Medical students entering their surgical clerkships often meet the operating room for the first time in its most unforgiving form: an intraoperative emergency, when a calm teaching environment abruptly becomes one entirely focused on saving the patient. A research team reports that simulating exactly that moment before rotations begin may help students interpret the intense, learner-unfriendly atmosphere not as a hostile learning environment but as the essence of patient-centered care.

The study, published in Global Surgical Education, the Journal of the Association for Surgical Education, arose from a concrete problem. End-of-surgery-clerkship feedback at the authors’ institution cited dissatisfaction with limited learner-centered education in the operating room and negative impressions of faculty professionalism and teaching. The authors hypothesized that many students misread the tonal shift that occurs when an OR emergency transforms the environment from learner-centered to patient-centered, and that safely rehearsing such experiences in advance would better prepare them.

To test that idea, the multidisciplinary team implemented an OR simulation for students entering the clerkship year. The session began with a pre-brief on psychological safety and roles. During the simulated case, intraoperative hemorrhage with hemodynamic instability triggered a sudden shift from a calm teaching environment to one entirely focused on patient care, deliberately placing learners outside their comfort zone. A debrief afterward explored strategies for continuing to learn during high-stress, patient-centered moments, reframing direct communication and hyperfocus as essential components of patient-centered care rather than signs of an inhospitable learning environment.

In total, 342 students participated between October 2023 and July 2025. In immediate post-session feedback, students consistently highlighted the realism of the simulation and the value of experiencing these dynamics before starting rotations. Reported preparedness for the OR was high across all three cohorts: 82 percent in 2023, 92 percent in 2024, and 88 percent in 2025.

The researchers also conducted an exploratory analysis of quarterly end-of-clerkship evaluation reports, comparing faculty and resident teaching ratings, learning environment scores, and the number of below-benchmark reports on faculty role modeling and positive learning environment before and after the simulation was introduced, across two clerkship years. They used descriptive statistics and two-sample t-tests. Five of the seven end-of-clerkship evaluation domains showed descriptive improvement in mean scores in both post-simulation years, although many domains showed early improvement followed by declines in quarters farther from the simulation.

Two measures reached statistical significance in the first clerkship year after implementation: below-benchmark reports on faculty role modeling (p = 0.047) and on the positive learning environment (p = 0.030) both improved significantly. The authors are careful to note that these are exploratory findings from institutional evaluation data, and that causation cannot be inferred from the before-and-after comparison.

The pattern of decline in quarters farther from the simulation carries a practical implication: students may benefit most from the exercise when it is delivered immediately before their surgical clerkship. The authors describe the simulation as well received, psychologically safe, and highly adaptable for other institutions seeking to prepare students for the realities of the operating room.

Because the evaluation relied on descriptive trends and a limited before-and-after comparison rather than a controlled design, the results should be read as promising institutional experience rather than proof of effectiveness. Still, the study offers a concrete model for addressing a common clerkship complaint: not by changing the operating room itself, but by changing how students understand what they are seeing when the teaching stops and the patient takes center stage.

Subject of Research: Simulation of an intraoperative emergency to prepare medical students for patient-centered learning in the operating room

Article Title: Reframing the clerkship OR experience: simulating an intraoperative emergency as preparation for patient-centered learning

Article References: Korman, A., Robak Scheer, M., Sibley, R. A., Westbrook Bressner, G., Kahen, S., Anderson, M., Heredia, P., Talib, M., Le Leannec, I., Oviedo, J., Pradhan, D., Schaye, V., & Krowsoski, L. (2026). Reframing the clerkship OR experience: simulating an intraoperative emergency as preparation for patient-centered learning. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 207. https://doi.org/10.1007/s44186-026-00614-3

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00614-3

Keywords: surgical education, operating room, simulation, medical students, clerkship, patient-centered care, psychological safety, debriefing, faculty evaluation, learning environment, Reframing, experience