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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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