C2A - 08: MEDICAL STUDENTS’ MOTIVATIONS AND PERCEPTIONS PRIOR TO THEIR SURGERY CLERKSHIP
Sophia McKinley, MD, EdM¹, Michael Kochis², Cynthia M Cooper, MD¹, Noelle Saillant, MD¹, Alex Haynes, MD¹, Emil Petrusa, PhD¹, Roy Phitayakorn, MD, MHPE¹; ¹Massachusetts General Hospital, ²Harvard Medical School

Purpose:  Despite recent trends to standardize surgery clerkship curricula, little attention has been given to identifying learners’ intrinsic motivations. This study aims to describe medical students’ pre-clerkship learning objectives and concerns and to determine the effect of an introductory workshop on their perceptions of surgeons.

Methods:  Prior to their core clinical rotations, 39 medical students attended a half-day workshop consisting of a didactic introduction to surgery, surgical resident panel, and high-fidelity operating room crisis simulation with debriefing. Surveys administered pre- and post-workshop assessed their previous surgery exposure and perceptions of surgeons.  Additional questions solicited clerkship-related learning desires and concerns. Free responses were inductively coded and analyzed for theme frequency by two independent raters with Cohen’s kappa statistic calculated prior to consensus review.  These results were compared to the established clerkship learning objectives.

Results:  The response rate was 97% (n=38, 53% women), with 37% (n=14) of students reporting previous exposure to general surgery and 53% (n=20) to other surgical subspecialties. There were no differences in pre-workshop perceptions by gender or surgery exposure. Free response analysis demonstrated ten themes with high inter-rater reliability (Cohen’s kappa=0.80-1.00, mean 0.89).  The most frequently identified learning objectives were technical skill acquisition (58% of students), surgical knowledge (53%), and better understanding of surgical culture and work (53%). The most common concerns included surgical clerkship demands (68%), personal clerkship performance (58%), and interactions with surgical educators (50%). Less than half of student learning objectives and concerns are explicitly addressed by the current surgical clerkship learning objectives. Perceptions of surgeons significantly improved on 14 of 21 items from pre- to post-workshop (p<0.05); however, students demonstrated persistent low regard for aspects of surgical lifestyle (being well-balanced, having time for families).

Conclusions:  This study provides some insight into the intrinsic motivations of medical students. These results may facilitate improvement of the surgical clerkship curriculum and preparation via better alignment of educator and student learning goals and objectives. Additionally, a pre-clerkship workshop can improve students’ perceptions of surgery, but more research is needed to improve impact and durability.