anatomy surgery

8/6/2019 Anatomy Surgery

1/8

Research Report

Surgical Clinical Correlates in Anatomy: Design and

Implementation of a First-Year Medical School Program

Lisa M. Haubert,1 Kenneth Jones,2 Susan D. Moffatt-Bruce1*1Department of Surgery, Division of Cardiothoracic Surgery, The Ohio State University Medical Center,

Columbus, Ohio2Department of Anatomy, The Ohio State University Medical Center, Columbus, Ohio

Medical students state the need for a clinically oriented anatomy class so to maximizetheir learning experience. We hypothesize that the first-year medical students, who takethe Surgical Clinical Correlates in Anatomy program, will perform better than theirpeers in their anatomy course, their surgical clerkships and ultimately choose surgicalresidencies. We designed and recently implemented this program for first-year medicalstudents. It consisted of General Surgical Knowledge, Orthopedic Surgery, Plastic Sur-

gery, Urology, Cardiothoracic Surgery, General Surgery, Vascular Surgery, and Ear,Nose, and Throat (ENT) sessions. Each session had defined learning objectives andinteractive cadaveric operations performed by faculty members and students. The pro-gram was elective and had 25 participants randomly chosen. An evaluative question-naire was completed before and after the program. Comparative analysis of the ques-tionnaires, first-year anatomy examination results, clinical surgical rotation scores, andresidency match results will be completed. The positive opinions of surgeons increasedfor all medical students from the pre-evaluation to the post-evaluation, and there was agreater increase in positive opinions for our participants. Our participants also had thehighest average overall for all combined anatomy examinations. A need exists amongmedical students to develop a clinically correlated anatomy program that will maximizetheir learning experience, improve their performance and allow them to makemore informed career choices. The recent implementation of this Surgical ClinicalCorrelates in Anatomy program fulfills this need. Anat Sci Educ 2:265272, 2009. 2009American Association of Anatomists.

Key words: gross anatomy; surgical education; residents as teachers; clinical correlations;medical curriculum; clinical integration

INTRODUCTION

There have been many changes to the curriculum of medical

schools with anatomy often having a reduced time allotment

or being completely removed (Cottam, 1999; Fitzgerald et al.,2008). The Ohio State University College of Medicine is noexception in that their first-year medical school anatomy

course was recently downsized from 12 to 10 weeks. Further-more, the field of anatomy has seen a significant decline ininterested and qualified teachers (Seyfer et al., 2007). A sur-vey from 2002 demonstrated that more than 80% of thedepartment chairs responsible for teaching anatomy antici-pated that they would have great or moderate difficultyrecruiting qualified faculty to teach gross anatomy(McCuskey et al., 2005).

To compound problems, the AAMC Graduation Ques-tionnaire suggested a decreasing interest for fourth-yearmedical students in general surgery from 1978 to 2001(AAMC, 2009). Additionally, the match results show a grad-ual trend of more general surgery positions being filled by

*Correspondence to: Dr. Susan D. Moffatt-Bruce, The Ohio State

University Medical Center, Division of Cardiothoracic Surgery,

Department of Surgery, Columbus, Ohio 43210, USA.

E-mail: [email protected]

Received 26 July 2009; Revised 20 August 2009; Accepted 21 August

2009.

Published online 17 September 2009 in Wiley InterScience (www.

interscience.wiley.com). DOI 10.1002/ase.108

2009 American Association of Anatomists

Anatomical Sciences Education NOVEMBER/DECEMBER 2009 Anat Sci Educ 2:265272 (2009)


2/8

international graduates due to lack of interest amongstAmerican graduates (NRMP, 2009; Schneider, 2009). It isthought that a lack of exposure to surgeons and surgicaltopics in the first two years of medical school may be thecause of the decreased interest in surgery (Fuller et al.,2008). This decreased interest in surgery has been attributedto concerns about lifestyle and hard work environments, aswell as the paucity of role models as surgical educators andtheir hesitancy to undertake educational leadership roles(Polk, 1999). Many surgeons are content to have others edu-cate medical students, likely due to perceived time and pro-fessional constraints. To increase medical student interest insurgery, surgical faculty and residents must become moreinvolved in medical education (Polk, 1999; Debas et al.,2005; Fuller et al., 2008).

Unfortunately, surgeons are not routinely sought after aseducators because they often suffer from an unfavorableimage. One study revealed that 34% of third-year medicalstudents believed surgeons to be unapproachable (Ek et al.,2005). Another study showed that 50% of students believedthat they were considered an inconvenience by attending sur-geons while on their third-year surgical rotations (De et al.,2004). However, previous studies have shown that even a

brief intervention by surgeons during the first-year of medicalschool can favorably influence students toward surgery(Kozar et al., 2003; Zaid et al., in press). Positive medicalstudent operative experience and resident and faculty mentor-ing interactions with the students have been correlated withstudents matching into categorical surgical residency positions(OHerrin et al., 2003, 2004; Berman et al., 2008).

These competing circumstances come at a time when ithas been clearly determined that there is an impending sur-geon shortage as early as 2009 (Debas et al., 2005). Thistrend is thought to greatly impact general surgery with theestimation of a shortage of 1,300 surgeons by 2010. If thisdecline continues, it is predicted that there will be a shortageof 6,000 general surgeons by 2050 (Williams and Ellison,

2008; Peters, 2009). A recent article estimates that the nationwill need 10,000 additional first-year residency slots and 60new medical schools by 2020 to control the crisis (Jancin,2007). This increase will place a greater strain on the alreadydeteriorating anatomical workforce.

It may seem that most of these issues are not related, butin fact, they are all significantly interconnected. If surgeonsembark on teaching anatomy, this will both help to alleviatethe stress on the anatomy departments and expose medicalstudents to surgery and surgical subspecialties early in theircareers. This will allow medical students to explore careeroptions during their first two years of medical school, insteadof waiting until their third-year to have these opportunities.This in turn has the potential to improve the image of sur-

geons, allow for an increased interest in surgery and createhigher match rates into surgical specialties.The Ohio State University College of Medicine prides itself

on being one of the leaders in innovation of medical curric-ula. Medical students, both those that enter surgical and med-ical specialties, state the need for a practical, surgically orien-tated anatomy class before their clinical surgical rotations sothat they might maximize their learning experience and bemore informed about residency choices. We have designedand implemented a program for first-year medical studentsthat will fulfill this need. As such, we hypothesize that thefirst-year medical students, who take the Surgical ClinicalCorrelates in Anatomy program, will perform better than

their peers in their anatomy course, their surgical clerkships,and ultimately choose surgical residencies.

EXPERIMENTAL DESIGN

Class Organization

The first-year anatomy course was designed to be taught overa 10-week period. Therefore, a two-hour time period was

chosen that fit into the anatomy schedule for each of theeight designated Surgical Clinical Correlates in Anatomyclasses. Each class covered a different surgical topic. Therewas approximately one class per week during the ten-weekanatomy course. These classes were held outside the scheduleof the standard anatomy dissections. We were permitted touse one of the dissection laboratories for all of our classes.We secured two cadavers for our class and the use of pro-sec-tions from the Department of Anatomy to supplement thedissections. A fresh cadaver was also obtained to be used dur-ing the ENT class. Surgical instruments that were no longerin use were donated by the Department of Orthopedic Sur-gery for our cadaver operations. Surgical faculty also suppliedextra instruments and materials to be used during their re-

spective classes. The Department of Anatomy allowed us toborrow their digital video camera and monitor to use duringeach class, which allowed for a close-up image of the surgerybeing performed. This allowed all 25 students a close view ofthe procedures during the demonstration phase of the class.

The 25 students divided themselves between the twocadavers. Each student took a turn during the dissections. Forexample, one student would make the skin incision, and thenanother student would take over and perform the next step inthe procedure. This allowed each student a hands-on experi-ence for each procedure.

Each class was divided into two parts. For the first part,each attending surgeon was asked to create a 30 to 45-minutepresentation that included a review of the relevant anatomy,

clinical correlations, pertinent radiologic studies, and anactual surgical video portraying the surgery the studentswould be performing. The attending surgeons were thenasked to perform procedures pertinent to their specialty thatallowed for hands-on experience and accommodate the timeconstraints of the class. During these sessions, the studentsparticipated in and performed the procedures on the cadaversso to fully appreciate the applied surgical anatomy.

Faculty Recruitment and Participation

An attending surgeon for each of the eight classes was chosenbased on merits of previous teaching experience amongst resi-dents. A letter was drafted inviting these individuals to partic-ipate as teachers. Each of the selected attending surgeonsaccepted the invitation. A meeting was then scheduled tomeet with each of these attending surgeons to discuss expect-ations for the class. The attending surgeons then submittedtheir intended surgical procedure(s), and this information wasshared with the students before the class.

Class Size Determination/Selection

It was determined that 25 of the 211 entering first-year medi-cal students was the minimum number needed to participatein Surgical Clinical Correlates in Anatomy for statistical sig-

266 Haubert et al.


3/8

nificance. The power for this study was based on 25 studentsparticipating in the Surgical Clinical Correlates in AnatomyProgram and approximately 175 students in the traditionalmedical program. The primary goal was to see if participa-tion in the program increased a students performance in theirthree anatomy examinations, their three practical examina-tions, and their third-year medical shelf examination. Toavoid a selection bias, the 25 students in the Surgical ClinicalCorrelates in Anatomy program were randomly selected fromthe 93 volunteers. The mean scores (standard deviation) ofprior final anatomy written and practical examinations were88.1 (68.5) and 91.4 (66.9), respectively. There will be apower of 90% to detect at least a 7% increase in both ofthese scores. This was based on a two-sided test with an a 50.0167 and a common standard deviation using 25 studentsin the surgical correlates program and 175 students with tra-ditional medical training. The mean scores (standard devia-tion) of recent third-year shelf examinations was 72.0 ( 68.7).There will be a power of 90% to detect at least a 10%increase in these scores. This power calculation uses the sameassumptions as above. The a was set to 0.0167 since we willbe testing to see if all three examination scores increase thusconserving the type I error at 5% due to the multiple testing.

To advertise this new program, a flier was created andplaced in each students mailbox during orientation week. Itwas also distributed on the first day of anatomy lecture and ashort presentation about the program was given. Of the first-year medical school class, 93 students volunteered to partici-pate in Surgical Clinical Correlates in Anatomy. The 25 posi-tions were filled by randomization of the interested students.Anticipating that we would need to follow the 25 studentsand compare them with the class as a whole to test our hy-pothesis, an IRB approval was successfully sought. Consentwas then achieved from all but 13 students of the entire first-year medical school class so that their results could be contin-uously monitored.

Class Composition/Session MatterAnatomy for the first-year of medical school curriculum con-tains three blocks over ten weeks. It was therefore decidedthat two to four Surgical Clinical Correlates in Anatomyclasses per block for a total of eight classes would be a rea-sonable and practical amount for implementation. Each classwas designed to be two hours. Surgical specialties were cho-sen to correlate with the anatomy blocks (Table 1). The firstblock, Upper Extremity and Back, began with a class on gen-eral surgical knowledge, which was an introduction to sur-gery and the operating room. Plastic Surgery was the secondclass to be included in this anatomy block. The second anat-omy block, Thorax, Abdomen, and Lower Extremity, would

include classes on Cardiothoracic Surgery, General Surgery,Urology, and Orthopedic Surgery. Head and Neck, the thirdblock, would contain classes on Vascular Surgery and ENT.

In the general surgical knowledge session, the studentstook part in an interactive session in order to become familiarwith surgical instruments, different types of sutures, woundhealing, and how to suture and tie. The class involved sutur-ing in a variety of ways on the cadavers. In the Plastic Sur-gery session, the students performed a carpal tunnel release,facial fracture repairs and appreciated the LeFort classifica-tion system. The third session, Cardiothoracic Surgery,included performing a thoracotomy and lobectomy, a sterno-tomy, and dissection of the human heart. The Urologic ses-

sion allowed the students to perform a nephrectomy andlearn the basics of pelvic floor resuspension. General Surgery,the fifth session, allowed the students to perform an appen-dectomy and a right hemicolectomy, with both hand sewnand stapled anastomoses. The orthopedic session involvedperforming an autograft anterior cruciate ligament recon-struction, a meniscus repair, tibial osteotomies, and an openreduction internal fixation of a tibial fracture. The vascularsurgery sessions involved the students performing a carotidendarterectomy and lower extremity amputations. The ENTsession allowed the students to perform radical neck dissec-tions. These sessions correlated with the dissections the stu-dents were performing in their regular anatomy lab.

The operations all took place on the same two cadavers.

This required the planning of the sessions such that pertinentbody parts were still available. For instance, the orthopedicsessions took place before the vascular surgery amputations.

Monitoring devices

A pre-evaluation and a post-evaluation questionnaire werecreated and distributed to the entire first-year medical schoolclass. The pre-evaluation included having the students ranktheir interest in common medical fields, both medical andsurgical, identify their opinions of surgeons, and provide infor-mation regarding prior anatomy classes, relatives as physicians

Table 1.

Surgical Clinical Correlates in Anatomy Program Sessions

Session Procedure(s)

General

surgical

knowledge

Identify and handle common surgical

instruments

Identify assorted sutures and their uses

Learn how to tie knots Learn general techniques of wound

re-approximation

Plastic

surgery

Carpal tunnel release

Repair of facial fractures

Cardiothoracic

surgery

Thoracotomy with lobectomy

Sternotomy with dissection of heart

General

surgery

Appendectomy

Right hemicolectomy

Urologic

surgery

Nephrectomy

Pelvic floor resuspension

Orthopedic

surgery

Tibial osteotomy

ACL reconstruction

ORIF tibial fracture

Meniscus repair

Vascular

surgery

Carotid endarterectomy

Above and below knee amputation

ENT Radical neck dissection

This table describes each procedure that was performed for eachindividual class. Students were given this hand-out prior to startof the program.

Anatomical Sciences Education NOVEMBER/DECEMBER 2009 267


4/8

and why they were interested in participating in Surgical Clini-cal Correlates in Anatomy (Table 2). The post-evaluationincluded the same questions as the pre-evaluation with addi-tional questions allowing the students to rank the program, thesurgeons, and the material in the classes (Table 3). The collec-tion rate of the pre- and post-evaluation was 100%. We hadplanned to compare the results to determine if there was achange in opinion of surgeons and interest in surgery. Ulti-mately, we will compare the third-year surgery clerkship exami-

nations and residency matches as we follow these studentsthroughout their medical school career. IRB approval wasobtained to follow the entire first-year medical school classthrough-out the four years and to use the data collected in acomparative analysis. The data was stored on a secured Excelspreadsheet (Microsoft Corp. Redmond, WA) in which the stu-dents were recognized only by a code known to the primary in-vestigator. IRB approval has also obtained to follow and collectdata from the future incoming first-year medical school classes.

Table 2.

Pre-evaluation Questionnaire for Surgical Clinical Correlates in Anatomy

Mailbox Number: _______

1- h Participant in Surgical Clinical Correlates in Anatomy h Non-participant in Surgical Clinical Correlates in Anatomy

2a- If you did not participate in the class, please comment on why you did not choose to participate.

2b- If you chose to participate in the class, please comment on why you chose to participate.

3a- Please rank your interest in the following specialties:

Family Medicine h Very Interested h Interested h Neutral h Not Interested

Surgery h Very Interested h Interested h Neutral h Not Interested

OB/GYN h Very Interested h Interested h Neutral h Not Interested

Internal Medicine h Very Interested h Interested h Neutral h Not Interested

Anesthesia h Very Interested h Interested h Neutral h Not Interested

Radiology h Very Interested h Interested h Neutral h Not Interested

Dermatology h Very Interested h Interested h Neutral h Not Interested

Ophthalmology h Very Interested h Interested h Neutral h Not Interested

Other ____________ h Very Interested h Interested h Neutral h Not Interested

4- If you chose to participate in the class, please comment on what you want to achieve by taking this class.

5- Do you feel that participation in this class will affect your exam results? If so, how?

6- Have you taken an anatomy class prior to medical school? If so, please state at which level of education and for how long.

7- Have you ever observed or participated in an operation?

8- Are any of your family members physicians? If so, which specialties?

9- What is your opinion of surgeons (check all that apply):

h friendly h approachable h good teachers h unapproachableh reserved h do not take time to teach h rushed h busy

h good listener h not team players h arrogant h cold h compassionateh inconsiderate

10- The course objectives are clear to me.

h True h False

11- Please list goals you have for this course.

Every student in the first-year medical school class was given this questionnaire before they started their anatomy block and before thestart of the Surgical Clinical Correlates program. All of the questionnaires were returned for evaluation.

268 Haubert et al.


5/8

Table 3.

Post-evaluation Questionnaire for Surgical Clinical Correlates in Anatomy

Mailbox Number: _______

1- h Participant in Surgical Clinical Correlates in Anatomy h Non-participant in Surgical Clinical Correlates in Anatomy

2a- If you did not participate in the class, please comment as to whether or not you think you should have participated in this class.

2b- If you chose to participate in the class, please comment on whether or not you would recommend this class to another student.

3a- Please rank your interest in the following specialties:

Family Medicine h Very Interested h Interested h Neutral h Not Interested

Surgery h Very Interested h Interested h Neutral h Not Interested

OB/GYN h Very Interested h Interested h Neutral h Not Interested

Internal Medicine h Very Interested h Interested h Neutral h Not Interested

Anesthesia h Very Interested h Interested h Neutral h Not Interested

Radiology h Very Interested h Interested h Neutral h Not Interested

Dermatology h Very Interested h Interested h Neutral h Not Interested

Ophthalmology h Very Interested h Interested h Neutral h Not Interested

Other ____________ h Very Interested h Interested h Neutral h Not Interested

4- If you chose to participate in the class, please comment on whether or not you achieved your goals by taking this class.

5- Do you feel that participation in this class affected your grades? If so, how?

6- Have you taken an anatomy class prior to medical school? If so, please state during at which level of education and for how long.

7- Have you ever observed or participated in an operation?

8- Are any of your family members physicians? If so, which specialties?

9- What is your opinion of surgeons (check all that apply):

h friendly h approachable h good teachers h unapproachableh reserved h do not take time to teach h rushed h busy

h good listener h not team players h arrogant h cold h compassionateh inconsiderate

10- The course objectives were clear to me.

h True h False

11- Do you think the length of the classes were appropriate?

12- Do you think there were too many classes, not enough classes, or the right amount of classes?

13- Was the video section of each class educational? Please comment on likes and dislikes of the videos.

14- Was the dissection component of each class educational? Please list specific likes and dislikes of each dissection.

15- Please rank each surgeon on a scale of 1 to 5 with 1 being poor, 2 being below average, 3 being average, 4 being above average,

and 5 being exceptional. Please list specific comments about each attending surgeon:

A- General Surgical Knowledge: h1 h2 h3 h4 h5

B- Orthopedic Surgery: h1 h2 h3 h4 h5

C- Cardiothoracic Surgery: h1 h2 h3 h4 h5

(Continued)

Anatomical Sciences Education NOVEMBER/DECEMBER 2009 269


6/8

In the future, as the students are followed, descriptive sta-tistics will be used to compare student demographics betweenthe students in the Surgical Clinical Correlates in Anatomyprogram and those in traditional medical school course. Atwo-sample t-test will be used to compare the third-year shelfexaminations between the groups as well as their residencymatch. These test scores may be regressed on the groups andadjusted by student demographics. All analyses will be car-ried out using Statistical Package for the Social Sciences

(SPSS) software, version17.0 (SPSS, Chicago, IL).

RESULTS

Student Grades After Implementation of the

Surgical Clinical Correlates Program

We divided the first-year medical school class into threegroups prior to evaluating their anatomy examination results.The first group consisted of the 25 participants of SurgicalClinical Correlates in Anatomy, the second group includedthe students that were not selected but had volunteered forthe program, and the third consisted of the remainder of thefirst-year class. Our 25 participants had the highest average,

87.69%, for all combined anatomy examinations. The secondgroup was next with an average of 86.90% and the thirdgroup was last with an average of 85.94%. There was atrend for our participants doing better than the rest of thefirst-year class, so we performed an ANOVA comparingscores by group while controlling for total MCAT score.Total MCAT score was used to control for the possibility ofpreexisting differences in academic aptitude across the threegroups. The ANOVA showed that there was no significantdifference between the three groups (P 5 0.388) (Fig. 1). Aswe were using groups of different sizes, we tested thedata for heterogeneity of variance and found that it was notsignificant.

Opinions of Students after the Implementation

of the Surgical Clinical Correlates Program

The post-evaluation questionnaire included specific questionsregarding opinions that may have changed due to participa-tion in the Surgical Clinical Correlates in Anatomy Program.Thirteen of the 25 participants felt that the program had infact improved their anatomy grades. Twenty-four studentsfelt the program was helpful and would recommend it toothers. Twenty-three students thought that the class shouldbe continued. Twenty-two students felt that the classes werewell-organized, while only three thought that they were notwell-organized. Importantly, the opinion of surgeons frombefore the program to after the program improved based ona variety of descriptors (Fig. 2). Overall, the positive opinionof surgeons increased for all students in the entire medicalschool class from pre- to post-evaluations (P < 0.003, t-test).There was a greater increase in positive opinions for partici-pants in Surgical Clinical Correlates program (P < 0.008,ANOVA).

DISCUSSION

The Surgical Clinical Correlates in Anatomy program wassuccessfully implemented at the OSU College of Medicine.Many challenges were met and obstacles had to be overcome.First, it was exceptionally difficult to schedule the sessionswith the attending surgeons due to time constraints. Therewere several times when organizational meetings were can-celled at the last minute due to patient emergencies. Schedul-ing attending surgeons for their sessions into available medi-cal student time slots was exceptionally complicated. Eachattending surgeon had clinical responsibilities that had to beworked around. Plus, we had to fit the classes into the first-year medical school curriculum. Two classes had to be

Table 3.

(Continued)

D- Cardiothoracic Surgery: h1 h2 h3 h4 h5

E- General Surgery: h1 h2 h3 h4 h5

F- Urologic Surgery: h1 h2 h3 h4 h5

G- Vascular Surgery: h1 h2 h3 h4 h5

H- ENT: h1 h2 h3 h4 h5

I- Plastic Surgery: h1 h2 h3 h4 h5

16- Do you think the number of students in the class was appropriate?

17- Do you think the classes were well-organized?

18- I enjoyed participating in this program.

h Strongly Agree h Agree h Neutral h Disagree h Strongly Disagree

Every student in the first-year medical school class was given this questionnaire after their final examination in anatomy. All of thequestionnaires were returned for evaluation.

270 Haubert et al.


7/8

rescheduled or started late due to conflicts or clinical respon-sibilities.We encountered difficulty in determining how to best

advertise the Surgical Clinical Correlates in Anatomy pro-gram to the incoming first-year medical students. A flier wascreated to promote the program, but we were not able toshare the information with the medical students prior to thefirst day of anatomy class. Fliers were placed in the medicalstudents mailboxes and the program was introduced duringthe first anatomy class. An e-mail was also distributed to allof the first-year medical students the weekend prior to thefirst day of class. Because of the late presentation of informa-tion, some students did not receive the flier because they didnot check their e-mail, mailboxes or show-up to class. We

have since gained permission to send out the advertisementflier to the incoming first-year medical students with the ori-entation packet mailed to the students many months prior tostarting classes.

Difficulties were also encountered during the student vol-unteer process. Several students either e-mailed after thedeadline or e-mailed the wrong person prior to the deadline.These students did not get included in the randomized lottery,but served as another study group comprising those studentsinterested, but not chosen. One student that was selected toparticipate in the program offered his position to a friendthat had not met the time deadline but this was interceded.None of the students chosen withdrew from the program.

With respect to the actual cadaver operations, we havediscovered many improvements that can be made for futureyears. For instance, the students had a difficult time all hav-ing an opportunity to dissect the human heart during the Car-diothoracic Surgery class. We, therefore, plan to have cowhearts available for each student to dissect and appreciatenext year. The room used this year was too small for 25 stu-dents, two cadavers and faculty. Therefore, we will use alarger room for the cadaver section next year and have asmall area where the students can sit down during the videoportion of the class. We are also going to increase the numberof faculty per session; each class will have two attending sur-geons and a fellow or senior resident. This will allow moresurgeon time per student for hands-on participation.

Overall, we felt that the evaluation questionnaire helpedus to assess our strengths and weaknesses in the implementa-tion of this program for the first time. The students in generalfelt that the program, which involved an extra time commit-ment, was worthwhile and should be offered to future stu-dents. Additionally, the majority of the students felt that itcovered the correct subject matter and that it was generallywell-organized. This is in light of the fact that this year, thefirst-year anatomy examination results did not differ between

those in the program, those that volunteered but were notchosen and those that had not expressed an interest. Theseequivocal results in examination scores may reflect the changein the curriculum this year and a new examination. Ourresults from the program next year, which will be the secondyear of the new curriculum, are therefore anxiously awaited.Last, the impression of surgeons statistically improved afterthe implementation of this program. This was most promi-nent amongst those that had participated in the program.This was not only statistically impressive but also a reality, inthat the overall participation of the surgical faculty and theinteraction with the medical students has palpably improved

Figure 1.Cumulative anatomy examination results for the first-year medical students.The first-year anatomy examinations, both practical and written, were com-pared between the participants in the Surgical Clinical Correlates Program, thevolunteers that were not selected due to space limitations and the remainder ofthe class that did not show any interest in the program. The 25 program par-ticipants had the highest average, 87.69%, for all combined anatomy examina-tions. The second group was next with an average of 86.90% and the thirdgroup was last with an average of 85.94%. The ANOVA showed that therewas no significant difference between the three groups (P 5 0.388). As wewere using groups of different sizes, we tested the data for heterogeneity of var-iance and found that it was not significant.

Figure 2.

Opinions of surgeons before and after participation in surgical clinical corre-lates in anatomy. Importantly, the opinion of surgeons from before the pro-gram to after the program improved based on a variety of descriptors, includ-ing being friendly, good teachers, approachable, busy, arrogant, rushed, andcompassionate. Overall, the positive opinion of surgeons increased for all stu-dents in the entire medical school class from pre- to post-evaluations ( P

anatomy surgery

Documents