Student and Attending Preceptor Perceptions of Longitudinal Clinic as a Surgical Education and Assessment Tool.

Abstract

Introduction: As undergraduate medical education becomes increasingly longitudinal, particular attention is needed to maintain sufficient exposure to surgical disciplines. While traditional medical student clerkships are isolated 4 to 8-wk blocks on a single service, one unique adjunct to the traditional clerkship model is the continuity clinic (CC): a weekly longitudinal requirement that occurs either during the traditional clerkship or following clerkships while conducting independent research. This study compares attending surgeon and medical student perceptions of important characteristics in evaluating a student in CC and the perceived utility of this experience in assessment and preparation for subinternships.

Methods: Attending preceptors in surgical specialties and medical students from two academic institutions who completed a surgical CC were surveyed on the importance of various characteristics in CC evaluation. Thirteen characteristics were ranked by importance (1-most important, 13-least important). Subjects were asked to rate the value of CC for evaluation and educational purposes. Students also completed presurveys/postsurveys examining their confidence in clinical skills before and after CC. Analysis was performed using Fisher's exact, Mann-Whitney, and unpaired t-tests where appropriate. Free-text comments were analyzed using natural language processing topic modeling.

Results: Altogether, 67 medical students and 38 attending surgeons completed the survey. Students ranked hard skills as more important and soft skills as less important in CC evaluation compared to attendings. Students ranked knowledge related to interpretation of radiologic or laboratory results, surgical planning, and routine disease processes higher than attending surgeons. Students ranked hard skills such as patient presentation and documentation, and soft skills such as interpersonal and communication skills and professionalism significantly lower than attendings. Following participation in CC, students reported increased confidence in several skills, including perioperative consultation, preoperative assessment, surgical planning, and disease surveillance, as well as improved self-evaluation of preparedness for subinternship. Forty-two percent of students planned to request a letter of recommendation from their CC preceptors, and attendings rated the assessment value of CC as at least equivalent to a subinternship (mean 5.6/10, 1-worse than subinternship, 10-better than subinternship for assessment).

Conclusions: CC is an educational tool that facilitates maintenance and improvement in student confidence in clinical skills in the perioperative setting. In evaluating performance, students tended to rank hard skills as more important and soft skills as less important than their attending preceptors. Notably, attendings saw CC as a comparable assessment tool to subinternships. As undergraduate medical education continues to implement longitudinal experiences and research years, CC should be considered as a strategy to improve perioperative education and promote self-efficacy in clinical skills.