Introducing a New Structured Approach to Orthopaedic Surgical Clerkship: The Dalhousie Method With Two-Year Follow-Up

Core surgical clerkship rotations remain an essential exposure to orthopedics for rotating medical students. Unfortunately, the lack of standardization can lead to very different surgical experiences and limited subspeciality exposure. Decreased exposure inevitably leads to less interest in a surgical field and would have significant consequences on increasing surgical waitlist times. A review of feedback from the previous Dalhousie University orthopedic clerkship rotation yielded gaps and limitations to medical student exposures. A new structure was proposed to enable improved structured orthopedic learning and evolve surgical training at the medical school level. To allow medical students a broad exposure to all subspecialties of orthopedics while balancing learning needs/experiences in ambulatory clinics, surgical operating rooms, and emergency room management of orthopedic trauma. The new structured rotation was introduced in the spring of 2022. Orthopedic surgical clerks would rotate through a three week designed program with a week dedicated to ambulatory clinics, the operating room, and emergency room orthopedic day coverage at a busy level 1 trauma center. While on their operating room and ambulatory clinic week schedules, they would be assigned daily to a different subspecialty to encounter different patient presentations, practice musculoskeletal physical examination skills, and learn appropriate treatment algorithms. Despite working with different orthopedic attendings on a daily basis, constructive feedback was deemed a priority and instituted daily with orthopedic specific evaluation forms. A qualitative review study was completed on Dalhousie University anonymous medical student feedback, inclusive of 2021–2024. Student feedback data was collected in the standard form of dedicated questions and likert scales (Strongly disagree to Strongly agree). Feedback was anonymous and presented as an annual aggregation to limit bias and protect privacy. We compared student feedback before and after the year of implementation, with minimum two year follow up. Additionally, written comments were analysed to note key themes that repeatedly occurred. Over the two years after implementation, 85% of medical students noted clear assigned roles and responsibilities (64% agreed, 21% strongly agreed). For questions pertaining to student ability in completing required patient logs, hence clinical exposure, 99% of medical students were in agreement (71% agreed, 28% strongly agreed). Likewise, 85% of medical students noted an appropriate balance between clinical exposure and independent study time (64% agreed, 21% strongly agreed). Key themes retrieved from written comments included “enhanced operative experience”, “enhanced clinical experience”, and “supported learning”. When analysing the narrative feedback of the year prior to implementation, key themes included “less exposure to emergency room traumas”, “limited subspecialty experience”, and “lack of guidance”. The ability to introduce medical students to the field of orthopedics while cultivating a deepened interest has been previously challenging during short rotations. With the Dalhousie redesigned method, we provide academic institutions a new clerkship structure to increase exposure to different orthopedics subspecialties while still encompassing student experiences in the operating room, ambulatory clinics, and emergency room management of orthopedic trauma.