Students' Surgical Experiences in a Distributed Model of Clinical Education: A Mixed-Methods Sequential Case Study

J Surg Educ. 2020 Nov 13;S1931-7204(20)30384-6. doi: 10.1016/j.jsurg.2020.10.007. Online ahead of print.

Abstract

Objective: Equal opportunity to learn has received much attention in higher education. Ensuring students' comparable educational experiences in the surgical clerkship can be challenging, especially when considering multiple sites in multiple regional medical campuses (RMCs). This study examined whether students were provided with comparable learning opportunities across different campuses/sites and what factors impacted students' educational experiences during the surgical clerkship.

Design: A mixed-methods explanatory sequential approach was used to elicit students' experiences. The study involved the separate data collection and analysis by first using a survey questionnaire, followed by focus groups. The quantitative phase provided a general understanding of students' experiences, and the qualitative data and analysis refined and further explained statistical results by exploring students' perceptions in much more depth. The responses to the Likert-scale survey items were analyzed using the Kruskal-Wallis test and the qualitative responses were analyzed through a standard qualitative thematic inductive coding approach.

Setting: The distributed clinical medical education program of College of Medicine, Central Michigan University, adopted a wide range of rural and urban communities across Michigan. Its surgical clerkship was located across 3 regional medical campuses, utilizing a total of 6 clinical sites.

Participants: A total of 92 students responded to the survey questionnaire at the end of their surgery rotation. Using the purposeful sampling, 2 focus groups with 7 participants were conducted.

Results: The survey results demonstrated some statistically significant educational experiences in different sites during the surgery clerkship within this context. Those site differences were related to roles and expectations, supervision, feedback, and team collaboration. Whether students had comparable surgery learning experiences across the RMCs was associated with multiple factors. Those factors that included Site Features (organizational culture and volume and specialties), Health Professionals (un/engaged surgeons and team dynamics), and Personal Traits (self-directed learning), combined together, contributed to students' achieved roles and responsibilities.

Conclusions: The research found students' differing educational experiences in the general surgery clerkship from students' perspectives using a case study design. More studies conducted with other medical schools are needed to fully understand the common conceptualization of comparable educational opportunities in the surgical clerkship. Further research is also necessary to investigate perceptions of clerkship directors, faculty, and other health professionals.

Keywords: comparability; comparable educational experiences; distributed medical education; regional medical campuses; surgery clerkship.