title: Improvement in acute care surgery medical student education and clerkships: use of feedback and loop closure.
abstract: BACKGROUND
  The unpredictable and sometimes chaotic environment present in acute care surgery services (trauma, burn, surgical critical care, and nontrauma emergency surgery) can cause high levels of anxiety and stress that could impact a medical students' experience during their third year of medical school surgical clerkship. This negative perception perhaps is a determinant influence in diverting talented students into other medical subspecialties. We sought out to objectively identify potential areas of improvement through direct feedback and implement programmatic changes to address these areas. We hypothesized that as the changes were made, students' perception of the rotation would improve.
  
  
  METHODS
  Review of end of clerkship third year of medical school trauma burn surgery rotation evaluations and comments was performed for the 2010-2011 academic year. Trends in negative feedback were identified and categorized into five areas for improvement as follows: logistics, student expectations, communication, team integration, and feedback. A plan was designed and implemented for each category. Feedback on improvements to the rotation was monitored via surveys and during monthly end of rotation face-to-face student feedback sessions with the rotation faculty facilitator and surgery clerkship director. Data were compiled and reviewed.
  
  
  RESULTS
  Perceptions of the rotation markedly improved within the first month of the changes and continued to improve over the study time frame (2011-2013) in all five categories. We also observed an increase in the number of students selecting a surgical residency in the National Resident Matching Program match from a low of 8% in 2009-2010 before any interventions to 25% after full implementation of the improvement measures in 2011-2012.
  
  
  CONCLUSIONS
  A systematic approach using direct feedback from students to address service-specific issues improves perceptions of students on the educational value of a busy trauma-burn acute care surgery service and may have a positive influence on students considering surgical careers to pursue a surgical specialty.
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan. Electronic address: jillcher@umich.edu.
authors.forename: Jill R
authors.initials: JR
authors.lastname: Cherry-Bukowiec
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: David
authors.initials: D
authors.lastname: Machado-Aranda
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Kathleen
authors.initials: K
authors.lastname: To
authors.affiliation: Section of Transplant Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Michael
authors.initials: M
authors.lastname: Englesbe
authors.affiliation: Division of Surgical Education, Department of Surgery, University of Michgian, Ann Arbor, Michigan.
authors.forename: Susan
authors.initials: S
authors.lastname: Ryszawa
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Lena M
authors.initials: LM
authors.lastname: Napolitano
mesh_terms: D002321:Career Choice; D002982:Clinical Clerkship / Q000379:methods* / Q000592:standards; D003422:Critical Care; D004504:Education, Medical, Undergraduate / Q000379:methods* / Q000592:standards; D000068156:Formative Feedback; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008824:Michigan; D058996:Quality Improvement; D012189:Retrospective Studies; D013337:Students, Medical / Q000523:psychology; D014194:Traumatology / Q000193:education*
keywords: Acute care surgery; Clerkship; Education; Feedback; Loop closure; Medical student; Surgical education; Surgical residency