Education
Integrating Surgical Skills Education into the Anatomy Laboratory

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Background

Preclinical education plays a pivotal role in improving the quality of patient care and safety. Early exposure to surgical skills training and surgical mentors enhance students’ retention and confidence in those skills, and may promote their interest in surgery.

Methods

Based upon a needs assessment survey of surgical education at UCSF, we introduced a curriculum to teach basic surgical techniques in the preclinical years with the intent of emphasizing several important skills and providing students with exposure to surgical mentors in a small group environment. We then surveyed the students to assess satisfaction with the new curriculum and the effect on perceptions regarding a career in surgery.

Results

Rising fourth y students at UCSF identified the need for increased exposure to basic surgical skills in preparation for third y clerkships. Collaboration between the Departments of Anatomy and Surgery subsequently produced an integrated suturing curriculum in the anatomy lab as part of the first y medical school coursework. The curriculum offered a focused exposure to skills identified by senior students as important for their clinical rotations. The vast majority of respondents agreed or strongly agreed that the exercise was enjoyable and worth continuing, and that their interactions with the surgeon volunteers were positive. Furthermore, 33% stated that their interest in surgery increased after the exercise. Qualitative comments praised both the experience and surgical faculty participation.

Conclusion

A needs-based surgical skills curriculum can be integrated into the traditional first-y anatomy course without detracting from didactic instruction in anatomy. Furthermore, students received early exposure to surgical mentors and skills training, which may translate into greater confidence on the wards and increased interest in surgical careers.

Introduction

The 2004 Blue Ribbon report to the American Surgical Association called upon surgeons to develop a greater role in undergraduate medical education [1]. A key recommendation was that surgical faculty and residents should be involved in the education of medical students in the first 2 y, teaching alongside the instructors from the basic science disciplines. Although surgery has seen a decrease in the applicant pool over the past decade, surgeon involvement in medical education has been shown to positively influence students’ interest in and choice of careers in the field 2, 3, 4, 5. Thus, the role of surgeon educators in the preclinical realm is not limited to skills training, but also to provide students with an opportunity to explore surgical careers through positive mentorship.

In traditional medical school curricula, students typically have little or no exposure to surgical skills or surgeon educators before their third y clerkships. For many years, the acquisition of important surgical skills has typically occurred in the operating room. This practice has been challenged by cutbacks in operating room time, reduced resident work hours, and the ethical issue of novices learning procedures on patients [6]. For optimal skill acquisition, medical education research has demonstrated that early and repeated practice of skills, such as the physical examination can enhance retention, potentially increasing confidence, student safety, and improving patient care [7]. Thus, the successful development of technical skills depends on regular exposure, supervision, and standardized teaching, elements that cannot usually be provided in the operating room.

Nationally, efforts are being made to redesign medical education at all levels. These efforts have emphasized important skills, such as communication and the physical examination in the first two y, without a focus on surgical skills. At the resident level, a patient safety curriculum and consensus recommendations have concentrated primarily on the use of surgical skills laboratories to enhance patient safety and quality of care [8]. Investing in the “dry” skills training improves clinical outcomes; indeed, this growing movement of utilizing nonoperative time to provide formalized surgical skills training has been extended to medical student education, but often in optional, elective settings 9, 10, 11. Only a subset of students take these electives, and the need for formal curricular interventions remains. The successful development of such necessary skills training would require extensive collaboration between the surgical and preclinical faculty at each medical school. Concerns regarding time and monetary investment, and appropriate context of teaching surgical skills to preclinical students, also remain.

In recent years, the University of California, San Francisco (UCSF) School of Medicine has redesigned the didactic content of its required anatomy laboratory course to be more interesting and clinically relevant for students. To increase students’ interest, promote professional development, and encourage life-long learning, we have also integrated new teaching approaches and clinical procedures into the anatomy dissection labs and clinical electives available to medical students [12]. This paper specifically describes our experience designing a suturing curriculum that was integrated into our first-y anatomy laboratory course to engage students, teach basic suturing skills, and provide early exposure to surgical mentors.

Section snippets

Needs Assessment and Curriculum Development

Preclinical surgical skills training was implemented after senior medical students at UCSF identified a need for greater skills training. Our first step in curriculum development was to assess the state of surgical education at UCSF through a voluntary survey of rising fourth-y medical students during a large group lecture. The survey sought to assess student perceptions of their third-y surgical experience, attitudes towards surgeons and the field of surgery, and the ways UCSF's medical

Needs Assessment

Fifty-six fourth-y medical students responded to the needs assessment survey. On a 1–5 Likert scale (1 = not helpful, 5 = very helpful), over 75% of respondents felt it would have been helpful or very helpful to have learned the following skills ahead of their surgery rotation: basic instrumentation (75%, 3.75 ± 1.15), basic knot tying (86%, 4.14 ± 1.12), and basic suturing (89%, 4.18 ± 1.09). Other areas of potential improvement included scrubbing and gowning, maintaining sterile fields,

Discussion

Our results demonstrate that a suturing skills curriculum can be integrated into a traditional first-y anatomy laboratory course for medical students. We found that the curriculum complemented the preexisting anatomy course and resulted in positive feedback from students, including enhanced confidence in basic surgical skills and increased interest in surgery as a whole. The development of this curriculum was motivated by a needs assessment survey of senior medical students that identified

Conclusions

We conclude that a surgical skills curriculum can be integrated into a traditional first y medical student anatomy course to supplement the didactic education in anatomy. This curriculum, driven by a needs assessment of senior medical students, can provide early exposure to surgical mentors, may promote accelerated skills acquisition and translate into greater confidence on the wards, and increased medical student interest in careers in surgery. This curriculum complements the existing anatomic

Acknowledgments

The authors thank Drs. Nancy Ascher, David Irby, Helen Loeser, Patricia O'Sullivan, Hobart Harris, and Marieke Kruidering for their input and guidance in developing the surgical skills curriculum. Pamela Derish of the UCSF Department of Surgery Publications Office provided critical feedback during the writing phase. The authors thank the Curriculum Ambassador Program at UCSF. They also thank all the surgical volunteers who participated in this new curriculum.

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