Medical school provides an opportunity to not only acquire the knowledge and skills but also experience in various specialties. Medical students in lower years of study, study and learn with the help of classroom lectures and other recently adopted clinically-oriented teaching methods1. After gaining basic medical knowledge, they learn skills through a rotating clinical clerkship over a period of 6 years after graduating from high school in Japan2. In addition to subject knowledge, medical students must learn the required attitude and skills that make them qualified to meet the needs of citizens3. In Japan, upcoming medical doctors should have clinical skills, especially in community-based health care for the super-aging society4. Thus, medical schools are modifying their curriculum to consider these societal needs. Thus, medical students obtain less experience in surgical subjects than in other essential medical specialties such as internal medicine, psychology, and primary healthcare5. To bridge this increasing gap in knowledge, several surgical departments have been trying to teach surgery more efficiently in an educational program (such as simulation-based learning) during clerkship.
Simulation-based learning is broadly used in medical schools globally. Simulation is very useful for beginners to learn invasive procedures, including the physical examination, puncture procedures, and emergency treatment6. To achieve better outcomes with simulation-based education, the following factors need to be considered: range of difficulty, repetitive practice, distributed practice, cognitive interactivity, multiple learning strategies, individualized learning, mastery learning, feedback, length of training, and clinical variation7. For expert training, more novel challenges are recommended. However, this adds to the financial cost and burden of faculties as simulation equipment is expensive and requires that instructors put in extra work. Nevertheless, simulation-based education is effective in imparting basic science and clinical knowledge and improving procedural skills, teamwork, and communication skills in undergraduate and graduate medical students8.
Choosing a specialty is one of the most important decisions for medical students9. In Japan, postgraduates rotate through several specialties within two years as junior residents before starting their training in their selected specialty2. Medical students and junior residents choose their specialty based on a variety of factors, including medical lifestyle, societal orientation, hospital orientation, scope of practice, and the impact of role models10. Compared to any other specialty, urology is less popular among medical students due to the misconception that urologists are generally male organ specialists11. A urologist deals with the entire genitourinary system of men and women. Moreover, the need for female urologists has increased over the past 10 years12. Medical students’ misunderstanding of urology will remain uncorrected unless they are exposed to the correct clinical circumstances. Students are more likely to be influenced to pursue surgical careers if they are offered early exposure to positive role models and career and academic opportunities13. Thus, early involvement of medical students may provide ideal opportunities or mentored externships for recruitment, not only in urology but also in other departments.
The school of medicine at the University of Tsukuba has given an “advanced course” to fourth-year medical students prior to starting their clinical clerkship. This short course consists of intensive lectures based on the concept of exposing pre-clinical clerkship students to recent, focused, and advanced medical issues. Several professors offer lectures on various disciplines such as basic science, medical statistics, internal medicine, psychology, surgery, anaesthesia, social medicine, and space medicine. Each student can select several courses in their fields of interest over one week. Our urology department has given hands-on seminars on endoscopic, laparoscopic, and robotic surgeries since 2012. Students who had attended this course were motivated to learn about surgery and were more interested in urology.
We hypothesized that specific factors could contribute to urological and surgical experience and that a positive experience would be associated with students’ interest in a career in not only surgery but also in urology. This study evaluated whether this urology course, designed to provide the required exposure to medical students, could cultivate an interest in surgery and urology among pre-clinical clerkship medical students.