Short Communication

Satisfaction of Medical Students with Surgical Training: A Survey of Northern Italy

Gabriela Azevedo Sansoni1, Patrizia Borzi2, Preetha Karki3, Shahzeen Khan Sajid4, Anastasia Semikhnenko3, Aswathy Varma3


doi: http://dx.doi.org/10.5195/ijms.2022.1450

Volume 10, Number 3: 277-287
Received 20 03 2022; Rev-request 23 06 2022; Rev-request 15 07 2022; Rev-recd 22 07 2022; Rev-recd 01 08 2022; Accepted 29 08 2022

ABSTRACT

Background:

Medical student satisfaction regarding the inclusion of surgical education into the medical curriculum may vary among learners. In this study, we analyzed the satisfaction of medical students in regard to how surgical topics were taught in Italian schools in 2021 through a survey. The results collected can be used to not only improve the quality of medical education in the future, but to help students make informed decisions about their own education.

Methods:

An electronic survey was sent out to medical students in their third to sixth years across three medical schools in Northern Italy via their respective institutional secretaries. The questionnaire was available in Italian and English. It included both closed and open-ended questions regarding satisfaction with the teaching of surgical topics in Italian medical universities.

Results:

Results were reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Most respondents (87%) preferred to have an increase in surgery-related electives and/or extracurricular courses. Further, 51.2% of respondents expressed an increased interest in surgery after having observed in the Operating Room (OR). The majority of respondents (73.3%) also expressed that the coronavirus disease 2019 (COVID-19) pandemic had negatively impacted the quality of teaching of surgical topics.

Conclusion:

In the present survey study, Italian medical students preferred hands-on practice over theoretical lectures for surgical education. The majority of students stipulated that the inclusion of suturing, scrubbing, and good surgical practice workshops along with an increased OR attendance would facilitate a better understanding of surgery.

Keywords: Surgical Procedures; Operative; Education; Medical; Survey (Source: MeSH-NLM).

Introduction

Surveys represent a valuable tool for collecting information on student perceptions of medical education. Educators and educational institutions often use surveys to collect relevant feedback and improve the quality of education.1,2

It is crucial to understand the perception of surgical educational programs by students as student satisfaction with their training is essential for the program's effectiveness and their career output. It goes without saying that the technical skills of surgeons are directly related to postoperative outcomes. In Italy, several studies based on surveys have been done. A study conducted in 2016 comparing the attitudes of medical students who experienced different training models for their surgical rotations demonstrated that learning in the Operation Room (OR) and through observed ward rounds provided the most effective training experience. Students who were not admitted to the OR reported poor educational experiences.3 Several studied in Saudi Arabia, for example, showed that surgical students were generally dissatisfied with their current training programs and revealed significant weaknesses in their education.4,5

Other surveys conducted in Italy revealed that the majority of medical students expressed concerns regarding distance learning during the SARS-CoV-2 disease (COVID-19) pandemic.6 Additionally, the COVID-19 pandemic has affected surgical medical education in unprecedented ways. Many countries have faced the necessity to move to distance learning through different methods and this has imposed many restrictions on surgical training and reflected in various ways on student satisfaction.7 Surgical residents and early-career surgeons across the globe have experienced reduced operating times due to cancellation of elective surgeries leasing to a decline in intraoperative practice and training opportunities.8,9

However, information regarding the level of student satisfaction with regards to the teaching of surgical skills in the context of the COVID-19 pandemic is still limited. This study, designed as a survey, aims to delineate the level of satisfaction in surgical training and the opinions of medical students on how surgical topics are taught in Italy in the context of the COVID-19 pandemic.

Methods

Setting, Sampling Method, and Population

Electronic Surveys were sent via email to the students’ respective medical school secretaries in three universities in Northern Italy. Responses were collected between the 26th of April and the 10th of August, 2021. Italian medical students in their third through sixth year.

Survey

This survey was developed using a precise sequence of item generation, item reduction, questionnaire formatting, composition, pilot testing, and transcription in both Italian and English.10 The closed-ended questions were created using Likert's 5-point rating scale system ranging from 1 to 5 (in which 1 corresponds to “not interested at all” and 5 to “very interested”;) as well as multiple-choice questions. The full survey is available in the Supplementary Material. Closed-ended questions facilitated robust data analysis, allowing reliable quantification of effect size.11 Respondents were also able to express their opinions through open-ended questions and to obtain a better understanding of participants’ perceptions. A soft-launch approach with a pilot survey determined the expected response rate and was used to correct any ambiguities before finalizing the survey.

Analysis

Results were reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES).12 Simple descriptive statistics (frequencies and percentages) were computed for each survey question using the Excel Office 16.51 functions and performed statistical analysis using GraphPad online software (QuickCalcs; http://www.graphpad.com/quickcalcs). The Google Forms platform, chosen to collect the data, is in accordance with the European Union General Data Protection Regulation.13 The survey questions were also reviewed and approved by the organization Women in Surgery Italia, who themselves carried out a survey study to assess satisfaction among female surgeons in Italy and gender-based discrimination.14

Results

Responses obtained before August 10th, 2021, at 12:00 pm Central European Time were analyzed. The survey was sent to a total of 419 students, of whom 103 responded (response rate of 24.6%). Two students (1.9%) enrolled in their non-clinical years were excluded from the survey. Overall, 30 (29.1%) respondents were enrolled in their third year, 22 (21.4%) in their fourth year, 36 (35.0%) in their fifth year, and 13 (12.6%) in their sixth year. The baseline characteristics of the participants are outlined in Table 1. Students’ interest in surgery (Figure 1) was variable throughout their degree.

Table 1.

Participant's Characteristics.

Participant characteristics Number Percentage (%)
Number of students that received the survey 419 N/A
Total number of survey respondents 103 N/A
 Response rate 103/419 24.6
Those who answered in English 87 84.5
Those who answered in Italian 16 15.5
Age (years)
 20–23 50 49.5
 24–27 43 42.6
 28 8 7.9
Gender
 Female 74 73.3
 Male 24 23.8
 Other 3 3.0
Year of study
 1st and 2nd year 2 1.9
 3rd year 30 29.1
 4th year 22 21.4
 5th year 36 35.0
 6th year 13 12.6
Nationality
 Italian 41 40.6
 Non-Italian 60 59.4
Employment status
 Full-time students 73 70.9
 Occasional workers 16 15.8
 Part-time workers 7 6.9
 Full-time workers 2 2.0
Place of study
 Lombardy 85 84.2
 Emilia-Romagna 16 15.8
Legend: Participant characteristics that were obtained through their answers at the beginning of the survey. N/A: non-applicable

Figure 1.

Interest in surgery at the beginning of students’ medical education compared with the time of the survey.


Legend: Level of Interest Rated from 1 (Not interesting at all) to 5 (very interested). Student's interest in Surgery at the beginning of their medical education compared to their interest in surgery at the time of answering the Survey.

Theoretical surgery courses included in the curriculum were evaluated by survey respondents with the use of a Likert scale. Only 5% of students found the classes “very interesting” while 76.3% of students ranked the courses from “not interesting at all” to “mildly interesting”. Just 4.1% of the respondents claimed that the existing surgery clerkships were very useful for their learning experience; 39.8% of respondents described the clerkships as somewhat useful for their learning experience and 24.5% as not useful. Of the responding students, 31.6% had not had surgical clerkship experiences yet.

As demonstrated in Figure 2, a majority of the respondents (82.2%) agreed that the mandatory hours of practice included in their institutional surgical courses were insufficient. Only 5.9% of respondents reported that the hours of practice were sufficient. A significant proportion of the respondents had never been to the OR (26.7%) or had been to the OR only 1 to 5 times (43.6%). Only 15.8% of respondents had been to the OR more than 10 times. Of those that attended the OR, more than half (51.2%) expressed an increased interest in surgery after the OR experience. Significant percentages of students reported wanting to go to the OR more frequently and disclosed that the hours of practice included in their surgical course were insufficient (Figure 2).



Figure 2.

Student's experience of and ideas for improvement for surgical skills teaching.


Legend: This figure presents the percentage of students that have selected these possible answer options for various questions in the survey pertaining to their experience and their suggestions for improvement relative to how surgery is taught.

Regarding the impact of the COVID-19 pandemic, most respondents (73.3%) confirmed that it negatively affected the quality of teaching of surgical topics. Less than a quarter (24.8%) did not notice any change in the quality of teaching of surgical topics due to the pandemic and 2.0% of the students found that the pandemic positively affected the quality of teaching.

Unpaired t-tests were performed to compare the interest in surgery among the participants at the beginning of medical school as well as their interest in surgery at the time of the survey.10 No statistical difference was found between men and women. However, a paired t-test of the interest in surgery in all participants at the beginning of university compared to the time of the survey showed a statistically significant decrease (p=0.01).

Discussion

This was the first study to evaluate the quality of surgical teaching as reported by students at Italian medical schools. High levels of dissatisfaction were highlighted- in that a significant percentage of the students (82.2%) reported that not enough hours of practice were included in the surgical courses at their institutions. The majority of the respondents (43.6%) had attended the OR one to five times only or had never attended it (26.7%) at all. The benefit of increasing surgical practical skill development is demonstrated by 51.2% of the respondents expressing an increased interest in surgery after OR experiences. The same percentage of students claimed that an increase in OR attendance would increase satisfaction with surgical training. The majority of respondents (87.0%) maintained that they would like to have more surgery-related electives and/or extracurricular activities to be included in core courses. Furthermore, a large percentage (Figure 2) of students responded that the inclusion of good surgical practice, scrubbing and suture workshops, as well as increased OR attendance would help in having a deeper understanding and knowledge of surgery14.

Strengths

The present survey provided critical insight into the opinions of third- to sixth-year medical students in Medicine and Surgery International courses in Italian medical schools. The inclusion of “Other” as an alternative to selected multiple-choice answers minimized the potential inflexibility inherent to questionnaires12,13. A soft launch approach via a pilot survey allowed the design of a clear and easily understandable questionnaire. The bilingual characteristic of the survey minimized the potential language barrier interference.

Limitations

Reduction of sampling bias was done by reaching out to students through their respective medical school secretaries. Due to the lack of response from many medical schools, it was only possible to reach students studying in the Lombardy and Emilia-Romagna regions, which limited the generalizability of this study geographically. Further investigation is vital to obtain a broader perspective of medical student surgical experiences. Nevertheless, such a limitation has a positive impact on the specificity of findings in characterizing a more specific population of medical students in Italy. In addition, the easily replicable method can be used in other regions to quantify the same variables.

Conclusion

Previous studies have shown that students are dissatisfied with how the theoretical aspects of surgery are taught. Furthermore, there is a much greater percentage of students that are dissatisfied with the number of learning opportunities for surgical practical skills. The present survey sheds light on the areas in which changes are necessary to improve the overall experience of students regarding surgical training and teaching. Lastly, regarding the implications of COVID-19 restrictions on surgical topics teaching, a large proportion of students reported significant impacts on medical learning. This result reiterates the preference for practical lessons and active learning in surgical teaching for students.

Summary – Accelerating Translation

Soddisfazione dei Studenti di Medicina e Chirurgia con l'Insegnamento della Chirurgia: un'Indagine del nord Italia

Questo studio si focalizza sulla soddisfazione degli studenti del corso di studio in medicina e chirurgia per quanto riguarda l'approccio all’insegnamento delle materie chirurgiche in alcune regioni dell'Italia settentrionale. Dopo svariati confronti tra studenti di medicina in Italia, è emersa l'impressione comune della presenza di un distacco tra l'insegnamento della chirurgia all’università e la realtà dell’attività e della professione chirurgica. Gli ultimi anni accademici sono stati inoltre segnati dalla pandemia di COVID-19, che ha imposto significativi cambiamenti nell’ambito delle esperienze pratiche e dei tirocini. Questo sondaggio mira a misurare l'impatto di questo nuovo problema anche nell'insegnamento delle materie chirurgiche. Abbiamo ritenuto che un sondaggio fosse il metodo appropriato per indagare le opinioni degli studenti su questo tema e per utilizzare potenzialmente i dati qualitativi raccolti per migliorare la futura qualità dell'istruzione degli studenti di medicina in Italia.

METODI

Un’indagine qualitativa è stata inviata agli studenti dal terzo al sesto anno di 3 diverse scuole di medicina dell’italia settentrionale tramite un'e-mail inoltrata loro dalle rispettive segreterie istituzionali. Il questionario è stato progettato e sperimentato su studenti di medicina per assicurarsi che il testo e le modalità di compilazione fossero chiari e di facile comprensione. Il questionario era disponibile in italiano e in inglese, in quanto queste sono le due lingue di insegnamento dei corsi di medicina e chirurgia in Italia, e comprendeva sia domande chiuse che aperte, riguardanti la soddisfazione per l'insegnamento delle materie chirurgiche nei corsi di studio in medicina.

RISULTATI

In totale abbiamo ricevuto 103 risposte. Abbiamo riscontrato che l’interesse per la chirurgia dei partecipanti al sondaggio ha subito dei cambiamenti durante il percorso di studio. È infatti emerso un calo di interesse per la chirurgia con l’avanzare degli studi: il 35.6% degli studenti aveva espresso di essere molto interessato alla chirurgia prima di iniziare a studiare medicina, ma solo il 25.7% ha dichiarato di essere molto interessato alla materia al momento della risposta al sondaggio. Mediante l’utilizzo di test statistici, abbiamo effettivamente riscontrato dei risultati rilevanti nel calo di interesse per la chirurgia dei partecipanti.

Abbiamo inoltre evidenziato una scarsa soddisfazione dei partecipanti relativamente ai corsi teorici di chirurgia. L’interesse veniva espresso nelle risposte con una scala Likert da 1 a 5, dove 1 rappresenta elementi “per nulla interessanti” e 5 “ molto interessanti”. Il 14.9% degli studenti li ha definiti “per nulla interessanti”, il 28.7% hanno dato un punteggio di 2 su 5, e il 32.7% di 3 su 5. Solo il 5% dei partecipanti li considera “molto interessanti”.

Per quanto riguarda la soddisfazione sull’insegnamento della chirurgia, abbiamo usato la stessa modalità di risposte e abbiamo riscontrato un pattern di risposte simile. Il 25.7% degli studenti ha dato un vuoto di 1 che corrispondeva a “per nulla” soddisfatti, il 24.8% ha dato un voto di 2, il 35.6% di 3 e solo il 5.0% erano “molto” soddisfatti.

Abbiamo poi indagato quanto la pratica sia necessaria nell'insegnamento della chirurgia: l’opinione del 97.0% degli studenti è che sia necessaria. Solo il 4.1% dei partecipanti al sondaggio ha però definito utili i tirocini pratici, e la maggior parte degli studenti (82.2%) ha concordato sul fatto che le ore pratiche incluse nei corsi di chirurgia siano insufficienti.

Il 26.7% dei partecipanti ha dichiarato di non essere mai stato in sala operatoria, e solamente il 15.8% di esserci stato più di 10 volte. Alla domanda “;quanto spesso vorresti andare in sala operatoria?” il 35.0% degli studenti ha risposto una volta alla settimana, il 43.8% una volta al mese, il 15.0% una volta all’anno, il 6.3% mai.

Abbiamo ricevuto una vasta gamma di risposte alla domanda riguardante i possibili miglioramenti dell'insegnamento della chirurgia: la maggior parte degli studenti partecipanti al sondaggio ha votato per corsi di vestizione, lavaggio e pratiche di comportamento in sala operatoria, per l’aggiunta di corsi di sutura e per l’aumentata frequenza in sala operatoria.

Per quanto concerne l’impatto della pandemia, il 73.3% ha affermato che questa ha negativamente impattato sulla qualità dell'insegnamento della chirurgia. Il 24.8% non ha notato alcun cambiamento, e solo il 2.0% ha notato dei cambiamenti in positivo.

CONCLUSIONE

Diversi studi hanno già evidenziato l’insoddisfazione degli studenti di medicina per quanto riguarda le modalità di insegnamento della parte teorica della chirurgia, ma ancor più studenti non sono soddisfatti della quantità di opportunità dedicate all’insegnamento della parte pratica.

Questo sondaggio vuole puntare i riflettori sugli aspetti che necessitano di essere migliorati per offrire agli studenti un’esperienza della chirurgia completa nella teoria e nella pratica, nell’insegnamento e nell’apprendimento.

Molti dei partecipanti hanno espresso interesse nel poter avere accesso a maggiori attività in ambito chirurgico, ad esempio con più corsi elettivi dedicati alla chirurgia, corsi di vestizione e pratiche di comportamento in sala operatoria. Questi, insieme ad una aumentata frequenza in sala operatoria, aiuterebbero significativamente a perseguire una preparazione più completa anche in ambito chirurgico.

L’insoddisfazione sulla qualità dell'insegnamento è stata evidenziata dall’ 82.2% degli studenti che ha espresso una carenza di ore di pratica; questo dato ø stato confermato anche dalle basse percentuali di studenti che hanno frequentato più di 5 volte la sala operatoria. I benefici dell’idea di aumentare le ore di pratica chirurgica sono dimostrati da un aumentato interesse degli studenti per la chirurgia dopo essere stati in sala operatoria, e dall’affermazione degli studenti che una maggiore frequenza della sala operatoria incentiverebbe il loro interesse per la chirurgia.

Infine, considerando l’impatto delle restrizioni imposte dalla pandemia di COVID-19 sull'insegnamento delle materie chirurgiche, la maggior parte degli studenti ha percepito un peggioramento: questo risultato evidenzia nuovamente la preferenza degli studenti per lezioni pratiche e apprendimento attivo. in nunc porta tristique. Proin nec augue.

Acknowledgments

We would like to thank all survey respondents that made this project possible. We would also like to thank Dr Gaya Spolverato and Dr Daunia Verdi from Women in Surgery Italia for reviewing the initial survey proposal.

Conflict of Interest Statement & Funding

The Authors have no funding, financial relationships or conflicts of interest to disclose.

Author Contributions

Conceptualization: GAS, PB, SKS, AS, AV. Data Curation: GAS, PK, AS, AV. Formal Analysis: PB. Investigation and Methodology: GAS, PB. Project Administration: GAS. Resources: PK. Supervision: GAS. Validation: GAS, PB, SKS. Visualization: GAS, AS, AV. Writing – Original Draft Preparation and Writing – Review & Editing: GAS, PB, PK, SKS, AS, AV.

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Supplementary Material

Engagement and satisfaction of medical students in Italy: how are surgical topics taught? (Italian version)

Questo è un sondaggio anonimo che indaga il coinvolgimento e la soddisfazione degli studenti nell’insegnamento della chirurgia nei corsi di Medicina e Chirurgia in Italia.

Non raccogliamo né trattiamo alcun dato personale; la piattaforma utilizzata per il sondaggio è conforme alla EU GDPR.

Rispondendo al questionario presti il consenso all’utilizzo delle tue risposte per finalità accademiche. La compilazione del sondaggio richiederà circa 3 minuti.

Grazie per la tua partecipazione!

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* Required

Engagement and satisfaction of medical students in Italy: how are surgical topics taught? (English version)

This is an anonymous survey about student engagement and satisfaction with how surgical topics are taught in Italian Medical Schools.

We are not collecting any identifiable personal data, and the platform used for the survey complies with EU GDPR.

By filling the survey you agree that we can use your answers for academic purposes. The time required to fill in the questionnaire is about 3 minutes.

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* Required

Gabriela Azevedo Sansoni, 1 Fourth year Medical Student. International Medical School. Milan, Italy.

Patrizia Borzi, 2 MD. International Medical School-Università degli Studi di Milano, Milan, Italy.

Preetha Karki, 3 Sixth-year Medical Student. International Medical School-Università degli Studi di Milano, Milan, Italy.

Shahzeen Khan Sajid, 4 Sixth-year Medical Student. Humanitas university, Milan, Italy.

Anastasia Semikhnenko, 3 Sixth-year Medical Student. International Medical School-Università degli Studi di Milano, Milan, Italy.

Aswathy Varma, 3 Sixth-year Medical Student. International Medical School-Università degli Studi di Milano, Milan, Italy.

About the Author: Gabriela is a 4th year medical student at the International Medical School, University of Milan, Italy, of a six year program She is also a recipient of the STREAM scholarship by the League of European Research Universities at University Medical Center Utrecht, her final project was awarded a prize at the OPorto Biomedical Summit. She is also the founder and president of the Association of Women Surgeons University of Milan Chapter.

Correspondence: Anastasia Semikhnenko. Address: Via Festa del Perdono 7, Milano, Lombardia, Italy. Email: Anastasia.semikhnenko@studenti.unimi.it

Editor: Kiera Liblik Student Editors: Marina Shatskikh & David Ulrich Dalle Proofreader: Mohammad Amin Khazeei Tabari Layout Editor: Ana Maria Morales Process: Peer-reviewed

Cite as: Azevedo Sansoni G, Borzi P, Karky P, Khan Sajid S, Semikhenko A, Varma A. Satisfaction of Medical Students with Surgical Training: A Survey of Northern Italy. Int J Med Stud. 2022 Jul-Sep;10(3):277-87.

Copyright © 2022 Gabriela Azevedo Sansoni, Patrizia Borzi, Preetha Karki, Shahzeen Khan Sajid, Anastasia Semikhnenko, Aswathy Varma

This work is licensed under a Creative Commons Attribution 4.0 International License.

International Journal of Medical Students, VOLUME 10, NUMBER 3, August 2022