Perceived Barriers to the Development of Technical Skill Proficiency in Surgical Clerkship

Abstract

Objective: Medical students are expected to achieve proficiency in a prescribed set of technical skills during surgical clerkship. However, available literature indicates students routinely report a lack of confidence and proficiency in these skills. Our study aims to identify barriers to technical skill development encountered by medical students during surgical clerkship with the goal of developing interventions to address these barriers.

Design: Three hundred and forty two medical students were surveyed about their experience learning and performing technical skills during surgical clerkship. Students reported confidence in skill performance and subjective barriers to achieving competency using forced-choice and free-text responses. Multivariate regression models identified factors independently associated with specific barriers and more frequent technical skills performance.

Setting: Main and satellite campuses of a Medical Council of Canada accredited Canadian academic medical center.

Participants: All third-year medical students.

Results: A total of 253 students (74%) responded to the survey. Following surgical clerkship, the only technical skills participants felt confident performing independently were sterile technique (96%) and basic suturing (52%). Interest in a surgical career, observership experience, gender, and medical campus site were independently associated with the frequency of skill performance. With respect to developing technical proficiency, commonly cited barriers included lack of suitable cases for student participation (35.0%), time constraints (33.4%), and lack of opportunities provided by both consultants (29.1%) and residents (24.7%). Female gender was independently associated with decreased resident instruction, decreased confidence in skill performance, and fewer opportunities to perform requisite skills. Students at satellite campuses reported fewer barriers.

Conclusions: We identified (1) lack of suitable cases, (2) time constraints, and (3) failure to provide students opportunities as the most common barriers to technical skill proficiency. Female gender increased the perception of barriers, while there were fewer barriers perceived by students at satellite campuses. Skill-specific simulation training and other interventions may improve skill development in medical students given obstacles to developing proficiency in the clinical setting.

Keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; Undergraduate surgical education; barriers; proficiency; technical skills.