Objective: According to the AAMC, during the 2020-2021 medical school admissions cycle, over 53,000 applicants applied for only 22,239 positions (42% matriculation rate). With intense competition for positions, applicants are required to demonstrate outstanding academics, research, and volunteer work. However, medical students are not frequently exposed to surgical work until completion of their first two years of medical school. Because of this, each year thousands of medical students take their first steps into a completely different classroom; a classroom that bears little resemblance to anything they have experienced before - the operating room.
The operating room has many potential benefits for students - a new setting, more 1-on-1 “teacher” interaction, and multimodal learning including auditory, visual, and hands-on experience in a team-based environment centered around patient-care (Wilhelmsson 2012). That said, to exploit these benefits, a new medical student must overcome many new barriers that can be both overwhelming and stressful. In fact, from a student perspective, it is expected you pick up on cues within the surgery, without training or direct communication all whilst overcoming personal and emotional fears of posing risk to the patient, answering unexpected pimping questions, and ultimately learning (Bowry 2014). These barriers also include navigating the hierarchical order that presents as early as the timeout and often includes intimidation as reported by medical students (Cochran 2015). Perhaps the most stress is added because the situation is real. For what may be the first time, students are dealing with patients\' lives where mistakes are directly impactful and detrimental to patient safety, quality of life, and overall health. It is no longer a classroom, it’s high-paced, unpredictable, and the student and their education is no longer the main focus of the “mentor”. These barriers benefit the student who is confident, adaptive, and have had prior OR exposure (Lyon 2003). But due to a litany of reasons not all students have the opportunity to have prior OR experience, and even the most confident student can be intimidated by the operating room.
Specifically, with the outbreak of COVID-19, medical students have faced new unprecedented challenges to their education. In a study addressing >700 medical students nationwide, 83% reported anxiety about returning to a clinical setting (Harries 2021). Moreover, 61.4% of these students think it has interfered with their ability to be prepared for residency. Along with the COVID-19 pandemic students opportunities to tour the hospital floor where they will be completing their clerkships, and see operating room and scrubs areas were eliminated in an attempt to protect from further spread of the virus. Therefore, virtual learning platforms have become critical over the past two years, a challenge with tasks that all but require in person learning, such as operating room procedures and etiquette.
It is clear that both being in a new learning environment, specifically the operating room, and burden of COVID-19, impinges on a student\'s ability to learn. Because of this, students need resources that allow them to feel safe and prepared, to ensure optimal learning and patient safety. Our study looks to combat the initial stresses of the operating room by teaching students about basic safety in gynecology surgery virtually, while evaluating the knowledge and comfortability of students before the video, after the video, and with the cessation of their third-year clerkship rotation..
Methods: The aim of this study was to allow students an easier transition into the learning environment of the gynecologic operating room for third-year medical students during the COVID-19 pandemic. To do this, a novel video was created in compliance with APGO guidelines to demonstrate how to surgical scrub, gown, glove, and assist in transferring, positioning, prepping, and draping patients while maintaining patient dignity and teaching proper and sterile technique. The video was filmed on a cellular device and incorporated multidisciplinary personnel at Miami Valley Hospital Berry Women’s Center in Dayton, Ohio. All participants photographed signed written-consent prior to taping. Once filmed, the video was edited and narrated via “iMovie”. Facts pertaining patient safety in gynecologic surgery were included and highlighted via written slides within the video before posting to an internet domain.
Four cohorts of third-year medical students in their 2021-2022 OB/GYN clerkship rotation at Wright State University Boonshoft School of Medicine participated in this study. One week before starting their virtual orientation, each student was invited to fill out a voluntary 10-question survey to assess their understanding, comfort-level, and prior knowledge of the gynecological OR setting using google forms (fig. 1). Students were made aware that questionnaire results were both anonymous and had no impact on their clerkship grade. Regardless of survey completion, the created instructional video was then viewed at students’ orientation. After the video, students were then able to fill out the same survey to evaluate the video\'s effectiveness. Participants were followed longitudinally and addressed at the summation of their clerkship and in two areas: did they use the information presented in their orientation within the clerkship, and did the video allow for more comfort within the operating room. Learner’s were also able to give comments on what they liked, disliked or would change with the video experience.
Data were analyzed with the Prism - GraphPad platform using paired t-test analysis. IRB approval was not needed due to the voluntary nature of this survey in an educational setting.
Results: The obstetrical operating room educational video series is a new and innovative way to introduce and instruct medical students to the unique situations they will experience during their Ob/Gyn Clerkship, in a low-stakes and safe environment. The objective of the study was to evaluate Ob/Gyn Clerkship students and their knowledge and feelings about operating room procedure. This was assessed using both a pre- and post-orientation survey, that contained both subjective and objective questions as demonstrated above. There is a third survey, a retrospective survey, taken by the students at the end of the clerkship which assessed the usefulness of the video series through the perspective of the students.
Currently, 69 students took the pre-orientation survey, 44 students took the post-orientation survey, and 38 students completed the retrospective survey. Students answer the first 5 questions on the pre- and post-orientation survey based on objective knowledge about the operating room and common complications, with each question having a single correct answer. The final 5 questions of the pre- and post-orientation survey, questions 6-10, are subjective questions with answer choices: strongly agree, agree, undecided, disagree, strongly disagree. The retrospective survey contains two subjective questions with answer choices stated previously, and with a comment section for students to provide suggestions and other comments.
Evaluating the pre- and post-orientation survey objective questions (questions 1-5) have a single correct answer, the total correct responses are in Table 1. Evaluating the pre- and post-survey subjective questions (questions 6-10) the answers “strongly agree and agree” are considered positive responses to determine if there is an improvement in positive responses from pre- to post-orientation surveys. The performance by students on the objective questions improved through all 5 questions, and the number of positive results for the objective questions improved across all 4 questions gauging the students’ comfortability in the operating room and the etiquette within.
The pre- and post-orientation survey questions were also evaluated by paired t-tests to determine the significance in the change of responses after viewing the orientation presentation, as seen in Table 2. The objective questions, questions 1-5 of the pre- and post-survey were evaluated using a paired t-test (p-value 0.0384, 95% CI 2.091 to 45.95) demonstrating a significant improvement in correct responses on the objective questions, and suggesting the improvement of student knowledge after watching the educational videos. The subjective questions, questions 6-10, were evaluated using a paired t-test (p-value 0.0088, 95% CI 15.29 to 48.56) demonstrating a significant increase in positive responses indicating an increase in student comfortability after viewing the educational videos. Question 8 was eliminated from statistical evaluation because it was used to evaluate whether students had been introduced to the operating room prior to their Ob/Gyn clerkship.
The retrospective survey answers are presented in Table 3, which demonstrate a strong positive response, suggesting the students’ feelings regarding the educational video series and its use during the clerkship.
Conclusion/ Discussion: The effort to prepare students on their Ob/Gyn rotation for participation in the operating room through an education video series was successful as demonstrated objectively from improvement in objective knowledge and subjective comfortability with operating room procedures and etiquette through the pre- and post-orientation surveys. Correct and positive responses increased in all questions on the surveys from pre- and post-viewing of the education video series. Student feedback suggests the video series will remain part of the clerkship orientation day, and continue to approve and adapt in the future.
Topics: Faculty Development Seminar, 2022, Student, Clerkship Director, Patient Care, Medical Knowledge, GME, Assessment, Simulation, General Ob-Gyn,
