Clinical Exposure During a Surgery Clerkship: Contrast between a

Canadian and an American Medical School

Division of General Surgery and the Center for Medical Education

McGill University

Sarkis Meterissian, A Sender Liberman and Moishe Liberman

Introduction Surgical clerkships should expose medical students to

common surgical disorders Clerkships should provide hands-on experience with

diagnosis and disease management Study at SIU showed that students on a surgical clerkship

had little opportunity to be the first to interact with patients in the ER, clinic or in-patient setting

Boehler ML, JACS 2002;195:539-542

Hypothesis

Due to discrepancies in health care delivery and resources between the US and Canada, medical clerks in Canada get more hands-on training than clerks in the United States

Objectives

1. Evaluate and quantitate the contact that medical students receive while on their surgical rotation in a Canadian medical school

2. Compare the patient exposure experienced by students between a Canadian and an American medical school

Methods

Survey (8-item) administered to students at a Canadian medical school

Survey examined student exposure to patients during a surgical clerkship

Results of surveys were compared between the two universities:- McGill University and Southern Illinois University

Surveys Surveys at SIU were given to twenty 3rd year

medical students to evaluate 311 different student-patient encounters

Surveys at McGill were e-mailed to all 3rd and 4th year medical students to assess their overall student-patient interaction experience

Responses were on a 4-point Likert scale (Never, Seldom, Often, Always)

Statistical Methods Results of specific questions posed to medical

students reported as group percentages Never/Seldom, Often/Always lumped together for

statistical analysis Between group differences were compared using:

Pearson Chi-Square Test and Fisher’s Exact Test (categorical variables)

Independent Samples T-test (continuous variables)

ResultsCanadian Medical School

Student N= 50 Med-3: 14 Med-4: 32 Unknown: 4

Unknown4%

JGH28%

RVH30% MGH

26%

SMH12%

ResultsMost frequent place of patient encounter Percent of Students

Place of Encounter Canada USA P-Value

Clinic 10% 34% 0.001

IP Consult 0% 2.9% 0.226

ER Consult 34% 1.9% <0.001

AM Admit 2% 19% 0.003

OP Surgery 4% 28% <0.001

IP Surgery 36% 15% <0.001

ResultsCanadian / American Comparison

Number of physicians evaluating patients prior to student

0

0.5

1

1.5

2

2.5

CANADA USA

Mean (SD)

Canada 1.60 (0.79)

USA 2.41 (1.49)

P = 0.001

ResultsCanadian / American Comparison

CANADA USA P-Value

Student First to Elicit Chief complaint

44.0% 22.5% 0.003

Student Had Access to PM records

82.0% 80.1% 0.46

Initial P.E. Performed by Student

64.0% 36.3% <0.001

ResultsCanadian / American Comparison

CANADA USA P-Value

How often did student generate hypothesis 46.0% 14.8% <0.001

How often did student order investigations 44.0% 11.6% <0.001

Was diagnosis known prior to work-up 54.0% 85.2% <0.001

Discussion

Problems with this study:

1. Actual patient contact logbooks not reviewed at

McGill

2. Low numbers of students: 20 at SIU and 46 at

McGill

Discussion

Students in our medical school received more hands-on training than their American counterparts

Explanations:

- Differing teaching philosophies

- Differing sites for the initial encounter

Conclusions

While educational value is not evaluated in this study, these differences may result in:

1. increased interest in general surgery as a career

choice

2. better training of medical students

ResultsCanadian Medical School

Never Seldom Often Always

Student First to Elicit Chief complaint

14% 42% 38% 6%

Student Had Access to PM records

0 18% 60% 22%

Initial P.E. Performed by Student

4% 32% 56% 8%