Poster4 - 07: CASE-BASED DISCUSSION IMPROVES CLINICAL KNOWLEDGE OF MEDICAL STUDENTS ON SURGICAL CLERKSHIP
Bobby D Robinson, MD, Danny C Little, MD; Scott and White Medical Center - Temple

Background: Surgical education for medical students is difficult to standardize. The basic tenets of surgical education seem to be universal: clinical and anatomic knowledge along with basic technical skills. These are commonly tested with the National Board of Medical Examiners (NBME) surgical clerkship exam and institutional oral exam. Students typically glean knowledge from independent study and immersive clinical experience. Our hypothesis was instituting a focused weekly session of case-based, small group discussions would improve medical student clinical knowledge.

Methods: Our teaching institution graduates 6 general surgery residents each year and has 12-18 medical students in 8-week rotations. Our standard clerkship curriculum was to have 1-2 lectures per week on various surgical topics given, and small-group (3-4 students per attending) discussion meetings with attendings; however, these meetings can be sporadic. At the beginning of this academic year, we instituted a 45-minute case discussion that occurred each Friday morning. The students were presented a case stem by email on Monday and asked individually to think about the following about the cases presented: epidemiology, etiology, pathophysiology, diagnosis, medical stabilization, and surgical therapy. The students were grouped into teams and in a turn-based fashion were asked to teach their peers the above concepts. The Friday sessions were led by either a third-year resident or the clerkship director. The goals were: build camaraderie among the students; prepare them for oral boards; change their thought process from a medical student into that of a physician; and challenge them.

Results: Two rotations of students have completed this new curriculum. The clinical knowledge grade, NBME score, and oral board scores from students of this new curriculum were compared to students in the same block a year ago (n=27 vs. n=32). We found that there was an increase in mean NBME score after implementation (76.56 vs. 71.06; p=0.004). There was no difference in clinical score (88.27 vs. 87.41; p=NS) or oral board score in the two cohorts (90.26 vs. 88.79; p=NS)

Conclusions: Having at least once-a-week sessions on case-based review improves clinical knowledge of medical students during their surgical clerkship.