A human factors curriculum for surgical clerkship students

Mitchell Cahan, University of Massachusetts Medical School
Anne C. Larkin, University of Massachusetts Medical School
Susan Starr, University of Massachusestts Medical School
Scott Wellman, University of Massachusetts Medical School
Heather-Lyn Haley, University of Massachusetts Medical School
Kate Sullivan, University of Massachusetts Medical School
Shimul A. Shah, University of Massachusetts Medical School
Michael P. Hirsh, University of Massachusetts Medical School
Demetrius E. M. Litwin, University of Massachusetts Medical School
Mark E. Quirk, University of Massachusetts Medical School

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Citation: Arch Surg. 2010 Dec;145(12):1151-7. Link to article on publisher's site

Abstract

HYPOTHESIS: Early introduction of a full-day human factors training experience into the surgical clerkship curriculum will teach effective communication skills and strategies to gain professional satisfaction from a career in surgery.

DESIGN: In pilot 1, which took place between July 1, 2007, and December 31, 2008, 50 students received training and 50 did not; all received testing at the end of the rotation for comparison of control vs intervention group performance. In pilot 2, a total of 50 students were trained and received testing before and after rotation to examine individual change over time.

SETTING: University of Massachusetts Medical School.

PARTICIPANTS: A total of 148 third-year medical students in required 12-week surgical clerkship rotations.

INTERVENTIONS: Full-day training with lecture and small-group exercises, cotaught by surgeons and educators, with focus on empathetic communication, time management, and teamwork skills.

MAIN OUTCOME MEASURES: Empathetic communication skill, teamwork, and patient safety attitudes and self-reported use of time management strategies.

RESULTS: Empathy scores were not higher for trained vs untrained groups in pilot 1 but improved from 2.32 to 3.45 on a 5-point scale (P < .001) in pilot 2. Students also were more likely to ask for the nurse's perspective and to seek agreement on an action plan after team communication training (pilot 1, f = 7.52, P = .007; pilot 2, t = 2.65, P = .01). Results were mixed for work-life balance, with some trained groups scoring significantly lower than untrained groups in pilot 1 and no significant improvement shown in pilot 2.

CONCLUSIONS: The significant increase in student-patient communication scores suggests that a brief focused presentation followed by simulation of difficult patient encounters can be successful. A video demonstration can improve interdisciplinary teamwork.