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An assessment of surgery core rotation quality at osteopathic medical schools

  • Taylor Casey EMAIL logo , Zachary Brennan , Kenneth Pereira , Grace Young , Sarin N. Paluri and Craig Gudakunst
Published/Copyright: November 3, 2023
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 124 Issue 2

Abstract

Context

Osteopathic medical schools have traditionally placed a heavy emphasis on the field of primary care. While graduating osteopathic students continue to pursue family medicine, internal medicine, and pediatrics at higher rates than their allopathic counterparts, it is unknown whether students feel that surgical rotations are held to similar standards.

Objectives

The purpose of this study was to assess osteopathic medical student opinions of the quality of their surgical clerkships and to determine if good or poor experiences influenced their decision to continue pursuing surgery.

Methods

After Institutional Review Board approval, a voluntary and anonymous Qualtrics survey was sent to all nationally registered members of the American College of Osteopathic Surgeons, Medical Student Section (ACOS-MSS) in their final 2 years of medical school. Analyses were conducted utilizing R statistical software.

Results

A total of 345 responses were recorded from the Qualtrics survey sent to 2182 ACOS students from the national registry (response rate of 15.8 %). Students who found a mentor during their surgical rotations were more likely to consider a surgical career after they completed their rotations (odds ratio [OR]=1.43, p=0.003). Students at academic sites had more opportunities for research than those at community hospitals (p=0.019). Most students responded that they were still considering surgery as a career after rotation completion; a significant portion (OR=0.36, p<0.001) responded that they were no longer interested.

Conclusions

Medical students are most likely to review a surgical rotation favorably if they can connect with a mentor while on rotation. Osteopathic medical schools may benefit from instituting mentorship programs for students interested in surgery, as well as ensuring that their students have ample opportunity for research.

Keywords: medical student; mentoring; osteopathic; surgery clerkship

According to data collected from the 2022 National Resident Matching Program (NRMP), the match rate for Doctor of Osteopathy (DO) medical students into categorical general surgery was 53.4 %, whereas the rate for allopathic medical students was 72.1 % [1]. 2020 was the first year in which the match occurred under a single accreditation system between the American Osteopathic Association (AOA) and the Accreditation Council on Graduate Medical Education (ACGME) [2]. That year, the match rate for osteopathic seniors into categorical general surgery was 59.3 % [3]. Although there remains a paucity of data on the effects of matching under a single accreditation system, preliminary studies suggest that fewer osteopathic medical students are matching into surgical specialties, despite the fact the number of DO applicants to general surgery residency programs has been steadily increasing since 2017 as demonstrated by a retrospective study of NRMP match data from 2020, 2018, and 2016 [2].

Previous literature has evaluated why DO students face discrepancies matching into surgical specialties. A 2022 study by Heard et al. [3] evaluating the attitudes of program directors toward accepting osteopathic graduates concluded that 47.3 % of responding programs to their survey did not have a DO in their program. Program directors often cite DO students not taking the United States Medical Licensing Examination (USMLE) in addition to the Comprehensive Osteopathic Medical Licensing Evaluation (COMLEX), not having enough research, and students not completing a subinternship in their desired specialty as the primary reasons behind the discrepancy [3, 4]. Compounding the issue further is the newly implemented single accreditation system for allopathic and osteopathic residencies. A 2021 study by Cummings [5] evaluating 159 osteopathic surgical residencies found that 26 % of eligible osteopathic surgical programs did not submit an application for ACGME accreditation, resulting in a loss of 41 former AOA programs available to osteopathic graduates. Additionally, as of the time of this writing, 33 new medical schools (both allopathic and osteopathic) have been established since the turn of the 21st century [6]. The effect of opening new medical schools can be seen in the preliminary 2023 NRMP data; 42,952 certified applicants applied for only 40,375 available positions [7, 8].

Osteopathic medical schools have traditionally placed a heavy emphasis on primary care, which includes the specialties of family medicine, internal medicine, pediatrics, and obstetrics and gynecology [9]. Peters et al. [10] noted that primary care physicians constituted a larger proportion of faculty at osteopathic schools compared to allopathic programs. Moreover, students at allopathic sites were more likely to describe themselves as technologically-scientifically oriented, whereas osteopathic students were more likely to be socioeconomically oriented. This concurs with current trends; 57.2 % of DO graduates match into a field of primary care, although only 28.7 % of MD graduates do [11].

Previous studies have investigated the components necessary to make a surgical core rotation worthwhile in the eyes of a student. As shown by a qualitative and quantitative study of 13 postgraduate year (PGY) 4 and PGY 5 residents, students are more likely to review a surgical rotation favorably if they have opportunities to interact with a strong role model, typically a resident [12]. One study of 100 medical students at a Midwestern academic institution in four surgical specialties (general, vascular, plastics, and ear, nose, and throat [ENT]) found that medical students working with the highest-rated residents were more likely to pursue a surgical career than compared to medical students working with lower-rated residents [13]. The degree of participation in the operating room, feeling like a valuable part of the surgical team, and knowing that attendings and residents care about medical student learning are also directly correlated to positive student experience [12], [13], [14]. Additionally, a study of nine third-year medical students revealed that the vast majority of students feel more confident asking questions if they know that they will not be criticized [15]. Operating room staff beyond that of the resident and attending surgeons also play a role. A study of 209 medical school graduates from five different teaching hospitals showed that medical students are more likely to attend a greater number of surgeries if scrub technicians and circulating nurses create welcoming environments for student learners [16].

Thus, it is well established what is necessary to make a surgical clerkship education successful. However, what remains unknown is whether osteopathic medical students are receiving this while on rotations. The purposes of this study were to assess osteopathic medical student opinions of the quality of their surgical clerkships, as well as to determine if good or poor experiences influenced their decision to continue pursuing surgery as a career.

Methods

All third- and fourth-year medical students in the American College of Osteopathic Surgeons, Medical Student Section (ACOS-MSS) national registry who had completed at least one general surgery rotation were emailed a 40-question Qualtrics survey (Appendix A). Following Michigan State University Institutional Review Board (#STUDY00007139) approval, 2,182 students received an invitation by e-mail to complete it. The survey was initially distributed on January 29th, 2022 and remained active until February 28th, 2022. A reminder email was sent to those who had not yet completed it on February 14th, 2022. The study link was limited by e-mail address, so each participant could only submit one survey response. Participation in the study was voluntary and anonymous, and no incentives were given. The survey consisted of four questions on demographics, 15 on operating room experience, two on research, two on mentoring, and 14 on general hospital experience (outpatient clinic experience, skills lab training, etc.). The remaining questions regarded consent and general ideas for improvement.

Statistical analysis

All analyses were conducted utilizing R statistical software. To measure what predictors are associated with an increased consideration of a surgical career, an ordinal regression with a cumulative link model and random effect was utilized. The analysis was performed utilizing the following predictors from the survey: (1) during operations, I felt as though I could ask questions; (2) if there was an issue, I felt comfortable bringing it up to a superior; (3) I was able to find a mentor-like figure on my surgical rotation; (4) I felt as though I was an important part of the surgical team; (5) how often did you feel the attending focused on teaching you as the student; and (6) how often did you perform operations alongside residents/fellows. All plots were produced utilizing the ggplot package of R. The ordinal regression data may be found in Table 1.

Table 1:

Ordinal regression data answering the question, “What predictors are associated with increased consideration of a career in surgery after surgical rotations?” The predictors of interest were labeled as follows:

Predictors Odds ratios CI p-Value
−2/−1 0.21 0.14–0.31 <0.001
−1/0 0.48 0.34–0.69 <0.001
0/1 9.43 6.00–14.82 <0.001
1/2 24.52 13.28–45.29 <0.001
Q25 0.88 0.66–1.18 0.398
Q47 1.07 0.81–1.41 0.622
Q28 1.43 1.13–1.83 0.003
Q26 1.14 0.86–1.51 0.360
Q41 1.03 0.81–1.32 0.816
Q33 1.08 0.93–1.26 0.321
Observations 280
R2 Nagelkerke 0.432

  1. q25 – During operations, I felt as though I could ask questions. q47 – If there was an issue, I felt comfortable bringing it up to a superior. q28 – I was able to find a mentor-like figure on my surgical rotation. q26 – I felt as though I was an important part of the surgical team. q41 – How often did you feel the attending focused on teaching you as the student? q33 – How often did you perform operations alongside residents and/or fellows? CI, confidence interval.

Another primary objective of the study was to compare how many students who indicated that they wanted to pursue a surgical career before the rotation were still considering surgery after rotation completion. This research question is tested with an ordinal regression utilizing a cumulative link model with a random effect that can be utilized to test for differences in paired ordinal data. The ordinal regression table and corresponding data may be found in Table 2 and Figure 1.

Table 2:

Ordinal regression table answering the question, “How many students say they are considering surgery as a career before and after surgical rotations?”.

Predictors Odds ratios CI p-Value
No/Maybe 0.26 0.18–0.37 <0.001
Maybe/Yes 0.63 0.46–0.87 0.005
Time (after surgical rotation) 0.36 0.25–0.52 <0.001
Random effects
σ 2 3.29
τ 00 Responseld 2.69
ICC 0.45
N ResponseId 331
Observations 662
Marginal R2/Conditional R2 0.042/0.473

  1. ICC, intraclass correlation coefficient.

Figure 1: Proportion of students answering the question, “How many students say they are considering surgery as a career before and after surgical rotations?” This corresponds with the ordinal regression data in Table 2.
Figure 1:

Proportion of students answering the question, “How many students say they are considering surgery as a career before and after surgical rotations?” This corresponds with the ordinal regression data in Table 2.

Opportunities for research at various clerkship site types were explored utilizing the Cochran–Armitage test for trend utilizing the coin package.

Results

A total of 345 responses were recorded from the Qualtrics survey (Appendix A) sent to 2182 ACOS students from the national registry (response rate of 15.8 %). Table 3 demonstrates the qualitative descriptions of recorded responses. Of those who responded, 155 (44.9 %) indicated that they were in their third year of medical school, while 190 (55.1 %) indicated they were in their fourth year. One respondent (0.2 %) answered that their required surgical rotation was 2 weeks in duration, 237 (68.7 %) responded 4weeks, and 107 (31.0 %) responded greater than 4 weeks. A total of 28 (8.1 %) responders practiced at an academic site, 56 (16.2 %) practiced at a community-based university-affiliated site, and 261 (75.7 %) practiced at community sites. A total of 152 (44.1 %) students indicated that their surgical rotation was their first exposure to the operating room, whereas 193 (55.9 %) reported having previous experience.

Table 3:

Description of student respondent characteristics.

Characteristic n % response
Year in school
3rd 155 46.1
4th 190 56.5
Time on rotation
2 weeks 1 0.3
4 weeks 237 70.5
>4 weeks 107 31.8
Site description
Academic 28 8.3
Community 261 77.7
Community-based university affiliated 56 16.7
First OR experience
Yes 193 45.2
No 152 57.4

  1. OR, operating room.

Factors affecting student opinions of their surgical rotations were explored. Figure 2 shows the proportions of student responses utilizing the Likert scale. Figure 1 and Table 2 show the results of students answering if they were considering a surgical career both before and after their rotation. Time on the rotation had a statistically significant effect on a student’s decision to continue pursuing a surgical career. Specifically, students were less likely to say that they were still considering surgery after rotation completion (p<0.001). The environment created by circulating nurses and scrub technicians and the effect that this had on students staying in the specialty was reviewed. When asked if they were made to feel welcome, 87 (67.0 %) who did feel welcome indicated that they are planning on staying in the specialty, but only 44 (31.2 %) who felt unwelcome were planning to stay (p=0.0167).

Figure 2: The proportion of responses to factors often associated with positive student learner experiences.
Figure 2:

The proportion of responses to factors often associated with positive student learner experiences.

Finding a mentor is significantly correlated with students continuing to pursue surgery (OR 1.43, p=0.0030). For many students, the simplest way to find a mentor is through research opportunities. Among the respondents, 116 (75.6 %) indicated that they completed their clerkship rotations at community sites. Our results indicated that the students that did their surgical rotations at academic sites were given more opportunities for research than those at community sites (p=0.0190).

Discussion

Given the rising population in the United States, particularly of those over the age of 65, there is going to be an estimated shortage of 2,525 general surgeons by the year 2030 [17]. A 20-year projection based upon the 2017 US Census determined that increases in specialization and increasing numbers of surgical trainees will not be enough to meet the demand for general surgeons in rural hospitals by 2040, where many DO surgeons practice [18]. Barriers to interest in surgery include the duration of residency training, high rates of burnout, and intrinsic stress related to the required work [19, 20]. Although osteopathic medical schools have long produced physicians in the fields of primary care, they should simultaneously foster interest in the surgical specialties to address this shortage. By following the recommendations outlined in this study, schools can facilitate further student interest and engagement, leading them to stay in the field. Moreover, in a retrospective study of NRMP match data from 2020, 2018, and 2016, Etheart et al. [2] demonstrated that the match rates of DO students into surgical specialties decreased by 3 %. Osteopathic physicians provide a unique, holistic aspect to patient care that benefits patient populations of all specialties, not just those of primary care.

In this study, we have sought to determine if third- and fourth-year osteopathic medical students feel as though they are receiving quality exposure to surgery during clerkship rotations. To our knowledge, this is the only study conducted of osteopathic student opinions. Our results indicate that students review surgical rotations positively when they are able to connect with mentors, which coincides with the current literature [9], [10], [11], [12], [13], [14], [15], [16].

Currently, both the ACGME and Liaison Committee on Medical Education stipulate that residents act as teachers to each other and medical students, but neither committee has set forth concrete guidelines for which teaching objectives should be fulfilled [21]. Various teaching hospitals throughout the United States have begun implementing “Residents as Teachers” initiatives, which provide educational resources and workshops on foundations of medical education. Attitudes toward these initiatives have been generally positive, with a vast majority agreeing that residents are invaluable tools to teaching junior residents and medical students [22]. Moreover, there may be benefits for the residents themselves. For instance, previous studies performed at a single academic institution over a three-year period assessing PGY 1 to PGY 5 residents indicated that residents reviewed as quality educators have higher job satisfaction, better knowledge acquisition, and higher performance on in-training examinations [23, 24]. Ubiquitous implementation may be limited by time and resource commitment, particularly at the smaller, community-based hospitals where most osteopathic medical students practice [25]. Clerkship coordinators and directors of medical education may benefit from assisting rotation sites in developing formal teaching curricula.

To augment student research opportunities, studies have demonstrated that the most effective programs exposed students to didactic material relevant to clinical research in the first 2 years of their education [26, 27]. These skills were reinforced and ameliorated through application with a mentor, leading to higher numbers of published papers compared to strict didactic curricula [26, 27]. The importance of research for osteopathic medical students cannot be understated. Heard et al. [3] described that with the USMLE Step 1 and COMLEX Level 1 both transitioning to a pass/fail system, program directors are more inclined to weigh other parts of an applicant’s file more heavily, such as research. The survey indicated that students at an academic base hospital had more research opportunities. Although that is not surprising, community programs should provide the means for medical students to obtain research experience elsewhere if not offered at their hospital. This can come in the form of collaborations with nearby hospitals and/or promoting membership in national committees like ACOS.

A recurring theme in the results indicated that attitudes of ancillary operating room staff play a significant role in whether a student will still consider pursuing surgery after clerkship. This correlates with the literature, which concludes that positive interactions between students and staff increase the likelihood that a student will consider a general surgery career [28]. Previous literature has shown that operating room staff perceive the medical student role in the operating theater as one of an observational learner [29]. Regardless, negative attitudes toward students persist when operating room staff feel there that is a gap in proper operating room etiquette, a lack of awareness of the sterile field, and a poor surgical gowning and gloving technique [29]. It must be noted that it is unlikely that students are willfully not performing the aforementioned skills, and more likely these skills may be entirely foreign concepts. Therefore, to circumvent a negative learning environment, it would be helpful for osteopathic schools to provide resources such as handbooks or module series that instruct students on proper operating room etiquette. Additionally, having students physically perform duties such as gowning, gloving, and maintaining sterile field in an operating room orientation day close to the date of their surgical clerkship can help them learn such skills in real time [30]. In our study, only 56.0 % of respondents answered that their institution hosts an operating room training day.

It must also be noted that it is very common for medical students to feel ignored in the operating room environment [19, 27]. Our study indicated that a significant number of students felt as though resident and attending superiors had little to no interest in teaching them. Students are much more likely to be engaged in the learning process if attendings and residents take the time to include them in instruction [27]. Cultivating a keen interest in procedures will encourage student learners to stay in the field. Literature has demonstrated that preoperative and postoperative debriefing sessions were successful in both reminding the attending physician that teaching was a necessary component of their occupation, but simultaneously informing the resident and medical student what they needed to learn [31]. Surgeons should be encouraged to narrate operations and demonstrate key concepts of anatomy.

Future studies may explore if attempts to ameliorate student experiences on the surgical rotation lead to more students choosing to pursue surgical careers. It would also benefit to perform preclerkship and postclerkship surveys to assess student expectations and whether or not expectations were fulfilled. These studies may be facilitated by the final question in our survey, which was open-ended and asked the respondents what they felt could have made the rotation a higher quality one. Of those that answered this question, 75 responses (30.1 %) were related to having a resident/attending that displayed more interest in teaching. In addition, 33 (13.2 %) indicated that having fewer medical students on the rotation was preferred, 19 (7.5 %) of respondents noted being allowed to participate more would have been beneficial, including more practice suturing, going over imaging with a superior, or being asked to present on rounds. The remaining topics included a clearer outline of expectations and allowing students to scrub in on surgical subspecialty cases.

Limitations

This study is subject to selection bias because it was only answered by students enrolled in the ACOS-MSS national registry and because it already has significant interest in surgery. The authors also acknowledge that although the survey was anonymous, some information may not have been shared for fear of retaliation. A response rate of 15.4 % may not represent the majority of opinions. Additionally, this survey was conducted during the COVID-19 pandemic, when multiple hospitals canceled elective procedures or may have made students complete virtual clerkships altogether. The effects of COVID-19 on the medical student clerkship experience are still being explored, and it is possible that the effects may have skewed our results.

Conclusions

With the demand for surgeons rising in the coming years, combined with decreasing match rates in surgery for osteopathic graduates, osteopathic programs need to prepare their students for careers in surgical specialties. Our study sought to determine if osteopathic students felt that they received satisfactory exposure to the specialty. Previous studies had already outlined favorable qualities for the educational experience. To facilitate these, clerkship directors and course instructors can ensure that rotating students have access to mentorship programs as well as structured research opportunities. A significant portion of respondents indicated that this was their first operating room experience; having a trusted guide through the process can foster interest and further educational opportunities. Students should spend dedicated time with ancillary operating room staff to receive instructions on the roles, duties, and proper operating room etiquette to avoid negative interactions. These were found to be the most important factors influencing a student’s decision to stay in the field

Corresponding author: Taylor Casey, BS, Michigan State University College of Osteopathic Medicine, 965 Wilson Road, 48824-1316 East Lansing, MI, USA, E-mail:

  1. Research ethics: This study was approved by the Michigan State University Institutional Review Board (#STUDY00007139). It was conducted in accordance with the Declaration of Helsinki.

  2. Informed consent: Not applicable.

  3. Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Competing interests: The authors state no conflicts of interest.

  5. Research funding: None declared.

  6. Data availability: The raw data can be obtained on request from the corresponding author.

References

1. National Resident Matching Program. Results and data: 2022 main residency Match®; 2022. https://www.nrmp.org/wp-content/uploads/2022/07/Charting-Outcomes-DO-Seniors-2022_Final.pdf [Accessed 3 Mar 2022].Search in Google Scholar

2. Etheart, I, Krise, SM, Burns, JB, Conrad-Schnetz, K. The effect of single accreditation on medical student match rates in surgical specialties. Cureus 2021;13:e14301. https://doi.org/10.7759/cureus.14301.Search in Google Scholar PubMed PubMed Central

3. Heard, MA, Buckley, SE, Burns, B, Conrad-Schnetz, K. Identifying attitudes toward and acceptance of osteopathic graduates in surgical residency programs in the era of single accreditation: results of the American College of Osteopathic Surgeons medical student section questionnaire of program directors. Cureus 2022;14:e22870. https://doi.org/10.7759/cureus.22870.Search in Google Scholar PubMed PubMed Central

4. Beckman, JJ, Speicher, MR. Characteristics of ACGME residency programs that select osteopathic medical graduates. J Grad Med Educ 2020;12:435–40. https://doi.org/10.4300/jgme-d-19-00597.1.Search in Google Scholar PubMed PubMed Central

5. Cummings, M. The impact of the ACGME/AOA single accreditation system on osteopathic surgical specialties, residents, and DO students. J Surg Educ 2021;78:1469–75. https://doi.org/10.1016/j.jsurg.2021.02.006.Search in Google Scholar PubMed

6. Whitcomb, ME. The development of new MD-granting medical schools in the United States in the 21st century. Acad Med 2020;95:340–3. https://doi.org/10.1097/acm.0000000000003048.Search in Google Scholar

7. National Resident Matching Program. Results and data: 2023 main residency match®; 2023 [Accessed 16 May 2023].Search in Google Scholar

8. National Resident Matching Program. Results and data: 2020 main residency Match®; 2020. https://www.nrmp.org/wp-content/uploads/2020/08/Charting-Outcomes-in-the-Match-2020_DO-Senior_final.pdf [Accessed 27 Feb 2023].Search in Google Scholar

9. Gevitz, N. The transformation of osteopathic medical education. Acad Med 2009;84:701–6. https://doi.org/10.1097/acm.0b013e3181a4049e.Search in Google Scholar

10. Peters, AS, Clark-Chiarelli, N, Block, SD. Comparison of osteopathic and allopathic medical schools’ support for primary care. J Gen Intern Med 1999;14:730–9. https://doi.org/10.1046/j.1525-1497.1999.03179.x.Search in Google Scholar PubMed PubMed Central

11. National Resident Matching Program. Results and data: 2021 main residency Match®; 2021. https://www.nrmp.org/wp-content/uploads/2021/08/Charting-Outcomes-in-the-Match-2021_DO-Senior_final.pdf [Accessed 3 Mar, 2022].Search in Google Scholar

12. Dickinson, KJ, Bass, BL, Pei, KY. What embodies an effective surgical educator? A grounded theory analysis of resident opinion. Surgery 2020;168:730–6. https://doi.org/10.1016/j.surg.2020.04.056.Search in Google Scholar PubMed

13. Jung, S, Greenberg, J, O’Rourke, AP, Minter, RM, Foley, E, Voils, CI. Comparison of the perspectives of medical students and residents on the surgery learning environment. J Surg Res 2021;258:187–94. https://doi.org/10.1016/j.jss.2020.08.070.Search in Google Scholar PubMed PubMed Central

14. Lamb, CR, Guerra, S, Sorensen, MJ. Qualities of excellent resident and attending teachers recognized by medical students: a qualitative analysis of nominations for surgical clerkship teaching awards. Am J Surg 2022;224:552–6. https://doi.org/10.1016/j.amjsurg.2022.02.004.Search in Google Scholar PubMed

15. Dickinson, KJ, Bass, BL, Pei, KY. Medical students’ perception of what embodies an effective surgeon educator. Am J Surg 2022;223:64–70. https://doi.org/10.1016/j.amjsurg.2021.07.019.Search in Google Scholar PubMed

16. Ravindra, P, Fitzgerald, JEF, Bhangu, A, Maxwell-Armstrong, CA. Quantifying factors influencing operating theater teaching, participation, and learning opportunities for medical students in surgery. J Surg Educ 2013;70:495–501. https://doi.org/10.1016/j.jsurg.2013.02.011.Search in Google Scholar PubMed

17. Ellison, EC, Pawlik, TM, Way, DP, Satiani, B, Williams, TE. Ten-year reassessment of the shortage of general surgeons: increases in graduation numbers of general surgery residents are insufficient to meet the future demand for general surgeons. Surgery 2018;164:726–32, https://doi.org/10.1016/j.surg.2018.04.042.Search in Google Scholar PubMed

18. Ellison, EC, Satiani, B, Way, DP, Oslock, WM, Santry, H, Williams, TE. The continued urbanization of American surgery: a threat to rural hospitals. Surgery 2021;169:543–9. https://doi.org/10.1016/j.surg.2020.06.027.Search in Google Scholar PubMed

19. Marshall, DC, Salciccioli, JD, Walton, SJ, Pitkin, J, Shalhoub, J, Malietzis, G. (2015). Medical student experience in surgery influences their career choices: a systematic review of the literature. J Surg Educ 2015;72:438–45, https://doi.org/10.1016/j.jsurg.2014.10.018.Search in Google Scholar PubMed

20. Chau, M, Aziz, F. Factors affecting the interest in a surgical career among medical students at a Nonurban, tertiary care academic institution. Ann Vasc Surg 2020;68:57–66. https://doi.org/10.1016/j.avsg.2020.06.022. Epub 2020 Jun 20. PMID: 32569816.Search in Google Scholar PubMed

21. Anderson, MJ, Ofshteyn, A, Miller, M, Ammori, J, Steinhagen, E. Residents as teachers’ workshop improves knowledge, confidence, and feedback skills for general surgery residents. J Surg Educ 2020;77:757–64. https://doi.org/10.1016/j.jsurg.2020.01.010.Search in Google Scholar PubMed

22. Geary, AD, Hess, DT, Pernar, LI. Resident-as-teacher programs in general surgery residency: context and characterization. J Surg Educ 2019;76:1205–10. https://doi.org/10.1016/j.jsurg.2019.03.004.Search in Google Scholar PubMed

23. Ratan, BM, Johnson, GJ, Williams, AC, Greely, JT, Kilpatrick, CC. Enhancing the teaching environment: 3-year follow-up of a resident-led residents-as-teachers program. J Grad Med Educ 2021;13:569–75. https://doi.org/10.4300/jgme-d-20-01167.1.Search in Google Scholar

24. Snell, L. The resident-as-teacher: it’s more than just about student learning. J Grad Med Educ 2011;3:440–1. https://doi.org/10.4300/JGME-D-11-00148.1.Search in Google Scholar PubMed PubMed Central

25. Geary, AD, Hess, DT, Pernar, LI. Efficacy of a resident-as-teacher program (RATP) for general surgery residents: an evaluation of 3 years of implementation. Am J Surg 2021;222:1093–8. https://doi.org/10.1016/j.amjsurg.2021.09.033.Search in Google Scholar PubMed

26. Lee, GSJ, Chin, YH, Jiang, AA, Mg, CH, Nistala, KRY, Iyer, SG, et al.. Teaching medical research to medical students: a systematic review. Med Sci Educat 2021;31:945–62. https://doi.org/10.1007/s40670-020-01183-w.Search in Google Scholar PubMed PubMed Central

27. Castillo-Angeles, M, Watkins, AA, Acosta, D, Frydman, JL, Flier, L, Garces-Descovich, A, et al.. Mistreatment and the learning environment for medical students on general surgery clerkship rotations: what do key stakeholders think? Am J Surg 2017;213:307–12. https://doi.org/10.1016/j.amjsurg.2016.10.013.Search in Google Scholar PubMed

28. Al-Heeti, KN, Nassar, AK, Decorby, K, Winch, J, Reid, S. The effect of general surgery clerkship rotation on the attitude of medical students towards general surgery as a future career. J Surg Educ 2012;69:544–9. https://doi.org/10.1016/j.jsurg.2012.04.005.Search in Google Scholar PubMed

29. Ji, YD, McKinley, SK, Farrell, M, Hemingway, M, Qadan, M, Saillant, N, et al.. Operating room staff perceptions of medical students. J Surg Educ 2022;79:370–82. https://doi.org/10.1016/j.jsurg.2021.10.011.Search in Google Scholar PubMed

30. O’Neill, R, Shapiro, M, Merchant, A. The role of the operating room in medical student education: differing perspectives of learners and educators. J Surg Educ 2018;75:14–28. https://doi.org/10.1016/j.jsurg.2017.06.013.Search in Google Scholar PubMed

31. Anderson, CI, Gupta, RN, Larson, JR, Abubars, OI, Kwiecien, AJ, Lake, AD, et al.. Impact of objectively assessing surgeons’ teaching on effective perioperative instructional behaviors. JAMA Surg 2013;148:915–22. https://doi.org/10.1001/jamasurg.2013.2144.Search in Google Scholar PubMed

Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/jom-2022-0165).

Received: 2022-08-12
Accepted: 2023-08-07
Published Online: 2023-11-03

© 2023 the author(s), published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  18. Letter to the Editor
  19. Identified strategies to mitigate medical student mental health and burnout symptoms
https://doi.org/10.1515/jom-2022-0165
Keywords for this article
medical student; mentoring; osteopathic; surgery clerkship
Creative Commons
BY 4.0

Articles in the same Issue

  1. Frontmatter
  2. Innovations
  3. Original Article
  4. The sternal brace: a novel osteopathic diagnostic screening tool to rule out cardiac chest pain in the emergency department
  5. Medical Education
  6. Original Articles
  7. An analysis of osteopathic medical students applying to surgical residencies following transition to a single graduate medical education accreditation system
  8. An assessment of surgery core rotation quality at osteopathic medical schools
  9. Musculoskeletal Medicine and Pain
  10. Original Article
  11. Social determinants of health in patients with arthritis: a cross-sectional analysis of the 2017 Behavioral Risk Factor Surveillance System
  12. Neuromusculoskeletal Medicine (OMT)
  13. Original Article
  14. Transrectal osteopathic manipulation treatment for chronic coccydynia: feasibility, acceptability and patient-oriented outcomes in a quality improvement project
  15. Public Health and Primary Care
  16. Original Article
  17. Evaluating attitudes among healthcare graduate students following interprofessional education on opioid use disorder
  18. Letter to the Editor
  19. Identified strategies to mitigate medical student mental health and burnout symptoms
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