case study by Kaitlynn E . Butler 1 ; Karina Clemmons , EdD 2 ; Saleema Karim , PhD 3 ; Linda L . M . Worley , MD 4 ; Hanna Jensen , MD , PhD 5
1
Medical Student , UAMS College of Medicine , Little Rock , Ark .
2
Associate Professor , Medical Humanities and Bioethics , UAMS College of Medicine , Little Rock , Ark
3
Dept . of Health Policy and Management , UAMS College of Public Health , Little Rock , Ark .
4
Professor of Psychiatry and Obstetrics and Gynecology UAMS College of Medicine , Little Rock , Ark
4
Adjunct Professor of Medicine Vanderbilt University School of Medicine , Nashville , Tenn . 5 Assistant Professor , Clinic Research , Departments of Surgery and Radiology , UAMS Northwest , Fayetteville , Ark .
Enriching the Surgical Clerkship Experience While Bolstering Interest in Anesthesiology
Abstract
In a state with an academic medical center with two geographically separate campuses , scheduling of third-year surgical and anesthesiology rotations is different . All students at the regional campus are exposed to anesthesiology , while only some students at the main campus complete anesthesiology as an elective rotation . This study examined students ’ experiences with the differing approaches via a survey . Students who rotated on anesthesiology reported greater comfort with procedures , enhanced understanding of and comfort within the operating room setting , and felt it contributed to their overall success on their surgical clerkship . Our data suggests a benefit from an anesthesiology rotation , and we encourage discussion about making this a component of medical education on both campuses .
Introduction
Anesthesiology clerkship requirements vary widely within medical schools across the U . S . According to the AAMC 2018- 2019 academic year report , just 18 % of medical schools required an anesthesiology clerkship ranging from one to four weeks , and occurring in the M2 , M3 , or M4 year . A 2018 study conducted at the Emory University School of Medicine concluded that a week-long anesthesiology clerkship positively impacted third-year students ’ knowledge of perioperative medicine when strategically placed in the middle of the surgical clerkship . 1 A number of other studies have concluded that required anesthesiology rotations have a positive impact on overall medical student education , regardless of the students ’ ultimate specialty choices , in addition to stimulating an increased interest in the field . 2-4
In a state with an academic medical center that has two geographically distant campuses , third-year students have varied educational experiences in anesthesiology . At the older , fully established campus , 100 % of the eight-week surgical clerkship is focused exclusively on surgery . At the regional campus , medical students complete a one-week integrated anesthesiology rotation embedded within their first week of the eight-week surgical clerkship . Separately , students at both campuses complete two “ selective ” rotations , each two-week rotations of the students ’ choices from eight options including but not limited to anesthesiology , emergency medicine , and surgical subspecialties . These selective rotations occur at different times throughout the year based on individual students ’ schedules , with some students completing them before the surgery clerkship and some after . In summary , all students at the regional campus are exposed to anesthesiology , specifically before their surgical clerkship , while students ’ exposures on the main campus occurs only if they elect to take the anesthesiology selective , which may occur before or after their surgical clerkship .
These differences in approach provided an opportunity to study how the presence and timing of exposure to anesthesiology impacts medical student education . Components examined include medical students ’ perceived knowledge of perioperative medicine ; acquisition of procedural skills such as peripheral IV placement , bag mask ventilation , and endotracheal intubation ; understanding of and interest in anesthesiology as a career choice ; knowledge of the flow of the operating room and the role of the student in the operating room ; and students ’ perceptions of their success within their surgical clerkship . Students who rotated on anesthesiology prior to their surgical clerkship were queried whether this preparatory experience influenced their overall success within their surgery clerkship .
Materials & Methods
A Likert scale survey was generated via a computerized survey software ( REDCaps ) and securely distributed via email to all 350 third- and fourth-year medical students at UAMS in spring of the academic year 2019-2020 . The survey was collected anonymously and did not ask for identifying factors . Eighty-seven responses ( 25 %) were received . Students were sorted based on their schedule . Group 1 consists of medical students who completed any anesthesiology training prior to their surgical clerkship . This included both the embedded one-week rotation at the regional campus and the two-week anesthesiology optional selective / clerkship at both campuses . Group 2 consists of medical students who completed an optional two-week selective / clerkship in anesthesiology after their surgical clerkship . Group 3 consists of students who had no exposure to anesthesiology .
Students were asked to indicate their opinion on a series of statements . For statistical analysis , “ strongly disagree ” responses were grouped with “ disagree ;” “ strongly agree ” responses were grouped with “ agree .”
A section was included for optional narrative explanations / comments . This study was approved by the Medical School ’ s Institutional Review Board . Distribution of questionnaire responses are presented using frequencies and percentages . Sta-
181 • The Journal of the Arkansas Medical Society www . ArkMed . org