Letter re: Reply to: A Novel Educational Tool to Improve Medical Student Knowledge Acquisition During Surgical Rotations

We congratulate Tremont et al for their recent work exploring a unique learning modality that simultaneously facilitates relationships between students and residents. The authors discuss the implementation of a resident-driven curriculum that allows medical students to engage in informal learning sessions throughout their surgery rotation. ¹ The proposed Ask-a-Resident-Topic (ART) card system presents applications across various specialties as a teaching modality. Multiple studies have shown that students who feel involved with the surgical team have a more favorable attitude toward surgical careers and will be more likely to show interest in the field. ² Those with higher levels of interest may work harder to achieve a higher score on the National Board of Medical Examiners (NBME) surgery exam as it becomes a higher stakes exam. Increased interest in surgery fostered by the ART system may serve as a confounder for the higher scores observed between the two cohorts.

To test this observation, a rudimentary analysis of the National Resident Matching Program (NRMP) placement data from the University of North Carolina School of Medicine was performed. We used the match data provided by University of North Carolina to tabulate the number of students who subsequently matched into surgery or a surgical subspecialty between 2016 and 2021. Interestingly, we found that there was a high variance across academic years, and that in the control cohort, there were significantly less students who matched into a surgical field. The lower interest in surgery in the control cohort could have contributed to the NBME surgery exam score average being lower than the 2018-2019 cohort that used the ART card system. Our analysis may be limited as it included all UNC students while the NBME surgery shelf score data only included 65% of 2018-2019 medical student scores. Our analysis also did not account for students taking time off between their third and fourth year as this information was unavailable.

Nonetheless, this teaching modality has high potential to be effective in training medical students. The current organizational hierarchy between students, residents, and attendings may promote timidness in medical students.^3,4 Students pursuing a career outside of surgery may be reserved and shy away from opportunities they may have embraced on other rotations due to fear of inconveniencing the team or appearing incompetent. These missed chances at engagement may result in the loss of potential surgeons and provide evidence for the continuation of surgical stereotypes. Implementation of informal learning sessions with senior team members may bridge this gap between team members and may encourage enhanced communication for student rotations. Additionally, utilization of the ART card system may provide residents opportunities to improve teaching skills and refresh their knowledge on important clinically relevant concepts. Further investigation should be conducted to trial this learning modality across all clerkships and even potentially between resident classes (ex. upper-level residents teaching interns).

In the setting of a busy surgical service in which finding time to teach is one of the primary obstacles that keeps physicians and residents from being able to train medical students, techniques that improve teaching efficiency should be prioritized over traditional didactic methods that are predominantly used in medical education today. Overall, we greatly support the authors of this article and advocate for exploring ways to make clinical education more effective and efficient. We hope that medical schools will continue to emphasize innovative learning modalities that mutually benefit both physicians and medical students.