Quick Shot II - Curriculum
CREATING SURGEONS FOR RURAL AMERICA: THE IMPACT OF RURAL SURGERY EXPOSURE ON CLERKSHIP STUDENTS
Danielle Shin, BS, Richard Aldan, MD, Melissa Easley, MD, Gagandeep Japra, BS, Kaitlyn Tice, BS, Luke Guy, BS, Ashley Oh, BS, Jeremy Altman, L. Renee Hilton-Rowe, MD; Medical College of Georgia at Augusta University
Background:
The American College of Surgeons projects a significant shortage of surgeons by 2034, with rural communities poised to face disproportionate impacts. Meaningful exposure to rural sites for medical students and early recruitment of physicians during training are key to addressing this disparity. Our study evaluates the impact of rural surgical clerkship sites on medical student interests in surgery and rural practice.
Methods:
Online surveys were administered to third- and fourth-year medical students following completion of their general surgery or surgical subspecialty rotations. Our surveys evaluated student perceptions of rural practice and interest in pursuing rural surgery. Responses were quantified using a Likert scale. Descriptive statistical analysis and Wilcoxon signed rank test were performed using SAS (version 9.4).
Results:
115 responses were collected, with 73 being obtained from students who completed either core or subspecialty surgery rotations at a rural site. Survey results indicated that students who rotated at rural sites developed increased interest in rural practice (p < 0.0001) and in pursuing a surgical career (p = 0.0004).
Conclusion:
Access to appropriate medical and surgical care in rural regions remains a key public health issue. It is critical for both medical students and residents to have early engagement with rural sites to facilitate interest in rural practice. The results of our study provide valuable insight into medical student perceptions of rural practice and interest in rural surgery, highlighting the value of including rural sites in medical clerkship curricula.
NEEDS ASSESSMENT FOR AN EDUCATIONAL CURRICULUM ON EMERGENCY CONVERSION FROM ROBOTIC THORACOSCOPY TO OPEN THORACOTOMY
Caroline Ricard, MD1, Dena Shehata1, Deanna Plewa1, Feiran Lou, MD2, Cameron T. Stock, MD1, Susan Moffatt-Bruce, MD1, Elliot Servais1, Ammara Watkins, MD1; 1Lahey Hospital and Medical Center, 2UMass Memorial Health
Introduction: Robotic assisted thoracoscopic surgery is the most common operative approach in the United States for anatomic lung resection. However, surgeon experience and confidence with emergency conversion (EC) to open thoracotomy is unknown. We sought to describe this educational gap by conducting a needs assessment for an EC curriculum for thoracic surgeons.
Methods: An online needs assessment survey was conducted for an EC curriculum for thoracic surgeons. The survey was developed by a group of stakeholders and revised after being piloted on a representative group of thoracic surgeons. We surveyed thoracic surgeons globally regarding their experience and confidence with EC; experience and confidence of their bedside assistant with EC; interest in an EC curriculum; and content and format for an EC curriculum. Surveys were distributed via the General Thoracic Surgery Club and Thoracic Outcomes Research Network listservs, and private social media outlets.
Results: Forty-five thoracic surgeons responded, reflecting viewpoints across North America. Only 40% of thoracic surgeons received EC training during residency or fellowship. Only 28.3% of surgeons report the presence of an EC protocol at their hospital, while 67.4% of surgeon respondents have had to perform EC intraoperatively. Some surgeons (26.1%) felt that their bedside assistant’s experience with EC influences their decision or timing to convert. Most surgeons (80.5%) demonstrated interest in participating in an EC curriculum. The most positively rated stakeholders to participate in the EC curriculum were the surgeon (97.8%), bedside assistant (97.8%), surgical resident/ fellow (95.7%), surgical technician (89.1%), circulating nurse (93.5%), and anesthesiologist (69.6%). The most positively rated content topics were EC rehearsal with the bedside assist (100%); troubleshooting robotic faults (100%) and bleeding scenarios (100%) that may necessitate EC; and communication best practices between the surgeon, bedside assist, anesthesiologist, and staff (100%). The most highly rated learning methods were group discussion, videos, and hands-on practice.
Conclusions: This needs assessment demonstrates that thoracic surgeons have inconsistent experience and confidence with EC, a strong interest in an EC curriculum, a desire to train the entire thoracic surgery team using experiential learning methods. Development of learning objectives and formal curricula for EC are needed to bridge this educational gap.
LOW-COST SIMULATION FOR HIGH-IMPACT LEARNING IN MANAGING BENIGN ANORECTAL CONDITIONS
Abigail J Hatcher, MD, MSc, Blake T Beneville, MD, Cory Fox, BA, Danyi Wang, BA, Paul E Wise, MD, Michael M Awad, MD, PhD, MHPE, Kerri A Ohman, MD; Washington University in St. Louis
Introduction:
Anorectal conditions are commonly encountered in general surgical and colorectal practice. Despite their prevalence, General Surgery (GS) residents often graduate with limited hands-on experience in managing these conditions, with the ACGME only requiring a minimum of 20 anorectal cases during residency. To standardize and broaden experience with these procedures, this study aimed at delivering to junior residents a simulation focused on multiple anorectal pathologies and related technical skills.
Methods:
A pilot study was conducted targeting PGY-1 and PGY-3 GS residents prior to their transition to consult and chief roles respectively, with colorectal surgery faculty and fellows serving as instructors for the 1.5-hour lab. Hemorrhoid, fistula, and abscess models were adapted from previously described methods (Figure 1). Procedures included hemorrhoidectomy, banding, fistula probing seton placement, and abscess incision and drainage (I&D) with mushroom catheter placement. Pre- and post-lab surveys investigated residents' prior clinical experience, procedural confidence, and lab feedback.
Results:
The study uncovered differences in experience between PGY-1 (n=17) and PGY-3 (n=13) residents, with PGY-3s reporting higher rates of performing the tested procedures. Self-reported confidence improved post-simulation for all procedures (p<0.05), specifically in performing a perirectal I&D (1.952.81 on a 5-point Likert scale from “not at all” to “extremely confident”) and hemorrhoidectomy (1.67-->2.63). All residents lacked experience with banding, exhibiting a marked increase in confidence performing one post-simulation (1.52-->2.74; p<0.05). Confidence in placing a mushroom catheter rose in PGY-1s (1.46-->2.84; p<0.05). Resident feedback for lab was overall positive with a mean of 3.5/5 (SD 1.05) in applicability to real-world scenarios, rating the experience between moderately and very useful. 78% of participants believed the lab was appropriate for PGY-1 and PGY-3 learners.
Conclusions:
Our novel simulation enhanced resident confidence in managing anorectal conditions, although knowledge scores remained static, indicating a need for iterative education sessions. The rise in confidence scores, though not to the level of complete procedural readiness, suggests that participants appropriately demonstrated progression toward proficiency, reflecting realistic skill development for junior trainees. The pilot revealed that the simulation lab shortened the educational gap, but continuous practice and integrated knowledge reinforcement are essential for comprehensive skill acquisition.
IMPACT OF STOP THE BLEED TRAINING INTEGRATION INTO MEDICAL STUDENT CURRICULUM
Jessica Santhakumar, MTM1, Elizabeth Raby1, Matthew Y Lin, MD2, Sarah Garden, RN3, Andre R Campbell4; 1University of California, San Francisco School of Medicine, 2University of California, San Francisco Department of Surgery, 3Trauma Program Zuckerberg San Francisco General Hospital, 4Zuckerberg San Francisco General Hospital Department of Surgery
Introduction: Studies estimate that hemorrhage or its complications cause 40% of trauma-related deaths. Stop the Bleed (STB) is a national curriculum training bystanders to administer life-saving care for traumatic bleeding until medical help arrives. However, limited instructor availability constrains teaching as many community members as possible. We evaluate the implementation and student perceptions of STB training during surgery clerkship curriculum with the goal of preparing medical students to serve as instructors.
Methods: Since 2019, we administered STB courses during 3rd year medical student surgery clerkships. These 3 hour trainings were traditionally led by registered nurses with hourly rates of $77-135 to fulfill the course-required 10:1 student to instructor ratio. Course completion qualifies learners to become instructors, and starting in March 2023, interested medical students volunteered to join the cadre of instructors. We describe the ability to implement the course for 6 years and evaluated responses to a 5 item post-course student survey to assess student’s perceptions of the course and willingness to become an instructor between February 2019 to September 2025.
Results: STB training was offered 39 times during general surgery clerkships from 2019-2025 reaching 838 medical students. Of the 20% of learners completed the feedback form, 99.4%(n=168) of respondents agreed that course content was delivered clearly, and 98.8%(n=167) of respondents felt confident that they would be able to help an injured person who was bleeding. 14.8%(n=124) of respondents expressed interest in becoming instructors, and 16 went on to teach courses. Since March 2023, medical students have joined as Associate Instructors to deliver 17 classes, reaching 403 community members. Volunteer medical student instructors provided a cost-saving benefit to the program by offsetting the cost of paid instructors and freeing up paid instructors for clinical responsibilities.
Conclusions: We conclude based on a sustained period of integration that STB can be taught to the entire class of medical students and expand instructor pools. Recruiting medical students as volunteer instructors provides students with opportunities for community engagement while offsetting the personnel cost of nursing instructors. This model can be applied in other medical schools to benefit both medical students and the community.