S. L. Ahle1, J. M. Healy1, K. Y. Pei1 1Yale University School Of Medicine,New Haven, CT, USA
Introduction: For medically complex patients, determining postoperative surgical risk is challenging. Previous studies demonstrated that resident and attending surgeons significantly overestimate risk of complications and death when compared to the ACS NSQIP risk calculator. Given that medical students learn through observation and clinical exposure during their clerkships, they may model similar prediction practices to their teachers. Medical students’ abilities to predict postoperative complications and death are unknown. We hypothesize that medical students will lack confidence in determining surgical risk, and will significantly overestimate surgical risk for post-operative morbidities and mortality.
Methods: Following completion of their clerkships, third year medical students at an urban, tertiary, academic medical center were invited to participate in an online, anonymous survey to assess their abilities to predict surgical risk. General Surgery residents were also invited to participate in the same assessment. The survey presented seven complex clinical scenarios representative of a diverse general surgery practice. Students were asked to assess the likelihood of any morbidity, mortality, surgical site infection, pneumonia, and cardiac complications on a 0-100% scale. Morbidity and mortality predictions were compared to the ACS NSQIP risk calculator. Using independent samples t-tests and Mann-Whitney U non-parametric tests, we determined if students and residents had statistically different risk assessments for each case.
Results: 24 students (80% response rate) and 76 residents (64% response rate) participated in the assessment. Most students were not confident about predicting post-operative complications (83.3%) or mortality (70.8%). Most students did not feel that the surgery clerkship adequately prepared them to assess surgical risk (69.6%). When compared to surgical residents for most presented cases (57% of cases), students and residents similarly over-estimated post-operative morbidities and mortality. For 3 cases, resident estimates were higher than medical students, but both groups still significantly overestimated when compared to the risk calculator. Estimates varied significantly, with wide 95% confidence intervals. Only 17% of NSQIP predicted estimates fell within the 95% confidence intervals (Figure 1: representative scenario).
Conclusion: Medical students overestimate morbidity and mortality following surgery in complex patients. Additionally, they lack confidence in their ability to predict surgical complications, and feel they are not adequately learning this skill on their surgical clerkship. A formal curriculum for risk prediction is needed for medical students.
