The learning environment is an important element of medical education and is defined as the physical, social, and psychological contexts in which students learn.1 It is heavily influenced by interactions with faculty, residents, and fellows, other students, staff, curriculum, facilities, and infrastructure. This complex system is a key component of medical student well-being, with perceived stress experienced within this system linked to burnout and decreased resilience.2 Efforts to improve medical student clerkships may be limited by difficulty interpreting end-of-rotation surveys that are standardized across specialties. These end-of-rotation surveys may lack actionable insights in 3 important ways; firstly, they often do not provide the opportunity to report on specific aspects of clinical rotation, including interactions with residents, nurses, or ancillary staff. Secondly, students are unable to describe how their experiences in dynamic, fast-paced settings such as morning rounds or the operating room impacted their learning experience, which limits educators’ ability to identify opportunities for enriching these learning environments. Thirdly, they offer students only a single opportunity to provide structured feedback which may precipitate issues with recall and the inability to identify time-sensitive issues. The limited specificity and timeliness of these surveys pose significant barriers to the development of successful educational quality improvement interventions.

Improving the medical student learning environment is an important target for the surgical profession. As the surgical workforce faces impending shortages for the aging US population,3 there has been growing attention on stimulating medical student interest in surgery.4 The surgery clerkship provides the most substantial exposure of medical students to the profession, making the educational experience important even for those choosing nonsurgical careers who will care for patients with surgical conditions throughout their professional lives. Additionally, perceptions of medical students of their surgical rotations may influence how they counsel their junior classmates by perpetuating or refuting negative stereotypes of a surgical career.

Traditional assessments of the learning environment are made difficult by the complexity of the medical student's experience on the surgical clerkship, where learners are particularly fearful due to unclear expectations or preconceived notions of the learning environment.5 Students on their surgical clerkships describe concern they will be embarrassed by being unsure of expectations, worry about “mental abuse,” and fear poor personal performance.6 They may feel compelled to conform to the prototypical masculine, confident, competitive surgical stereotype to succeed.7 Previous studies suggest these stress-provoking emotions and experiences detract from the learning environment and overall wellness,2 but many are constrained by recall bias and by limiting input to issues predetermined by the researchers in structured, forced-choice questionnaires.8

Surgical educators and leaders must gain a deeper understanding of the multifaceted issues that influence medical students’ experiences on their surgical clerkship to implement effective changes that improve the learning environment. However, student recall of experiences may change over time, partly based on personal narrative.9 Instant feedback reduces recall bias and permits in-depth understanding of a complex social experience through open-ended questions. We hypothesized that medical student dissatisfaction with the surgical learning environment is multifactorial and includes experiences with faculty, residents, nursing staff, and systems-level factors. The goal of the current study was to use a mobile application to collect and analyze real-time input from medical students on their perspectives of the surgical rotation.