Improving the surgical learning environment for medical students: Feeding back to the teachers

Abstract

Introduction: During their clinical training, medical students are attached to clinical teams in teaching hospitals and immersed in a clinical learning environment (CLE). This CLE is highly variable and unpredictable, particularly during surgical rotations. Knowledge of this information could help enhance the medical student's experiences in general surgery and encourage the choice of surgery as a career. Aim: To evaluate medical students' impressions of their CLE during rotations in general surgery and whether providing feedback to surgical consultants could improve these perceptions. Methods: Year 4 medical students at the University of Auckland were surveyed during their general surgery rotation over the course of 18 months. The survey instrument used was adapted from a previously validated 25-item learning environment questionnaire. At 6- monthly intervals, the data were analysed and a feedback document was prepared for surgical consultants at one teaching hospital. Surgical consultants at other clinical sites were used as controls. The feedback document also included the students' Objective Structured Clinical Examination scores. Results: Of 331 students approached, 316 completed the questionnaire (response rate 96%). The Cronbach's alpha for the questionnaire was 0.94. The students' perception of their CLE during surgical rotations was generally satisfactory. There was no significant change in the CLE score or Objective Structured Clinical Examination score after feedback documents were given to consultant surgeons. Students reported spending most of their time with registrars, and although they spent a lot of time in the operating theatre, seeing patients in an acute care setting was the learning opportunity they found most useful. Other themes that arose from the qualitative comments included lack of awareness about student objectives on the part of the surgical team, the significant role of the registrar, and a desire for medical students to be included in the surgical team. Conclusion: The general perception of the CLE is satisfactory among medical students during their surgical rotations. Providing surgeons with student feedback does not necessarily translate into improved perceptions of the CLE. Registrars appear to play a critical role in the CLE of students during their surgical rotations.