Education
Why do students choose careers in surgery?

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Abstract

Background

Recent changes in medical education have emphasized primary care careers. This could have a negative impact on the number of applicants to surgical residencies. We hypothesized that experiences during the third year surgical clerkship are influential for students’ subsequent residency choice.

Materials and methods

Third year medical students who completed their surgical clerkship in the 2001–02 academic year were surveyed pre- and post-surgical clerkship. Responses were analyzed and correlated to the 2003 match results.

Results

The response rate of students surveyed was 98% (82 surveys/83 match results). Pre-clerkship, 6/82 students (7%) expressed an interest in surgery or surgical subspecialty careers. Post-clerkship, 34/84 students (40%) expressed an increased interest a surgical career; 13/84 (15%) expressed a decreased interest, and 37% of students expressed no change in career interest. Of those students expressing an increased interest in surgery, the clerkship experiences most noted to be influential were (1) number of cases participated/scrubbed (95%), (2) resident interaction (85%), (3) faculty interaction (80%), and (4) number of cases observed (65%). The number of hours spent on rotation (call, rounds) was the leading experience associated with a decreased interest in a surgical career. 12/83 students surveyed (14%) ultimately matched into a surgical program (NRMP 2003 match results).

Conclusions

These data suggest that operative exposure and interaction with residents and faculty have a positive influence in students’ choice of a surgical career. Although only 6% of students expressed an interest in surgery pre-clerkship, a 2-fold increase in this number was noted in choice of residency (14%). Work hours were the primary negative indicator for surgery residency. As medical curriculum is restructured and surgical exposure decreased, these data underscore the importance of quality exposure to both procedures and role models during the 3rd year surgical clerkship.

Introduction

The surgical clerkship experience in the third year of medical school typically consists of a balance between general surgery exposure and exposure to various surgical subspecialties. In the past decade, there has been evidence of a declining interest in general surgical careers as reflected in the National Residency Match Program (NRMP) results, with 68 surgical programs going unfilled in March of 2001. While the 2002 and 2003 match results reflect improvement in the general surgical programs’ match rate, this downward trend is of concern, as a paucity of surgical trainees will ultimately result in a shortage of surgical practitioners.

Multiple factors appear to be responsible for changes in the specialty choices of United States medical graduates 1, 2. Many authors have investigated this trend and found that the issue of a controllable lifestyle may have a significant influence on residency choice and subsequent practice of the most recent U.S. medical school graduates 1, 2, 3, 4. The demographics and desires of graduating medical students appear to have changed dramatically over the past 2 decades. Medical students are now drawn from a variety of college majors, often having embarked on a career prior to entering medical school 4, 5. These medical students, who may be slightly older than the traditional new college graduate, may be more reluctant to embark on an arduous and time consuming residency (such as the traditional general surgical training program) due to financial and family constraints.

We have previously demonstrated a correlation between exposure to general surgery procedures and match to a categorical general surgery residency program [6]. We have observed a similar trend in students who subsequently match into surgical subspecialty residencies (data not shown). However, the results of these studies pose the obvious question—are the students who match into their respective surgical programs merely seeing more of their chosen cases because of a preexisting interest in the field?

We hypothesized that multiple experiences during the third year clerkships are responsible for a student’s ultimate residency and career choice. To investigate our hypothesis, we designed a survey to be administered to third year medical students prior to and following their third year surgical clerkship. The survey is designed to interrogate any preexisting interest or exposure to surgical fields and to elucidate any change of interest in a surgical career following the surgical clerkship.

Section snippets

Materials and methods

After obtaining human subjects approval by the University of Wisconsin Institutional Review Board, surveys were administered to medical students at the University of Wisconsin School of Medicine prior to and immediately following their third year surgical clerkship in the 2001–2002 academic year (n = 84). Although a total of 151 medical students participated in the 2003 match, the surveys were only administered to the latter four surgical rotations (due to delays while awaiting IRB approval).

Results

Overall, the response rate of students surveyed was 98%; 2 students who completed postclerkship surveys failed to complete surveys prior to the initiation of their clerkships. The majority of students surveyed were 25–29 years old (67%); 24% of students were 20–24, 6% were between the ages of 30 and 34, and 1% of students were >45 years old at the time of their surgical clerkship; 68% of students were single, 29% were married or involved in a significant relationship, and 2% were divorced. The

Discussion

The declining match rate in general surgical programs has understandably created a great deal of concern in the field 4, 6. The implications of unfilled programs are numerous, not only with regard to the quality of training a “short-handed” program may be able to provide, but also with the quality of applicants that surgical programs are able to attract [7]. Additionally, if we are not able to correct the problems underlying the decline in match rate, we will ultimately face a critical shortage

Conclusion

As medical schools continue to promote primary care fields, and surgical clerkships are restructured, we as surgeons must continue to investigate and address the issues affecting the declining interest in surgery as a career. Our data suggest that operative exposure and positive interaction with residents and faculty are important factors in students’ choice of a surgical career. Although only 6% of students expressed an interest in surgery preclerkship, a twofold increase in this number was

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    Citation Excerpt :

    Cochran et al. identified that experiences in the clerkship did improve students' opinion of surgeons as compassionate physicians who were respected by patients, although this did not influence the students' overall decision to go into a surgical career.16 Alternatively, O'Herrin et al. identified an increase in student interest in surgery due to a positive influence of operative exposure and interaction with residents and faculty.17 These studies highlight the significance of the student experience during the clerkship and support the perception of mattering as an integral component of their experience on the surgery clerkship, and, potentially, even their decision to pursue a career in general surgery.

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