Early exposure to anesthesiology: a summer preceptorship program for first-year medical students

Abstract

Introduction

A 4-week summer preceptorship offered first-year medical students early exposure to anesthesiology following their preclerkship courses in pharmacology and cardiopulmonary physiology. The main objective was to provide students with clinical skills and prepare them for rotations while immersing them in a unique experience, introducing a specialty not covered in core rotations.

Methods

Participants were selected via their responses to an application. In addition to shadowing anesthesiologists, curriculum components included weekly faculty lectures on core aspects of anesthesiology (introductory basics, perioperative drugs, airway, and crisis management); multiple simulation labs (workstation setup, intubation clinics, intravenous and central line placement, ultrasound techniques); research opportunities; and mentorship from physicians and senior medical students. The program culminated in each student successfully leading a simulated case to receive a certificate of completion.

Results

A survey of 15 participants revealed significant improvements in ability to intubate (P < 0.05), ability to perform a transthoracic echocardiogram (P < 0.05), interest in anesthesiology as a specialty (P < 0.05), and preparedness for future rotations (P < 0.05).

Discussion

This program accelerates clinical exposure for preclerkship students, providing insights into anesthesiology early in their medical journey. It provides research and mentorship, fosters professional growth, and enhances individual competitiveness for residency program applications.

In light of the recent transition of the United States Medical Licensing Examination Step 1 exam to a pass-fail grading system and the extended summer breaks now offered by many medical schools, there is a growing interest among students in the exploration of diverse medical specialties. Baylor University Medical Center in Dallas, Texas, presents an annual preceptorship program that introduces the specialty of anesthesiology, building on the foundation of preclerkship pharmacology and cardiopulmonary physiology courses. This program aspires to accomplish several objectives, including the cultivation of leadership competencies, mentorship opportunities, and research prospects for medical students. Additionally, the program offers a unique clinical experience that grants early exposure to the intricacies of anesthesiology—a discipline not typically encompassed within the core clinical rotations of medical curricula, resulting in the student’s first exposure to the specialty of anesthesiology often not occurring until the fourth year of medical school.

METHODS

Setting and participants

The program itself spanned 4 weeks throughout June 2023 and was associated with the anesthesiology department at Baylor University Medical Center. The setting included a private practice group at an academic hospital in the process of establishing a residency program. This program provides the department with the experience and tools to train future faculty and residents. In addition, faculty were not compensated for their time, as students joined them during their normal clinical hours. However, any time spent outside of clinical duties, such as for lectures or simulation labs, was converted into continuing medical education credits.

The selection process for program participants was characterized by an assessment of their qualifications and interests, primarily by evaluating responses to an application released during the spring of 2023. The ultimate decisions concerning acceptance or rejection were determined by the program’s two directors and the overseeing physician. The cohort for this year’s program included 12 students from Texas A&M School of Medicine, one student from The University of Texas McGovern Medical School, and one student from The University of Texas Southwestern Medical School.

Curriculum design

Over the course of 4 weeks, students shadowed various anesthesiologists. Other components of the program’s curriculum included the following:

• Weekly didactic lectures led by faculty on core aspects of anesthesiology (introductory basics, common perioperative drugs, airway management modalities, crisis management techniques)

• Four simulation lab experiences covering anesthesia workstation setup, intubation modalities, peripheral and central intravenous catheter placement, and ultrasound techniques

• Research opportunities in the field of anesthesiology

• Ongoing physician mentorship and advice from experienced medical students

This preceptorship ended with each student directing a complicated, simulated patient case scenario from start to finish. Upon successfully finishing the program, students were awarded a certificate of completion.

The steps for students performing endotracheal intubation included the following: the mannequin head was tilted to achieve optimal sniffing position and the mouth was opened with a scissoring technique of the thumb and index finger. Then, a Macintosh 3 blade was inserted to the right of the tongue to sweep around and obtain a view of the vocal cords. Finally, a 7.0 mm endotracheal tube was advanced through the vocal cords and the tube cuff was inflated. Students confirmed proper tube placement via direct visual confirmation in the trachea of the mannequin and via successful inflation of the mannequin’s lungs with a bag valve mask. The time started with tilting the mannequin’s head and ended with lung inflation.

To perform a transthoracic echocardiogram, students achieved both subxiphoid and apical four-chamber views on a peer model in the supine position. The recorded time began with probe placement at the apical position and ended with the successful identification of the four heart chambers.

Participant evaluation

Data collection was facilitated through surveys. The preprogram survey was distributed 1 week before the program’s commencement, and the postprogram survey was administered within a week following the program’s end. Identical sets of questions were posed in both surveys, allowing us to assess the impact of the preceptorship on participants’ perspectives and clinical skills. In addition, clinical skills were assessed during the first and final simulation labs with objective data collected accordingly. The timed clinical skills that were assessed included endotracheal intubation on a mannequin and a transthoracic echocardiogram on a peer volunteer.

RESULTS

A total of 15 participants completed the program surveys, comprising three students from the 2022 program and 12 students from the 2023 program. Following analysis of the collected feedback, notable improvements were observed in the participants’ ability to intubate (P < 0.05) and perform a transthoracic echocardiogram (P < 0.05) (Figures 1 and 2). Furthermore, students had a substantial rise in interest in anesthesiology as a specialty (P < 0.05; Figure 3) and level of preparedness for future rotations (P < 0.05; Figure 4).

Figure 1.

Change in ability to perform an endotracheal intubation and a transthoracic echocardiogram at the start (day 1) and end (last day) of the 4-week program (n = 15).

Figure 2.

Correlation between the total number of intubations a student performed and the time to successfully perform the intubation (n = 15). Total number of intubations performed includes all intubations recorded per student during the 4-week program. Time to successful intubation was recorded on the last day of the final week.

Figure 3.

Change in student interest in anesthesiology from the beginning of the preceptorship (day 1) to the end (last day) (n = 15). On a scale of 1 to 5, 1 represents the least interest and 5 the most interest in pursuing a career in anesthesia.

Figure 4.

Change in perception of anesthesia rotation preparedness from the beginning (day 1) to the end (last day) of the preceptorship (n = 15). Preparedness was measured on a scale of 1 to 5, with 1 being the least prepared and 5 being the most prepared to do well on an anesthesia clinical rotation.

We also evaluated the clinical skills acquired by participants during the preceptorship. Before the program, only two individuals were able to successfully perform an endotracheal intubation using a standardized mannequin, and only two could conduct a transthoracic echocardiogram on a peer volunteer. By the program’s conclusion, all 15 participants demonstrated the ability to intubate effectively in <1 minute and perform an echocardiogram.

DISCUSSION

This 4-week anesthesiology preceptorship program significantly improved clinical skills, particularly in endotracheal intubation and transthoracic echocardiography. All participants demonstrated proficient intubation abilities by the end of the program, which enhanced readiness for real patient care.¹ The program’s structured curriculum and simulation labs were instrumental in achieving this improvement. In addition, this preceptorship led to an increased interest in a career in anesthesiology. Exposure to anesthesiologists, didactic lectures, and hands-on experiences made the specialty more appealing, which could help improve the shortage of anesthesiologists in the workforce, encouraging more students to pursue this path. Finally, preceptorship programs like this bridge the gap between theory and practice, offering students practical experiences.^2,3 The mentorship component is essential for guiding and motivating students, emphasizing the importance of such support in medical education.

The study’s limitations include subjective, self-reported survey data and a small sample size. While multi-institutional studies could provide a more comprehensive understanding, we are emphasizing the positive impact of an anesthesiology preceptorship program on clinical skills, career interests, and preparedness for clinical rotations. The article highlights the value of structured, immersive experiences in medical education, with the potential to benefit both students and the healthcare system.

In conclusion, this preceptorship program offers preclerkship students the invaluable opportunity to gain early clinical exposure in their medical careers rather than waiting until third-year rotations. Furthermore, participants have the chance to explore the complexities of a highly sought-after medical specialty that is typically presented as an elective while gaining invaluable mentorship within the field. Finally, the program provides students with a unique experience that cultivates leadership skills and fosters professional growth, setting them apart from their peers when applying to residency programs in the future. We are committed to building on the foundation established during our pilot program to enhance and expand this preceptorship for future aspiring medical students seeking to explore anesthesiology as a specialty.

CONFLICTS OF INTEREST

The authors report no funding or conflicts of interest.