Most of the students in this study had an average score (77.0%) in assessing the knowledge of surgical and clinical skills and a very small group managed to achieve scores above the average (2.8%) Compared to 20.2% who received a low score.
These statistics indicate that there is a flaw in the medical curricula in our country.
In order to identify the areas of this defect, it was necessary to conduct our study which is considered to be the first of its kind in Syria and included all public and private universities in all governorates. Through it, we were able to monitor and evaluate two basic types of skills that must be included in the clinical and pre-clinical teaching years, which are surgical and clinical skills.
Regarding surgical skills:
The questions that tested the students’ anatomical information got a very good percentage of correct answers when asked about the areas of the surgical incisions and the location of the pericardiocentesis procedure, with a percentage of (47.6%, 51.0%), respectively.
We can justify this by their excellent anatomical background provided by the anatomy courses accompanying them in their early pre-clinical years.
A previous study at the University of Cameroon indicated a similar result. Access to basic knowledge of these skills was well covered through lecturing and clinical teaching (7).
As for the radiographs, it is known that the ability to read them correctly requires knowledge of many basic sciences, on top of which is anatomy (8).
However, although our results showed that the students are well acquainted with the anatomical information, we noticed a significant defect in their ability to make the correct description of the radiographic images. The percentage of those who knew the type of hemorrhage in the MRI image was only (33.8%), and the percentage of those diagnosed with the umbilical hernia on the CT image was (29%)versus a high percentage (41.4%) admitted that they were completely unfamiliar with the picture, and this indicates their awareness of their weakness in this regard.
This result is not surprising because, despite the essential role of radiology in diagnostic medicine, especially in the field of surgery, it is given very briefly in many medical curricula and is not limited to our curricula (9).
A previous study confirmed this by showing that there is a lack of guidelines and standard curricula in teaching radiology to medical students across Australia (10).
As for the skills that require knowledge of surgical tools and how to use them, we noticed a disparity in percentages according to the tool, as the percentage of students who were able to identify surgical needle packages, their measurements and their types was somewhat excellent, reaching (76.8%).
We can find a justification for this encouraging percentage, given that surgical sutures are one of the most important topics that they learn in their practical lessons, noting that we cannot predict through this percentage the extent of their practical ability to perform sutures and tie knots despite their ability to accurately identify the tools.
In a contrasting study, training in the usual procedural skills such as suturing and tying knots was present in a small percentage in the British medical curricula (24.7%) and (17.4%) (4).
These percentages are not satisfactory at all, given that these skills are performed by junior doctors in operating rooms, and are not considered among the difficult skills that only professionals can master (4).
As for the percentage of students who knew the function of the tool from its image (the tissue grabbing tool), it was (34.8%).
This indicates a gap that students have in linking the shapes of tools and understanding how to use them.
In contrast, the percentage of students who admitted that they did not know the function of the tool through its name (Farabeuf retractor) was (47.2%), and the percentage of those who knew the correct answer was close to( 44.8%).
All of these results are significant, as cross-sectional data in a previous study suggests that at least 22% of students intend to practice surgery (11).
We can conclude from the two previous results that it is necessary to strengthen the visual memory and link it with the functional aspect as a more important step than strengthening the nominal memory with a purely theoretical significance, while not neglecting the necessity of both.
Regarding for clinical skills, when asked about taking the history, medical history and clinical examination in general, the results were as follows: (98.4%) of the students were able to know how to start taking a clinical story, and (82%) were able to ask about pain correctly, and we believe that the reason is due to the great interest of teachers in this topic due to its importance in clinical practice in various disciplines.
On the other hand, only 26.6% of the students were able to ask about the medical history of a breast cancer patient, only 9% were able to find out the reason for the formation of nail pits, and 46.6% of the students were able to find out the reason for the sweaty and cold hands, and this could be attributed to the lack of patients examined by the students, and in another study conducted in In one of the Western universities, it was observed that there is a kind of modesty among students in conducting the clinical physical examination despite the openness of the Western culture to these matters, which is directly reflected on their clinical skills (12). Another study also proved that only 41.6% answered yes when asked about the knowledge of the examination. Clinical through online learning (13) Here we note the emphasis on the idea that clinical skills must be acquired through practice.
On the other hand, in a study conducted in Britain, it was noted that medical students have high confidence in clinical examination procedures (14) and this may be due to the recommendations of the General Medical Council on the necessity of early confrontation between medical students and clinical practice (15) (16).
The American Society also emphasized the necessity of frequent interaction with patients to improve clinical work (17).
From the above, it can be said that teaching the general clinical examination and taking the story is good, but it requires a larger number of patients and more practice.
As for the more detailed medical specialties, the results were somewhat unsatisfactory, as for cardiovascular matters only 35.4% were able to determine the most common presentation of myocardial infarction, and only 16.8% were able to determine the first sign of disseminated thrombosis across the vessels, and 13% knew what was required when examining the jugular heartbeat. (While in a study conducted in Jordan, it was found that 71% of male students and 48% of female students had at least ten clinical cardiac examinations during their study career, which gave them a good experience (18).
Here, it can be said that the short duration of clinical lessons in the cardiology division in Syrian universities and the focus in them on theoretical topics more than practical matters affected the students’ outcomes, as learning cardiovascular examinations through simulation, including audio recordings, does not necessarily lead to an improvement in practical clinical skills (19).
As for chest issues, 27% were able to answer the tracheostomy question, which is considered a low percentage. This can be justified by the small number of tests that students conduct on the respiratory system level during clinical work, if compared with Jordan, where 80% of males and 62% of females have performed more than 10 examinations. For the respiratory system during their study career (18) and neurologically only 42.8% were able to answer when asked about the neurological reflexes of the farmers, and this percentage is considered somewhat strange if compared with the repetition of this type of information over the clinical and pre-clinical years.
With regard to gender, there was a statistically significant relationship (p = 0.14), as we found that the percentage of those who got a poor rating is 53 females versus 48 males, and an average rating of 208 females against 177 males.
Although the results suggest a preponderance in favor of females, we cannot acknowledge this as long as the number of females in the entire sample exceeds the number of males (52.6% females, 47.4% males).
As for those with excellent grades, the ratio was overwhelming in favor of males (12 vs. 2), and we cannot find a logical justification for the result except that the males are more daring to test the abilities they possess on a practical level, and therefore more distinguished with regard to these skills they learn.
In another study conducted in Jordan, no effect of sex was observed for cardiovascular, digestive, thoracic and glandular matters. As for urinary and reproductive matters, the effect of sex was clearly found, as 27% of the males performed more than 5 tests of the male reproductive system, compared to 2% for females and 33% of the males. Females performed more than 5 breast exams compared to only 6% of males (18).
We noticed a statistically significant difference between universities in the level of knowledge(p =. 000), where the percentage of students who obtained an excellent grade was majorly from Damascus University.
Also, (85.3%)of Damascus University students got an average rating, and this indicates the high level of medical education at Damascus University thanks to the educational cadres and qualified university hospitals it possesses.
This percentage confirms that the advantageous position of Damascus University is due to the fact that it attracts students from different governorates as well, such as As-Suwayda, Daraa and others, due to the lack of universities to teach medicine in all Syrian governorates.
This result is not surprising given the demographic and economic data that the capital, Damascus, enjoys like any other capital, but this great disparity seems worrying and requires measures to raise the level of the rest of the Syrian universities in terms of teaching and in terms of financial capabilities as well.
We also found that most of the private university students had low scores, and we can only justify this result by the presence of a gap in their education despite the emphasis on attendance and its obligation, knowing that university professors in public universities teach in private universities as well.
We did not find a statistically significant relationship in terms of material status (p = .286), academic year (p = .188), marital status (p = .118), work (p = .436), as shown in Table 3.