Expectations and experiences of medical students in the surgery clerkship

Purpose The third-year surgical clerkship marks many students’ first exposure to surgery. However, what students expect they will engage in during their clerkship compared to their actual experience is largely unknown. We aimed to compare the expectations and realities of medical students’ experience during the surgery clerkship. Methods A survey assessing how frequently students expected to perform certain fundamental tasks and skills was administered to all third-year medical students before their clerkship. A similar survey was administered at the conclusion of the clerkship exploring what activities students actually engaged in and if any barriers to engagement were encountered. Results 83 students responded to the pre-survey and 69 responded to the post-survey (response rates of 97% and 80%, respectively). When examining fundamental tasks, 6/10 domains demonstrated marked discordance between student expectations and what was actually experienced. The greatest areas of discrepancy were writing orders (Pre: 64.5% perform 2–5x | Post: 73.9% never), writing brief operative notes (Pre: 38.7% perform 2–5x | Post: 91.3% never), and preparing the team list for rounds (Pre: 44.1% perform > 5x | Post: 75.4% never). With respect to fundamental skills, 3/10 domains demonstrated marked discordance: dissecting tissue during an operation (Pre: 50.5% perform 2–5x | Post: 36.3% never), placing a nasogastric tube (Pre: 53.8% perform 2–5x | Post: 46.4% never) and placing an IV (Pre: 44.1% perform 2–5x | Post: 84.1% never). On the post-clerkship survey, students rated seeing patients independently in clinic and the ED/inpatient setting as the most important tasks with mean Likert scores of 2.43 and 2.63, respectively (1 = most important, 9 = least important). Suturing a wound and interpreting radiology were considered the most important skills (Likert score 2.9 each). Common barriers to student participation were time constraints, conflicting responsibilities, lack of opportunities, and feeling unwelcome. Conclusions Medical students expect to be engaged in fundamental tasks and skills of the surgery clerkship at a much higher frequency than they actually experience. These results will help us target the areas of greatest discrepancy, set realistic expectations and minimize the barriers to student participation during the surgery clerkship.