Lymphedema Education 100 Years Later: Evaluating Understanding Of The Revised Starling Principle In Medical Student Learners
Michael F. Amendola, MD, James Dittman.
VA Medical Center/VCU Health System, Richmond, VA, USA.
BackgroundMedical education has reinforced the application of the Starling Principle (SP) to describe primary lymphatic drainage return at the venule via osmotic gradients. Recent literature in the indicates the Glycocalyx mitigates this absorption with the lymphatic channels taking on most all fluid (Revised Starling Principle; RSP). We set forth to survey medical students at our institution regarding their understanding of the RSP in the context of lymphedema education. MethodsA survey regarding general concepts including selection of SP versus RSP was sent to all medical students enrolled in a virtual surgical conference in 2020. Survey responses for students who recalled specific lymphedema curriculum were compared against those who did not using Fisher’s Exact test. Results:Of 54 medical students (100%) who participated in the survey, 40 (74%) were certain regarding whether they had been taught about lymphedema during medical school. 87% of these 23 clinical learners and 53% of these 17 pre-clinical learners recalled lymphedema education and the students who recalled lymphedema curriculum were significantly more likely to select SP over RSP as the schematic representing lymphatic flow.
Conclusions:Our analysis indicates learners who recalled lymphedema curriculum were significantly more likely to select the traditional, now discredited SP schematic. Clinical students were more likely to recall lymphedema education, indicating the importance for faculty to ensure accurate conceptual reinforcement occurs during clinical rotations. 
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