Post on 29-Dec-2015
Flex-timeFlex-time
Enhancing Surgical Education in the Third-year Medical
School Curriculum
Penn State Hershey Medical CenterDepartment of Surgery
Penn State Hershey Medical CenterDepartment of Surgery
Adrian Ionescu BS, Eric Pauli MD, Lillian Erdahl MD, Timothy Shope MD FACS
DisclosuresDisclosures
Nothing to disclose
What is the problem?What is the problem?
Surgical clerkship lengths vary but are decreasing in length
Surgical knowledge base increasing in complexity
Students remain responsible for all aspects of surgery, including subspecialties
Surgery clerkships must provide opportunities for education across the spectrum
Lind DS, Deladisma AM, Cue JI, Thomas AM, MacFadyen BV, Nesbit RR. Survey of student education in surgery. J Am Coll Surg. 2007 May;204(5):969-74
Educational FrameworkEducational Framework
Needs assessment Goals/Objectives Resource analysis “Curriculum” design Implementation Evaluation
Structure of the ClerkshipStructure of the Clerkship
8 week rotation 4 weeks core general surgery
60% at Hershey Medical Center 40% at affiliate sites
2 weeks surgical specialty 1 week Orthopedics 1 week ENT
Curet, MI. Surgical Practice of Primary Care Physicians in a rural state: Implications forcurriculum design. Fam Med; 32: 97-101
What is Flex-Time?What is Flex-Time?
One AM or PM per week Only on 4 week Surgery rotation at HMC Student chooses the venue
Neurosurgery clinic Plastic surgery case Colorectal surgery endoscopy cases Pediatric surgery (for a future pediatrician) Directed reading
What is Flex-Time?What is Flex-Time?
Student MUST Notify service prior to
the day of “flexing” Request permission to
observe/participate from service/individual to which you are flexing
Submit Flex time sheet to Clerkship director to confirm use of the time
Evaluate this system
Student MAY NOT Abuse the system Bump another student Overload a team Abandon their own
team
MethodsMethods
IRB exemption Anonymous survey to students on
completion of clerkship Dichotomous questions
Was Flex-time used? Was Flex-time valuable? Did Flex-time provide broader educational
opportunities? Did Flex-time provide a more complete
experience?
AnalysisAnalysis
Percentage of positive responses identified
Comparison to previous year NBME raw and percentile scores for students on same rotation (Student’s T-test) Assess for improvement Confirm no detriment to performance
ResultsResults
Used Flex-Time 16/39 41%
Valuable tool 15/16 93.8%
More opportunity 15/16 93.8%
More complete 12/15 80%
39/66 students eligible to use Flex-time completed the survey (59.1%)
ResultsResults
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10
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40
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Score
Raw %ile
NBME Shelf Exam Scores
'05-'06
'06-'07
p=ns
ResultsResults
How was it used? Sub-specialty self study 16 Off service surgery 7 Journal articles 1 Breast clinic 1 CT clinic 1 Cleft palate clinic 1
Some students did more than one activity
BarriersBarriers
Students “No appropriate time to talk to my team” “I felt I was slacking” “I worried it would affect my grade” “Didn’t fit in for me” “Didn’t know how my team would react” “Difficult to make the arrangements with another service”
Residents “Residents teased me” “Residents gave us funny looks” “Flex-time was greatly discouraged by my chief resident” “Service was not very receptive”
BarriersBarriers
Staff “Some doctors personally hate Flex-time” “Should be made very explicit by a
higher-up authority” “Did not understand why I wanted to go” “All attendings need to be aware…”
Overcoming barriersOvercoming barriers
Students Empower Encourage stewardship of their own education
Residents “This is not your mother’s medical school”
Adapted from J. Tarpley President APDS 4/16/08 Accept need for education of your student and
your role as an educator Staff
Buy-in Understanding of diverse educational needs
within limited time
LimitationsLimitations
Small numbers Student concern about “appearance”
may have limited participation Limited to only one site (University)
May be some selection bias Early in process
Would “buy-in” be different next year?
ConclusionsConclusions
Flex-time Valuable educational tool Provides more educational opportunities
than traditionally offered Creates a more complete clinical
experience for MS3 surgery students Needs further evaluation
FutureFuture
Further evaluation and refinement
Apply to affiliate sites
Consider application to other specialties
QuestionsQuestions