Introduction to Theatre and Basic Surgical and Anaesthetic Skills: A New Theatre Induction Course for Medical Students

Traditionally, the operating theatre is a suboptimal educational setting for medical students. It is an unfamiliar learning environment for those new to clinical medicine, with its own rituals, protocols and etiquette. Learning objectives are not defined clearly and many students perceive the time spent in the operating department as being of little or no educational benefit. Furthermore, most students receive very little or no formal induction into the theatre environment and this has a negative impact on learning behaviours and, indeed, patient safety.

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Training in Theatre: Are Bigger Hospitals Better?

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363512x13311314196258 ◽

2012 ◽

Vol 94 (6) ◽

pp. 1-4

Author(s):

M Field ◽

S Mitchell ◽

D van Dellen ◽

D Wall ◽

S Roff

Keyword(s):

Medical Students ◽

Learning Environment ◽

Career Choice ◽

Working Life ◽

Active Role ◽

Operating Theatre ◽

Junior Doctors ◽

Training Experience ◽

Profound Impact ◽

And Training

The operating theatre is a central part of a surgeon's working life. Medical students are exposed to it as a learning opportunity and as an introduction to a possible career. Junior doctors experience the operating theatre as a learning and training experience as well as a process in which they play an active role. Despite its obvious importance as a learning environment, it has received comparatively little interest and research as a distinct environment. However, the environment within the operating theatre may have a profound impact on learning and on subsequent career choice.

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Medical students’ perception of behaviors in the clinical learning environment evolve with increasing clinical exposure as measured with situational video vignettes

Medical Teacher ◽

10.1080/0142159x.2020.1759790 ◽

2020 ◽

Vol 42 (7) ◽

pp. 822-827

Author(s):

Howard B. Fleit ◽

Wei-Hsin Lu ◽

Doreen M. Olvet ◽

Latha Chandran

Keyword(s):

Medical Students ◽

Learning Environment ◽

Clinical Learning ◽

Clinical Learning Environment ◽

Clinical Exposure ◽

Video Vignettes

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Medical Students and Patients Benefit from Virtual Non-Medical Interactions Due to COVID-19

Journal of Medical Education and Curricular Development ◽

10.1177/23821205211028343 ◽

2021 ◽

Vol 8 ◽

pp. 238212052110283

Author(s):

Taylor M Coe ◽

Trevor J McBroom ◽

Sarah A Brownlee ◽

Karen Regan ◽

Stephen Bartels ◽

...

Keyword(s):

Medical Students ◽

Communication Skills ◽

Patient Experience ◽

Clinical Medicine ◽

Organ Transplant ◽

Medical Patient ◽

Pilot Program ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Clinical Communication

Background: Patient care restrictions created by the COVID-19 pandemic constrained medical students’ ability to interact directly with patients. Additionally, organ transplant recipients faced increasing isolation due to the rise of telemedicine, the importance of social distancing and their immunosuppressed state. We created a pilot program to pair students with transplant patients for structured, virtual encounters and studied its impact on medical students and patients. Methods: In May 2020, medical students conducted virtual visits with patients via telephone or video conferencing. Patients and students were surveyed regarding their experiences and independent focus groups were conducted. The survey responses and focus group discussions were deidentified, transcribed, and analyzed for themes. Results: Ten participating students were in their first, second, or final year of medical school. The 14 patients were liver or kidney transplant recipients or kidney donors. All interactions lasted longer than 30 minutes, with 56% greater than 1 hour. Three themes emerged related to the student experience: improvement of their clinical communication skills, development of knowledge and attitudes related to organ transplantation and donation, and independent management of a patient encounter. Three themes related to the patient experience: appreciation of the opportunity to share their personal patient experience to help educate future physicians, a cathartic and personally illuminating experience and an opportunity to share the message of donation. Conclusions: This pilot program provided a novel opportunity for virtual student-patient interactions that was feasible, well-received, and mutually beneficial. The use of virtual non-medical patient experiences allowed for experiential learning during which students learned about both clinical medicine and enhanced their communication skills directly from patients. Additionally, patients were able to engage with medical students in a new way, as teachers of clinical interactions, and reported a high level of satisfaction in addition to deriving personal benefit.

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The impact of integrating environmental health into medical school curricula: a survey-based study

BMC Medical Education ◽

10.1186/s12909-020-02458-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Benjamin Kligler ◽

Genevieve Pinto Zipp ◽

Carmela Rocchetti ◽

Michelle Secic ◽

Erin Speiser Ihde

Keyword(s):

Climate Change ◽

Medical Education ◽

Medical Students ◽

Medical School ◽

Environmental Health ◽

School Curriculum ◽

Learning Objectives ◽

Lead Contamination ◽

Institute Of Medicine ◽

The Impact

Abstract Background Inclusion of environmental health (EH) in medical education serves as a catalyst for preparing future physicians to address issues as complex as climate change and health, water pollution and lead contamination. However, previous research has found EH education to be largely lacking in U.S. medical education, putting future physicians at risk of not having the expertise to address patients’ environmental illnesses, nor speak to prevention. Methods Environmental health (EH) knowledge and skills were incorporated into the first-year medical school curriculum at Hackensack Meridian School of Medicine (Nutley, New Jersey), via a two-hour interactive large group learning module with follow up activities. Students completed the Environmental Health in Med School (EHMS) survey before and after the year 1 EH module. This survey evaluates medical students’ attitudes, awareness and professionalism regarding environmental health. In year 2, students completed the Environmental Health Survey II, which measured students’ perceptions of preparedness to discuss EH with future patients. The research team created both surveys based upon learning objectives that broadly aligned with the Institute of Medicine six competency-based environmental health learning objectives. Results 36 year 1 students completed both the pre and post EHMS surveys. McNemar’s test was used for paired comparisons. Results identified no statistically significant changes from pre to post surveys, identifying a dramatic ceiling. When comparing year 2, EHS II pre-survey (n = 84) and post-survey (n = 79) responses, a statistically significant positive change in students’ self-reported sense of preparedness to discuss environmental health with their patients following the curriculum intervention was noted. Conclusions Our conclusion for the EHMS in Year 1 was that the current generation of medical students at this school is already extremely aware of and concerned about the impact of environmental issues on health. Through the EHS II in Year 2, we found that the six-week environmental health module combining didactic and experiential elements significantly increased medical students’ self-reported sense of preparedness to discuss environmental health issues, including climate change, with their patients.

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764 Human Factors in Operative Theatres During the Covid-19 Pandemic: A Cross-sectional Analysis of Operating Theatre Staff Experiences in a Regional Centre

British Journal of Surgery ◽

10.1093/bjs/znab134.084 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

L E Murchison ◽

R Anbarasan ◽

A Mathur ◽

M Kulkarni

Keyword(s):

Human Factors ◽

Online Survey ◽

Situational Awareness ◽

Negative Impact ◽

High Stress ◽

Operating Theatre ◽

Free Text ◽

Cross Sectional ◽

Chi Squared ◽

Theatre Staff

Abstract Introduction In the already high-risk, high-stress environment of the operating theatre, operating during Covid-19 has brought its own unique challenges. Communication, teamwork and anxiety related new operating practices secondary to Covid-19 are hypothesised to have a negative impact on patient care. Method We conducted a single-centre online survey of operating theatre staff from 22nd June–6th July 2020. Respondents completed 18 human factors questions related to COVID-19 precautions including communication, teamwork, situational awareness, decision making, stress, fatigue, work environment and organisational culture. Questions consisted of yes/no responses, multiple choice and Likert items. Kruskall-Wallis tests, Chi-Squared, Mann Whitney U tests, Spearman’s correlation coefficient, lambda and Cramer’s V tests were used. Free-text responses were also reviewed. Results 116 theatre staff responded. Visual (90.5%), hearing/ understanding (96.6%) difficulties, feeling faint/lightheaded (66.4%) and stress (47.8%) were reported. Decreased situational awareness was reported by 71.5% and correlated with visors (r = 0.27 and p = 0.03) and FFP2/3 mask usage (r = 0.29 and p = 0.01). Reduced efficiency of theatre teams was reported by 75% of respondents and 21.5% felt patient safety was at greater risk due to Covid-19 precautions in theatre. Conclusions Organisational adjustments are required, and research focused on development of fit-for-purpose personal protective equipment (PPE).

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Perceptions of a Remote Learning Pathology Elective for Advanced Clinical Medical Students

Academic Pathology ◽

10.1177/23742895211006846 ◽

2021 ◽

Vol 8 ◽

pp. 237428952110068

Author(s):

Kara S. Tanaka ◽

Rageshree Ramachandran

Keyword(s):

Medical Students ◽

Learning Environment ◽

Online Survey ◽

Learning Goals ◽

Asynchronous Learning ◽

Self Directed Learning ◽

Anatomic Pathology ◽

Institutional Review ◽

Clinical Clerkships ◽

Remote Learning

In mid-March 2020, our institution removed most medical students from in-person clinical clerkships due to the COVID-19 pandemic. The Department of Pathology responded by transitioning a fourth-year clinical elective to an all-remote format composed of synchronous didactics, daily clinical sign-out utilizing digital microscopy, and asynchronous learning materials. Thirty-seven medical students completed 2- or 4-week anatomic pathology electives tailored to meet their career goals and allowing them to progress toward graduation. Institutional Review Board approval was granted to survey students’ perceptions of engagement in the remote learning environment. Quantitative and qualitative data were collected using a standardized school-wide end-of-rotation survey, an online survey developed by the authors, and students’ self-directed learning goals. End-of-rotation data showed the remote pathology course performed well (4.88 of possible 5) when compared to all advanced clinical clerkships (4.51, n = 156 courses), all elective rotations (4.41, n = 50 courses), and the traditional in-person pathology elective (4.73). Core strengths in the virtual environment included high educational value, flexibility of content and schedule, organization, tailoring to an individual’s learning goals, and a positive education environment. Deficits included the inability to gross surgical specimens, inadequate observation or feedback about students’ skills, and impaired social connections. Areas for improvement included requests for in-person experiences and development of themed tracks for career exploration. Many aspects of anatomic pathology appear well-suited to the remote learning environment. While the remote model may not be sufficient for students pursuing careers in pathology, it can be adapted to increase nonpathologists’ understanding of interdisciplinary clinical collaboration with pathologists.

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Incorporating patient safety into early undergraduate medical education: teaching medical students to perform surgical time outs during anatomy

BMJ Open Quality ◽

10.1136/bmjoq-2020-001229 ◽

2021 ◽

Vol 10 (1) ◽

pp. e001229

Author(s):

Abdul-Rahman M Suleiman ◽

Daniel Amarasinghe ◽

Priya Kathuria ◽

Jacob Vandel ◽

Jordan Holloway ◽

...

Keyword(s):

Medical Education ◽

Patient Safety ◽

Medical Students ◽

Gross Anatomy ◽

First Year ◽

Surgical Time ◽

Surgical Safety ◽

Wayne State University ◽

Time Out ◽

Surgical Errors

ObjectivesTo introduce surgical safety checklists and time outs to future physicians through early incorporation of time outs in the first year gross anatomy course.SettingThe Wayne State University School of Medicine Anatomy Lab.ParticipantsApproximately 300 first year medical students per year participated in the intervention.InterventionsAn educational presentation on medical errors focusing on surgical errors was developed. Students in 2017–2018 viewed the presentation and completed two time outs, one with the first anatomy dissection and a second with the last dissection. Preintervention and postintervention surveys were completed and results compared. Students completed a second postintervention survey after the second time out. Students in 2018–2019 were asked to complete the time outs before every dissection. Time out procedure sheets were collected to determine completion rates. The intervention was further modified for academic year 2019–2020 and time out sheets were again collected.Outcome measuresFour domains of learning were surveyed: (1) major components and goals/limitations of universal protocol, (2) medical error lexicon, (3) components of a time out, and (4) confidence in completing time out checklists.ResultsPostintervention surveys demonstrated significant improvement in each domain. Students found time outs easy to complete and developed confidence in performing time outs. Following a successful pilot, time outs were incorporated into every dissection. Students continued to perform this procedure despite absence of adverse consequences for not doing so.ConclusionStudents found the time outs easy to complete and developed the confidence and ability to perform a surgical time out early in their medical education. The new skills, knowledge and attitudes that these medical students have developed will hopefully improve the care they provide to patients, thereby advancing the practice of quality improvement and patient safety in the clinical setting.

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