More student directed learning
About a month ago, we published the first installment in a series of articles we’ll be providing over this academic year featuring student directed learning that’s occurring in our school. We heard at that time of Alyssa Louis’ exploration of aerospace medicine. This week, I’ve asked Meds ’16 student Riaz Karmali to report on behalf of a group who have worked together and collaborated with faculty to develop a special learning experience in practical surgical skills. Riaz adds some personal perspectives based on his own experience with a medical student fellowship at the MD Anderson Cancer Centre.
Stepping from Idea to Reality: My Experience with the Surgical Skills and Technology Elective Program (SSTEP)
Only a handful of medical schools in North America have structured surgical bootcamps available to pre-clerkship medical students. Two summers ago, the Surgical Skills and Technology Elective Program (SSTEP) was piloted at Queen’s for second year students. This 2-week simulation-based program is designed to build technical skill and prepare students for the operating room. Participants practice suturing, vascular anastomoses, bone fixation, local skin flap design, and nasogastric and chest tube placement amongst other procedures in the surgical skills laboratory. The inaugural program had 22 participants and ran again this summer with increased faculty support and expanded simulation workshops.
How did SSTEP, an entirely student-led initiative, transform from a progressive educational idea into a sustainable program? The success of any early-stage venture, like a high-stakes horse race, is based on two players: the idea itself (the horse) and the team behind it (the rider). Jennifer Siu, Daniel You, and Stefania Spano were the “instigators.” As driven students, outside-of-the-box thinkers, and great team players, they developed a comprehensive proposal and pitched it to Queen’s faculty. Thankfully, they allowed me to come along for the ride. The goal was to prove that SSTEP was worth its $10,000 budget, faculty time commitments, and use of surgical training and laboratory resources.
The SSTEP curriculum has both a didactic and hands-on component integrated into each day. It was eventually tailored to align with clerkship learning objectives. The idea is to provide students with a non-threatening academic environment where they can practice with up-to-date surgical simulation technology. Students can also be able to explore their interest in surgery and surgical subspecialties. In addition, they can receive guidance from senior medical staff and take advantage of a low faculty to student ratio. The curriculum went through multiple iterations before faculty and administration approval.
But how do we know that SSTEP actually builds technical skills? The concept of hands-on instruction in a simulation-based laboratory accelerating the acquisition of technical skill is intuitive. I had experienced this as a first year medical student. I won a summer research fellowship to MD Anderson Cancer Center in Houston, Texas where my project required me to learn basic microsurgery techniques. In the laboratory, I started out with silicon tubes and progressed to arteries and veins in a live rat. However, I was disappointed that I could not quantify my improvement.
Naturally, we then decided that SSTEP participants should complete an Objective Structured Assessment of Technical Skill (OSATS) before and after the program. It was mandatory to complete a 12-minute basic suturing station in order to track skill acquisition. This research was particularly important given our cost-sensitive healthcare environment that is increasingly dominated by outcomes assessment.
Outside of technical skill, SSTEP also develops surgical knowledge, confidence, and career interest. With the guidance of our supervisor, Dr. Paul Belliveau, we created a written test (partly adapted from Principles of Surgery Royal College Exams) and exit survey to measure these outcomes directly. Our results were accepted to the Association of Surgical Education (ASE) and Canadian Conference on Medical Education (CCME). Jenn and Dan recently presented at the CCME. Hopefully, our experience with SSTEP can be a template for other medical schools interested in launching a pre-clerkship surgical boot camp. At Queen’s, we punch above our weight!
Outcomes of SSTEP:
→ The SSTEP written exam had a maximum test score possible of 73 and students scored significantly higher on the post-test compared to the pre-test (52.1 5.9 vs. 35.8 6.5 p =0.01)
→ Participants showed an increase in technical skill:
→ At the end of the program, 50% of participants said they considered a new surgical subspecialty while 72% of participants reconsidered elective choices
→ SSTEP was recommended to fellow pre-clerks by 100% of participants
→ Comparative and long-term analyses of SSTEP outcomes will continue with subsequent generations of the program
Looking forward, new “disruptive” ideas and technologies will continue to change the way medicine is taught and practiced. The mobile web, big data, robotics, and accelerated drug development are just a few domains where we have seen an unprecedented explosion of investment. Therefore, it is important that the next generation of physicians be dynamic thinkers that can anticipate future challenges and meet them with relevant experience. Any venture that improves the way we take care of a patient, treat disease, or deliver therapy is well worth the successes and failures that go along with it.
I would like to thank the leaders of SSTEP, Jenn, Dan, and Stefania, for bringing me onto their team. I would like to thank Dr. Belliveau for his support with the research study, Dr. Reznick, Dr. Rudan, and Dr. Sanfilippo for their dedication and wisdom, Ms. Kim Garrison for help with the surgical skills lab, Dr. Winthrop for curriculum development, Dr. Leslie Flynn and Bill Leacy for their financial expertise, all of the residents and faculty facilitators, and the amazing support staff who made SSTEP possible!
A vastly expanded number of practice options are now available to our students. At graduation, they are faced with a choice between no fewer than thirty direct entry postgraduate training programs. Providing opportunities to explore career options and to tailor their learning experience has therefore become a common and major objective of both students and medical schools. Working with our students, building on their imagination and initiative, is proving to be a winning strategy.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education