Z. J. Ahola1, S. Sullivan1, S. Agarwal1, A. O’Rourke1, H. Jung1, A. Liepert1 1University Of Wisconsin,Department Of Surgery,Madison, WI, USA
Introduction: The transition from medical school to surgical internship is a period of heightened anxiety. To ease this transition, over 50 medical schools have developed courses to prepare graduating medical students for intern responsibilities. This study aimed to demonstrate that a surgical intern preparatory course (S-IPC) decreases student anxiety pertaining to intern year and that an orientation to a simulation experience improves clinical decision-making while lowering anxiety during the simulation.
Methods: Nine fourth year medical students who had matched into an ACGME-accredited general surgery internships participated in the two-week S-IPC. The curriculum was instructed in a step-up approach consisting of lecture-based review sessions, hands-on technical skill instruction, small group discussions, high-fidelity clinical decision-making simulations, and a live porcine surgical experience. The students’ anxiety levels were measured via a six-question short form of the State-Trait Anxiety Index (STAI) prior to the course and surrounding the simulations. Simulation confidence levels were also obtained after each session. For the first simulation session, participants were divided into two groups with only one group receiving an orientation to the simulation environment. An attending surgeon evaluated each participant’s performance during the simulation using a standardized assessment tool. All students received the same orientation prior to the second simulation session which occurred at the end of the course and was comprised of two case scenarios. Following the course, students were asked to reassess anxiety levels regarding intern year.
Results: Prior to the first simulation, the entire cohort reported a heightened level of state anxiety (M = 2.28 ± 0.62) when compared to trait scores (M = 1.64 ± 0.44, Z = –2.31, p = 0.021) with no significant difference observed between the control and oriented groups. Following the first simulation scenario, the oriented group reported a higher confidence level (M = 2.63 ± 0.78) regarding the simulation experience than the control group (M = 1.63 ± 0.29, U = 0.00, p = 0.014). The oriented group significantly outperformed the control group (M = 4.57 ± 0.23 vs. M = 3.11 ± 0.53, U = 0.00, p = 0.014) during that simulation. A difference in performance was not observed during the second or third simulation scenarios. After completion of the course, a decrease in anxiety regarding intern year was observed, although the result was not significant (M = 3.00 ± 0.47 vs. M = 2.78 ± 0.42, Z = –1.414, p = 0.157).
Conclusion: There was not a significant change in participant anxiety regarding the beginning of intern year associated with this S-IPC. However, in the high-fidelity simulation scenario, the oriented group outperformed and reported higher confidence in their performance following the simulation experience than the control group.