Friday, April 21, 2017

Resources 3rd-year medical students study during general surgery clerkships

At the University of Florida medical school, the answers to that question varied widely. According to a paper published ahead of print in the American Journal of Surgery, students at UF use review books, e-books such as UpToDate, government agency and professional organization websites, textbooks, journals, and more.

The recommended textbook for the course is Lawrence’s Essentials of General Surgery, now in its fifth edition.

The authors surveyed the 133 members of the 2014-2015 third-year class, and 92 (69.2%) responded. Regarding each resource used, they could answer with one of four choices: always, usually, sometimes, never.

The students used review books significantly more often than the Internet, which was second. The most popular review book was Dr. Pestana’s Surgery Notes, used by 74% of respondents; NMS Surgery and Surgical Recall were used by 46% and 37% of the class, respectively.

More than half the class (56%) said they never used a textbook. Only 8.7% used Lawrence’s Essentials of General Surgery even though it could be obtained on loan in both print and electronic forms from the school. Almost 20% of students said they read formal textbooks such as Greenfield, Sabiston, and Schwartz.

Considering the price differential between Pestana at as little as $15 and the traditional textbooks costing anywhere from $60-$150, it's surprising that any student would buy the latter which contain much more information than anyone could assimilate during an 8-week rotation.

Despite its reputation as a flawed scientific site, Wikipedia led the list of Internet resources with 39.1% of users followed by UpToDate at about 33% and the school's faculty generated intranet sites at just under 30%.

Scores on the National Board of Medical Examiners surgery examination were not significantly related to the resources used, nor did high-or low-scoring students use significantly different materials. The average score for the Florida students was statistically similar to the overall national average.

Did the students learn surgery? It depends on whether you consider the NBME test a good indicator of learning.From the authors' discussion, "To an extent, there is likely a sense of studying for the test instead of studying to understand surgery."

What is the bottom line?

The authors of the paper had hoped to use the survey results as a needs assessment tool to help them update their online curriculum, but they concluded, "As relationships between exam performance and resource use had no correlation within the study, this suggests that much of a student's objective performance relies heavily on abstract factors that are challenging to define and quantify."

In other words, "We don't know what to do with the information."


Anonymous said...

In regards to the comment about the cost of textbooks:
A brief look at their medical school library's website shows that they currently subscribe to AccessMedicine, which contains a large number of ebooks (including Schwartz). That's likely how they've been accessing the textbooks. At least that's how I've been doing it (though I've gravitated more towards Sabiston on ClinicalKey, which I don't see a link to on their website).


Vamsi Aribindi said...

The resources have very different uses. Pestana is useful for the boards, especially for the urology, ent, and ortho questions. NMS case book is useful for the gen surg portion of the exam. And recall is the best for looking good during rounds and cases and getting the pimp questions right.

Skeptical Scalpel said...

Anon, thank you for that information. I find reading anything more than 2-3 pages of text online quite difficult. It may be my age.

Vamsi, thanks for the explanation of the differences among the three books.

I should have mentioned the top four resources in order from 1 to 4 were Pestana, NMS Surgery, Wikipedia, and Surgical Recall.

ayeekaz said...

From my own student days - it was difficult in clinical rotations to know what to learn : you want to learn about the diseases your patients have and know them well, but it felt like that wasn't what came up on exams. The short nature of rotations was also a factor - I gravitated towards the absolute basic textbooks for the first 3 weeks and switched to exam books for the last 2. I only ever used the "prescribed text" if I had to present a case or in those rare instances where I had a patient that I really wanted to know more about. The information was useful no doubt, but not helpful in passing the exam.

As to whether I actually learned anything...

Skeptical Scalpel said...

Ayeekaz, you have discovered what I have been saying for years. The material on tests has nothing to do with what is important day-to-day. This is the same argument that opponents of maintenance of certification are making. They are being tested on topics not relevant to their practices.

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