clinical exposure during a surgery clerkship: contrast between a canadian and an american medical...
TRANSCRIPT
Clinical Exposure During a Surgery Clerkship: Contrast between a
Canadian and an American Medical School
Division of General Surgery and the Center for Medical Education
McGill University
Sarkis Meterissian, A Sender Liberman and Moishe Liberman
Introduction Surgical clerkships should expose medical students to
common surgical disorders Clerkships should provide hands-on experience with
diagnosis and disease management Study at SIU showed that students on a surgical clerkship
had little opportunity to be the first to interact with patients in the ER, clinic or in-patient setting
Boehler ML, JACS 2002;195:539-542
Hypothesis
Due to discrepancies in health care delivery and resources between the US and Canada, medical clerks in Canada get more hands-on training than clerks in the United States
Objectives
1. Evaluate and quantitate the contact that medical students receive while on their surgical rotation in a Canadian medical school
2. Compare the patient exposure experienced by students between a Canadian and an American medical school
Methods
Survey (8-item) administered to students at a Canadian medical school
Survey examined student exposure to patients during a surgical clerkship
Results of surveys were compared between the two universities:- McGill University and Southern Illinois University
Surveys Surveys at SIU were given to twenty 3rd year
medical students to evaluate 311 different student-patient encounters
Surveys at McGill were e-mailed to all 3rd and 4th year medical students to assess their overall student-patient interaction experience
Responses were on a 4-point Likert scale (Never, Seldom, Often, Always)
Statistical Methods Results of specific questions posed to medical
students reported as group percentages Never/Seldom, Often/Always lumped together for
statistical analysis Between group differences were compared using:
Pearson Chi-Square Test and Fisher’s Exact Test (categorical variables)
Independent Samples T-test (continuous variables)
ResultsCanadian Medical School
Student N= 50 Med-3: 14 Med-4: 32 Unknown: 4
Unknown4%
JGH28%
RVH30% MGH
26%
SMH12%
ResultsMost frequent place of patient encounter Percent of Students
Place of Encounter Canada USA P-Value
Clinic 10% 34% 0.001
IP Consult 0% 2.9% 0.226
ER Consult 34% 1.9% <0.001
AM Admit 2% 19% 0.003
OP Surgery 4% 28% <0.001
IP Surgery 36% 15% <0.001
ResultsCanadian / American Comparison
Number of physicians evaluating patients prior to student
0
0.5
1
1.5
2
2.5
CANADA USA
Mean (SD)
Canada 1.60 (0.79)
USA 2.41 (1.49)
P = 0.001
ResultsCanadian / American Comparison
CANADA USA P-Value
Student First to Elicit Chief complaint
44.0% 22.5% 0.003
Student Had Access to PM records
82.0% 80.1% 0.46
Initial P.E. Performed by Student
64.0% 36.3% <0.001
ResultsCanadian / American Comparison
CANADA USA P-Value
How often did student generate hypothesis 46.0% 14.8% <0.001
How often did student order investigations 44.0% 11.6% <0.001
Was diagnosis known prior to work-up 54.0% 85.2% <0.001
Discussion
Problems with this study:
1. Actual patient contact logbooks not reviewed at
McGill
2. Low numbers of students: 20 at SIU and 46 at
McGill
Discussion
Students in our medical school received more hands-on training than their American counterparts
Explanations:
- Differing teaching philosophies
- Differing sites for the initial encounter
Conclusions
While educational value is not evaluated in this study, these differences may result in:
1. increased interest in general surgery as a career
choice
2. better training of medical students
ResultsCanadian Medical School
Never Seldom Often Always
Student First to Elicit Chief complaint
14% 42% 38% 6%
Student Had Access to PM records
0 18% 60% 22%
Initial P.E. Performed by Student
4% 32% 56% 8%