This study explored learning barriers and facilitators medical students encountered during a general surgical rotation in various surgical environments, to create a framework to enhance learning in these environments. This was a cross-sectional qualitative study using an open-ended questionnaire with separate versions for students and teachers. An inductive thematic analysis was conducted, followed by a theory-informed deductive analysis. The study was conducted at Christchurch Hospital, a tertiary care teaching hospital in New Zealand, during general surgical rotations. Participants included 38 fourth year medical students and 31 surgical teachers from a single institution. All participants were recruited on a voluntary basis, and responses were anonymized. Both students and teachers identified active patient care involvement as a key facilitator of learning. Proactive students were noted to receive more opportunities for engagement, creating a positive feedback loop that improved motivation and learning outcomes. Teachers emphasized attendance and engagement as crucial, while students highlighted the importance of clear communication regarding roles and expectations. A lack of active patient care involvement was a commonly cited barrier, with students attributing this to overcrowded settings and unclear expectations, while teachers viewed it as a result of student passivity. Overcrowding during ward rounds and in operating theatres hindered active involvement but allowed for limited passive learning. These findings aligned with a theoretical model of workplace learning for junior doctors. The study highlights the importance of active patient care involvement, clear communication and proactive student behaviors to facilitate learning in surgical rotations. Strategies such as smaller group ward rounds, role clarification, and pre-rotation instructional materials may mitigate barriers. These findings can guide the development of interventions to improve student learning in surgical settings.
Krauss et al. (Sat,) studied this question.