From classroom to OR: A novel pre-clerkship surgical workshop

Abstract

The transition from pre-clinical studies to clinical training represents a significant shift for medical students as they move from classroom-based, theoretical learning to hands-on experiences in clinical settings. While medical curricula traditionally prioritize foundational knowledge and technical skills, it often does not adequately address the interpersonal skills needed to navigate complex team dynamics.¹ As a result, students entering clinical rotations often feel unprepared, struggling to understand the specific roles and expectations of their surgical teams. Consequently, they may struggle to engage effectively in the learning process, leading to heightened anxiety and decreased confidence, which impacts their performance in clerkship.¹ Recognizing these gaps early is crucial for improving surgical clerkship experiences. Our workshop was the first of its kind in Canada, designed to specifically address these unmet needs.

The development of our workshop was guided by Kern's six-step approach to curriculum. A needs assessment (Steps 1 and 2), conducted with second-year medical students and stakeholders at our institution, revealed a high demand for teaching non-technical competencies for clerkship. Learning objectives (Step 3) covering key competencies such as OR workflow, rounding, progress notes, surgical consults, oral case presentations, and strategies for managing overnight call were established. To achieve these, we employed multiple educational strategies (Step 4), such as interactive role-play scenarios, case-based discussions, and individualized coaching. Our workshop included diverse group of instructors, including a staff surgeon, OR nurse, surgical residents, fellows, and a medical student.

The workshop was implemented (Step 5) through five 1-h stations, ensuring an optimal learner-to-instructor ratio (ranging from 6:1 for the non-operative skills stations and 2:1 for the operative skills station). Evaluation and feedback (Step 6) were gathered through post-workshop surveys measuring students' confidence, preparedness and objective skill performance.

Our curriculum effectively addressed gaps in surgical education by integrating practical skill development, near-peer teaching, and a collaborative learning environment to prepare students for surgical clerkship. Near-peer instructors, having faced similar challenges, made the content more relatable and engaging, while diverse team of instructors provided valuable insights that demystified clerkship. As a result, students reported reduced anxiety and increased confidence in starting surgical rotations. This early intervention also improved students' perceptions of surgery, enhanced preparedness and eased the emotional burden of high-pressure surgical settings.

Students' feedback after the workshop:

While organizing the workshop, we faced a few challenges, including coordinating instructors' schedules, securing funding, admitting limited learners due to space constraints and selecting essential content to fit the available time. To address these, we scheduled sessions on weekends to align with instructors' availability and sought institutional support to help offset costs. We also prioritized high-yield topics based on student feedback and clerkship expectations. Currently, we are collaborating with institutional stakeholders to integrate the workshop into the pre-clerkship curriculum. Furthermore, our curriculum can be adapted for implementation at other institutions, expanding its reach and impact.

Prachikumari Patel: Conceptualization; writing—original draft; methodology; writing—review and editing; formal analysis; project administration. Emily Lan-Vy Nguyen: Conceptualization; writing—review and editing; methodology; project administration. Chaya Shwaartz: Conceptualization; writing—original draft; methodology; validation; writing—review and editing; project administration; supervision.

None.

The University Health Network (UHN) Quality Improvement Review Committee (QIRC) reviewed and approved this project as a quality improvement project and formally exempted it from the Research Ethics Board review (QI ID# 23-0622).