Change of interest in surgery during medical school: a comparison of men and women

The Impact of Same Gender Speed-Mentoring on Women's Perceptions of a Career in Surgery - A Prospective Cohort Study

BACKGROUND

Mentoring is critically important for the personal and professional development of a surgeon. Early career stage mentoring by same-gender role models may help ameliorate the gender imbalance in surgery based on our understanding of barriers for women pursuing surgical careers. A novel method of establishing these relationships is speed mentoring. This study aims to examine the impact of a one-day speed-mentoring session with same gender mentors on a cohort's perceptions of a career in surgery.

DESIGN

This prospective pre-post study compared attitudes and perceptions of a career in surgery before and after a speed-mentoring session with female surgeons. Mentees were assigned into groups of 1 or 2 and were paired with a female surgeon for 8 minutes. Each mentee group then rotated to another mentor for the same amount of time and this process continued for a total of twelve sessions. Mentees completed a 19-point questionnaire before and after the speed mentoring intervention.

SETTING

This multicenter study included participants from across the United Kingdom.

PARTICIPANTS

Inclusion criteria were female gender and medical student or foundation year doctor (internship year 1 or 2) status. Three hundred and forty participants participated in the intervention, 191 were included in the analysis.

RESULTS

Following intervention, the percentage of participants who agreed that having a family would negatively impact a woman's surgical career progression significantly decreased from 46.6% to 23.0%. The percentage of participants who agreed that an "old boys' club" attitude exists in surgery also significantly decreased (73.8%-58.1%). The percentage of participants who agreed it was more difficult for a woman to succeed in her surgical career than a man significantly decreased (73.8%-64.9%). One hundred and eighty-three (96%) participants agreed that mentorship is important for career progression and 153 (71.2%) participants stated that they did not have someone who they considered a mentor.

CONCLUSIONS

Conducting a speed mentoring program with same-gender role models significantly changed female medical students' and junior doctors' perceptions of women in surgery. The results suggest that such programs may be effective tools for facilitating mentor-mentee relationships and could be employed by surgical organizations to encourage a diverse uptake into surgery.

Exploring the Impact of the Surgical Exploration and Discovery (SEAD) Program on Medical Students' Perceptions of Gender Biases in Surgery: A Mixed-Method Evaluation

OBJECTIVE

Female representation in surgery is increasing; however, many surgical specialties continue to observe disproportionately fewer females entering their residencies. This study assesses how medical students' gender-based perceptions of surgical careers are impacted by attending the Surgical Exploration and Discovery (SEAD) program, a 2-week, immersive procedural program that offers observerships, mentorship, and workshops across 8 surgical specialties.

DESIGN

In this mixed-method prospective cohort study, medical students' awareness, beliefs, and experiences of gender bias in surgery were assessed using a 10-item Gender Bias in Medical Students Assessment-Surgery (GBMSA-S) psychometric survey instrument inspired by the validated Gender Bias in Medical Education Scale (Parker et al., 2016).

SETTING

Undergraduate Medical Education, Faculty of Medicine, at the University of Ottawa in Ottawa, Ontario, Canada.

PARTICIPANTS

Eighteen first-year medical students in the experimental group (8 male, 10 female) and 18 in the control group (7 male, 11 female).

RESULTS

Compared to the control group, SEAD participants had significant changes in agreement with the statements: "surgery is male-dominated," "medical studies are mainly done in males," "gender discrimination is more pronounced in surgery than other medical professions," "consideration of my gender is an important factor in whether or not to pursue surgery as a career," and "I have encountered gender-biased attitudes and/or behaviors among non-physician health care staff" (p < 0.05). Perceptions of gender bias were reduced post-SEAD. Subgroup analysis by gender suggested that the significance of these changing perspectives was due to female participants' responses. SEAD also produced an increase in the level of interest in surgery (p = 0.04). Receptive and authentic dialogue was identified as a critical step toward social inclusivity (n = 11).

CONCLUSIONS

Early surgical exposure through SEAD produces a statistically significant increase in surgical interest and reduces certain perceptions of gender bias in surgery, particularly among female medical students.

The future of general surgery in Ireland: factors influencing career decisions of medical students

INTRODUCTION

The decline in popularity of general surgery as a career has been well described. A number of factors have been put forward to explain this, for example, trainee burnout and perceived difficulty with work/life balance. The aim of this study was to elucidate the reasons for this among medical students in Ireland.

METHOD

A questionnaire was distributed to clinical year medical students in Ireland using an online survey via SurveyMonkey™. Domains assessed included demographics, career plan and associated rationale. Anonymised responses were collated and evaluated.

RESULTS

There were 307 responses (response 23%). Females accounted for 66% (202). Mean age was 24 years (SD = 2.89). One hundred twelve responses (36%) were contemplating becoming surgeons. One hundred nine-five responses were not considering surgery: however 87 had previously considered. Of the 87, 41 (47%) attributed the decision to work/life balance, 30 (35%) to impact on personal relationships and 10 (11%) blamed unclear career projection. Students interested in surgery were asked to quantify their knowledge of the application process-17 (15%) good, 39 (35%) fair and 56 (50%) poor.

CONCLUSION

A small proportion of respondents plan to pursue a career in general surgery. This is concerning in view of attrition rates through junior years. Although lifestyle factors are significant, clarity regarding training pathways was also reported. Undergraduate education regarding career trajectory, quality of life and practicalities of a career in general surgery may increase applications.

An Undergraduate Surgery Interest Group: Introducing Premedical Students to the Practice of Surgery

PURPOSE

Early exposure and surgical mentorship can augment interest in surgery. We evaluate the effect and feasibility of offering education and mentorship opportunities in surgery to premedical students at our institution through an undergraduate surgery interest group (USIG).

MATERIALS AND METHODS

We conducted a 1-year assessment of our USIG and reviewed its organizational structure, funding resources, media promotion, and educational activities. Our USIG hosted introductory-level surgical skills workshops, guest lectures by surgeons, and various facility tours. To assess participants' interests, as well as the influences on them to pursue a surgical profession, we analyzed pre- and post-event questionnaires. Similar questionnaires were completed by medical students in our medical student surgery interest group to compare any differences in perception between premedical and medical students.

RESULTS

Our USIG currently has 378 undergraduate student members, with a higher proportion of women than in our medical student surgery interest group (P < 0.003). Neurosurgery was the most popular career choice among undergraduate participants. Participants reported the highest satisfaction with suturing and high-fidelity trauma surgery skills workshops. Undergraduate participants indicated that their intrinsic interest in the sciences is the highest motivation to pursue a surgical profession. Resident lifestyle and social obligations of a surgical career were actually positive influences for undergraduate participants; in contrast, medical students viewed those variables as negative factors.

CONCLUSION

Our USIG was met with enthusiasm by premedical students and faculty alike. Participation strengthened premedical students' interest in pursuing surgery and increased their understanding of the surgical profession. Early mentorship may positively influence premedical students' perception of surgical careers. USIG is economically feasible and time-efficient; we encourage other academic institutions and educators to consider investing in similar interest groups.

The Use of Laparoscopy Simulation to Explore Gender Differences in Resident Surgical Confidence

Background. The objective of this study was to determine whether female surgical residents underestimate their surgical abilities relative to males on a standardized test of laparoscopic skill. Methods. Twenty-six male and female general surgery residents and 25 female obstetrics and gynecology residents at two academic centers were asked to predict their score prior to undergoing the Fundamentals of Laparoscopic Surgery standardized skills exam. Actual and predicted score as well as delta values (predicted score minus actual score) were compared between residents. Multivariate linear regression was used to determine variables associated with predicted score, actual score, and delta scores. Results. There was no difference in actual score based on residency or gender. Predicted scores, however, were significantly lower in female versus male general surgery residents (25.8 ± 13.3 versus 56.0 ± 16.0; p < 0.01) and in female obstetrics and gynecology residents versus male general surgery residents (mean difference 20.9, 95% CI 11.6–34.8; p < 0.01). Male residents more accurately predicted their scores while female residents significantly underestimated their scores. Conclusion. Gender differences in estimating surgical ability exist that do not reflect actual differences in performance. This finding needs to be considered when structuring mentorship in surgical training programs.

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.

The Nonwhite Woman Surgeon: A Rare Species

BACKGROUND

As of 2012, 39% of medical student graduates were nonwhite, yet very few nonwhite women graduates chose to become surgeons.

METHODS

To better understand issues regarding nonwhite women in surgery, an online survey was sent to surgeons across the United States. Results are based on self-reported data. Mean data are reported.

RESULTS

A total of 194 surgeons (42% women) completed the survey; only 12% of responders were nonwhite. Overall, 56% of nonwhite women felt they earned less than what men surgeons earn for equal work. Nonwhite women surgeons earned less than what men surgeons ($224,000 vs. 351,000, p < 0.00002) and white women surgeons ($285,000, p = 0.02) earned. Overall, 96% of nonwhite surgeons believed that racial discrimination currently exists among surgeons.

CONCLUSIONS

The few nonwhite women surgeons in the United States recognize that they are paid significantly less than what other surgeons are paid. Inequitable remuneration and a discriminatory work environment encountered by nonwhite women surgeons must be addressed.

Sex, role models, and specialty choices among graduates of US medical schools in 2006-2008

BACKGROUND

Undergraduate education studies have suggested instructor sex can influence female students to pursue a discipline. We sought to evaluate a similar hypothesis in medical students.

STUDY DESIGN

We obtained Association of American Medical Colleges (AAMC) data about the specialization of 2006-2008 graduates of US medical schools, the sex of their faculty and department chairs, and sex of residents in the residency programs in which they enrolled. We used logistic regression to examine associations between faculty and leadership sex and female students' pursuit of 5 surgical specialties along with 3 nonsurgical specialties for context. We used Wilcoxon rank-sum tests to evaluate whether women entered residency programs with a higher proportion of female residents.

RESULTS

In 2006-2008, US medical school graduates included 23,642 women. Women were substantially under-represented among residents in neurosurgery, orthopaedics, urology, otolaryngology, general surgery, and radiology; women constituted 47.4% of US graduates specializing in internal medicine and 74.9% in pediatrics. We found no significant associations between exposure to a female department chair and selection of that specialty and no consistent associations with the proportion of female full-time faculty. Compared with male students, female students entered residency programs in their chosen specialty that had significantly higher proportions of women residents in the year before their graduation.

CONCLUSIONS

Although we did not detect consistent significant associations between exposure to potential female faculty role models and specialty choice, we observed that female students were more likely than males to enter programs with higher proportions of female residents. Sex differences in students' specialization decisions merit additional investigation.

Female medical students: who might make the cut?

Personality distinctions exist between male and female doctors, and between surgeons and non-surgeons, but given the predominance of males in surgery, the personality profile of females interested in surgery is less clear. This study examined personality and other attributes of female medical students attracted to the surgical profession. A total of 580 second-year medical students in Australia completed questionnaires that measured their likelihood of considering various medical specialties, personality traits using the NEO Five-Factor Inventory (NEO-FFI), and the importance of several other parameters in directing career choice. Significantly fewer females than males rated surgery highly likely as a career. Females interested in surgery had higher Neuroticism and Agreeableness scores, and placed greater importance on ability to help people, and less importance on prestige and financial reward compared to males interested in surgery. Compared to males not interested in surgery, females interested in surgery had higher Openness scores, and placed greater importance on ability to help people, interesting and challenging work, and less importance on lifestyle. Lastly, females interested in surgery had lower Agreeableness scores, and placed greater importance on prestige and less importance on lifestyle compared to females not interested in surgery. Common findings that surgeons compared to non-surgeons are more tough-minded, less patient-oriented and less empathic may be a function of the prevalence of males in surgery. In our sample, the females interested in surgery retained an overall similar personality profile to those less interested, with only few differences.

Career choices of today's medical students: where does surgery rank?

INTRODUCTION

The national junior doctor recruitment crisis prompts an appraisal of medical student attitudes to different career pathways. The purpose of this study was to perform a national review of surgical career intentions of Irish final year medical students.

METHODS

Ethical and institutional approval was obtained at each study location. A questionnaire was designed and distributed to final year students. Domains assessed included demographics, career plans and reasons associated. Anonymised responses were collated and evaluated. Categorical data were compared with Fisher's exact test.

RESULTS

Responses were obtained from 342 students in four medical schools of whom 78.6% were undergraduates. Over half (53%) were Irish, with Malaysia, Canada and the USA the next most common countries of origin. Only 18% of students intended to pursue surgery, with 60% stating they did not plan to, and 22% undecided. Of those who plan not to pursue surgery, 28% were unsure about a speciality but the most common choices were medicine (39%), general practice (16%) and paediatrics (8%). Reasons for not picking a career in surgery included long hours and the unstructured career path. Suggestions to improve uptake included earlier and more practical exposure to surgery, improved teaching/training and reduction in working hours.

CONCLUSIONS

In this study 18% of final year medical students identified surgery as their chosen career pathway. Although lifestyle factors are significant in many students' decision, perceived quality and duration of surgical training were also relevant and are modifiable factors which, if improved could increase interest in surgery as a career.

Gender-related perceptions of careers in surgery among new medical graduates: results of a cross-sectional study

BACKGROUND

Despite promotional measures at a national level, female surgeons account for only 10% of the consultant workforce in the United Kingdom. With rising proportions of female medical graduates, it is important that surgery continues to recruit the most able candidates regardless of sex. This study investigates the differing perceptions of surgical careers among recent medical school graduates and identifies factors discouraging female doctors from pursuing a career in surgery.

METHODS

Newly qualified graduates from the University of Nottingham Medical School, Nottingham, UK, were invited to complete a nonmandatory questionnaire investigating career intentions and factors influencing this.

RESULTS

Two hundred and eight questionnaires were returned (a 66% response rate). Male respondents were significantly more likely to rate surgery as an attractive or very attractive career (P = .0116). Overall, only 33 (25%) female doctors expressed interest in a surgical career as opposed to 33 (42%) male doctors (P = .010). Frequently cited reasons included no interest in surgery itself (21%) and negative attitudes toward women in surgery among the surgical teams (18%). Irrespective of career interests, 59% of male and 68% of female respondents believed surgery was not a career welcoming women (P = .186). Reasons included difficulty maintaining family life, limited flexible training, and lack of role models.

CONCLUSIONS

This study identifies significant sex differences in the perception of surgical careers. The majority believes surgery does not welcome female trainees. Future strategies to promote surgery must address attitudes and behaviors in both sexes while taking active steps to support female surgeons during their training and in the workplace.

Distress and empathy do not drive changes in specialty preference among US medical students

BACKGROUND

Although medical student specialty choices shape the future of the healthcare workforce, factors influencing changes in specialty preference during training remain poorly understood.

AIM

To explore if medical student distress and empathy predicts changes in students' specialty preference.

METHODS

A total of 858/1321 medical students attending five medical schools responded to surveys in 2006 and 2007. The survey included questions about specialty choice, burnout, depression, quality of life, and empathy.

RESULTS

A total of 26% (205/799) changed their specialty preference over 1 year. Depersonalization--an aspect of burnout--was the only distress variable associated with change in specialty preference (OR, odds ratio 0.962 for each 1-point increase in score, p = 0.03). Empathy at baseline and changes in empathy over the course of 1 year did not predict change in specialty preference (all p > 0.05). On multi-variable analysis, being a third year (OR 1.92), being male (OR 1.48), and depersonalization score (OR 0.962 for each point increase) independently predicted a change in specialty preference. Distress and empathy did not independently predict students' losing interest in primary care whereas being a fourth-year student (OR 1.83) and being female (OR 1.83) did.

CONCLUSION

Among those who did have a major change in their specialty preference, distress and empathy did not play a major role.

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 impact of the 80-hour work week on student interest in a surgical career

INTRODUCTION

In July 2003, an 80-h work wk was initiated for residents across the United States, with the potential benefit of improving resident quality of life. Using a survey of medical students, we evaluated whether this change increased medical students' interest in pursuing a career in surgery.

METHODS

Surveys were administered to 505 medical students prior to and after completing their surgical clerkship at a university-based medical school. Results were then analyzed with significance determined as a P≤0.05.

RESULTS

Overall, 55 (10.9%) medical students stated they anticipated pursuing a surgical career prior to starting their clerkship. There was no difference in the pre-rotation interest in a surgical career from before to after introduction of the 80-h work wk (8.3% versus 12.6%, P=0.14). Men were also more likely than women to report a pre-rotation interest in surgery (16.9% versus 6.1%, P<0.001). The most important factor influencing a student's post-clerkship interest in pursuing a career in surgery was a pre-rotation interest.

CONCLUSION

These data indicate that the 80-h work wk has not improved medical students' or females' interests in surgery. Since the strongest predictor of pursuing a career in surgery is a pre-rotation interest, we need to continue efforts to appeal to medical students earlier in their education and improve upon their perceptions of surgery.

Changes in U.S. medical students' specialty interests over the course of medical school

BACKGROUND

Studies have examined factors affecting medical students' specialty choice, but little research exists on stability of these specialty interests.

OBJECTIVE

To describe patterns of change in specialty interests during medical school and examine associations between specialty change patterns and gender, desire for a high-prestige career, and interest in prevention.

DESIGN

Medical students (Class of 2003) at 15 representative US schools were invited to complete surveys during freshman orientation, entry to wards, and senior year.

PARTICIPANTS

This analysis used data from 942 students who completed all 3 surveys.

MEASUREMENTS

In addition to a number of other items, students were asked to choose the 1 specialty they were most interested in pursuing.

RESULTS

The most common specialty choices among freshman students were pediatrics (20%) and surgery (18%); least common choices were psychiatry and preventive medicine (1% each). General internal medicine was the initial specialty choice for 8%. Most students changed their specialty choices, regardless of initial interest. Only 30% of those initially interested in primary care (PC) remained interested at all 3 time points, compared to 68% of those initially interested in non-PC. Female versus male students were more commonly interested in PC at all 3 time points. Senior students interested in non-PC specialties were more likely to desire a high-prestige career (48%) than those interested in PC (31%).

CONCLUSIONS

Medical students may benefit from more intensive introduction to some specialties earlier in pre-medical and medical education. In addition, increasing the prestige of PC fields may shape the physician workforce.

The neurosurgical workforce in North America: a critical review of gender issues

OBJECTIVE

The role of women in Western society has changed dramatically in the past several decades. Despite this, many gender disparities still exist for professionals in the health care sector. In neurosurgery, a disproportionately small percentage of the workforce in the United States and Canada is female. These figures are lower than most reported in other medical specialties. This review critically examines factors that may be influencing women's ability to advance in demanding subspecialties such as neurosurgery.

METHODS

The literature on women in medicine, and surgery in particular, were reviewed to identify different issues facing women currently in practice in neurosurgery. In addition, the concerns of prospective trainees were examined.

RESULTS

There remain many challenges for women entering neurosurgery, including unique lifestyle concerns, limited mentorship, out-dated career programs, and deep-seeded societal beliefs. Discrimination and harassment are also contributing factors.

CONCLUSION

If neurosurgery is to continue to progress as a subspecialty, the issue of gender inequality needs to be scrutinized more closely. Innovative programs must be developed to meet the needs of current female faculty members and to ensure attracting the brightest individuals of both genders into a career in neurosurgery.

Why are women deterred from general surgery training?

BACKGROUND

This study explored the factors contributing to the low application rates to general surgery (GS) residency by female students and compared perceptions of GS between students and female surgeons.

METHODS

We distributed surveys to final-year students at 4 medical schools and nationwide to every female general surgeon in Canada.

RESULTS

Of students who were deterred from GS, women were less likely than men to meet a same-sex GS role model and more likely to experience gender-based discrimination during their GS rotation (P < .05). Female students had the perception that GS was incompatible with a rewarding family life, happy marriage, or having children, whereas female surgeons were far more positive about their career choice.

CONCLUSIONS

Both real and perceived barriers may deter women from a career in GS. Real barriers include sex-based discrimination and a lack of female role models in GS. There are also clear differences in perception between students and surgeons regarding family and lifestyle in GS that must be addressed.

From a relationship to encounter: an examination of longitudinal and lateral dimensions in the doctor–patient relationship

Existing conceptualizations of the doctor-patient relationship provide little insight into this complex and perhaps now nonexistent "relationship" in the 21st century. Today, the word "relationship" as applied to the doctor-patient experience may be a misnomer--or at least an inappropriate description of the experience. One could ask, for example, if a person's most recent physician visit was more akin to their encounter with their last cab driver, or the person who sold them their last pair of shoes. After reviewing the 20th century theoretical conceptions of the doctor-patient relationship and describing the state of illness and health care delivery and policy in the United States, we develop a theoretical rubric for examining the 21st century physician-patient relationship. We argue that while patients should continue to be educated on how to use their time with physicians effectively and efficiently and physicians should continue to improve their communication with patients, we also argue that for policy purposes, it is not the physician or the patient that needs to change but rather the pressures and constraints of the organizational context within which the doctor-patient encounter takes place.

Potential Targets to Encourage a Surgical Career

BACKGROUND

Our goal was to identify factors that can be targeted during medical education to encourage a career in surgery.

STUDY DESIGN

We conducted a cross-sectional survey of first and fourth year classes in a Liaison Committee on Medical Education-accredited medical school. Students scored 19 items about perceptions of surgery using a Likert-type scale. Students also indicated their gender and ranked their top three career choices.

RESULTS

There were 121 of 210 (58%) first year and 110 of 212 (52%) fourth year students who completed the survey. First year students expressed a positive correlation between surgery and career opportunities, intellectual challenge, performing technical procedures, and obtaining a residency position, although length of training, work hours, and lifestyle during and after training were negatively correlated with choosing surgery. Fourth year student responses correlated positively with career and academic opportunities, intellectual challenge, technical skills, role models, prestige, and financial rewards. Factors that correlated negatively were length of training, residency lifestyle, hours, call schedule, and female gender of the student respondent. Forty-four percent of first year male students expressed an interest in surgery versus 27% of fourth year male students (p < 0.04). Eighteen percent of first year female students expressed an interest in surgery versus 5% of fourth year female students (p < 0.006).

CONCLUSIONS

Lifestyle issues remain at the forefront of student concerns. Intellectual challenge, career opportunities, and technical skills are consistently recognized as strengths of surgery. Additionally, fourth year students identify role models, prestige, and financial rewards as positive attributes. Emphasizing positive aspects may facilitate attracting quality students to future careers in surgery.

Medical student concerns and fears before their third-year surgical clerkship

BACKGROUND

This study describes the personal concerns of third-year medical students beginning their surgical clerkship. To assess these needs, we studied the expectations, interests, and concerns of beginning surgical clerks.

METHODS

Beginning surgical clerks during the 2002-2003 academic year were invited to respond to a written survey. Responses were categorized into domains of interest and domains of concern. Analysis controlled for prior surgical experience, interest in a surgical career, and academic term.

RESULTS

The response rate was 83%. Students were most curious about surgical practice, technical skills, and issues of lifestyle/balance among surgeons. Students were most concerned about fatigue, long hours, potential mental abuse, and poor performance. Differences between groups are described.

CONCLUSIONS

Beginning surgical clerks have questions and concerns about topics often not addressed in the curriculum or syllabus. This study suggests the nature of improvements that could assist the inexperienced student in creating a positive clerkship experience and guiding their choice of career.

The surgical workforce crisis: rising to the challenge of caring for an aging America

In the past century, both the field of surgery and the population it serves have markedly changed. The number of elderly individuals in the United States is rapidly increasing. However, this increase has not been accompanied by commensurate growth in the surgical workforce. As the demographic characteristics of medical students have become more diverse, medical student interest in surgical training has declined. These trends raise two fundamental questions. (1) Will there be enough surgeons to meet the needs of an aging United States population? (2) Who will these surgeons be?

Comparison of private versus academic practice for general surgeons: a guide for medical students and residents

BACKGROUND

Medical students and residents often make specialty and practice choices with limited exposure to aspects of professional and personal life in general surgery. The purpose of this study was to portray practice composition, career choices, professional experiences, job satisfaction, and personal life characteristics specific to practicing general surgeons in the United States.

STUDY DESIGN

A 131-question survey was mailed to all female members (n = 1,076) and a random 2:1 sample of male members (n = 2,152) of the American College of Surgeons in three mailings between September 1998 and March 1999. Respondents who were not actively practicing general surgery in the United States and both trainees and surgeons who did not fit the definition of private or academic practice were excluded. Detailed questions regarding practice attributes, surgical training, professional choices, harassment, malpractice, career satisfaction, and personal life characteristics were included. Separate five-point Likert scales were designed to measure influences on career choices and satisfaction with professional and personal matters. Univariate analyses were used to analyze responses by surgeon age, gender, and practice type.

RESULTS

A response rate of 57% resulted in 1,532 eligible responses. Significant differences between private and academic practice were noted in case composition, practice structure, and income potential; no major differences were seen in malpractice experience. Propensity for marriage and parenthood differed significantly between men and women surgeons. Overall career satisfaction was very high regardless of practice type. Some differences by surgeon gender in perceptions of equal career advancement opportunities and of professional isolation were noted.

CONCLUSIONS

This study offers a comprehensive view of general surgery to enable more informed decisions among medical students and residents regarding specialty choice or practice opportunities.