Importance of future motivation for skill acquisition among medical students undergoing endoscopic forceps training

Abstract

Background

In recent years, surgical procedures have shifted from open thoracotomy and laparotomy to minimally invasive endoscopic surgery, making endoscopic forceps training essential. In our department, we teach endoscopic forceps training to medical students in dry laboratories. We examined differences in the skill acquisition of medical students undergoing endoscopic forceps training.

Methods

Ninety-eight fourth-grade students at Kagoshima University Graduate School of Medicine underwent endoscopic forceps training every day in a dry laboratory during a two-week period in our department. Before the start of the training, we administered a questionnaire. We focused on the differences in skill acquisition levels between the first and second halves of the training period.

Results

Twenty-eight of the 63 male students and 9 of the 35 female students aspired to become surgeons (hereafter: “aspiring surgeon group”). All students showed a significant improvement in their skill acquisition from the first to the second half (p < 0.001). At the start of training, there was no difference in skill acquisition between the 37 in the aspiring surgeon group and the other students. However, during the second half of the training, the aspiring surgeons acquired skills significantly faster (p = 0.007). Among them, male aspiring surgeons, in particular, acquired skills significantly faster. Focusing on the speed of skill acquisition, there was no correlation between sex (p = 0.18) or sports activity (p = 0.64) and improvement in endoscopic forceps skills.

Conclusions

In dry laboratory endoscopic forceps training among medical students, all participants showed skill improvement with repeated practice. However, aspiring surgeons demonstrated significantly faster improvement, likely due to clear goal setting. As demonstrated in this study, goal-setting in student education may be associated with skill acquisition.

Background

Endoscopic surgery has become the standard in modern surgical procedure due to its advantages in patient recovery and clinical outcomes. This shift has increased the need for early and structured technical training in surgical education. Unlike traditional open surgery, endoscopic procedures require refined manual dexterity, hand–eye coordination, and precise instrument handling, necessitating a strong foundation in technical skills from the early stages of medical training [1,2,3,4].

Previous research suggests that motivation plays a crucial role in medical education, influencing both engagement and skill acquisition [5, 6]. In particular, goal-setting theory posits that clear objectives enhance performance and learning outcomes, which has been demonstrated in surgical training contexts [7]. While hands-on practice is essential, studies indicate that intrinsic motivation and well-defined goals contribute significantly to skill improvement in technical disciplines [8]. Given these findings, it is necessary to examine whether medical students’ career aspirations and motivation levels influence their progression in endoscopic forceps training.

During the clinical training period in our department, we instruct fourth-grade students at Kagoshima University Graduate School of Medicine on how to use endoscopic forceps in the dry laboratory, and investigate their interest in surgery. Some medical students aspire to become surgeons. We examined whether this aspiration impacted the acquisition of forceps skills.

Material and methods

From January 4 to December 23, 2022, 98 fourth-grade students (male, n = 63; female, n = 35) at Kagoshima University School of Medicine underwent clinical training in our department. Before the start of clinical training, students completed a questionnaire about their preferred clinical department and club activities.

During the 2-week clinical training period (5 days in the first half and 5 days in the second half), we conducted endoscopic forceps training in a dry laboratory.

We conducted time trials in which the time taken to transfer nine rubber tubes (5 mm thick and 1 cm long) from one box to another using two forceps was measured (Fig. 1). During the clinical training period, students could practice as many times as possible, and the fastest time of the day was recorded. Skill acquisition was defined as the difference in the average time trial times between the first and second halves, to examine any differences between students.

Fig. 1

Medical students practicing endoscopic forceps training in a dry laboratory (a), transferring nine rubber tubes from one box to another using two forceps (b), (c), (d)

Statistical analysis

Statistical analyses were performed using the Mann–Whitney U test and Fisher’s exact test for intergroup comparisons. Skill acquisition was assessed using a simple regression analysis of the time trial average times in the first and second halves, and the rate of skill acquisition was compared using an analysis of covariance. All statistical analyses were performed using the EZR software program (Saitama Medical Center, Jichi Medical University, Saitama, Japan). P values of < 0.05 were considered to indicate statistical significance.

Results

According to the questionnaire results, 37 respondents indicated that they aspired to become a surgeon (hereafter: aspiring surgeon group) and 61 indicated other aspirations (hereafter: non-aspiring surgeon group). The details of the groups are presented in Table 1. More male medical students aspired to become surgeons; however, the difference was not statistically significant (p = 0.08). There was no significant difference in the proportion of male and female medical students participating in sports activities (p = 1.00).

Table 1 Details of the medical students characteristics (n=98)

The average time trial times in the first and second halves of the training period were compared by sex for all medical students (Fig. 2a). The time (mean ± 2SD) of the male medical students improved from 73.6 ± 67.2 s in the first half to 45.2 ± 45.4 s in the second half (p < 0.001, Cohen’s d = 0.96, 95% CI [17.14, 37.42]). Similarly, the time of the female medical students improved from 67.0 ± 40.6 s in the first half to 48.4 ± 26.6 s in the second half (p < 0.001, Cohen’s d = 1.18, 95% CI [11.59, 27.85]) (Fig. 2b). The time of the aspiring surgeon group improved from 71.4 ± 48.5 s in the first half to 41.5 ± 26.4 s in the second half (p < 0.001, Cohen’s d = 1.23, 95% CI [13.45, 30.25]) (Fig. 2b). Similarly, the time of the non-aspiring surgeon group improved from 70.5 ± 67.4 s in the first half to 48.9 ± 43.6 s in the second half (p < 0.001, Cohen’s d = 0.94, 95% CI [16.14, 36.35]).

Fig. 2

Comparison of average time trial times in the first and second halves of the training period by sex for the entire cohort (a), Comparison of average time trial times in the first and second halves of the training period according to desired clinical department for the entire cohort (b)

Figure 3 shows the difference in the rate of skill acquisition. We divided the students into groups based on sex, preferred clinical department, and club activity (Fig. 3). However, we found that the aspiration to become a surgeon was the only factor that impacted the rate of skill acquisition. The aspiring surgeon group progressed faster. (p = 0.007). Furthermore, we examined differences in the rate of skill acquisition according to surgical aspirations by sex (Fig. 4). Although aspirations to become a surgeon significantly impacted the rate of skill acquisition among males (p = 0.004), it showed no significant impact in females, possibly due to the small number of female aspiring surgeons (p = 0.68).

Fig. 3

Differences in the rate of skill acquisition according to sex (a), desired clinical department (b), and club activity (c)

Fig. 4

Differences in the rate of skill acquisition among male (a) and female (b) medical students, grouped by desired clinical department

Discussion

In this study, we investigated the impact of different student background factors on skill acquisition during endoscopic forceps training. All participating students demonstrated skill improvement after consistent training, with the aspiring surgeon group showing significantly faster improvement. While prior studies have focused on technical skill improvement among surgical residents, our research focused on medical students with different career interests, including students who were undecided and students aiming for non-surgical specialties [9, 10]. Students practiced endoscopic forceps training for a two-week period. We investigated whether differences in skill acquisition levels were influenced by their background. Interestingly, the baseline performance of the aspiring surgeons (71.4 ± 48.5 s, mean ± 2SD) and non-aspiring surgeons (70.5 ± 67.4 s, mean ± 2SD, p = 0.94) groups was comparable, indicating that the aspiring surgeon group had no inherent advantage before training. However, by the second week, the aspiring surgeon group performed the time trial significantly faster than the non-aspiring surgeon group (41.5 ± 26.4 s vs. 48.9 ± 43.6 s, p = 0.03). Unlike surgical residents, whose skill acquisition increases with the number of surgeries performed, medical students aspiring to become surgeons demonstrated a faster rate of skill improvement, suggesting a potential association between career aspiration and skill acquisition. The students in this study had different training periods, and factors such as prior experience with forceps manipulation and confidence may have influenced the results.

The shortage of surgeons in Japan is a serious issue, and securing a sufficient number of surgeons is an urgent task. Fourth-grade medical students receive clinical training in the Department of Thoracic Surgery at Kagoshima University. During this training period, students engage in lectures, observe surgeries, and practice endoscopic forceps training in a dry laboratory. The dry laboratory is used for practicing surgical skills, and has proven to be effective in improving skills when approached with creativity and effort [11, 12]. The results of this study demonstrated that overall surgical skills improved, even among the non-aspiring surgeon group. This indicates that providing all students with opportunities to learn surgical skills has significant educational value. One of the key objectives during the clinical training period is to foster interest in surgery by allowing students to practice using instruments that are actually employed in surgical procedures [13,14,15]. Ryan et al. reported that surgical skills training for medical students not only enhances students’ technical abilities, but also increases their motivation to pursue a career in surgery [16]. Even students who do not initially aspire to become surgeons may develop an interest in surgery in the future if they experience an improvement in their surgical skills. This underscores the importance of educational strategies that promote the appeal of a surgical career from the student years. By doing so, we can increase the number of aspiring surgeons and help address the challenge of surgeon shortages [17, 18].

Additionally, differences in surgical experience and exposure to complex procedures between sexes have been reported, highlighting the challenging situation faced by female surgeons in Japan [19, 20]. The underlying factors include issues related to childcare and the working environment [21]. In this study, only 9 of 35 female students expressed interest in pursuing a career in surgery. However, this study did not identify any significant differences in skill acquisition between the sexes. This suggests that improving environmental factors may contribute to an increase in the number of female surgeons. Surgeons are often perceived as requiring physical endurance because of concerns about extended working hours, particularly in emergencies and surgical procedures [22]. Among students, there is a tendency to shy away from pursuing a career in surgery because of concerns about physical endurance.

Kathryn et al. evaluated the impact of sports participation among medical students on their academic performance and surgical training. They reported that regular sports activities were beneficial for improving both academic performance and surgical training [23]. However, in the present study, no association was found between participation in sports activities and the acquisition of forceps skills.

The present study was associated with several limitations. First, this study was conducted at a single institution and the number of female students was small. Additionally, clinical training was conducted in groups of 5 students over a two-week period, and approximately one year was required for all students to complete the training.

Due to differences in training periods, there may be biases such as prior experience with endoscopic forceps training in other departments. Additionally, since practice sessions were not standardized, differences in individual practice frequency may have introduced bias. Aspiring surgeons, in particular, may have engaged in additional self-practice, leading to variability in skill improvement. To minimize this confounding factor, future research should implement a controlled practice schedule to ensure comparability across participants.

While time-based improvement is a widely used objective metric for assessing skill acquisition, it does not comprehensively reflect surgical proficiency, which also encompasses factors such as precision, safety, and technique. Future studies should incorporate additional qualitative measures, such as error rates and accuracy, to provide a more holistic evaluation of skill development.

Conclusion

All medical students acquired skills in endoscopic forceps training within the dry laboratory through repeated practice. However, aspiring surgeons showed significant skill improvement at a faster rate, possibly due to their clear goal. As demonstrated in this study, goal-setting in student education may be associated with skill acquisition, though additional factors such as prior experience and motivation may also contribute.