Comparing Student and Resident Expectations of their Roles for the Third-Year Medical Student General Surgery Clerkship

Technical Summary: Comparing Student and Resident Expectations of Roles in the Third-Year General Surgery Clerkship

Problem Statement
The general surgery clerkship serves as a primary formative experience for medical students and is the most influential component in their decision to pursue a surgical specialty. However, the field faces challenges in recruitment due to persistent negative stereotypes regarding workplace culture, work-life balance, and hostility. While residents are identified as primary role models and educators, prior literature suggests that misalignment in expectations between students and residents can negatively impact the educational experience. Existing studies, many over a decade old, have largely focused on unidirectional expectations or have not accounted for the shift in medical education from time-based to competency-based models and the expansion of e-learning. This study addresses the gap in understanding the current state of alignment between third-year medical students and general surgery residents regarding their respective roles, responsibilities, and expectations during the clerkship.

Methodology
This was a single-institution, survey-based study conducted at Stanford University School of Medicine between July 2024 and June 2025. The study received Institutional Review Board exemption.

• Participants: The study surveyed 33 general surgery residents (across all PGY levels) and 23 third-year medical students who had recently completed their core surgical clerkship.
• Instrument: Parallel electronic surveys were distributed to both groups. Questions utilized five-point Likert scales, multiple-choice formats, and short free-response fields. The surveys were standardized, with modifications only to adjust for the responder's role (student vs. resident).
• Data Analysis: Categorical data were analyzed for statistical significance using Pearson's chi-square test (significance threshold $p < 0.05$). Thematic analysis was applied to free-response questions. Data analysis was performed using R (version 4.5.1).

Key Contributions
The study provides a bidirectional assessment of role expectations, moving beyond previous unidirectional analyses. It specifically investigates:

1. Operational Duties: Expectations regarding pre-rounding, clinic attendance, floor work, and operating room (OR) participation.
2. Feedback Mechanisms: Expectations regarding daily feedback on student notes.
3. Leadership of Orientation: Identification of which team member typically leads the initial discussion of clerkship expectations.
4. Student Perception: Assessment of student clarity regarding expectations and their sense of belonging and value within the team.

Results

• Alignment: Students and residents shared similar views on several core duties, including pre-rounding, attending clinic, initiating communication with chief residents, floor work, and preparation for operative cases. Both groups also agreed that residents should review and provide daily feedback on student notes.
• Significant Discrepancies:
  • Operating Room Participation: There was a significant difference regarding the expectation that students should scrub into all possible operative cases. 100% of residents agreed or strongly agreed with this expectation, compared to only 80% of students ($p = 0.05$).
  • Patient Load: Students expected to follow a higher number of patients (2–3 patients) compared to residents, who generally expected students to follow 0–1 patients ($p = 0.03$).
  • Leadership of Expectations: Views differed significantly on who leads the initial discussion of clerkship expectations. While 63% of residents reported this was led by the senior resident, students reported a more diverse experience, with only 36% attributing leadership to the senior resident; others cited multiple teammates, junior residents, or attendings ($p = 0.001$).
• Student Sentiment:
  • 26.1% of students disagreed or strongly disagreed that expectations were clear.
  • 13% of students disagreed or strongly disagreed that they felt like a valued member of the team.
  • 30.4% of students rated their sense of belonging as "somewhat weak."
• Qualitative Findings: Free-response analysis from residents indicated that "Rounding Expectations" (68.7%) and "Preparation for the Operating Room" (63.2%) were the most frequently discussed topics. However, specific expectations regarding which cases to attend were less frequently explicitly communicated compared to rounding protocols.

Significance and Claims
The paper claims that while residents and students share a common understanding of many roles, specific significant differences in expectations exist that may require intervention to improve alignment and satisfaction. The authors posit that these discrepancies—particularly regarding patient load and OR participation—may contribute to student frustration and reinforce negative stereotypes about surgical specialties.

The study concludes that the observed misalignments suggest opportunities for improved mutual understanding. The authors state that these findings can be used to "tailor interventions targeting these areas of opportunity" to promote greater alignment. The paper notes that interventions based on these results have been designed and are currently in the process of implementation. The authors maintain a modest scope, focusing on the identification of these specific discrepancies within a single institution as a basis for improving the working relationship and educational experience, rather than making broad generalizations about the entire surgical workforce.