Influence of clerkship sites on National Board of Medical Examiners surgery subject examination performance.

BACKGROUND: As one measure of comparability of student experiences on a 2-month surgery clerkship, scores on the National Board of Medical Examiners Surgery Subject Examination (NSSE) were evaluated against a number of variables. METHODS: NSSE scores for 701 students completing the surgery clerkship over 3.5 years were analyzed. Students rotated at academic, VA, and community hospitals with 1 month of general surgery paired with 1 month of a surgical subspecialty. The effect of 15 rotation site pairings on NSSE performance was analyzed by analysis of variance. The relationship of site-specific student evaluation variables and NSSE scores was examined by stepwise multivariate linear regression. RESULTS: No statistical differences were demonstrated between NSSE scores and site-specific parameters of duty hours, resident participation, or type of hospital, nor between NSSE scores and paired sites constituting the overall clerkship experience. CONCLUSION: Performance on the NSSE was not impacted by any assigned paired sites, supporting comparability of overall clerkship experiences.

Does the surgical clerkship meet the needs of practicing primary care physicians?

INTRODUCTION: A substantial amount of medical students enter primary care (PC) specialty careers. With the interest in reforming the curriculum to align the needs of our students to practice in their chosen specialties, an evaluation of our current surgical clerkship was done with the needs of PC practitioners in mind. We explored the needs of selected PC physicians in Wisconsin in relationship to the surgical clerkship curriculum. METHODS: A survey was mailed to 186 PC physicians practicing in Wisconsin. Included in this group were internal medicine, family medicine, and pediatric physicians. One follow-up mailing and an e-mail were sent to all non-respondents. Respondents rated the importance of 10 curricular areas, including the specialties of general, orthopaedic, plastic, transplant, vascular, cardiothoracic, and pediatric surgery, as well as otolaryngology, neurosurgery, and urology. Respondents also rated the importance of exposure to 24 surgical diagnoses and identified office procedures important to PC physicians. RESULTS: A total of 84 PC physicians responded to the survey. The highest-ranked curricular areas were general surgery, orthopaedic surgery, and otolaryngology. The 5 diagnoses that received the highest ranking from the PC physicians surveyed were abdominal pain, gastrointestinal bleeding, gastroesophageal reflux disease (GERD), biliary tract/gallbladder disorders, and breast disease, all of which are included in the general surgery curriculum. The 5 most common office procedures important to PC physicians were suturing, local anesthetic administration, dressing/wound management, wound debridement, and insertion of intravenous cannula. CONCLUSIONS: Our survey confirmed the importance of core knowledge of general surgery and common general surgical disease processes to PC physicians. The need for additional exposure to otolaryngology and orthopaedic surgery was identified, as was as the importance of basic procedures. This information may be valuable to students interested in PC and inform the surgical clerkship curriculum in order to optimally prepare students for their chosen careers.