Walking the Walk: A Review of Medical Students’ Perspective of a Surgical Theatre as the New Classroom
DOI:
https://doi.org/10.5195/ijms.2023.1942Keywords:
Medical Education, Medical Students, Learning, Operating Room, Education, Medical student, Knowledge, Attitudes and Practices, Surgery training, Surgery, Surgical theatre, MD, MBBS, MD-PhD, MD-MSc, Curriculum, DO, MD student, MBBS student, MD-MSc student, MD-PhD student, DO student, Surgical skills, Surgical trainingAbstract
Medical school trains eligible students for a medical degree (MD). As part of the clinical years in the MD program, students attend surgical theatre sessions to learn medical concepts from hands-on experience in the theatre. This review aims to provide a comprehensive overview of the role surgical theatre plays in the learning process and clinical experience of medical students. Google Scholar, PubMed and NCBI databases were searched for articles from 1990 to March 2022 using the search terms ‘Operating Room’ or ‘Operating Theatre’ or ‘Surgical Theatre’ and ‘Learning’, ‘Medical Students’ and ‘Surgeons’. Only articles on medical students’ perceptions on their learning experience in the surgical theatre were included. Thirty-four articles were eligible for inclusion. Unpreparedness, anxiety, lack of clear learning outcomes, fear and intimidation were the most common reported experiences by students. These demotivate medical students from attending theatre, along with poor surgical field visibility, resulting in a negative learning experience. Positive experiences during theatre time were more likely to attract students to choose a future surgical career. Limitations include the inclusion of surgical residents’ perspectives and the exclusion of other surgical team members’ perspectives. Studies included students across different clinical years, and results were primarily based on subjective perceptions. Evidently, the surgical theatre is a great learning opportunity for medical students. However, for this learning environment to be beneficial, students need to be included during surgical discussions and procedures. Additionally, clear learning outcomes need to be present whilst adequately training students prior to their first surgical attendance.
Metrics
References
Karle H. How do we Define a Medical School?: Reflections on the occasion of the centennial of the Flexner Report. Sultan Qaboos Univ Med J. 2010;10(2):160–8.
Association of American Medical Colleges. What to Expect in Medical School. Available from: https://students-residents.aamc.org/choosing-medical-career/what-expect-medical-school. Last updated 2015; cited Aug 5, 2022.
Croghan SM, Phillips C, Howson W. The operating theatre as a classroom: a literature review of medical student learning in the theatre environment. Int J Med Educ. 2019;10:75–87. DOI: https://doi.org/10.5116/ijme.5ca7.afd1
Stark P. Teaching and learning in the clinical setting: a qualitative study of the perceptions of students and teachers. Med Educ. 2003;38(11):975–82. DOI: https://doi.org/10.1046/j.1365-2923.2003.01675.x
Hartman EK. A medical student’s first experience of theatre. Med J Aust. 2016;205(7):311–2. DOI: https://doi.org/10.5694/mja16.00617
Wilhelmsson B. Teachers’ intention for outdoor education: conceptualizing learning in different domains [Master thesis]. 2012.
GMC. Outcomes for Graduates. Available from: https://www.gmc-uk.org/-/media/documents/practical-skills-and-procedures-a4_pdf-78058950.pdf. Last updated 2018; cited Aug 5, 2022.
GMC. Tomorrow’s Doctors. Available from: https://www.gmc-uk.org/-/media/documents/Outcomes_for_graduates_Jul_15_1216.pdf_61408029.pdf. Last updated 2009; cited Aug 5, 2022.
Twigg V, McNally SA, Eardley I. What are the differences between medical schools that graduate more aspiring surgeons than others? Bulletin. 2020;102(2):e009. DOI: https://doi.org/10.1308/rcsbull.2020.e009
Agha RA, Papanikitas A, Baum M, Benjamin IS. The teaching of surgery in the undergraduate curriculum--reforms and results. Int J Surg. 2005;3(1):87–92. DOI: https://doi.org/10.1016/j.ijsu.2005.03.017
Kent F, McGregor E, Jamieson RW. Faculty development review: Improving learning in the operating theatre. Clin Teach. 2021;18(1):33–6. DOI: https://doi.org/10.1111/tct.13265
Taylor I. Surgery in the UK undergraduate curriculum. Surgery (Oxford). 2003;21(5):i–ii. DOI: https://doi.org/10.1383/surg.21.5.0.15502
Gaines S, Luo JN, Gilbert J, Zaborina O, Alverdy JC. Optimum operating room environment for the prevention of surgical site infections. Surg Infect (Larchmt). 2017;18(4):503–7. DOI: https://doi.org/10.1089/sur.2017.020
Agency for Healthcare Research and Quality (AHRQ). National Guideline Clearinghouse (NGC). Guideline summary: Guideline for sterile technique. Available from: https://www.ahrq.gov/hai/cusp/clabsi-neonatal/nclabsi2.html. Last updated 2012; cited Aug 20, 2022.
Abdelwahab R, Aden A, Bearden B, Sada A, Bostwick JM. Surgical scrubbing and attire in the operating room and ICU: A multicultural guide. J Am Coll Surg. 2021;234(2):332–7. DOI: https://doi.org/10.1016/j.jamcollsurg.2021.05.005
Lyon PM, Brew A. Reflection on learning in the operating theatre. Reflective Practice. 2003;4(1):53–66. DOI: https://doi.org/10.1080/1462394032000053495
Knight WR, Glaysher MA, Wheble GA. Introduction to theatre and basic surgical and anaesthetic skills: a new theatre Induction course for medical students. The Bulletin of the Royal College of Surgeons of England. 2013;95(1):1–4. DOI: https://doi.org/10.1308/147363513X13500508916892
Lyon PM. Making the most of learning in the operating theatre: student strategies and curricular initiatives. Med Educ. 2003;38(8):680–8. DOI: https://doi.org/10.1046/j.1365-2923.2003.01583.x
Yerkes RM, Dodson JD. The relation of strength of stimulus to rapidity of habit-formation. J Comp Neurol Psychol. 1908;18(5):459–82. DOI: https://doi.org/10.1002/cne.920180503
Chapman SJ, Hakeem AR, Marangoni G, Raj Prasad K. How can we enhance undergraduate medical training in the operating room? A survey of student attitudes and opinions. J Surg Educ. 2013;70(3):336–4. DOI: https://doi.org/10.1016/j.jsurg.2013.01.008
Nagji A, Brett-MacLean P, Breault L. Exploring the benefits of an optional theatre module on medical student well-being. Teach Learn Med. 2013;26(3):201–6. DOI: https://doi.org/10.1080/10401334.2013.801774
Bowrey DJ, Kidd JM. How do early emotional experiences in the operating theatre influence medical student learning in this environment? Teach Learn Med. 2014;27(2):113–20. DOI: https://doi.org/10.1080/10401334.2014.883986
Stone JP, Charette JH, McPhalen DF, Temple-Oberle C. Under the knife: medical student perceptions of intimidation and mistreatment. J Surg Educ. 2015;72(4):749–53. DOI: https://doi.org/10.1016/j.jsurg.2015.02.003
Zundel S, Wolf I, Christen H-J, Huwendiek S. What supports students’ education in the operating room? A focus group study including students’ and surgeons’ views. Am J Surg. 2015;210(5):951–9. DOI: https://doi.org/10.1016/j.amjsurg.2015.03.011
Fernando N, McAdam T, Cleland J, Yule S, McKenzie H, Youngson G. How can we prepare medical students for theatre-based learning? Med Educ. 2007;41(10):968–74. DOI: https://doi.org/10.1111/j.1365-2923.2007.02839.x
Barnum TJ, Salzman DH, Odell DD, Even E, Reczynski A, Corcoran J, et al. Orientation to the Operating Room: An Introduction to the Surgery Clerkship for Third-Year Medical Students. MedEdPORTAL. 2017;13:106-52. DOI: https://doi.org/10.15766/mep_2374-8265.10652
Ravindra P, Fitzgerald JEF, Bhangu A, Maxwell-Armstrong CA. Quantifying factors influencing operating theater teaching, participation, and learning opportunities for medical students in surgery. J Surg Educ. 2013;70(4):495–501. DOI: https://doi.org/10.1016/j.jsurg.2013.02.011
O’Neill R, Shapiro M, Merchant A. The role of the operating room in medical student education: differing perspectives of learners and educators. J Surg Educ. 2018;75(1):14–29. DOI: https://doi.org/10.1016/j.jsurg.2017.06.013
Fernando N, McAdam T, Youngson G, McKenzie H, Cleland J, Yule S. Undergraduate medical students’ perceptions and expectations of theatre-based learning: How can we improve the student learning experience? Surgeon. 2007;5(5):281–4. DOI: https://doi.org/10.1016/S1479-666X(07)80024-2
Lewis L, Jones J, Haynes E. Low-cost video-films in the teaching of undergraduate and postgraduate medical students. J Telemed Telecare. 2000;6 Suppl 2:S45-7. DOI: https://doi.org/10.1258/1357633001935545
McIntyre TP, Monahan TS, Villegas L, Doyle J, Jones DB. Teleconferencing surgery enhances effective communication and enriches medical education. Surg Laparosc Endosc Percutan Tech. 2008;18(1):45–8. DOI: https://doi.org/10.1097/SLE.0b013e31815746a8
Hexter AT, O’Dowd-Booth C, Hunter A. Factors that influence medical student learning in the operating room. Med Teach. 2019;41(5):555–60. DOI: https://doi.org/10.1080/0142159X.2018.1504163
Hunukumbure AD, Leedham-Green KE, Rajamanoharan A, Patel K, Tang A, Das S. Twelve tips for surgeons to maximise medical student learning in the operating theatre. Med Teach. 2022;44(3):267–62. DOI: https://doi.org/10.1080/0142159X.2021.1908975
Lupien SJ, Maheu F, Tu M, Fiocco A, Schramek TE. The effects of stress and stress hormones on human cognition: Implications for the field of brain and cognition. Brain Cogn. 2007;65(3):209–38. DOI: https://doi.org/10.1016/j.bandc.2007.02.007
Schwind CJ, Boehler ML, Rogers DA, Williams RG, Dunnington G, Folse R, et al. Variables influencing medical student learning in the operating room. Am J Surg. 2004;187(2):198–200. DOI: https://doi.org/10.1016/j.amjsurg.2003.11.024
Jensen RD, Seyer-Hansen M, Cristancho SM, Christensen MK. Being a surgeon or doing surgery? A qualitative study of learning in the operating room. Med Educ. 2018;52(8):861–76. DOI: https://doi.org/10.1111/medu.13619
Wound, Ostomy and Continence Nurses Society (WOCN) Wound Committee, Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) 2000 Guidelines Committee. Clean vs. sterile dressing techniques for management of chronic wounds: a fact sheet. J Wound Ostomy Continence Nurs. 2012;39(2 Suppl):S31-4. DOI: https://doi.org/10.1097/WON.0b013e3182478e06
Azevedo Sansoni G, Borzi P, Karki P, Khan Sajid S, Semikhnenko A, Varma A. Satisfaction of Medical Students with Surgical Training: A Survey of Northern Italy. Int J Med Stud. 2022;10(3):297–87. DOI: https://doi.org/10.5195/ijms.2022.1450
Published
How to Cite
License
Copyright (c) 2023 Tamara A. Mallia, Sarah Cuschieri
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to contact@ijms.org
Infringing material
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to contact@ijms.org