A brief private group practice rotation changes junior medical students' perception of the surgical lifestyle

BACKGROUND: Surgical practice is often perceived by students as a stressful and demanding lifestyle in which personal and family issues take low priority. For students to receive a more balanced view of surgical practice, we instituted a private practice preceptorship during the last week of our junior surgery clerkship in 2001. We hypothesized that a 4-day preceptorship with surgeons in private practice would improve student perception of surgery as a valid career choice without compromising student educational performance. METHODS: From January to December 2002, 107 junior medical students were assigned to a brief preceptorship with volunteer private practice surgeons during the surgery clerkship (group 1), while 28 students did not participate in the preceptorship (group 2). We assessed student satisfaction via questionnaire and compared student grade performance between groups. RESULTS: One hundred two questionnaires (95%) were returned. Overall, the preceptor experience was rated positively (9.0+/-0.1) based on a 10-point Likert scale. All students commented on the educational or enjoyment value of the preceptorship, with 44% specifically stating that the lifestyle in private surgical practice appeared pleasant. Interestingly, 9% of students volunteered that the experience had swayed them to consider surgery as a career. Twenty-four percent of questionnaires contained negative comments, mainly concerning not enough "hands-on" participation. Grades for the clerkship did not decrease in group 1 when compared with group 2 or with historic controls (n=113). CONCLUSIONS: A 4-day private practice preceptorship at the end of the junior surgery clerkship favorably alters student perceptions of a surgical career without diminishing student grade performance.     

What influences medical students' choice of surgical careers

BACKGROUND: Recent emphasis in medical education has been to encourage students to pursue primary care careers. This could have a negative impact on applications to surgical residencies. METHODS: To determine what factors are most influential for a student to pursue a surgical career in spite of this environment, third- and fourth-year medical students were surveyed with a 40-item questionnaire. RESULTS: The response rate was 37% (76/205). Those students considering a career in surgery were more likely than their counterparts to be motivated by role models (P <.006), career opportunities (P <.006), and academic opportunities (P <.013) in surgery. They were less likely than their counterparts to be discouraged from surgery on the basis of lifestyle (P <.001), time commitment (P <.001), call schedules (P <.001), or residency length (P <.028). No differences regarding financial rewards, research opportunities, or intellectual challenges were seen between the groups. Neither race nor sex had a significant role in the selection of surgery as a career. CONCLUSIONS: The data suggests that students are more likely to be influenced to pursue surgical careers by offering early exposure to positive role models and career and academic opportunities in surgery. Knowledge of these influences on student career choices should help surgical educators attract and maintain student interest in surgical careers.     

Effects of a laparoscopic course on student interest in surgical residency.

BACKGROUND: The number of surgical residency applicants has been declining. Early introduction of the discipline of surgery is thought to stimulate early interest in surgical residency. This study investigated the hypothesis that a laparoscopic skills course introduced in preclinical years would stimulate student interest in entering surgical residency. METHODS: Preclinical medical students participated in a laparoscopic skills training course. All students underwent an animate laboratory at the beginning and at the end of the course. Students were divided into 4 separate groups: virtual reality, box trainer, both trainers, and control group. Before and after the course, students were asked their residency interest. First- and second-year medical students participated in the course. RESULTS: Before the course, 56% of the students desired to go into general surgery or a surgical subspecialty. After the course, 49% of the students expressed interest in entering general surgery or a surgical subspecialty. A decrease occurred in students who desired to go into surgical subspecialty residency from 31% to 15% (P = NS), and an increase occurred in students who desired to go into general surgery residency from 25% to 34% (P = NS). No statistically significant difference was seen in the 4 individual training subgroup analyses. CONCLUSIONS: Participation in a laparoscopic skills course does not affect medical student interest in entering surgical residency. A trend was noted in students choosing general surgery over surgical subspecialty training after this course. Surgical educators need to investigate methods to encourage preclinical medical student interest in surgical residencies.     

New focus on anatomy for surgical trainees

The demise of anatomy teaching in the undergraduate medical curriculum has inevitably reduced the general level of applied anatomical knowledge displayed by junior doctors. Initiatives such as the European Working Time Directive have exacerbated the problem by reducing trainees’ opportunities to acquire appropriate anatomical knowledge and clinical skills through workplace training. Medical Schools and postgraduate Colleges and Schools of Surgery must work together to design and deliver quality‐assured courses in core and non‐core anatomy, that cross the undergraduate/postgraduate interface. All medical students should learn a core syllabus of anatomy, agreed by a panel of clinicians and anatomists but delivered according to the pedagogic style favoured by individual Medical Schools. This core will define the anatomy, that all F1 doctors should know, particularly the anatomy associated with clinical procedures: it will be assessed across all years of the undergraduate medical programme. Medical Schools should also offer modules in non‐core surgical and/or radiological anatomy, some of which may be designed and delivered in partnership with Colleges of Surgery and Radiology: these modules would be particularly attractive to students contemplating a career in surgery or interventional radiology, but would not be offered exclusively to this cohort. At present, the inadequate anatomical knowledge of Foundation doctors must be addressed by ensuring that early postgraduate training programmes include explicit, formal teaching in anatomy, for example, the Core Surgical Anatomy course currently being piloted at the Royal College of Surgeons of England.     

Medical student operative experience correlates with a match to a categorical surgical program

BACKGROUND: Interest in general surgical residencies has decreased significantly. Because medical student clerkship experiences may affect specialty preferences, we attempted to determine if the degree of exposure to surgical procedures influenced career choices. METHODS: Operations observed by students who completed the third-year surgical clerkship between 1998 and 1999 were reviewed. These 146 medical students, who matched to residency training programs in March 2000, were then divided into three groups based upon residency fields. Surgical case exposures were then compared between the groups. RESULTS: The total number of operations observed was similar between the groups. However, students who matched into categorical general surgical programs participated in significantly more abdominal and general surgical procedures than those matching in surgical subspecialty or nonsurgical residencies (P < 0.01). CONCLUSIONS: There appears to be a correlation between surgical case exposure during the third-year clerkships and future residency fields. Thus, the degree of exposure to surgical procedures may influence medical student career choices.     

The UCT Surgical Society - a society on the cutting edge

The University of Cape Town Surgical Society is a student-run society established in 2006 and is affiliated with the Department of Surgery. The aims of the society are to supplement undergraduate training, to promote medical and surgical research, and to motivate students to pursue a career in surgery. Regular monthly lectures and surgical skills courses are offered, as well as weekly anatomy workshops. A recently launched Shadow Programme enables students to interact with practising surgeons in theatre, thereby gaining insight into the advantages and challenges involved in a future career in surgery.     

Educational interventions aimed at the transition from surgical training to surgical practice

The transition from surgical training to surgical practice is a critical juncture in the career progression of surgeons. This period is associated with myriad challenges that need to be addressed through specific educational interventions to ensure delivery of safe care to patients and to support the career aspirations of junior surgeons entering the practice environment. These interventions should be based on principles of contemporary surgical education and training, and focus on the needs of surgery residents and junior surgeons entering practice. The specific systems of patient care in which the junior surgeons will work should also be considered while planning and implementing such educational interventions. Senior surgeon colleagues within these systems should play key roles in supporting the junior surgeons entering practice, and may require special training to serve as effective mentors, preceptors, and coaches. Professional societies should play a key role in establishing national standards regarding the educational programs aimed at this transition and develop programs to complement local efforts to address various needs. The American College of Surgeons Division of Education has developed a spectrum of innovative programs that are aimed at this important transition.     

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.     

Surgeons underestimate their influence on medical students entering surgery

BackgroundPositive surgical role models influence medical students to pursue a career in surgery. However, the perception by role models of their own effectiveness has yet to be examined. In this study, we evaluated the influence of surgical role models on medical student career choice, and how these role models perceive themselves.MethodsWe distributed a voluntary and anonymous survey to third-year medical students, general surgery resident applicants, general surgery residents, and attending surgery faculty during the 2010–2011 academic year. We performed statistical analysis using the chi-square and Cochran–Mantel–Haenszel tests (P < 0.05 was significant).ResultsMedical students and resident applicants agreed that faculty and residents are important in shaping the career paths of students. The applicants were more likely to agree than were students that clerkship role models (P = 0.0049) and mentors (P = 0.0035) affected their interest in surgery. The applicants were also more likely to agree than the students that attending surgeons (P = 0.0004), senior (P = 0.0019) and junior (P = 0.0028) surgery residents served as positive role models. Although the surgical faculty and residents agreed with the students that each level of the surgical team served as positive role models, they did not agree as strongly with the students that they have an important role in shaping students' career path (P < 0.0001).ConclusionsSurgical faculty and residents serve as positive role models for medical students. They have an essential role in shaping students' career paths and should be more cognizant of their influence, which may draw a student toward or lead them away from the field of surgery.     

Undergraduate experience of surgical teaching and its influence and its influence on career choice

BACKGROUND: The purpose of this survey was to determine the views of final year medical students in Melbourne regarding both undergraduate surgical teaching and the students' career aspirations. METHODS: A structured questionnaire was given to all final year medical students at Monash and Melbourne Universities in 2003. The questions dealt with the factors influencing graduating medical students, including theatre experience, encouragement/support from surgeons, presence of mentors, lifestyle factors and gender issues. RESULTS: The response rate was 61.2% (251/410). Of these, 50.6% were male, 32.3% declared an interest in surgical training with the remainder either uncertain (24%) or uninterested (44%). Male students were more likely to be interested in surgery. General surgery was the most popular field (69%), followed by plastic surgery (37%) and orthopaedic surgery (35%). Of respondents, 78% reported positive influences towards pursuing a surgical career during their undergraduate years, while 63% reported a negative experience. A total of 67% believed that the current curriculum is adequate and 43% that there is enough support/encouragement towards a surgical career. Only 44% of respondents reported that surgeons are approachable. Lifestyle and family factors were the most important career influence. In particular, 57% of female respondents felt discouraged from pursuing a surgical career and 99% of these women reported lifestyle/family factors as the main source of discouragement, with a further 72% identifying a lack of female role models. CONCLUSIONS: This survey highlights important issues in current undergraduate perception of surgical teaching and higher training. Issues that may encourage or discourage a graduating student to pursue a surgical career are identified.     

Caseload in rural general surgical practice and implications for training

Background : Despite increasing specialization within general surgery, many general surgeons, particularly in rural practice, continue to treat a wide range of conditions. The aim of the present paper was to provide accurate information on three rural surgeons’ caseloads to illustrate the spectrum of surgery encountered and to assist in the planning of rural general surgical training. Methods : A review was conducted of a prospectively maintained database of operations performed by three rural general surgeons in different parts of Victoria, Australia over a 5‐year period. Results : A large volume and wide range of procedures was performed by each surgeon, who averaged more than 500 operations per year (excluding endoscopies). Although most were within the range of procedures covered in the Royal Australasian College of Surgeons (RACS) Fellowship in general surgery, some encroached upon other specialties such as orthopaedics, urology, paediatric surgery and obstetrics/gynaecology. Operations outside of ‘general’ surgery reflected individual training and local community needs. Conclusions : The current RACS Fellowship in general surgery, augmented by training in other specialties as required, will help prepare general surgeons for rural practice.     

PAEDIATRIC SURGICAL TRAINING: A SYSTEM THAT WORKS

Background : Paediatric surgical trainees going through the system at the Royal Children's Hospital (RCH), Melbourne, have been impressed with the amount of time dedicated to postgraduate training compared with other institutions. They generally felt well prepared to sit for Fellowship examinations. We decided to look at the programme offered at the RCH and objectively assess the results. Method : A review was undertaken of the training system at the RCH. Opinions were sought from recent and current trainees and compared with trainees in other disciplines. Figures were obtained from the RACS Examinations Office with respect to pass rates at Fellowship examinations. Results : The training programme is outlined in some detail. A total of 79% of candidates passed their FRACS in paediatric surgery while at the RCH since 1985, compared with 52% from all other institutions. Conclusions : A successful training programme requires a commitment to educate one's junior colleagues. Busy consultants can contribute actively by offering to teach and by encouraging their trainees to attend rounds and tutorials. The rewards are better-educated and well-rounded surgeons as well as, hopefully, a higher pass-rate at the Part 2 examination.     

Novel method for assessment and selection of trainees for higher surgical training in general surgery

The aim of the study was to select surgeons for a higher surgical training in general surgery programme at the Royal College of Surgeons in Ireland (RCSI) using an objective, transparent and fair assessment programme. Thirty-two individuals applied for higher surgical training in general surgery in Ireland in 2006. Sixteen applicants were short-listed for interview and further assessment. All applicants were required to report on their education performance at undergraduate level and their postgraduate professional development. Applicants were scored on their training record during basic surgical training, structures references, clinical experience, approved technical skills courses, validated logbook and consolidation sheet. Assessments of their research and academic surgery included, the award of a higher degree by thesis, and other surgically relevant degree's or diplomas that had been obtained through part-time studies and were awarded by educational establishments recognized by RCSI or the Irish Medical Council. Short-listed applicants completed validated objective assessment simulations of surgical skills, an interview and assessment of their suitability for a career in surgery. The nine individuals who were selected for higher surgical training in general surgery consistently scored higher than those candidates who were not, in post-graduate development (P < 0.001), surgical skills (P < 0.002), interview scores (P < 0.007) and suitability for a career in surgery (P < 0.002). All performance assessment elements except undergraduate education showed high internal reliability alpha = 0.89 and good statistical power (range 0.95-0.99). The statistical power of undergraduate education was 0.7. The objective assessment programme introduced by RCSI for selection of candidates for the programme in higher surgical training in general surgery reliably and consistently distinguished between candidates. Candidates selected for further training consistently outperformed those who were not in good concordance between measures. This common selection process for higher surgical training is now being rolled out for selection into higher surgical training across all surgical specialties in Ireland.     

Factors affecting choice of surgical residency training program

BACKGROUND: A significant problem facing American surgery today is the lack of participation from women and minorities. In 1995 and 1996, 15.1 and 15.8% of United States general surgical residency graduates were women. Of our 71 graduates in the last 12 years, 38% were women. The aim of this study was to identify the factors influencing our residents' choice of training program and the reasons why our program has a high percentage of female graduates. METHODS: Between 1989 and 2000, 27 women and 44 men completed general surgical training at our university and 44/71 (59%) responded to our survey. The age at residency completion was 34 +/- 2.2 years for men and 33.9 +/- 2.8 years for women. Fifty-five percent of men and 30% of women went on to fellowship training; and 36% of men and 20% of women are in academia. RESULTS: Factors influencing our graduates' selection of training program are: Only 23% of men had a female faculty as their mentor, whereas 90% of women had a male faculty as their mentor during training. Only 59% of men but 80% of women (P < 0.05) agreed that female medical students need role models of successful female faculty members. Fifty-five percent of men and 45% of women would encourage a female medical student to choose surgery as a career, but 82% of men and 50% of women would encourage a male medical student to do so. Ninety-one percent of men and 85% of women would choose surgery as a career again. CONCLUSIONS: A surgical residency training program with strong leadership, good clinical experience, and high resident morale will equally attract both genders. Women may pay more attention to the program's gender mix and geographic location.     

The specialty mentor effect in enhancing surgical experience of medical students: A randomised control trial

IntroductionThe positive learning experiences of students on surgical rotations which subsequently influence career choice may be delineated into practical and interpersonal themed factors. It remains unclear the relative impact each component has on the student experience and subsequent specialisation.AimsWe evaluate the influence of having senior resident mentor during practical simulation in orthopaedic surgery has on medical student interest in surgery; their comfort in theatre; and its role in enhancing knowledge acquisition within the rotation.MethodsMedical students undergoing clinical rotations in a Regional University Hospital were randomised to undertaking a virtual reality simulated operation independently or performing under the guidance of an experienced resident. Baseline levels of interest in surgery, comfort in theatre, perceived barriers to surgical learning and entry to surgery were established and compared to answers following completion of the tutorial. Qualitative feedback was collected regarding the benefits and limitations to the experience. Presented according to CONSORT guidelines.ResultsParticipants in the trainee guided group achieved significantly higher simulated performance scores compared to the control (p < 0001), with an increase in interest in orthopaedic surgery from baseline expressed to a statistically significant degree (p = 0.01). Participants in the unsupervised group demonstrated no significant increase in interest in Orthopaedic surgery (p = 0.3). 100% participants strongly agreed it was a beneficial learning experience which would be useful in surgical curricula.ConclusionSurgical trainee guided simulation led to improved performance and interest in orthopaedic surgery, while virtual practical experience was felt to be a useful learning tool independent of supervision. Further research is needed to establish the role of interpersonal interactions in student surgical experience.     

Effective surgical residents strongly influence medical students to pursue surgical careers

BACKGROUND: There is a paucity of data about the influence of surgical residents on the career choices of medical students. We hypothesized that medical students exposed to effective surgical residents would be more likely to pursue careers in surgery. STUDY DESIGN: From 1998 to 2003, 108 surgical residents were evaluated by medical students rotating on the third-year clerkship. Residents were scored on a 4-point scale (1 = outstanding to 4 = poor). The career choices of all medical students were also tabulated. RESULTS: We examined 2,632 evaluations on 108 residents. Medical students who eventually pursued surgical residency training were exposed to surgical residents who were more effective clinical teachers, role models, and overall residents. In addition, medical students exposed to the highest-rated residents were more likely to pursue surgical residency training compared with students exposed to the least effective residents (12% versus 4.9%, p = 0.022). CONCLUSIONS: These data suggest that surgical residents who are effective educators and mentors influence medical students to pursue surgical careers. Efforts to provide more leadership and teaching workshops to surgical residents may not only create better future surgeon educators, but may also increase the number of students pursuing surgical training.     

Acquiring surgical skills: the history of surgical teaching at the University of Sydney 1883–2014

There have been at least 10 major revisions of the medical curriculum since the inauguration of the Faculty of Medicine at the University of Sydney in 1883. This study traced the evolution of the teaching of surgery at our institution by examination of the set curriculum of each period; the expectations of student knowledge in the final examination as well as examining some of the insights provided by past students of their surgical experience through their writings. In the early years, medical graduates were qualified to perform operative surgery without any further training, whereas the modern postgraduate medical curriculum provides students with the basis for further surgical training.     

The extended surgical team

The extended surgical team encompasses a variety of non-medical healthcare practitioners who work alongside junior doctors in delivering care to patients. In large part, their roles have developed in response to workforce shortages and working time changes. A variety of roles exist including Physician Associates, Surgical Care Practitioners, Advanced Clinical Practitioners and Surgical First Assistants. These roles have different training pathways and different regulators. They work across the emergency and elective surgical patient pathway with some roles being primarily theatre based. There is evidence that they enhance training for junior surgical trainees by enabling better attendance at daytime training sessions in the operating theatre and the outpatient clinic. They also appear to be well received by patients.     

Factors influencing medical students and junior doctors in choosing a career in surgery

Background/purposeIdentification of those factors which influence career choice will help to avoid a shortfall in surgical recruitment. We aimed to determine the views of medical students and junior doctors regarding influences on their career aspirations, such that potential disincentives to a career in surgery could be identified.MethodsA structured questionnaire was distributed in paper-form and online. 290 respondents were asked to score 20 items regarding influence on their career aspirations using Likert-scales ranging from 1 (no influence) to 5 (strong influence). Stepwise regression was employed to determine those factors most important when considering a surgical career.ResultsThe response rate was 84%. 13.2% of respondents felt they would choose surgery, with males more likely to see it as a realistic career choice (p = 0.006). Factors which most influenced career choice were future employment, career opportunities, and intellectual challenge. Those aspiring to a career in surgery placed most emphasis on prestige, whilst an emphasis on lifestyle during training was associated with those choosing an alternative to surgery. Influences varied according to career stage.ConclusionsFuture employment, career opportunities and intellectual challenge are most important when considering which discipline to choose within medicine, with job prestige of particular importance to those interested in a surgical career. These findings represent an opportunity for surgical educators to reinforce the positive aspects of life as a surgeon, and the job security which is inherent within a surgical career. Surgery remains a disproportionately unpopular choice for women, with lifestyle factors identified as the key deterrent.