Virtual Learning During Medical School May Inadequately Prepare Students for General Surgical Residency
Authors: Bhatti Umar F. , Schwed Alexander C. , de Virgilio Christian , Tolles Juliana , Brooks Nicole E. , Nagle Richard , Johnson Melissa , Smith Brian , Donahue Timothy , Calhoun Kristine , Poola V. Prasad , Frey Edgar , Wu Esther , Gauvin Jeffrey , Amersi Farin 
Published: November 2024

Purpose: Due to pandemic-related restrictions, medical schools transitioned to virtual clinical rotations in 2020. Virtual learning is now an integral part of medical education, but there remain questions as to whether it adequately prepares students for the rigors of surgical residency. We hypothesized that students exposed to virtual learning during medical school demonstrate inferior performance during residency as compared to their predecessors.
Methods: Data were collected from 12 General Surgery Residency programs. Residents who began training in academic years (AY) 2018-2022 were included and followed for two years. Residents who started in AY2018-2020 (conventional group) prior to the introduction of virtual rotations were compared to residents who started in AY2021-2022 (virtual group) after virtual clinical rotations were implemented during medical school. The primary outcome was the sum of annual milestone scores, adjusted for post-graduate year and analyzed with a linear mixed-effects model. Secondary outcomes included milestone scores by ACGME competency category, USMLE scores, ABSITE percent correct, remediation, and attrition.
Results: 334 residents were included: 199 in the conventional group and 135 in the virtual group. There was no difference in mean USMLE score between conventional vs virtual groups: USMLE Step1: 239 vs 240, p=0.52, USMLE Step2: 251 vs 251, p=0.77. When adjusted for post-graduate year (PGY), virtual learning was associated with an average decrease of 2.3 points over the sum of all milestones over the course of a year of residency when compared to the conventional group (95% CI -0.4 to -4.2, p=0.02). In the analysis of categorized ACGME competency milestone scores, virtual learning was associated with a decrease in scores for patient care (virtual vs conventional: -0.1, 95% CI -0.032 to -0.16, p<0.01), systems-based practice (virtual vs conventional: -0.11, 95% CI -0.047 to -0.17, p<0.01), and interpersonal and communication skills (virtual vs conventional: -0.075 95% CI -0.001 to -0.14, p=0.05). A non-statistically significant 2% decrease in ABSITE percent correct in the virtual group (95% CI 1-5%, p=0.07) was noted. 40 residents underwent remediation: 19 (11%) in the conventional group and 21 (16%) in the virtual group (odds ratio (OR), virtual vs conventional, 1.74, 95%CI 0.85-3.59, p=0.14p=0.14). Twelve residents underwent attrition: 7 (4%) in the conventional group and 5 (4%) in the virtual group (OR, virtual vs conventional, 1.05 95% CI 0.26 - 3.96, p=1). There was no difference in average annual case numbers between the groups after accounting for PGY (p=0.18).
Conclusion: Virtual learning during medical school is associated with poorer performance as a junior surgical resident, compared with in-person instruction, as indicated by a small decrease in milestone scores, and a trend towards inferior ABSITE performance and increased remediation. In-person and hands-on learning experiences during medical school should be prioritized to better prepare medical students for surgical residency.