SURG546 General Surgery,

Anesthesia and Pain Medicine Course Review

Academic Year 2011-2012

C2013

SURG546 Clerkship Coordinator: Dr Kamran Fathimani SURG546 Clerkship Administrator: Jenni Marshall Undergraduate Surgical Education Senior Director: Dr Jonathan White Undergraduate Surgical Education Team Lead: Shannon Erichsen

Department of Surgery – Undergraduate Surgical Education 2

Executive Summary The Class of 2013 brought with them the biggest class of medical students the Faculty of Medicine and Dentistry has ever had. While we had been preparing for their arrival into clerkship for two years, we were curious to see how previous changes to team based learning would accommodate for this group of 167 learners. Dr. Kamran Fathimani took over as clerkship coordinator for this course from Dr. Jonathan White. Jenni Marshall continues to be the program administrator for SURG546. Our course wiki continues to be a one-stop schedule, contact/course information, educational resource learning platform. Our data suggests that we were able to provide the same level of learning encounters as we have to previous cohorts of learners and maintain a preceptor to student ratio that was also similar to previous years. This year was the third year of our team based learning and assessment method. Data Sources 167 students completed this clerkship. Data sources employed to generate this report include: • Clinical Encounter Log (completed by students) • Clerkship Calendar (completed by students) • One 45 student evaluations of teachers (completed by students) • Multi-source feedback assessment of student (completed by faculty) 100% of students (n=167) completed the Clinical Encounter Log 99% of students (166 of 167) completed the Clerkship Calendar 99% of students (166 of 167) listed the names of the faculty members worked with in the clerkship calendar.

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Learning Activities Students recorded a median of 30 days learning activity over the 6 weeks (range 11-34), describing activity with a median of 12 different physicians (range 3-18), made up of an average of 9 different surgeons (maximum 14) and 4 different anesthetists (maximum: 6). Other learning activities were logged as listed below. A median of 26 was listed in activities relating to General Surgery and a median of 4 days was logged in activities relating to Anesthesiology.

LEARNING ACTIVITIES LOGGED Median Maximum Operating Room: Anesthesiology 4 7 Operating Room: General Surgery 9 16 General Surgery Call 5 11 General Surgery Clinic 6 12.5 General Surgery ward work 0 4.5 General Surgery: Endoscopy 1 4.5 Pathology 0 0 Pediatric Surgery 0 7.5 Examination Day 1 1 Med 531 – check data 0 1 Studying time 0 3 Post call 2 4 Total Days recorded 30 34

FACULTY WORKED WITH Median Maximum Surgeons 9 14 Anesthesiologists 4 6

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Educational Outcomes Data from the clerkship calendar indicates that students logged exposure to most of the core conditions expected and also a wide range of other important conditions. This logging was in addition to routine checking done upon exiting the clerkship to ensure that all students have seen the minimum set of conditions. CONDITIONS

CORE CONDITIONS YOU MUST SEE Median Min Max Appendicitis 5 1 10 Hernia 10 1 10 Bowel obstruction 5 1 10 Gallstones 8 1 10 Colon cancer, haemorrhoids, IBD 6 1 10 Breast Cancer 5 1 10 Pre-op assessment of an ASA II/III patient 5 0 10 Patient with acute post-op pain 3 0 10

CONDITIONS YOU SHOULD TRY TO SEE Median Min Max Inflammatory bowel disease 3 0 10 Pancreatitis 1 0 10 Anal fissure, anal fistula 3 0 10 Haemorrhoids 5 0 10 Thyroid mass 3 0 10 Peptic ulcer 1 0 10 Trauma to the chest or abdomen 2 0 10

This data is comparable with previous year’s data, with all minimums being recorded.

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PROCEDURES PROCEDURES YOU HAVE SEEN Median Min Max

Appendectomy (lap or open) 4 0 10 Cholecystectomy (lap or open) 7 0 10 Breast surgery 4 0 10 Hernia repair 8 0 10 Trauma laparotomy 0 0 6 Colectomy (lap or open) 3 0 10 Other midline laparotomy 2 0 10 Other laparoscopic surgery 1 0 10 Chest tube 1 0 8 Tracheostomy 0 0 4 Spinal or epidural anaesthetic 2 0 10

PROCEDURES YOU HAVE DONE Median Min Max

Infiltrate a wound with anesthetic (awake patient) 1 0 10 Close a wound using interrupted sutures 5 0 10 Close a wound using subcuticular sutures 8 0 10 Tie a knot 10 0 10 Change a wound dressing 1 0 10 Remove sutures or staples from a wound (awake patient) 1 0 10 Insert a nasogastric tube 0 0 6 Insert and remove an intravenous line 3 0 10 Insert an endotracheal tube 5 0 10 Remove a central venous catheter 0 0 8 Insert a Foley catheter 2 0 10 Insert IV cannula 3 0 10 Perform bag and mask ventilation 6 0 10 Perform a preoperative assessment 6 0 10 Insert a laryngeal mask airway 2 0 10

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Other Procedures Seen (total # recorded, all students, presented as logged)

Procedure # Procedure # Procedure # Abcess 1 Insert chest tube 10 Thyroidectomy 17 Carpal Tunnel 21 Lap Band 25 Whipples 6 Chest Tube Insertion 2 Lipoma 16 HPB Mass 1 Colonoscopy 8 Lipoma Excursion 4 Melenoma 9 Spinal Anesthetic 1 Liver Biopsy Drain 4 CPR 1 Liver Resection 4 Gallstones 6 Cyst Drainage 2 Paratidectomy 4 Anal Fistula 3 Cyst Removal 1 Pilonidal Drain 2 Perianal Warts 10 Diverticulitis 5 Remove chest tube 5 ABG 3 Drain ischiorectal abscess 1 Remove Drain 2 Vacuum Drain 1 Endoscopy 9 Skin Debridment 1 Remove Bag 1 Eversal Hartman 1 Spleenectomy 2 GERD 2 Reversal Hartman 1 Hernia 3 Sigmoid Resection 1 Pilondial Sinus 1 CVP Insertion 4 Anal Warts 5 Ischemic Colitis 2 Drain Insertion 8 Bariatric 10 Gastroscopy 5 OG Tube 1 Lung Resection 3 HIPEC 6 Staple wound 7 Fistula 2 Bronchoscopy 7 JP Drain 19 Bariatric 5 Liver Transplant 1

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Student Assessment One of 167 students failed to meet the required standard of assessment. This student failed the OSCE component of assessment; however the student has re-written the OSCE and has passed. All students passed the team-based assessment component as well as the clerkship assignment. Comparing the results of the MCQ and the OSCE over the last 4 academic years, this year’s students showed an increased performance in the MCQ and expected performance in the OSCE. MCQ 2009 2010 2011 2012 10th percentile 59.2% 63.0% 60% 64% 25th percentile 63.4% 67.0% 63% 70% 50 th percentile 70.0% 72.0% 70% 74% 75th percentile 74.0% 75.0% 75% 79% 90th percentile 78.0% 78.0% 78% 83% OSCE 2009 2010 2011 2012 10th percentile 69.8% 67.2% 67% 70%

25th percentile 71.7% 69.0% 69% 74%

50 th percentile 74.2% 72.5% 72% 77% 75th percentile 77.4% 75.8% 75% 80% 90th percentile 80.0% 78.5% 77% 83%

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Team Based Assessment All students submitted the required number of signed assessment forms on time.

# of assessment forms submitted Median Max Surgeon 4 7 Anesthesiologist 2 4 Chief Resident 2 3 Senior Resident 2 4

Ward Nurse/AHP/ 2 5 OR Nurse 2 4 Peer 4 6 Patient 6 10

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Assessment and Evaluation Surgeons According to the data logged in the clerkship calendar, 55 general surgeons were involved in teaching 167 students, providing a total of 1,370 learning encounters over 3,534 days (a learning encounter is defined as a single educational encounter occurring between one surgeon and one student). Each learning encounter logged lasted a median of 2.3 days (range 0.8-4.5) Each surgeon’s name appeared in the log of a median of 23 students (range: 3-49), spending a median of 57.5 days per year teaching (range: 2.5-149.5); the median number of days spent with each student was around 2. The 55 surgeons completed a total of 690 assessment forms, with each surgeon assessing a median number 12 of students per year (range: 0-30). A median of 50% of teaching encounters were associated with an assessment (range 0%-89%). Students completed a total of 620 teaching evaluations for surgeons (3.7 per student). The average surgeon received a median of 13 teaching evaluations (range: 1-27), suggesting that students were able to evaluate 43% of teaching encounters (range 0%-74%). Anesthesiologists According to the data logged in the clerkship calendar, 154 anesthesiologists were involved in teaching 167 students, providing a total of 548 learning encounters over 573 days. Each learning encounter logged lasted a median of 1 day (range 0.5-2). Each anesthesiologist’s name appeared in the log of a median of 3 students in the year (range: 1-11), spending a median of 3 days per year teaching (range: .5-12). 154 anesthesiologists completed a total of 389 student assessment forms during the year, each assessing a median number of 3 students per year (range: 1-10); 67% of teaching encounters were associated with an assessment. Students completed a total of only 26 teaching evaluations for anesthesiologists, with students evaluating a total of only 21 of the 154 anesthesiologists (14%) over the year. This represents an improvement on the preceding academic year.

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C2013 SURG546 – General Surgery

Department of Surgery – Undergraduate Surgical Education 11

C2013 SURG546 – Anesthesia

Department of Surgery – Undergraduate Surgical Education 12

The Average Medical Student in SURG546 – General Surgery, Anesthesia and Pain Medicine

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Program Evaluation Data from webEval One45

SITES FSK GNH MCH RAH SCH UAH

Number of Evaluations 22 58 52 73 21 77

The learning objectives, and professional behaviors expected of me were made clear. 4.5 4.3 4.4 4.3 4.1 4.4

Important contact and schedule information, course materials and policies were provided to me.

4.4 4.3 4.3 4.2 3.8 4.5

Classroom-based instruction was useful and of high quality. (Education sessions, seminars, rounds).

4.5 4 4 3.9 4.3 4.3

Clinical encounter-based instruction was useful and of high quality. (bedside/clinic teaching, clinical teaching sessions, morning report).

4.8 4.1 4.4 4.0 3.9 4.3

Evidence based practice and reflective practice were taught and role-modeled. 4.4 4.2 4.3 4.1 3.9 4.2

Adequate knowledge resources were provided to achieve learning objectives. 4.4 4.2 4.2 4.1 4.0 4.3

I had frequent opportunities to apply what I had learned to relevant patient problems and clinical situations.

4.6 4.3 4.4 4.0 4.2 4.3

Residents and fellows provided effective teaching during the clerkship. 4.5 4.3 4 4.2 4.5 4.3

Supervision of my clinical activities on this rotation was appropriate. 4.8 4.4 4.3 4.3 4.4 4.4

Supervision of my clinical activities on this rotation was adequate to ensure patient safety (in my opinion).

4.8 4.5 4.4 4.4 4.4 4.5

When I paged my supervisor, he/she responded in a timely fashion. 4.8 4.5 4.4 4.4 4.4 4.5

I was exposed to effective and collegial interaction with other health care team members (nurses, social workers, physiotherapists, etc).

4.5 4.2 4.1 4.0 4.1 4.3

I was treated with respect on this rotation. 4.8 4.3 4.5 4.2 4.1 4.4

The on-call rule was upheld in regards to my clinical duties. 3.9 3.6 3.7 3.7 3.8 3.7

I received regular, timely pertinent, and constructive feedback on my progress and behavior, throughout the rotation.

4.5 3.9 4.3 3.9 3.9 4.0

Suggestions for achievable improvements were linked with the means to accomplish them.

4.5 4.1 4.2 4.0 3.9 4.0

This rotation increased my interest in this discipline as a career choice. 4.2 3.9 3.9 3.5 3.5 4.1

Overall 4.6 4.2 4.3 4.1 4.1 4.3

General Surgery 2005/6 2006/7 2007/8 2008/9 2009/10 2010/11 2011/12 Change 2011 to 2012

Grey Nuns Hospital 3.3 3.9 4.2 4.1 4.1 4.1 4.2 0.1

Misericordia Hospital 3.7 3.9 4.1 4.2 4 4.1 4.3 0.2

Royal Alexandra Hospital 3.7 3.9 4 4 4 3.9 4.1 0.2

University of Alberta Hospital 3.9 3.8 4 4 3.9 3.8 4.3 0.5

FSK (new) 4.5 4.6 0.1 SAH (new) 3.9 4.1 0.2

Department of Surgery – Undergraduate Surgical Education 14

Changes planned for 2012-2013 Although the class size for the upcoming year lowers slightly, we have lowered the number of assessments students are required to receive in the evaluation process of team based assessment. This was based on student feedback and consensus at our clerkship meeting. We have carried over the same concept to the 4th year surgical clerkship as well. Dr. Ron Cheng will be the Anesthesia coordinator, taking over from Dr. Kate Faccenda.

SURG546 has also entered the age of social media. The Undergraduate Office of Surgical Education had a Planning and Development Retreat in the summer of 2012. One of the suggestions that resulted from the workgroup was to consider social media as a way of connecting with students. Twitter accounts

were created for both SURG546 and SURG556 and have been gaining popularity as the school year has progressed. The Faculty of Medicine and Dentistry has changed online learning platform for its dissemination of learning material, scheduling and reporting. SURG546 was the first and only clerkship that was able to move to this new platform for the beginning of the academic school year. We are working closely with the developers and the Faculty to assist them in streamlining some processes and will be assisting other clerkships with their transition based on our experience and expertise.