A systematic review of the methodological quality and outcomes of RCTs to teach medical undergraduates surgical and emergency procedures

• Published in: Canadian Journal of Surgery 2007-08, Vol.50 (4), p.278-290
• Main Authors: Thomas, Roger E., MD, Crutcher, Rodney, MD, Lorenzetti, Diane, MLS
• Format: Article
• Language: English
• Subjects: Analysis; Clinical trials; College students; Education, Medical, Undergraduate; Emergency Medical Services; Health education; Humans; Medical education; Medical procedures; Methods; Outcome Assessment (Health Care); Quality; Randomized Controlled Trials as Topic; Research Design; Review; Study and teaching; Surgery; Surgical Procedures, Operative - education
• ISSN: 0008-428X; 1488-2310

Background There is no systematic review of the methodological quality of randomized controlled trials (RCTs) of teaching surgical and emergency skills to undergraduates. Methods We searched the Cochrane Collaboration Controlled Trials Register, the Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, ERIC, DARE and the University of Toronto Continuing Medical Education database for RCTs in all languages. Results We identified 19 RCTs. Four tested methods of IV access, 1 found intraosseous access faster than the umbilical vein in neonates, and 1 found that one type of intraosseous needle had higher success rates. Two RCTs of intubation skills did not identify a superior technique. One RCT of CPR found video instruction superior to the American Heart Association Heartsaver course. Of 2 RCTs of trauma skills, 1 found no improvement and 1 found improvement only on the day of instruction. One RCT found both computer and seminar training improved epistaxis management. One RCT gave students preoperative anatomy instruction, and they received higher ratings from surgeons. One RCT asked students to study surgical scenarios preoperatively, and they improved their surgical intensive care unit skills. One RCT gave students video and paper-cut instruction of the Whipple procedure; both groups improved, but there were no differences between groups. One RCT taught uteteroscopy and stone extraction and found groups that used low-and high-fidelity bench models improved, compared with the didactic group. Four of 5 RCTs of knot tying showed improvement. Conclusions This systematic review assessed the quality of RCTs used in teaching undergraduates surgical and emergency skills. There are many positive study outcomes, but there are significant methodological weaknesses in the study design. Students varied in their skills, and most did not demonstrate optimal performance in any of the procedures. This review provides a baseline for further work important to both medical education and clinical practice.