1. Clinical Exposure During a Surgery Clerkship: Contrast between a Canadian and an American Medical School Division of General Surgery and the Center for Medical Education McGill University Sarkis Meterissian, A Sender Liberman and Moishe Liberman

2. Introduction  Surgical clerkships should expose medical students to common surgical disorders  Clerkships should provide hands-on experience with diagnosis and disease management  Study at SIU showed that students on a surgical clerkship had little opportunity to be the first to interact with patients in the ER, clinic or in-patient setting Boehler ML, JACS 2002;195:539-542

3. Hypothesis Due to discrepancies in health care delivery and resources between the US and Canada, medical clerks in Canada get more hands-on training than clerks in the United States

4. Objectives 1. Evaluate and quantitate the contact that medical students receive while on their surgical rotation in a Canadian medical school 2. Compare the patient exposure experienced by students between a Canadian and an American medical school

5. Methods  Survey (8-item) administered to students at a Canadian medical school  Survey examined student exposure to patients during a surgical clerkship  Results of surveys were compared between the two universities: - McGill University and Southern Illinois University

6. Surveys  Surveys at SIU were given to twenty 3 rd year medical students to evaluate 311 different student- patient encounters  Surveys at McGill were e-mailed to all 3 rd and 4 th year medical students to assess their overall student-patient interaction experience  Responses were on a 4-point Likert scale (Never, Seldom, Often, Always)

7. Statistical Methods  Results of specific questions posed to medical students reported as group percentages  Never/Seldom, Often/Always lumped together for statistical analysis  Between group differences were compared using:  Pearson Chi-Square Test and Fisher’s Exact Test (categorical variables)  Independent Samples T-test (continuous variables)

8. Results Canadian Medical School Student N= 50  Med-3: 14  Med-4: 32  Unknown: 4

9. Results Most frequent place of patient encounter Percent of Students Place of Encounter CanadaUSAP-Value Clinic10%34%0.001 IP Consult0%2.9%0.226 ER Consult34%1.9%<0.001 AM Admit2%19%0.003 OP Surgery4%28%<0.001 IP Surgery36%15%<0.001

10. Results Canadian / American Comparison Number of physicians evaluating patients prior to student Mean (SD) Canada1.60 (0.79) USA2.41 (1.49) P = 0.001

11. Results Canadian / American Comparison CANADAUSAP-Value Student First to Elicit Chief complaint 44.0%22.5%0.003 Student Had Access to PM records 82.0%80.1%0.46 Initial P.E. Performed by Student 64.0%36.3%<0.001

12. Results Canadian / American Comparison CANADAUSAP-Value How often did student generate hypothesis 46.0%14.8%<0.001 How often did student order investigations 44.0%11.6%<0.001 Was diagnosis known prior to work-up 54.0%85.2%<0.001

13. Discussion  Problems with this study: 1. Actual patient contact logbooks not reviewed at McGill 2. Low numbers of students: 20 at SIU and 46 at McGill

14. Discussion  Students in our medical school received more hands-on training than their American counterparts  Explanations: - Differing teaching philosophies - Differing sites for the initial encounter

15. Conclusions  While educational value is not evaluated in this study, these differences may result in: 1. increased interest in general surgery as a career choice 2. better training of medical students

17. Results Canadian Medical School NeverSeldomOftenAlways Student First to Elicit Chief complaint 14%42%38%6% Student Had Access to PM records 018%60%22% Initial P.E. Performed by Student 4%32%56%8%