Squeamish? Don’t worry, medical students are too

surgeryBMC Medical Education has just published an interesting study that examined the incidence of fainting among medical students observing surgery.  Apparently, more than 1 in 10 medical students almost or completely pass out in the operating theatre.

The authors of this study surveyed 630 clinical medical students in their fourth or fifth (final) year of study at the University of Nottingham medical school in northern England.  A total of  77 (12%) students reported at least one episode of near or actual operating-theatre-related loss of consciousness, also known as syncope.

The authors looked pretty closely at factors affecting whether a student was likely to faint in the theatre.  Those who did lose consciousness were on average 23 years old (range 20–45 years), were more likely to be an undergraduate student than a graduate student (60 undergrads versus 17 graduates) and were significantly more likely to be female than male (68 females versus 9 males).  Gynaecological operations were most likely to cause syncope among the fainters (29% of cases), followed by colorectal surgery (16%) and vascular surgery (16%).

The majority of students who passed out put their episode(s) down to the hot temperature of the theatre or the length of time spent standing.  None of the fainters identified needle or blood phobias as a cause of their fainting.  The authors do note, however, that 16% of episodes occurred during laparoscopic, or keyhole, surgery.  Given that keyhole surgery doesn’t involve much gore and blood, this finding suggests that the operation itself remains a strong contributory factor to fainting in the operating theatre.

Interestingly, more than 50% of the students who reported surgery-related fainting were still keen to pursue a career in surgery, although 16% said that their fainting episode(s) put them off that particular career path.

As well as affecting the clinical education and career choices of medical students, such operating-theatre-related syncope also has implications for patients.  In 9% of cases, the operation was affected by the medical student passing out, the most common issue being delays to surgery while the a new assisting student was brought in.

Student BMJ has some practical tips for squeamish medical students. Jessica Whitworth experienced episodes of syncope well into her penultimate year of medical school and eventually got some help from her university’s psychologist, who suggested distraction, dissociation and rationalisation techniques to overcome her problem.

I also have an illustrious history of passing out in medical circumstances. As well as several dramatic fainting episodes during work experience placements at local hospitals, I also spent a considerable proportion of my undergraduate human dissection classes with my head between my legs. In fact, a particularly gruesome lecture even made me pass out once. I find it quite reassuring to know that seasoned medical students also have this problem!

(h/t to Dr RW who pointed out this research on his blog Notes from Dr R.W.)

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Jamjoom A et al. (2009) Operating theatre related syncope in medical students: a cross sectional study BMC Medical Education 9 (1) DOI: 10.1186/1472-6920-9-14

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