Preclinical students: who are surgeons?1

A Hands-On Surgical Event to Improve Medical Student Operating Room Confidence

INTRODUCTION

The negative perceptions and lack of exposure to surgery and the operating room (OR) have been known to divert students away from surgical specialties. This study describes the impact of a surgical subspecialty exposure event (OR Essentials), combined with surgical faculty and M4 mentorship on preclinical medical students' confidence at an academic medical center.

METHODS

OR essentials event teaches surgical skills to preclinical medical students through hands-on skill-based workshops in a simulated OR setting. Pre and postevaluations were administered to measure program impact.

RESULTS

One hundred four preclinical medical students participated. Following OR essentials, students reported a significant increase in confidence in the OR (P < 0.0001) and in basic surgical skills (P < 0.0001).

CONCLUSIONS

Early surgical exposure events like OR essentials provide opportunities to improve medical student confidence in the OR, which will hopefully support recruitment of future surgeons.

The Role of Gender-Concordant Mentorship in Women Premedical Students' Perception and Pursuit of Surgical Careers

OBJECTIVE

Evaluate the impact of a 6-month structured mentorship program between women premedical student mentees paired with women medical students and surgical residents on mentees' interests and perceptions of surgical careers.

DESIGN

Prospective qualitative and quantitative study.

SETTING

This study took place at the Boston University School of Medicine, a single institution tertiary care hospital.

PARTICIPANTS

Self-identified women premedical students at Boston University were eligible for inclusion in this program (n=90). Participants were recruited and grouped with self-identified women medical student (n=52) and resident (n=19) mentors. Participants were provided with a monthly curriculum to guide discussions. Mentees completed pre- and postprogram surveys with 5-point Likert scale questions regarding interest and exposure to surgery, role models and mentorship, and effect of COVID-19 on their career interests. Pre- and postprogram responses were compared using a Wilcoxon rank sum test.

RESULTS

Of the 90 mentees, 63 (70%) completed preprogram surveys, and 53 (59%) completed postprogram surveys. Survey respondents indicated statistically significant increased exposure to positive role models (preprogram mean 3.15, postprogram mean 4.06, p=0.0003), increased exposure to women role models (preprogram 2.30, postprogram 3.79, p<0.0001), increased access to dedicated mentors (preprogram 2.11, postprogram 3.75, p<0.0001), and increased availability of support persons to answer their questions and concerns about careers in surgery (preprogram 3.03, postprogram 3.85, p=0.001). There was also a statistically significant increase in the reported effect that exposure to gender-concordant role models in surgery had on participants' decisions to consider a surgical career (preprogram 3.58, postprogram 4.23, p=0.001).

CONCLUSION

This 6-month structured mentorship program for undergraduate premedical students increased mentees' exposure to positive women role models and mentors, and increased mentee's interest in pursuing a surgical career. This emphasizes the need for structured gender-concordant mentorship programs early in women's careers to encourage pursuit of surgical careers in an otherwise men-dominated field.

Real-Time Student Feedback on the Surgical Learning Environment: Use of a Mobile Application

OBJECTIVE

Improvements to the medical student surgical learning environment are limited by lack of granular data and recall bias on end-of-clerkship evaluations. The purpose of this study was to identify specific areas for intervention using a novel real-time mobile application.

DESIGN

An application was designed to obtain real-time feedback from medical students regarding the learning environment on their surgical clerkship. Thematic analysis of student experiences was performed at the conclusion of 4 consecutive 12-week rotation blocks.

SETTING

Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts.

RESULTS

Fifty-four medical students at a single institution were asked to participate during their primary clerkship experience. Students submitted 365 responses over 48 weeks. Multiple themes emerged which were dichotomized into positive and negative emotions centered on specific student priorities. Approximately half of responses were associated with positive emotions (52.9%) and half with negative emotions (47.1%). Student priorities included the desire to feel included in the surgical team (resulting in feeling engaged/ignored), to have a positive relationship with members of the team (perceiving kind/rude interactions), to witness compassionate patient care (observing empathy/disrespect for patients), to have a well-planned surgical rotation (experiencing organization/disorganization within teams), and to feel that student well-being is prioritized (reporting opportunities/disregard for student wellness).

CONCLUSION

A novel, user-friendly mobile application identified several areas to improve the experience and engagement of students on their surgery clerkship. Allowing clerkship directors and other educational leaders to collect longitudinal data in real time may allow for more targeted, timely improvements to the medical student surgical learning environment.

Diversity of the physician workforce: Specialty choice decisions during medical school

Background

Despite efforts to increase the overall diversity of the medical student body, some medical specialties have a less diverse applicant pool based on both gender and race than would be expected based on medical graduate demographics.

Objectives

To identify whether women and Underrepresented in Medicine (URiM) medical students have baseline differences in their career interests or if their career plans change more during medical school when compared to men and non-URIM students.

Methods

Secondary data analyses of all medical students who applied through ERAS from 2005–2010 was conducted. Binary logistic regression models with the response being a planned career in one of four medical specialties (internal medicine, pediatrics, OB/GYN, and general surgery/surgical specialties) at medical school entry and graduation. Regression models included demographics, student attitudes, debt, academic metrics, and medical school experiences.

Results

Comparatively, women were less likely to be interested in internal medicine and surgery and more interested in pediatrics and OB/GYN at matriculation. URiM students expressed more interest in OB/GYN and surgery when starting medical school. At graduation, women were less likely to plan for internal medicine and surgery and were more interested in pursuing OB/GYN and pediatrics. URiM students were more likely to plan for a career in internal medicine and less likely to choose pediatrics.

Conclusions

From matriculation to graduation, women have relatively stable preferences regarding planned medical specialties. In contrast, URiM students’ specialty plans shifted over time among the four specialties, with variation in preferences occurring between matriculation and graduation.

Attracting the Best Students to a Surgical Career

The predicted shortage of surgeons in the future workforce is already occurring in rural areas and is expected to worsen. US allopathic medical school graduates have been losing interest in surgery for the past 40 years. The residency match remains unaffected because of foreign and osteopathic applicants. Negative myths regarding surgeon training, lifestyle, and personality persist among medical students, proving to be a powerful deterrent to students who might consider a surgical career. Proven strategies for making surgery more attractive to students are not always used and can be as simple as getting early exposure to students before clinical rotations.

Passing The Scalpel: A Student Initiative in Identifying and Addressing Unmet Needs in Dental Education

PURPOSE

Becoming an oral-maxillofacial surgeon is often challenging for young trainees. The purpose of this manuscript is to explore how a student-led group, which emphasizes networking, mentorship, and academic opportunities, may impact one's journey to becoming an oral-maxillofacial surgeon.

PATIENTS AND METHODS

This was a cross-sectional descriptive study where a 5-question Likert-type survey was administered to students who matriculated into residency and participated in a student-led group called Passing The Scalpel (PTS). This survey evaluated the value of PTS in providing exposure, career decision-making, networking/mentorship, and camaraderie. The results were analyzed, and statistical outcomes were evaluated.

RESULTS

There was an 80.5% response rate (n = 29). Question 1 regarding first exposure to oral-maxillofacial surgery had a mean score of 2.55 (standard deviation [SD] = 1.35; χ² = 15.39; P < .05). Question 2 regarding choosing oral-maxillofacial surgery as a career had a mean score of 3.66 (SD = 1.11; χ² = 10.84; P < .05). Question 3 regarding offering mentorship and networking had a mean score of 4.14 (SD = 0.92; χ² = 27.81; P < .05). Question 4 regarding increasing applicant camaraderie had a mean score of 4.21 (SD = 0.77; χ² = 36.71; P < .05). Question 5 regarding the importance of PTS within a dental curriculum had a score of 4.48 (SD = 0.68; χ² = 41.89; P < .05).

CONCLUSION

PTS is an effective student-led initiative that emphasizes early exposure, networking, and mentorship opportunities and encourages students in choosing oral-maxillofacial surgery as a specialty. PTS demonstrates that student-led initiatives can fulfill unmet needs in the dental curriculum.

"Fighting an uphill battle": A mixed methods exploration of surgeon involvement in medical schools' preclinical curricula

BACKGROUND

Limited exposure to surgeons early on in medical school may adversely impact students' clerkship experiences and professional development. This explanatory sequential mixed methods study investigates a perceived discrepancy between surgical and nonsurgical instructors in our institution's preclinical curriculum.

METHODS

The demographics of preclinical faculty were assessed before and after a curricular reform. Semi-structured interviews with 13 surgical faculty explored barriers and facilitators to surgeon involvement. Responses were inductively coded and thematically analyzed.

RESULTS

Surgeons' contributions to preclinical instruction fell from 10% to 5% across the curriculum reform. Barriers both leading to and reinforced by surgeons' limited involvement relate to surgeon, medical school, and student factors. Participants proposed three solutions to barriers in each domain.

CONCLUSIONS

Surgeons provide a minority of our preclinical instruction and may be disproportionately impacted by reform efforts. Deliberate efforts are necessary to increase opportunities for surgeons to engage with preclinical medical students.

Medical Student Values Inform Career Plans in Service & Surgery-A Qualitative Focus Group Analysis

BACKGROUND

Diversifying the surgical workforce is a critical component of improving care for underserved patients. To recruit surgeons from diverse backgrounds, we must understand how medical students choose their specialty. We investigate how preclinical students contemplate entering a surgical field.

MATERIALS AND METHODS

We conducted semistructured focus groups during two iterations of a seminar class called Service Through Surgery. Discussion goals included identifying student values and assessing how they inform early career decisions. We used a systematic, collaborative, and iterative process for transcript analysis, including developing a codebook, assessing inter-rater reliability, and analyzing themes.

RESULTS

Twenty-four preclinical medical students from diverse backgrounds participated in seven focus groups; most were women (16; 67%), in their first year of medical school (19; 79%), and interested in surgery (17; 71%). Participants ranked professional fulfillment, spending time with family, and serving their communities and/or underserved populations among their most important values and agreed that conducting groundbreaking research, working long hours, and finding time for leisure activities were the least important. We constructed a framework to describe student responses surrounding their diverse visions for service in future surgical careers through individual doctoring interactions, roles in academia, and broader public service.

CONCLUSIONS

Our framework provides a basis for greater understanding and study of the ways in which preclinical medical students think about their personal values and visions for service in potential future surgical careers. This research can guide early interventions in medical education to promote diversity and care for the underserved in surgery.

The role of gender in the decision to pursue a surgical career: A qualitative, interview-based study

BACKGROUND

Previous literature has explored the underrepresentation of women in surgery. However, this research has often been quantitative or limited by considering only the perspectives and experiences of women at more advanced career stages. Here, we use a qualitative methodology and a sample of women and men across the career continuum to identify the role that gender plays in the decision to pursue a surgical career.

METHODS

We audio-recorded and transcribed semi-structured interviews conducted with 12 women and 12 men ranging in their level of medical training from medical students to residents to staff surgeons. We used Braun and Clarke's six-step approach to thematic analysis to analyze the data, maintaining trustworthiness and credibility by employing strategies including reflexivity and participant input.

RESULTS

Our findings suggested that the characteristics of surgery and early exposure to the profession served as important factors in participants' decisions to pursue a surgical career. Although not explicitly mentioned by participants, each of these areas may implicitly be gendered. Gender-based factors explicitly mentioned by participants included the surgical lifestyle and experiences with gender discrimination, including sexual harassment. These factors were perceived as challenges that disproportionately affected women and needed to be overcome when pursuing a surgical career.

CONCLUSIONS

Our findings suggest that gender is more likely to act as a barrier to a career in surgery than as a motivator, especially among women. This suggests a need for early experiences in the operating room and mentorship. Policy change promoting work-life integration and education to target gender discrimination is also recommended.

"Bedside Anatomy": A Tool to Contextualize Learning and Introduce Surgical Careers

BACKGROUND

Many medical students cite an unwelcoming culture in surgery and perceive surgeons as arrogant or unfriendly. These perceptions have been reported as factors discouraging medical students from applying to surgical residency programs. This highlights an opportunity early in medical education to address these negative stereotypes and create opportunities for positive interactions with surgeons. We hypothesize that positive experiences with surgical residents and introduction to representative surgical cases early in the medical school curriculum can provide a real-world context for learning anatomy and encourage students to consider a surgical career.

METHODS

We developed and implemented a series of structured, one-hour, cadaver-based sessions cofacilitated by anatomists and surgical residents for medical students during their anatomy didactics. Sessions included common surgical cases and focused on critical thinking and problem-solving skills, while offering opportunities to review cadaver anatomy. Students completed a postcourse survey.

RESULTS

Nine sessions were implemented with involvement of eight surgical residents and 185 students; 83 students completed a postcourse survey (response rate of 45%). A majority of students rated the sessions "very helpful" in terms of highlighting the importance of anatomy in medical education (n = 52, 63%) and providing clinical context (n = 59, 71%). 54% (n = 45) indicated interest in a surgical career and 64% (n = 53) agreed that session participation had increased their interest in surgery.

CONCLUSIONS

Overall, students agreed that sessions provided clinical context for their learning and increased interest in a surgical career. Surgical faculty and residents should engage in preclinical medical education to bridge the basic science and clinical years and introduce positive surgical role models early during medical training.

Influence of Cardiorespiratory Clinical Placements on the Specialty Interest of Physiotherapy Students

Clinical placements are an important part of health students’ training. Whilst much value is placed on the clinical environment as a place to learn, there is a paucity of direct evidence about its effectiveness. The aim of this study was to compare the competence, importance, and interest in cardiorespiratory physiotherapy of students before and after one month of clinical practice. A pre- and post-placement questionnaire about students’ interest in different physiotherapy subspecialties was used. The students with a cardiorespiratory clinical placement showed a significant change in their perception about the importance of the cardiorespiratory specialty (0.348 ± 1.01; p < 0.001), while no significant change was observed in the students without cardiorespiratory placement (−0.014 ± 0.825; p = 0.883). The presence or absence of clinical placements seems to have a definitive impact on students’ choice of a specialty. This implies the need for developing a set of clinical placements in all the subareas of physiotherapy in order to give undergraduate students the opportunity to make a better decision.

Evaluation of a Curricular Addition to Assist Medical Students in Specialty Selection

Early hands-on experience with surgical procedures may help medical students make better-informed choices if considering a surgical specialty. Here, we evaluate a curricular addition in surgical anatomy, formally exposing second-year students to different surgical subspecialties. Students met with surgeons for 7 weeks (one afternoon per week) and practiced surgical procedures on human cadavers with supervision. About a quarter of the participants reported a change in their top choice of specialty upon completing the course, and about half of the students reported changes in their second and third choices. At the time of graduation, 85% of those surveyed reported participation in the course impacted their final choice of specialty. These results demonstrate such a course helped medical students select a specialty during early training.

Factors influencing US medical students' decision to pursue surgery

BACKGROUND

Interest and applications to surgery have steadily decreased over recent years in the United States. The goal of this review is to collect the current literature regarding US medical students' experience in surgery and factors influencing their intention to pursue surgery as a career. We hypothesize that multiple factors influence US medical students' career choice in surgery.

METHODS

Six electronic databases (PubMed, SCOPUS, Web of Science, Education Resources Information Center, Embase, and PsycINFO) were searched. The inclusion criteria were studies published after the new century related to factors influencing surgical career choice among US medical students. Factors influencing US medical student surgical career decision-making were recorded. A quality index score was given to each article selected to minimize risk of bias.

RESULTS

We identified 38 relevant articles of more than 1000 nonduplicated titles. The factors influencing medical student decision for a surgical career were categorized into five domains: mentorship and role model (n = 12), experience (clerkship n = 9, stereotype n = 4), timing of exposure (n = 9), personal (lifestyle n = 8, gender n = 6, finance n = 3), and others (n = 2).

CONCLUSIONS

This comprehensive systemic review identifies mentorship, experience in surgery, stereotypes, timing of exposure, and personal factors to be major determinants in medical students' decisions to pursue surgery. These represent areas that can be improved to attract applicants to general surgery residencies. Surgical faculty and residents can have a positive influence on medical students' decisions to pursue surgery as a career. Early introduction to the field of surgery, as well as recruitment strategies during the preclinical and clinical years of medical school can increase students' interest in a surgical career.

Medical Students' Perceptions of Surgeons: Implications for Teaching and Recruitment

OBJECTIVE

The purpose of this study was to assess first-year medical students' implicit perceptions of surgeons, focusing on the roles of gender and demeanor (communal = supportive, associated with women; agentic = assertive, associated with men).

DESIGN

Survey study. Each survey had 1 of 8 possible scenarios; all began with a short description of a surgeon who was described as accomplished and well trained, then varied by surgeon gender (male/female), surgeon demeanor (agentic/communal), and type of surgery (breast cancer/lung cancer). Using a 0 to 5 scale, respondents rated their perception of the surgeon through 5 questions. These 5 items were averaged to create a composite perception score scaled from 0 to 5.

SETTING

Surveys were administered at the University of California, San Francisco, and the University of California, Los Angeles.

PARTICIPANTS

We administered surveys to 333 first-year medical students who could read English and voluntarily agreed to participate.

RESULTS

A total of 238 students responded (71.5%). They preferred the communal vs agentic surgeon (4.2 ± 0.7 vs 3.9 ± 0.7, p = 0.002) and male medical students perceived surgeons more favorably than female medical students did (4.2 ± 0.6 vs 4.0 ± 0.8, p = 0.036). The preference score did not differ according to surgeon gender (female 4.12 vs male 3.98, p = 0.087). There were no significant interactions between the factors of student gender, surgeon gender, or demeanor. Students who reported an interest in surgery as a career did not perceive surgeons more favorably than the students interested in other fields (4.3 ± 0.7 vs 4.0 ± 0.7 respectively, p = 0.066).

CONCLUSIONS

Based on our findings, surgeon educators would likely find success in teaching and recruiting medical students by employing a communal demeanor in their interactions with all students, regardless of the students' gender or stated interest in surgery.

A survey of factors influencing career preference in new-entrant and exiting medical students from four UK medical schools

BACKGROUND

Workforce planning is a central issue for service provision and has consequences for medical education. Much work has been examined the career intentions, career preferences and career destinations of UK medical graduates but there is little published about medical students career intentions. How soon do medical students formulate careers intentions? How much do these intentions and preferences change during medical school? If they do change, what are the determining factors? Our aim was to compare medical students' career preferences upon entry into and exit from undergraduate medical degree programmes.

METHODS

This was a cross-sectional questionnaire survey. Two cohorts [2009-10, 2010-11] of first and final year medical students at the four Scottish graduating medical schools took part in career preference questionnaire surveys. Questions were asked about demographic factors, career preferences and influencing factors.

RESULTS

The response rate was 80.9% [2682/3285]. Significant differences were found across the four schools, most obviously in terms of student origin [Scotland, rest of UK or overseas], age group, and specialty preferences in Year 1 and Year 5. Year 1 and Year 5 students' specialty preferences also differed within each school and, while there were some common patterns, each medical school had a different profile of students' career preferences on exit. When the analysis was adjusted for demographic and job-related preferences, specialty preferences differed by gender, and wish for work-life balance and intellectual satisfaction.

CONCLUSIONS

This is the first multi-centre study exploring students' career preferences and preference influences upon entry into and exit from undergraduate medical degree programmes. We found various factors influenced career preference, confirming prior findings. What this study adds is that, while acknowledging student intake differs by medical school, medical school itself seems to influence career preference. Comparisons across medical school populations must therefore control for differences in input [the students] as well as context and process [the medical school] when looking at output [e.g., performance]. A robust, longitudinal study is required to explore how medical students' career preferences change as they progress through medical school and training to understand the influence of the learning environment on training choice and outcomes.

Factors influencing the choice of surgery as a career by pre-registration interns

BACKGROUND

The dwindling interest in surgery and surgical specialties raises the fears that the surgical man-power requirements of the society may not be met adequately in coming years. There is a need to explore ways of stimulating interest in surgery in order to forestall this.

OBJECTIVE

To identify factors that influence or predict the choice of surgery as a career by interns.

METHODS

A descriptive cross-sectional study of 271 interns was conducted using structured self administered questionnaires. The data obtained included demographic details, details of internship rotations, choice of specialty, reasons for nonconsideration of surgery and if the interns had role models, staff advisers and first degree relatives who were surgeons. Data were analysed using descriptive and inferential statistics (SPSS software) with the level of significance at p < 0.05.

RESULTS

There were 163 (60.1%) males and 108 (39.9%) females with a mean age of 25.8 years. The majority (97%) wished to commence residency training soon after internship; surgery (37.6%), and internal medicine (22.4%) were the most popular choices. Reasons for non-consideration of surgery included: stressful (46.1%), future family plans (41.3%) and difficult training (18.1%). Males were more likely to choose surgery than females (52.1% vs. 13.0%, p < 0.001). Married interns were less likely to choose surgery compared to their single colleagues (0% vs. 37.5%, p = 0.042). Having surgeons as role models, staff advisers or first degree relatives were significantly associated with selecting a career in surgery.

CONCLUSION

Gender, marital status, having surgeons as role models, staff advisers or first degree relatives in medical school are significant factors influencing the choice of a career in surgery.

Associations between medical school and career preferences in Year 1 medical students in Scotland

OBJECTIVES

Little is known about the relationship between the career preferences of medical students and the medical schools at which they are enrolled. Our aim was to explore this relationship early in students' medical training.

METHODS

Year 1 (2009-2010) medical students at the five Scottish medical schools were invited to take part in a career preference questionnaire survey. Questions were asked about demographic factors, career preferences and influencing factors.

RESULTS

The response rate was 87.9% (883/1005). No significant differences were found among medical schools with regard to first-choice specialty. Surgery (22.5%), medicine (19.0%), general practice (17.6%) and paediatrics (16.1%) were the top career choices. Work-life balance, perceived aptitude and skills, intellectual satisfaction, and amount of patient contact were rated as the most important job-related factors by most respondents. Few differences were found among schools in terms of the impact of job-related factors on future career preferences. Students for whom the work-life balance was extremely important (odds ratio [OR]=0.6) were less likely to prefer surgery. Students for whom the work-life balance (OR=2.2) and continuity of care (OR=2.1) were extremely important were more likely to prefer general practice.

CONCLUSIONS

Students' early career preferences were similar across the five medical schools. These preferences result from the interplay among demographic factors and the perceived characteristics of the various specialties. Maintaining a satisfactory work-life balance is very important to tomorrow's doctors, and the data hint that this may be breaking down some of the traditional gender differences in specialty choice. Longitudinal work is required to explore whether students' career preferences change as they progress through medical school and training.

Differences in final product of a bowel anastomosis of male and female novice surgeons

INTRODUCTION

There is a disproportionate ratio of male to female surgeons when compared with the ratio at medical school. Although gender differences in surgical technical ability is not known, studies have shown gender differences in visuospatial ability and manual dexterity. We devised a study to assess objectively the quality of final product of small bowel anastomosis in male and female novice surgeons to explore differences in surgical technical ability.

METHODS

Thirty-six novice surgeons in the final year of medical school with minimal surgical experience were taught surgical knot tying and small bowel suturing. The students were asked to complete 7 small bowel anastomosis in 7 separate sessions. The quality of the final product was assessed looking at the "fine details" (number of sutures and accuracy, ie, ratio of sutures piercing the full thickness of the bowel) and the "gross apposition" of the bowel ends at the anastomotic site. A grading system for apposition was devised to assess apposition.

RESULTS

The results with fine details and accuracy of suturing revealed that female surgeons were significantly better in the fourth to the sixth sessions with no gender difference in the number of sutures placed. With gross apposition at the anastomotic ends, male surgeons were consistently better between the third to the sixth session. However, these differences were eliminated with training.

CONCLUSIONS

Known gender differences in visuospatial ability and manual dexterity may explain the initial gender differences in the quality of the final product. However, these differences were not present by the end of the training sessions. Therefore, with training, no difference in surgical technical ability was found between male and female novice surgeons.

Academic careers and lifestyle characteristics of 171 transplant surgeons in the ASTS

This manuscript reports the demographics, education and training, professional activities and lifestyle characteristics of 171 members of the American Society of Transplant Surgeons (ASTS). ASTS members were sent a comprehensive survey by electronic mail. There were 171 respondents who were 49 ± 8 years of age and predominantly Caucasian males. Female transplant surgeons comprised 10% of respondents. ASTS respondents underwent 15.6 ± 1.0 years of education and training (including college, medical school, residency and transplantation fellowship) and had practiced for 14.7 ± 9.2 years. Clinical practice included kidney, pancreas and liver organ transplantation, living donor surgery, organ procurement, vascular access procedures and general surgery. Transplant surgeons also devote a significant amount of time to nonsurgical patient care, research, education and administration. Transplant surgeons, both male and female, reported working approximately 70 h/week and a median of 195 operative cases per year. The anticipated retirement age for men was 64.6 ± 8.6 and for women was 62.2 ± 4.2 years. This is the largest study to date assessing professional and lifestyle characteristics of abdominal transplant surgeons.

Determinants of choosing a career in surgery

INTRODUCTION

Student choice is an important determinant of the specialty mix of practicing physicians in Canada. Understanding student characteristics at medical school entry that are associated with a student choosing a residency in surgery can assist surgical educators in supporting medical students interested in surgery and in serving health human resources needs.

METHODS

From 2002 to 2004, data was collected from entering students in 15 classes at eight of 16 Canadian medical schools. Surveys included questions on career choice, attitudes to practice, and socio-demographics. Students were followed prospectively with survey data linked to their residency choice. Multiple logistic regression analysis was used to identify entry characteristics that predicted a student's ultimate choice of a surgical career.

RESULTS

Eight entry variables predicted whether a student named surgery (including obstetrics) as their top residency choice: having surgery as their top career choice, having a relative or friend in a surgical career, having undertaken volunteer work with sports teams, an interest in narrow scope of practice, greater interest in medical the social patient problems, an interest in urgent care, and younger age were identified as predictors of a surgical career choice.

DISCUSSION

Surgical educators may wish to attend to the factors that we found that predicted students selecting a surgical residency as their top career choice at medical school exit in order to foster and support students interested in the surgical disciplines during medical school. In addition, these factors could be used to identify students interested in a surgical career at medical school entry.

The influence of surgical demonstrations during an anatomy course on the perceptions of first-year medical students toward surgeons and a surgical career

OBJECTIVE

We previously have demonstrated the educational benefits of surgical demonstrations to first-year medical students. The aim of this current study was to analyze the influence of these demonstrations on the perceptions of students toward surgeons and a possible career in surgery.

METHODS

A faculty member from the Department of Surgery provided an instruction on pancreatic malignancies and management to first-year medical students during their gross anatomy course. After this instruction, using a lightly embalmed cadaver, the clinically relevant anatomy was detailed and a pancreaticoduodenectomy was performed on the cadaver. Immediately after the demonstration, a brief survey was conducted to obtain feedback from the students about the experience.

RESULTS

A total of 170 students over 2 years returned the survey for a response rate of 69%. The demonstration provided 77% of students with a favorable impression of surgeons, and 90% of the students felt that this exposure gave them an understanding of the knowledge, skills, and qualities needed to become a surgeon. Additionally, 57% of respondents stated that watching the demonstration increased the likelihood of them pursuing a surgical career. For the 67% of students who were considering a surgery career, the demonstration reinforced their interest; however, for the students who were not interested in surgery, the demonstration did not alter their opinion.

CONCLUSION

The results of this study showed that surgical demonstrations to first-year medical students can influence their perceptions favorably about surgeons and a surgical career. This interaction provided students with information and motivation to pursue a career in surgery and also may counteract any negative stereotypes of the field that first-year students may have had.

Emergency medicine preclerkship observerships: evaluation of a structured experience

OBJECTIVE

Medical students are expected to make residency and career decisions early in their undergraduate medical education. In medical school curricula, there is limited exposure to emergency medicine (EM) in the preclerkship years. The purpose of this study was to evaluate a structured EM observership program for preclerks by surveying the students' perceptions and attitudes about the program following their participation.

METHODS

A structured observership program was developed and implemented at the University of Toronto Medical School in February 2007. All first- and second-year students were eligible to participate on a voluntary basis. Nine emergency department (ED) teaching sites were enlisted, with each site recruiting interested preceptors. The observership consisted of two 4-hour shifts with 1 preceptor at 1 site. Specific expectations were provided to the students at the start of the observership. A convenience sample was used for the period between Feb. 26 and Nov. 4, 2007, to conduct an anonymous online survey about the students' experience after the observership.

RESULTS

During the study period, 82 students completed 99 observerships at 9 sites with 54 different preceptors. Of the 82 students who completed the observerships, 70 students completed the survey. Overall, all the students (70/70) found the experience to be worthwhile. Most students (68/70) viewed the preceptors as good role models. As a result of the observership, 47 of 70 students reported that their attitudes about and interest in EM had changed and most (59/70) planned on exploring other opportunities in EM (e.g., electives).

CONCLUSION

Structured EM observerships are viewed by medical students to be worthwhile. These observerships can change attitudes about and interest in EM and allow students to make more informed career choices.

Whether or wither some specialties: a survey of Canadian medical student career interest

BACKGROUND

Given the looming shortage of physicians in Canada, we wished to determine how closely the career preference of students entering Canadian medical schools was aligned with the current physician mix in Canada.

METHODS

Career choice information was collected from a survey of 2,896 Canadian medical students upon their entry to medical school. The distribution of career choices of survey respondents was compared to the current physician specialty mix in Canada.

RESULTS

We show that there is a clear mismatch between student career choice at medical school entry and the current specialty mix of physicians in Canada. This mismatch is greatest in Urban Family Medicine with far fewer students interested in this career at medical school entry compared to the current proportion of practicing physicians. There are also fewer students interested in Psychiatry than the current proportion of practicing physicians.

CONCLUSION

This mismatch between the student interest and the current proportion of practicing physicians in the various specialties in Canada is particularly disturbing in the face of the current sub-optimal distribution of physicians. If nothing is done to correct this mismatch of student interest in certain specialties, shortages and misdistributions of physicians will be further amplified. Studies such as this can give a window into the future health human resources challenges for a nation.

An experience in surgical anatomy to provide first-year medical students with an early exposure to general surgery: a pilot study

INTRODUCTION

The level of interest expressed by medical students toward the field of general surgery has decreased. The aims of this study were to (1) describe an educational scheme in surgical anatomy that increases interaction between practicing surgeons and first-year medical students and (2) garner feedback and opinions of these medical students from a pilot study of this educational experience.

MATERIALS AND METHODS

A faculty member from the Department of Surgery provided a review of pancreatic malignancies and its management to first-year medical students during their anatomy course. Then, using a cadaver, the clinically relevant anatomy was detailed, and a pancreaticoduodenectomy was performed with the help of student volunteers. A 7-question survey using the 5-point Likert response scale ranging from "strongly agree" to "strongly disagree" was used to obtain feedback from the students.

RESULTS

A total of 145 responses (of 205) were collected for a response rate of 70.38%. Most students (99%) felt that this type of surgical demonstration during the anatomy course was extremely beneficial. The students also felt that this approach improved their understanding of the relevant anatomy and its clinical importance. The survey also demonstrated that most students would like these surgical demonstrations to be repeated in future. Less than 1% of the students did not find these demonstrations beneficial.

CONCLUSIONS

The results of this study demonstrate the benefit of surgical demonstrations by surgical faculty to first-year medical students. These findings have led to the incorporation of this educational scheme into the medical school anatomy curriculum on a regular basis at our University.

Can brief interventions by hand surgeons influence medical students toward a career in hand surgery?

PURPOSE

In 2004, the American Society for Surgery of the Hand and the American Association for Hand Surgery formed a joint task force to deal with the difficulty of promoting hand surgery as a career choice to medical students. The purpose of this study was to use a previously validated format to expose medical students to a brief intervention early in their medical education that might influence their perceptions of hand surgery as a career choice.

METHODS

First-year medical students were asked to rank 11 items on a Likert scale from 1 (not important) to 5 (very important) regarding their beliefs about hand surgery as a career before and after a brief 1-hour presentation by a hand surgeon. Additional information about career choice and prior exposure to hand surgery was obtained before the intervention, and student interest in hand surgery was measured after the intervention.

RESULTS

Of 110 first-year medical students, 72 (65%) students completed both the pre-lecture survey and the post-lecture survey. Of the 72 students with matched responses, 8 (11%) ranked surgery as their first career choice, whereas 13 (18%) ranked a surgical subspecialty as their first choice. Thirty-nine (54%) students stated that the lecture raised their interest in hand surgery as a possible career, and 36 (50%) were interested in doing an elective in it while in medical school. Nonparametric tests showed improvement in knowledge after the lecture for length of training, technical aspects, intellectual challenge, and fellowship requirements.

CONCLUSIONS

A positive information-providing encounter with a hand surgeon may favorably influence the perceptions of first-year medical students toward hand surgery.

Perspectives of Third-Year Medical Students Toward Their Surgical Clerkship and a Surgical Career

INTRODUCTION

A deficit of surgeons currently exists in the health care workforce. We have designed a study that identifies predictors of students choosing a career in surgery. First, we conducted two feasibility studies, and on the basis of these data, designed a third study for addressing our specific aims. The design and one-year results for the new study are provided here.

METHODS

For the feasibility studies, students participating in the third-year surgery clerkship at our institution were asked to complete surveys using two different study designs. For the new study, which began in June 2005, students complete surveys covering domains of interest at the beginning of the clerkship and at weekly intervals throughout the clerkship, and will be providing match results.

RESULTS

The feasibility studies offered insight into ways to improve our study design. In the first year of this multi-year study, 93 students participated (response rate = 77%). Forty-five students were women (48%), and the average age was 26.09 (sd 2.85). Proportion of students rating general surgery or a surgery subspecialty in their top three choices for a career increased over the course of the clerkship by 24.7% (n = 32, 34.4% at baseline; n = 55, 59.1% at end of clerkship). Seventy-one students (76.3%) reported having a meaningful experience on the clerkship, and 30 (32.3%) received honors grades.

CONCLUSION

Our study design benefitted from the knowledge we gained from our feasibility studies. We look forward to achieving the necessary sample size in the next several years to report the final results of this study.

Factors influencing the decision to practise obstetrics among Québec medical students: a survey

OBJECTIVE

The objectives of this study were to track changes in medical students' interest in obstetrics from the beginning of their studies in medicine to the end of their pre-clinical clerkships and to identify factors that influenced this interest.

METHODS

This was a cohort study of all Québec medical students who, in 2003, were about to begin their clerkships (n = 500). A questionnaire was administered at this time (T1) and at the end of the clerkship (T2). The main outcome variables were an intention to provide prenatal care without deliveries and an intention to deliver infants in future practice. Logistic regression analysis was used to assess relationships between the various determinants and the decision to practise obstetrics.

RESULTS

A total of 353 students, or 70.6% of the cohort, completed both questionnaires. At the end of their clerkships, 32 students (9.1%) were definitely planning to include complete obstetrical care in their future practices, and 45 (12.7%) said that they probably would. Between the beginning and the end of their clerkships, only 8% of students had changed their minds in favour of an obstetrical career, and 20% had decided against it. An intention to deliver infants is associated with the following factors: considering the practice of obstetrics gratifying (odds ratio [OR] 6.73; 95% confidence intervals [CI] 3.30-13.70); having been exposed to obstetrical care outside the clerkship in obstetrics and gynaecology (OR 4.4; 95% CI 1.6-10.26); having completed university studies before studying medicine (OR 4.08; 95% CI 1.11-15.3); and having had a decisive, positive experience with obstetrics (OR 2.86; 95% CI 0.96-8.50). Students who believed that specialists had played a key role in their decision and that obstetrics is a demanding practice were less likely to plan a career that included delivering infants (OR 0.43; 95% CI 0.23-0.69 and OR 0.35; 95% CI 0.21-0.59, respectively).

CONCLUSION

This study shows that an interest in practising obstetrics emerges very early in medical training. However, a student's learning experiences during an obstetrical rotation affect this decision. Departments of family medicine and obstetrics and gynaecology may be able to work together to create more positive role models.

The Training Needs and Priorities of Male and Female Surgeons and Their Trainees

BACKGROUND

Over the past decade, interest in general surgery careers has declined and the number of female medical school graduates has increased. This study was performed to identify the needs of both male and female surgical trainees and to guide design of training programs because attracting medical students to, and maintaining residents in, general surgery training programs can be difficult without a clear understanding of the training needs and priorities of both men and women. We hypothesized that men and women would express similar training priorities, yet have subjectively different experiences.

STUDY DESIGN

Medical students, surgical residents, fellows, and fully trained surgeons affiliated with at least one of four major surgical societies were asked to complete a level-specific survey located on the American College of Surgeons Web site.

RESULTS

There were 4,308 respondents (76% men). Men and women selected similar reasons for choosing a surgical career and residency program and criteria critical to a successful residency program, with women placing greater emphasis on clerkship experience and faculty diversity. There were no statistically significant differences between the men and women's perceptions of their own training. Although, when asked to evaluate whether certain aspects of training were comparable for male and female residents, women were statistically less likely to agree that their experiences were comparable with those of their male colleagues.

CONCLUSIONS

Male and female surgical residents, fellows, and trained surgeons identified almost identical training needs and priorities yet women perceived disparate treatment.