Asurvey of 3,693 first- and second-year surgical residents found that 48.1% said medical school did not adequately prepare them for the rigors of surgical residency. Although the more overnight calls a student participated in, the more significantly likely they were to have felt adequately prepared for residency, only 51.6% reported taking call less than twice per month, as did 43.3% during sub-internships. However, one-third of those who took call more than four times per month still felt unprepared. Other factors limiting preparedness included rules and regulations limiting what students could do during clerkships and students acting as observers only when taking overnight call. Meanwhile, residents who felt well prepared for surgical training reported significantly fewer symptoms of emotional exhaustion, depersonalization, and burnout.
The paper, published in JAMA Surgery, surveyed residents who were training at hospitals that participated in the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial.
A faculty member interview as part of the investigation noted that in the current culture, medical students were not allowed to write progress notes. A program director said, “I think that we’ve done a real disservice to the medical students at this point, giving them an improper perception of what residency means and what going into surgery means in general.”
These findings did not surprise me. In one of my first blog posts in 2010, I wrote, “The third-year surgery rotation in medical school is not necessarily a good simulation of what it’s like to be a surgical resident.” The school I was with at the time had mandated that the students be allowed to go to bed at 11:00pm and only be awakened for major cases. I further explained this in a 2012 post, saying, “I believe a major cause [of attrition] is that medical students do not understand what surgical residency training is really like. In some schools, third-year [surgical] clerkships are as short as 4 to 6 weeks, and part of that time may be spent on clinic or subspecialty rotations.” I also pointed out that many schools limited the amount of overnight call for students to once per week, resulting in “an unrealistic picture of what a surgical
residency is like.”
The authors of the JAMA Surgery paper concluded, “Adequate exposure to the necessary realities of surgical training and independent practice, particularly overnight call during the medical school clerkship, may [my emphasis] contribute to improved preparedness, lower attrition, and lower rates of burnout in general surgery residency.”
I hope the paper is widely read by medical and surgical educators.