Table 1 shows the information of the participants in this research project. A total of 14 postgraduate students participated in this study, including 12 males and 2 females; the participants’ ages ranged between 23 and 25 years with a mean age of 24.35 years. The time required to conduct the interviews was 10–20 minutes.
Table 1
Characteristics of the study sample (N = 14)
| Fraction | Percent |
Male | 12/14 | 85.71% |
Female | 2/14 | 14.29% |
Department | | |
Hepatobiliary, Pancreatic and Splenic Surgery | 3/14 | 21.43% |
Urological Surgery | 2/14 | 14.29% |
Breast and Nail Surgery | 1/14 | 7.1% |
Plastic Surgery | 1/14 | 7.1% |
Gastrointestinal Surgery | 7/14 | 50% |
The following two main themes and four subthemes were obtained from the interview data:
1. Surgical competence is considered to be very important by clinical medicine professional surgical postgraduate students
1-1. Surgical ability is considered to be useful for improving clinical operation by clinical medicine professional surgical postgraduate students
1-2. Surgical ability is considered to be useful for developing the clinical thinking of clinical medicine professional surgical postgraduate students
The ways in which surgical ability can be improved according to clinical medicine professional surgical postgraduate students
2-1. Clinical medicine professional surgical postgraduate students believe that more effort is needed to develop surgical skills
2-2. Clinical medicine professional surgical postgraduate students believe that they need more help from the hospital/department in terms of improving their surgical skills
1. Surgical competence is considered to be very important by clinical medicine professional surgical postgraduate students
1-1. Surgical ability is considered to be useful for improving clinical operation by clinical medicine professional surgical postgraduate students.
Due to the unique nature of the surgeon's profession, most clinical medicine professional surgical postgraduate students considered surgical competence to be essential to the task of becoming a surgeon as well as an important way in which surgeons must participate in clinical work in the future; thus, they must work diligently to learn about this topic during their postgraduate studies.
See the following quotations from postgraduate students:
Our clinical medicine professional surgical postgraduate students constitute an important force that can quickly add to the medical work after graduation, and then as a surgeon, a professional master's degree in surgery, (surgery) is what we will look for in the future ...... The tool we use to support our family is surgery... (7)
The answer to this is simple; the development of surgical ability is certainly important because the foundation of surgery is surgery, whether it is treatment or some other aspect. Successful surgical treatment can reduce patients’ pain and medical costs, so the development of surgical ability as a postgraduate student of surgery is also very important ... (2)
... The development of surgical competence is certainly important, and surgery itself is a discipline based on surgery as an important treatment modality ... Surgical competence is the lynchpin of the surgeon's profession... The proper use of surgical skills is related to the safety of the patient, the function of certain organs ... (6)
Some postgraduate students noted that clinical medicine professional surgical postgraduate students hold both a master's degree in clinical medicine and residency status, indicating that the clinical medicine professional surgical postgraduate students are trained for the purpose of being able to participate in clinical work quickly after graduation. To achieve this goal, their surgical skills must be proficient, which can be obtained through extensive practice.
See the following quotations from postgraduate students:
Because we (clinical medicine professional surgical postgraduate students) are mainly focused on training our clinical operation ability, surgery should be a very high proportion for our postgraduate students ... And our future work environment is also mainly (surgery) ... The basic operations of our daily work are also surgical operations. (11)
The training of surgical ability is certainly very important; surgery itself is a clinical department based on surgery as an important treatment, the training of clinical medicine professional surgical postgraduate students is the training of applied postgraduate students, and if surgical ability is not effective, there is no way to become a qualified surgeon. (8)
1-2. Surgical ability is considered to be useful for developing the clinical thinking of clinical medicine professional surgical postgraduate students
Some clinical medicine professional surgical postgraduate students indicated that surgical skills do not apply solely to specific operations but are also beneficial for clinical thinking. Surgery is a concrete collection of clinical operations, anatomical knowledge, physiology and other disciplines. Perioperative management is also important; for example, for patients who exhibit a great deal of bleeding during surgery, postoperative indicators such as hemoglobin should be considered, and this type of clinical thinking is equally important for the clinical competence of postgraduates.
See the following quotations from postgraduate students:
I feel that at this stage, the most important thing is the cultivation of the usual surgical ideas, which should be a relatively important point for the clinical specialty. (5)
In the middle of surgery, you can master some basic knowledge, basic concepts, basic operations, basic thinking about surgery, guidance regarding how to do something, and this will be very important for a graduate student. (2)
The clinical thinking associated with encountering and solving problems during surgery is not limited to the surgical procedure itself. One postgraduate student noted that studying to become a surgeon is a long-term process, that the problems encountered during study or clinical work can be solved by applying a similar way of thinking and that this ability to combine theoretical knowledge with practice and solve problems is very important.
See the following quotation from a postgraduate student:
... Cultivate this hands-on ability, and at the same time, immediately after finding such problems, go to the literature and books and then study and consolidate some theoretical knowledge with practice. (4)
2. The ways in which surgical ability can be improved according to clinical medicine professional surgical postgraduate students
2-1. Clinical medicine professional surgical postgraduate students believe that more effort is needed to develop surgical skills
Some clinical medicine professional surgical postgraduate students expressed their belief that since medical professional surgical postgraduate students must perfect their clinical work and their own research tasks simultaneously, the time available to them after work is especially critical. They believe that they must spend more energy on this goal than on other recreational activities to improve their surgical ability within the limited timeframe available to them.
See the following quotations from postgraduate students:
For clinical medicine professional surgical postgraduate students, the time spent in clinical work is more; there are 33 months, but after clinical work, we need to spend a lot of time to conduct a research study and then even to meet the requirements for your own master's degree; so, the pressure (to improve surgical ability) is still relatively large. (3)
... we are postgraduate students; this is the stage where we have to focus on our studies ... Usually, work will be busy, but after work, study is also not indispensable. (12)
Training in basic operations is essential to improve surgical competence. Surgeons feel comfortable that someone who is skilled in performing operations is involved during important steps of surgery; thus, some postgraduate students train carefully to perform operations to ensure that they can be involved in more steps of the procedure and thus enhance their knowledge in the field of surgery.
See the following quotation from a postgraduate student:
... Various operating skills .... For example, knotting, suturing and so on; those are required in free time or at home, more practice, and becoming so skilled before the actual operation on the stage rather than learning on the operating table. (1)
The improvement of surgical competence is not limited to operational proficiency. A fundamental element of proficiency is the understanding of operative anatomy [19]. For this reason, anatomical and surgical knowledge is also essential, and most postgraduate students had recognized this fact and thus aimed to learn the relevant knowledge. They aimed to test their knowledge by participating in actual surgical procedures.
See the following quotations from postgraduate students:
Our own discipline knowledge, including this anatomy or that kind of surgery, well, if we are not very clear about this anatomy, you cannot talk about this surgery at all. (9)
... I think it is still with yourself (related) because your ability to finish the work is based on self-digestion ability, the self-digestion of a process; after all, the director, the main surgeon for some surgery (operation), is more difficult for us, and after work, the self-digestion process is also very important. (12)
2-2. Clinical medicine professional surgical postgraduate students believe that they need more help from the hospital/department in terms of improving their surgical skills
One postgraduate student claimed that working on one’s own is insufficient to improve one’s surgical skills; rather, help from external sources such as the supervising physician/hospital is also indispensable. In clinical work, postgraduates encounter some problems that they cannot solve; thus, they ask their supervisors for help. In the process of participating in surgery, postgraduates also encounter difficulties in understanding surgical operations, and timely answers from supervising teachers are very helpful for postgraduates.
See the following quotations from postgraduate students:
... The most important is the clinical operation ability of their own teachers, the teachers on stage who can explain things to their students and then demonstrate some of the ... I think all can (help improve the ability to operate) (11)
... I think I would have progressed very fast if I had a teacher to explain to me during my own participation in the surgery and if I learned the surgery mainly in this way. (7)
The improvement of surgical ability requires standardized study. In clinical work, we cannot merely rely on the content contained in books but must rather standardize the corresponding courses. Furthermore, if relevant courses are provided to postgraduate students at the very beginning of their studies, then postgraduate students believe that their surgical ability can be improved significantly.
See the following quotation from a postgraduate student:
If we had someone to take us through it at the beginning, the flow of this procedure, the location of the anatomical structures, it would have helped us a lot in the end. (9)
Training on surgical topics is meaningful to postgraduate students, who look forward to it and claim that observing specific surgical presentations can deepen their understanding of surgery and improve their surgical-related skills.
See the following quotations from postgraduate students:
Can organize some training for surgery ... for the departmental organization to go to training ... or training organized by the hospital ... some training related to the relatively simple operation of the surgery (5)
... The surgical procedure is, after all, a very stressful one, and the instructor leading it does not always have the time and energy to describe it in detail, and I think it is very helpful to explain the procedure. (4)
Surgical ability cannot be improved without proficiency in the use of surgical instruments, but one postgraduate student noted that surgical instruments are common in the operating room but difficult to find elsewhere. This student claimed that his surgical ability would improve if he were given more access to surgical instruments.
See the following quotation from a postgraduate student:
It is difficult to have the opportunity to personally operate those instruments; if we can provide those instruments for us to operate, it is certainly helpful for some of our future work. (11)
One postgraduate student claimed that the simulated surgery training is also beneficial with respect to surgical ability and can increase trainees’ proficiency at surgical operations; however, this student also mentioned that he can encounter other in the simulated training and noted that he can deal with an accident in time if it happens during the simulation training, which he believes can strengthen his surgical ability and help him prevent such accidents during real surgeries.
See the following quotation from a postgraduate student:
If you can get familiar with those surgical instruments and procedures first on some virtual instruments, it may be more helpful for you to perform in the surgery afterward. (8)