1. A Mentorship-Based Preclinical Elective Increases Exposure, Confidence and Interest in Surgery Patrick M. Mulvaney, BA 1 Suma Sangisetty, MD 1 Brian C. Drolet, MD 1,2 Beth A. Ryder, MD, FACS 1 William G. Cioffi, MD, FACS 1 1 Department of Surgery, The Warren Alpert Medical School of Brown University, Rhode Island Hospital 2 Division of Plastic Surgery

2. Disclosures Financial support provided by the Rhode Island Hospital Office of Graduate Medical Education for SurveyMonkey® licensing Preliminary data from this study were presented as a poster at the American College of Surgeons Clinical Congress, October 2012 No conflicts of interest

3. Outline Describe course rationale, programming and structure Report results from student surveys

4. Rationale Health Research and Safety Agency predicts a shortage of over 20,000 general surgeons by 2020 Exposure to surgery translates into favorable opinions of the field (O’Herrin, 2003 and 2004; Naylor, 2010) Preclinical years viewed as a potential target for intervention (Bland, 2003) Methods identified or utilized to improve interest: Surgeons as anatomy lab instructors (Zaid, 2010) Surgical skills workshops (Markovic, 2012) Student-resident mentorship (Nguyen, 2006) Structured course offering (Sammann, 2007)

5. Course Purpose and Goals Identify medical students interested in surgery Provide an opportunity for these students to explore surgical interests through a structured course Maintain and enhance professional interest in surgery through education and resident mentorship

6. Course Logistics Started in the fall of 2012, 4 th class is currently in session 12-week course, grading: pass/fail Average enrollment: 8 students (range: 5-11) Didactic 6 case modules led by BR, BD and SS 1 case presentation led by each student Experiential 8 operative experiences 2 departmental conferences (Grand Rounds, M&M, etc.) 1 of each of the following: outpatient clinic, team rounds, skills session (laparoscopic or suturing/knot tying)

7. Leadership Structure

8. Study Design IRB-approved, anonymous survey of students Administered to: Elective students before the course Elective students after the completion of all requirements Non-elective M1 and M2 students at the Warren Alpert Medical School of Brown University 29 multiple-choice questions on a five-point Likert Scale in a self-administered electronic format

9. Results Elective (test) group: n=24 (100% response rate) General (control) cohort: n=147 (67% response rate) Overall course satisfaction: 4.8/5 Significant difference (p<0.01) in most pre- vs. post- course metrics aimed at assessing confidence, exposures and perceptions of surgery

10. Composite Results (1= least through 5= most)

11. Exposure

12. Confidence

13. Conclusions A preclinical elective centered around mentorship can effectively improve exposure, confidence and interest in surgical careers Effective course implementation requires: Institutional support Effective leadership Dedicated resident-mentors Motivated students

14. Future Work Continued improvement based on student feedback Evaluate course impact on: Clerkship performance Match rates

15. Thank you Questions

16. References Physician Shortage Spreads Across Specialty Lines. AAMC. (Accessed Aug. 8, 2012, at https://www.aamc.org/newsroom/reporter/oct10/152090/physician_shortage_spreads_across_specialty_lines.html.) Bland KI. The recruitment of medical students to careers in general surgery: emphasis on the first and second years of medical education. Surgery 2003;134(3):409-13. Markovic J, Peyser C, Cavoores T, Fletcher E, Peterson D, Shortell C. Impact of endovascular simulator training on vascular surgery as a career choice in medical students. J Vasc Surg 2012;55(5):1515-21. Naylor RA, Reisch JS, Valentine RJ. Do student perceptions of surgeons change during medical school? A longitudinal analysis during a 4-year curriculum. Journal of the American College of Surgeons 2010;210(4):527-32. Nguyen SQ, Divino CM. Surgical residents as medical student mentors. American journal of surgery 2007;193(1):90-3. O'Herrin JK, Lewis BJ, Rikkers LF, Chen H. Why do students choose careers in surgery? The Journal of surgical research 2004;119(2):124-9. O'Herrin JK, Lewis BJ, Rikkers LF, Chen H. Medical student operative experience correlates with a match to a categorical surgical program. American journal of surgery 2003;186(2):125-8. Sammann A, Tendick F, Ward D, Zaid H, O'Sullivan P, Ascher N. A surgical skills elective to expose preclinical medical students to surgery. The Journal of surgical research 2007;142(2):287-94. Zaid H, Ward D, Sammann A, Tendick F, Topp K, Maa J. Integrating Surgical Skills Into the Anatomy Laboratory. 2010; 158(1): 36-42