Just “Culture”? A qualitative study on stressors impacting surgical clerkship student learning and well-being

Transition into the surgery clerkship is stressful and challenging for third-year medical students. We conducted this study to explore medical students’ learning stressors during the surgery clerkship which may diminish their learning and well-being. Findings will help to identify targets for future educational well-being interventions to enhance students’ preparedness to enter surgery clerkship.

We conducted semi-structured interviews with medical students who had completed their surgery clerkship in 2022 at a university-based hospital system using convenience sampling. The interviews were recorded, transcribed, and de-identified. Investigators iteratively coded and analyzed transcripts using a framework method for emerging themes until reaching data saturation.

We performed 17 interviews with medical students rotating on main campus and community sites from 2 consecutive clerkship cohorts. Each interview was approximately 30 min. Three dominant themes emerged regarding stressors that negatively influenced medical student learning and well-being: 1) expectation mismatch (e.g., student felt incompetent at driving a laparoscope and believed this was a skill she was expected to have), 2) exclusion from the team (e.g., perceiving that their questions are burdensome to the team, and 3) logistical challenges (e.g., where and when to arrive on the first day of clerkship or how to navigate the complexities of the operating room schedule).

Our study suggests three predominant stressor themes that may jeopardize medical student surgery clerkship learning and well-being. Interventions during clerkship orientation are recommended to establish expectations, clarify logistical confusion, and build a welcoming and supportive surgical culture to facilitate student integration within the medical team.