Available online 17 October 2023

Author links open overlay panel, , , , , , Objective

We sought to better define surgical etiquette and elucidate operating room (OR) personnel expectations of medical students to determine areas for medical education improvement.

Design

A questionnaire probing medical student performance regarding elements of OR etiquette was developed. Questions were designed to obtain structured feedback through Likert scales and open-ended responses. Descriptive and thematic analysis was conducted on Likert scale and free-text responses, respectively.

Setting

Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. Tertiary academic center.

Participants

A questionnaire was distributed to nurses, surgical and anesthesia faculty and residents. The survey was distributed via email amongst various hospitals, predominantly our home institution.

Results

We received 126 complete responses. About half of respondents (46.3%) self-identified as female. Most respondents were part of the surgical team (74.7%), with most (57.8%) from attending physicians. A majority of respondents agreed that medical students responded well to feedback. Roughly half of respondents agreed that medical students understand their role, maintain sterility, and assist in delivery of effective patient care. More than half of respondents did not believe that medical students understand traffic patterns. The majority of respondents indicated that medical students are not appropriately prepared with basic surgical skills prior to entering the OR. Two-thirds of respondents did not feel that medical students contribute towards maintaining safety in the OR. We identified 4 themes from free text responses: students should assume an active role in the OR, utilize situational awareness, understand sterility and OR workflow, and have knowledge of basic operative technique and anatomy.

Conclusions

Medical students are not meeting OR personnel expectations and may benefit from early educational interventions to optimize the OR as a learning environment.

Section snippetsINTRODUCTION

The operating room (OR) can be a challenging environment, which many medical students may have no experience with prior to their surgical clerkship. Challenges for students include stereotype threat,1 fear of mistreatment and burnout,2 and perceived lack of preparation.3 Both preclinical and clinical experiences can influence a medical student's perceptions of surgery and surgeons.1,4,5 Direct efforts by academic institutions to provide a supportive and equitable learning environment may

MATERIALS AND METHODS

The study was conducted between December 2021 and June 2022. A short questionnaire was developed to understand perceptions of medical student preparedness for the OR upon entering their surgical clerkship. Likert scale questions were developed based on input from surgery, anesthesia, and nursing personnel. Evidence of content validity was established by dissemination of the survey to a small group of OR personnel. During a 6-month period, surveys were disseminated via Qualtrics to OR personnel

RESULTS

The survey received 136 responses, of which 126 completed the entire questionnaire. Of those who indicated a gender, 53% identified as male and 47% female. The most common age group of respondents was 31 to 40 years (38% n = 51), with other age groups representing a smaller proportion of respondents (18-30 years 17% n = 23; 41-55 years 26% n = 35; 55+ years 19%, n = 25). Nearly all respondents were employed by academic medical centers (88% N = 119), with few from community (9% n = 12) and rural

DISCUSSION

Our survey of OR personnel suggests areas for targeted improvement in medical student preparedness. Areas where respondents indicated that medical students are lacking included understanding their role on the team, maintaining sterility, assisting in effective patient care, preparing basic surgical skills, and maintaining safety. Free response questions further indicated that students need to be situationally aware and have knowledge of basic knowledge of technique and anatomy.

Safety is of the

CONCLUSIONS

In conclusion, there is significant room for improvement in medical student education for the OR. Medical students are not meeting OR personnel expectations in many areas. We suggest that an unclear understanding of expectations and fear of surgeons, surgery and the OR may contribute to medical students’ shortcomings in these domains. Thus, active interventions should be taken to bridge this gap and optimize the OR as a learning environment. To do so, we have developed a Surgical Culture and

ACKNOWLEDGEMENTS

The authors acknowledge Susette Coyle and Marie Macor for their assistance in development and execution of the survey.

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© 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.