portions of the medical school clerkship experience.

Workplace Based Learning (WBL): An Effective Learning Modality during Orthopaedics Surgical Clerkship: Students' Perspective.

OBJECTIVE: To evaluate the student's perspective about educational and training efficacy of workplace based learning (WBL) during surgical clerkship in Orthopaedics amongst 4th and 5th year medical students. STUDY DESIGN: Cross-sectional study. Place and Duration of the Study: Department of General Surgery, Shifa Tameer-e-Millat University, Islamabad, from September 2020 to December 2021. METHODOLOGY: The inclusion criteria was fourth and final year MBBS students who had completed their orthopaedic surgery mini-clerkship. The exclusion criteria was medical students who did not attend the orthopaedics clerkship in the study period. The research instrument was a questionnaire based on the principles of experiential based learning. The participants were sent an online questionnaire as well as a consent form through e-mail. The responses were recorded and analysed for descriptive statistics. RESULTS: From the target group, 140 responses were received, 94 students (67%) expressed that workplace environment was conducive to learning and 98 (70%) agreed that their diagnostic and management skills further developed following exposure to the orthopaedic workplace. A short duration of 2 weeks served as a hindrance with 53 (38%) of students expressing that they were not able to effectively inculcate all concepts within that limited time-frame. Moreover, 52 (37.5%) students described limited patient's clerking time. CONCLUSION: Though majority of students were satisfied with teaching and learning strategies, design and implementation of the curriculum at the orthopaedics department; yet, there were significant limitations requiring further evaluation and cooperation by both students and faculty in order to establish ecosystem focusing on experiential learning. KEY WORDS: Orthopaedics, Workplace based learning (WBL), Student, Clerkship, Learning environment.

Practical Ethics: A Medical Student's Ethical Case in Surgery Clerkship.

AbstractOne factor that impedes medical students from speaking up about ethical situations is the lack of sufficient knowledge and skills in conflict resolution. This may also affect students' decision and timing to intervene. This article will provide practical ways to effectively and efficiently address the medical student's ethical case presented in August A. Culbert et al.'s "Navigating Informed Consent and Patient Safety in Surgery: Lessons for Medical Students and Junior Trainees."

Preclinical Immersion Experiences Improve Medical Student Perceptions of Surgery.

INTRODUCTION: Medical students historically receive little to no preclinical exposure to surgery and surgical subspecialties. As a result, by the time they reach their clinical clerkship time, students often have already found interest in other specialties. The goal of this study is to utilize the knowledge to action (KTA) implementation framework to design and refine a clinical immersion experience during the second year of medical school. METHODS: A total of 94 second-year Harvard Medical School students underwent the surgical immersion experience between 2019 and 2022 (the program was postponed in 2020 due to COVID). The development and refinement of the curriculum were nicely modeled by the KTA implementation framework. We identified a gap in medical student preclinical education, adapted a curriculum for preclinical medical students at Massachusetts General Hospital , selected the curriculum components to provide a high-level overview of surgery, monitored the student experience, and evaluated outcomes using the student surveys. Based on the survey results, inductive thematic analysis was utilized to identify prominent positive and negative themes. The feedback was then used to tailor subsequent iterations of the immersion experience. RESULTS: Eighty-eight medical students completed the survey (RR = 93.6%), and 85% rated the immersion experience as "excellent", 11% "very good", 4% "good", and 0% "fair" or "poor". There was no significant difference in ratings between sessions. Several key themes were identified, including changed perceptions, diversity of surgical fields, teamwork, surgery clerkship preparedness, and the need for more preclinical exposure. CONCLUSIONS: Preclinical medical students gave overwhelmingly positive reviews of the surgical immersion experience. A half-day intervention is sufficient to begin changing students' views toward surgery, disproving stereotypes, and even inspiring some to consider a surgical field themselves. In addition, the KTA implementation framework is a useful model for the development and refinement of medical education curricula.

Impact of Obstetrics and Gynecology Clerkship Order on NBME Exam Scores After a Curriculum Change.

OBJECTIVE: Our Institution instituted curriculum reform in 2013. We sought to examine the impact of rotation order on the end of clerkship National Board of Medical Examiners (NBME) Obstetrics and Gynecology (Ob/Gyn) Subject Exam scores after curriculum restructuring. DESIGN: This is a retrospective analysis of Ob/Gyn NBME scores over 2 years after curriculum reform. At our university, a 15-week block is divided into 5-week intervals of General Surgery, Ob/Gyn, and surgical subspecialties, in any order. During the 16 weeks, students take the NBME Subject Examinations for Ob/Gyn and Surgery. We defined rotation groups by proximity to the shelf exam. Group 1 completed Ob/Gyn first, furthest away from the exam, Group 2 completed Ob/Gyn second, and Group 3 completed Ob/Gyn last, closest to the test. We compared average shelf exam scores between Groups. SETTING: Uniformed Services University of Health Sciences during the clerkship year. PARTICIPANTS: Medical students at the Uniformed Services University. RESULTS: We obtained data from 331 students (118 students in Group 1, 106 in Group 2, and 107 in Group 3). Scores ranged from 55 to 99 (mean 72.5, SD 7.3). Mean (SD) NBME score was 71.9 (6.9) in Group 1, 73.2 (7.2) in Group 2, and 72.6 (7.7) in Group 3 (p = 0.415). CONCLUSION: Rotation order does not affect NBME Ob/Gyn Subject exam scores in a fifteen-week integrated clerkship block.

Creating ophthalmology experiences in undergraduate medical education: pilot of a cased-based learning ophthalmology tool.

PURPOSE: To evaluate medical student perceptions of a novel ophthalmology resource delivered through facilitated workshops in the core clerkship curriculum. METHODS: We created www.2020sim.com, a free case-based learning (CBL) ophthalmology tool, adapted from NephSIM (www.nephsim.com). The tool was first piloted with the internal medicine (IM) residents. After confirming a need, we focused on undergraduate medical education (UME) by expanding the 20/20 SIM content and partnering with the neurology (pilot academic year [AY] 2020-2021) and pediatric clerkships (pilot AY 2021-2022) to deliver a facilitated one-hour ophthalmology workshop within each clerkship's didactic curriculum. We evaluated the tool using pre- and post-surveys and knowledge assessments. RESULTS: Of 80 IM residents, 33 (41.3%) completed the needs assessment. Of the 25 residents who attended the workshop, 23 (92.0%) completed the exit survey. IM residents reported discomfort in several ophthalmology domains (9 of 14 rated mean score < 3.0), confirming a need. Most (n = 21/23, 91.3%) rated the tool as good/excellent. Of 145 neurology clerkship students, 125 (86.2%) and at least 88 (60.7%) students completed the pre- and post-test/exit surveys, respectively. On average, participants highly rated the tool, perceiving 20/20 SIM to be relevant to their education [4.1 (0.8)]. Mean pre- to post-test knowledge scores increased from 7.5 to 8.5/10.0 points (p < 0.001). Of the 136 pediatric clerkship students, 67 (49.3%) and 51 (37.5%) completed the pre- and post-surveys, respectively. Respondents perceived increased comfort with ophthalmology topics after the facilitated workshop [3.8 (0.8)]. Mean pre- to post-test knowledge scores trended from 1.8 to 2.0/5.0 points (p = 0.30). Collectively, 20/139 (14.4%) of exit survey respondents visited www.2020sim.com within 1 month after the workshop. CONCLUSION: After identifying areas of greatest need with residents, we partnered with core clerkships to deliver cross-disciplinary ophthalmology content in UME. We found high engagement with 20/20 SIM, with trends toward increased knowledge.

Revisiting Medical Student Expectations on the Surgery Clerkship.

OBJECTIVE: Medical students frequently report ambiguity of expectations in their feedback of the surgery clerkship. Herein, we aimed to gauge general surgery resident and attending expectations of students on their clerkship. DESIGN: Residents and attending surgeons were surveyed on medical student expectations for rounding and floor duties, the operating room, clinic, and professionalism. RESULTS: There were slight differences in expectations between residents and attendings, which were then utilized to facilitate a discussion to create consensus expectations for students. Early outcomes demonstrate improved understanding of expectations by medical students. CONCLUSION: Identifying differences in resident and attending expectations of medical students on their surgery clerkship can help improve the alignment of such expectations. We hope that longterm, this intervention can facilitate a better learning environment for medical students on their surgery clerkship.

Developing a Surgical Simulation Curriculum for the Rwandan Context.

OBJECTIVE: We report on the development and implementation of a surgical simulation curriculum for undergraduate medical students in rural Rwanda. DESIGN: This is a narrative report on the development of scenario and procedure-based content for a junior surgical clerkship simulation curriculum by an interdisciplinary team of simulation specialists, surgeons, anesthesiologists, medical educators, and medical students. SETTING: University of Global Health Equity, a new medical school located in Butaro, Rwanda. PARTICIPANTS: Participants in this study consist of simulation and surgical educators, surgeons, anesthesiologists, research fellows and University of Global Health Equity medical students enrolled in the junior surgery clerkship. RESULTS: The simulation training schedule was designed to begin with a 17-session simulation-intensive week, followed by 8 sessions spread over the 11-week clerkship. These sessions combined the use of high-fidelity mannequins with improvised, bench-top surgical simulators like the GlobalSurgBox, and low-cost gelatin-based models to effectively replace resource intensive options. CONCLUSIONS: Emphasis on contextualized content generation, low-cost application, and interdisciplinary design of simulation curricula for low-income settings is essential. The impact of this curriculum on students' knowledge and skill acquisition is being assessed in an ongoing fashion as a substrate for iterative improvement.

Survey Study of Clerkship Curriculum on Learner's Choice to Pursue Surgery: Positive Impact of Extracurricular Opportunities.

OBJECTIVE: Prior studies have focused on the role of the learning environment on students' decisions to pursue surgery, but few have analyzed the impact of the clerkship curriculum. This study assessed surgical clerkship curricula across United States (US) medical schools and their impact on students' likelihood of pursuing a surgical residency. DESIGN: A cross-sectional survey was developed to assess surgery clerkship characteristics. Questions included clerkship duration, number of offered and required surgical services, method of service assignment, and number of advanced clinical electives (e.g., fourth-year sub-internships) and additional surgical clinical opportunities (e.g., surgical elective rotations). Survey results were merged by the Association of American Medical Colleges with the percentages of students who matched into a surgical specialty. Linear regression models estimated the association of covariates with the percentage of students who (1) matched in surgical specialties, (2) were interested in surgery at medical school matriculation and ultimately matched into surgical residency (retention rate), and (3) were not interested in surgery at medical school matriculation but ultimately matched into surgical residency (recruitment rate). SETTING: The survey was distributed to clerkship directors and coordinators at 66 medical schools through the Association for Surgical Education (ASE) from 5/1/2021 to 8/1/2021. PARTICIPANTS: All US medical schools in the ASE. RESULTS: A total of 21 medical schools responded (34.8% response rate). The overall retention rate was 36.4%, and the overall recruitment rate was 25.0%. Clerkships were 4 to 12 weeks. In 81% of programs, students submitted preferences and were assigned services. The percentage of students applying to surgical specialties was not associated with clerkship duration (p=0.79) or the number of required services (p=0.15), subspecialty services offered (p=0.33), or advanced clinical electives (p=0.24) but was associated with a program's having additional surgical clinical opportunities (p=0.02). Most of these factors were not associated with retention or recruitment rates. CONCLUSIONS: Offering more extracurricular surgical clinical opportunities was associated with having more students pursue surgical careers. Though limited by a relatively small sample size, our findings suggest that having shorter clerkships or limited subspecialty offerings may not have a significant influence on students' career choices.