"Renovating Undergraduate Education"

David Backstein

The Undergraduate Education Program in the Surgery Department is managed by David Backstein, Yaron Shargall and Carmela Calorendi with assistance from the coordinators in each of the three undergraduate academies.

The time available for undergraduate surgical training has been reduced in order to accommodate expanded time for disciplines such as Family and Emergency Medicine and allow for new longitudinal experiences such as the "Clerkship Portfolio". Nevertheless, the surgery rotation accomplishes a great deal in the 8 weeks allotted over the course of the third year.

The undergraduate surgery rotation begins with a five day "Crash Course in Surgery" consisting of intensive training using lectures, skills lab simulators and models. An Advanced Trauma Life Support module is conducted at St. Michael's Hospital organized by Jameel Ali, using the Sim - man trauma simulator. During the Crash Course, students learn to tie, suture, cast fractures, catheterize, perform lumbar punctures, drape and place chest tubes in this intensive and well - coordinated training program. For example, after a one hour chest trauma lecture, they place chest tubes in a simulator; after the orthopaedics lecture, they are taught how to apply a cast. Following the highly concentrated crash course at the beginning of each rotation, students spend 7 weeks on the surgical wards and in the operating room. Students report that they are more comfortable on the wards after the Crash Course and the evaluations of the program support this. The advantage of this format is that students are not pulled away from the clinical setting to attend lectures intermittently throughout their clerkship. The disadvantage is the intensity of the experience, an overload of information in a short period of time.

While Surgery no longer has rotations in both 3rd and 4th year, it may take place for an individual student anywhere between September of the third year and December of the fourth chronological year. In this way, all students have been exposed to surgery before the residency match. An additional one month selective in either Surgery or Medicine is mandatory for all students at the end of their final year. In addition to rotations in any of the Surgical subspecialties, surgical selectives will include options in ambulatory surgery, surgical research and rural surgery.

Yaron Shargall

In the new curriculum, students are now evaluated with two centralized objective structured clinical examinations during the clerkship. Within the Surgery rotation they are assessed using the surgical component of the National Board of Medical Examiners (NBME) Shelf exam and a structured oral examination. The NBME is an excellent exam on which our students do very well. Students get a mid - term evaluation in addition to their examinations. Teacher effectiveness scores are quite high in the Surgery Department with an average of 15 on a scale of 20.

Carmela Calorendi

Yaron Shargall has developed a program to integrate undergraduate surgical education into the community hospitals. This program has been very well received by students and faculty. Carmela Calorendi has been managing the Undergraduate Program for 23 years. She coordinates with Liz Doherty, Michelle Dominey and Renita Yap who manage surgical offices at each of the academies. These coordinators have been very effective in balancing the number of students on electives to control overcrowding.

The success of the undergraduate surgery program is clearly evident. Historically, about 24% of the U of T graduating class apply to surgical programs.

M.M.