J Educ Eval Health Prof.  2013;10:10.

Is it time for integration of surgical skills simulation into the United Kingdom undergraduate medical curriculum? A perspective from King's College London School of Medicine

• Hamaoui K
• Sadideen H
• Saadeddin
• Onida S
• Hoey AW
• Rees J

Abstract

PURPOSE
Changes in undergraduate medical curricula, combined with reforms in postgraduate education, have training implications for surgical skills acquisition in a climate of reduced clinical exposure. Confidence and prior experience influences the educational impact of learning. Currently there is no basic surgical skills (BSS) programme integrated into undergraduate curricula in the United Kingdom. We explored the role of a dedicated BSS programme for undergraduates in improving confidence and influencing careers in King's College London School of Medicine, and the programme was evaluated.
METHODS
A programme was designed in-line with the established Royal College of Surgeons course. Undergraduates were taught four key skills over four weeks: knot-tying, basic-suturing, tying-at-depth and chest-drain insertion, using low-fidelity bench-top models. A Likert-style questionnaire was designed to determine educational value and influence on career choice. Qualitative data was collected.
RESULTS
Only 29% and 42% of students had undertaken previous practice in knot-tying and basic suturing, respectively. 96% agreed that skills exposure prior to starting surgical rotations was essential and felt a dedicated course would augment undergraduate training. There was a significant increase in confidence in the practice and knowledge of all skills taught (p<0.01), with a greater motivation to be actively involved in the surgical firm and theatres.
CONCLUSION
A simple, structured BSS programme can increase the confidence and motivation of students. Early surgical skills targeting is valuable for students entering surgical, related allied, and even traditionally non-surgical specialties such as general practice. Such experience can increase the confidence of future junior doctors and trainees. We advocate the introduction of a BSS programme into United Kingdom undergraduate curricula.

Keyword

Surgical skills; Undergraduate training; Evaluation; Career choice; Confidence; United Kingdom

MeSH Terms

Career Choice
Climate
Curriculum*
Education
General Practice
Great Britain*
Humans
Learning
Motivation
Surveys and Questionnaires

Figure

• 

  Fig. 1 Reported confidence in performing knot tying (A), knot tying at depth (B), suturing (C), and chest drain insertion (D) prior to enrolling in the course and after completion, with significant increase across all four skills (p<0.01) in 2008/09 academic year, King’s College London School of Medicine.

Reference

1. Wass V. Monitoring the medical education revolution. BMJ. 2003; 327:1362. http://dx.doi.org/10.1136/bmj.327.7428.1362.

2. Naylor R a, Hollett L a, Castellvi A, Valentine RJ, Scott DJ. Preparing medical students to enter surgery residencies. Am J Surg. 2010; 199:105–109. http://dx.doi.org/10.1016/j.amjsurg.2009.09.003.

3. Sanfey H, Dunnington G. Verification of proficiency: a prerequisite for clinical experience. Surg Clin North Am. 2010; 90:559–567. http://dx.doi.org/10.1016/j.suc.2010.02.008.

4. Meyers MO, Meyer AA, Stewart RD, Dreesen EB, Barrick J, Lange PA, Farrell TM. Teaching technical skills to medical students during a surgery clerkship: results of a small group curriculum. J Surg Res. 2011; 166:171–175. http://dx.doi.org/ 10.1016/j.jss.2010.05.019.

5. Zaid H, Ward D, Sammann A, Tendick F, Topp KS, Maa J. Integrating surgical skills education into the anatomy laboratory. J Surg Res. 2010; 158:36–42. http://dx.doi.org/10.1016/j.jss.2008.08.012.

6. Sadideen H, Kneebone R. Practical skills teaching in contemporary surgical education: how can educational theory be applied to promote effective learning? Am J Surg. 2012; 204:396–401. http://dx.doi.org/10.1016/j.amjsurg.2011.12.020.

7. Kneebone R, Arora S, King D, Bello F, Sevdalis N, Kassab E, Aggarwal R, Darzi A, Nestel D. Distributed simulation--accessible immersive training. Med teach. 2010; 32:65–70. http://dx.doi.org/10.3109/01421590903419749.

8. DiMaggio PJ, Waer AL, Desmarais TJ, Sozanski J, Timmerman H, Lopez JA, Poskus DM, Tatum J, Adamas-Rappaport WJ. The use of a lightly preserved cadaver and full thickness pig skin to teach technical skills on the surgery clerkship: a response to the economic pressures facing academic medicine today. Am J Surg. 2010; 200:162–166. http://dx.doi.org/10.1016/j.amjsurg.2009.07.039.

9. Royal College of General Practitioners [Internet]. London: Royal College of General Practitioners; [cited 2013 Apr 16]. Available from: http://www.rcgp.org.uk/new_professionals/students.aspx .

10. NICE update of guidance on the treatment and care of people with skin cancer May 2010 [Internet]. London: National Institute for Health and Care Excellence; 2010 [cited 2013 June 6] Available from: http://www.nice.org.uk/newsroom/pressreleases/NICEUpdatesSkinCancerGuidance.jsp?domedia=1&mid=CFD181FC-19B9-E0B5-D4A6D733187B4EE6.