P. I. Abbas1,2, J. G. Holder-Haynes1, D. J. Taylor1, B. G. Scott1, M. L. Brandt1,2, B. J. Naik-Mathuria1,2 1Baylor College Of Medicine,Michael E. DeBakey Department Of Surgery,Houston, TX, USA 2Texas Children’s Hospital,Division Of Pediatric Surgery,Houston, TX, USA
Introduction:
The majority of general surgery operations are now performed laparoscopically. Students are usually delegated to holding the camera, a primarily passive learning experience as opposed to skills they might actively learn during open procedures. We introduced laparoscopic skills sessions to medical students during their first surgery rotation in order to provide hands-on experience. We hypothesized that the exposure and ability to practice during the sessions would improve basic laparoscopic skills and increase student interest in a surgical career.
Methods:
All students on the core general surgery rotation attended 2 separate 1-hour sessions in the surgical simulation lab. Instruction was provided by Department of Surgery faculty members. Surveys were used to assess prior exposure to laparoscopic surgery and video games (VG) as well as interest in a surgical career before and after the course. Course effectiveness was assessed by a pre and post-instruction laparoscopic peg transfer exercise.
Results:
One hundred and one students participated in the course. Eighty-two students had documented pre and post-instruction peg transfer times. There was an overall improvement in median transfer times after instruction (pre 63 sec (IQR 46-84.5) vs. post 50.5 sec (IQR 39-65.2), p<0.001). When stratified by gender, men (n=40) had faster median pre-intervention peg transfer times (65 sec (IQR 51-88)) vs 81 sec (IQR 65-98) for women (n=61) (p=0.030). However, both genders had equivalent post-instruction transfer times (men 48 sec (IQR 36-61) vs women 51.3 sec (IQR 43.2-68.3), p=0.478). Similarly, students with prior VG use had faster pre-intervention peg transfer time (72sec (IQR 52-88)) vs no VG use (90 sec (IQR 74-149)) (p=0.002). However, post-instruction time was similar (VG 48.5 sec (IQR 39.5-60.5) vs no VG 58.2 sec (IQR 45.6-73), p=0.183). There was no difference in transfer time between students with exposure to <5 laparoscopic cases (79 sec (IQR 57.8-97.5)) and students with exposure to 5-10 lap cases: 81 sec (IQR 56.3-88); p=0.139. Fifty students completed both pre and post surveys. There was no significant increase (pre-24% vs post-34%, p=0.29) or decrease (pre-32% vs post 22%, p=0.13) in interest in surgical career after the course.
Conclusion:
A laparoscopic course for medical students on their first surgery rotation is effective in improving laparoscopic skills. Although male gender and video game use may be associated with better intrinsic skills, instruction and practice allows female students and non-video game users to “catch up.” There was a possible trend towards a change in student perception about a career in surgery. A larger sample size would be required to determine whether learning laparoscopic skills during the surgery core clerkship would truly increase interest in surgery as a career.