Surgical careers and preparedness of graduating residents--an outcomes-based study

PURPOSE: Outcome-based measures have recently become the focus of residency program evaluations. The ultimate outcome of a surgical training program is the successful development of surgical careers by its graduates. METHODS: We developed a survey that was sent to all residents completing our surgical residency from 1989 to 1999 in order to evaluate practice location, type of practice, practice mixture, additional training obtained after residency, Board certification, and membership in the American College (ACS) or other professional societies. Graduates were asked to report their impression of their residency education program's ability to prepare them for surgical practice as well as to give an overall opinion of their training using a scale of 10 (high) to 1 (low). Solicitations were also made for means to improve the training program. RESULTS: Of 32 graduates sent surveys, 30 responded (94%). A total of 29 of 30 responding graduates (97%) are active in surgery. A total of 26 of 30 graduates are in private or government practice, 3 of 30 are full-time academic, and 1 of 30 is completing fellowship training. A total of 13 of 30 (43%) immediately entered practice, whereas 17 of 30 (57%) received additional fellowship training. Board certification has been achieved by 24 graduates. A total of 17 of 30 (59%) are members of the ACS, and 24 of 30 (83%) are members of at least 1 regional or specialty society. The average score for practice preparedness was 8.35. Overall score for the residency program was 8.7. Specific graduate comments demonstrated a perceived need for additional vascular and oncology operative experience that led to changes in our program. These results demonstrate an overall high satisfaction with our training program by graduates over the past 10 years as well as high success rate as evidenced by successful surgical practices by 97% of our graduates. CONCLUSIONS: We believe this type of outcome information provides valuable feedback to programs with regard to planning and development based on the types of careers graduates choose as well as specific changes in curriculum based on perceived deficiencies.     

An MBA: the utility and effect on physicians' careers

BACKGROUND: Higher economic, legislative, legal, and administrative constraints in health-care services in the United States have led to an increase in physician dissatisfaction and a decrease in physician morale. In this study, we attempted to understand the motivation for a physician to enroll in a business school, and to discover the utility of the Master of Business Administration degree and how it changed the career path for the practicing clinician. METHOD: We conducted a retrospective study in which a twenty-seven-question survey was distributed by the United States Postal Service and by e-mail to 161 physician graduates of three East Coast business schools. The results were evaluated, and a statistical analysis was performed. RESULTS: Eighty-seven physicians (54%) responded. Eight surveys were discarded because of incomplete data or stray marks, leaving seventy-nine surveys. The average age of the respondents was 41.4 years. The major motivations for going back to school included learning the business aspects of the health-care system (fifty-three respondents; 67%) and obtaining a more interesting job (forty-one respondents; 52%). The time that the respondents allocated for health-care-related activities before and after obtaining the degree was 58.3% and 31.8%, respectively, for patient care (p < 0.001); 8.5% and 3.68% for teaching (p < 0.001); 4.57% and 1.46% for basic-science research (p = 0.11); 4.23% and 4.55% for clinical research (p = 0.90); and 11.8% and 33.5% for administrative responsibilities (p < 0.001). The physicians stated that the most pertinent skills they had acquired were those related to evaluating systems operations and implementing improvements (thirty-nine respondents; 49%), learning how to be an effective leader (thirty-five; 44%), comprehending financial principles (thirty-three; 42%), working within a team (twenty-seven; 34%), and negotiating effectively (twenty-five; 32%). Sixty-four physicians (81%) believed that their business degree had been very useful or essential in the advancement of their careers. CONCLUSIONS: Many physicians decide to acquire a Master of Business Administration degree to understand the business of medicine. After they complete the degree program, their practice patterns substantially change, which is reflected particularly by an increase in time spent on administrative responsibilities. In order for physicians to overcome the multifaceted challenges of the evolving health-care system, it is essential to continue educating a proportion of physicians in both medicine and business.     

Perceived gender-based barriers to careers in academic surgery

BackgroundWomen represent roughly 50% of US medical students and one third of US surgery residents. Within academic surgery departments, however, women are disproportionately underrepresented, particularly at senior levels. The aim of this study was to test the hypothesis that female surgeons perceive different barriers to academic careers relative to their male colleagues.MethodsA modified version of the Career Barriers Inventory–Revised was administered to senior surgical residents and early-career surgical faculty members at 8 academic medical centers using an online survey tool. Likert-type scales were used to measure respondents' agreement with each survey item. Fisher's exact test was used to identify significant differences on the basis of gender.ResultsRespondents included 70 women (44 residents, 26 faculty members) and 84 men (41 residents, 43 faculty members). Women anticipated or perceived active discrimination in the form of being treated differently and experiencing negative comments about their sex, findings that differed notably from those for male counterparts. Sex-based negative attitudes inhibited the career aspirations of female surgeons. The presence of overt and implicit bias resulted in a sense that sex is a barrier to female surgeons' career development in academic surgery. No differences were observed between male and female respondents with regard to career preparation or structural barriers.ConclusionsFemale academic surgeons experience challenges that are perceived to differ from their male counterparts. Women who participated in this study reported feeling excluded from the dominant culture in departments of surgery. This study may help guide transformative initiatives within academic surgery departments.     

Enhancing interest in nephrology careers during medical residency

Promoting interest in nephrology as a career is vital to sustain a workforce adequate to meet the projected demand for nephrologists. The educational experiences that internal medicine residents have may play an important role in influencing such choices, and attempts to enrich such experiences could prove a useful strategy to help facilitate interest in careers in nephrology. Like many electives, nephrology rotations typically consist of activities heavily weighted toward inpatient care. This type of elective is unlikely to provide a representative exposure to the breadth of nephrologists' roles and may lack sufficient mentoring opportunities. We describe an innovative design for a nephrology elective that provides residents with educational experiences in both inpatient and outpatient venues and exposure to faculty with diverse interests and areas of expertise. Our experience with this elective in comparison to a traditional inpatient-based elective suggests that the combined elective format is perceived favorably by medical residents and provides them with a better educational experience, more representative exposure to nephrology, positive mentoring experiences, and the potential for greater interest in pursuing nephrology as a career. Our findings offer the possibility that interventions at the level of medical resident education might be a means to help promote interest in careers in nephrology.     

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.     

The training and careers of regional anesthesia fellows--1983-2002

BACKGROUND AND OBJECTIVES: The education and subsequent careers of regional anesthesia fellows have not been examined but may provide insight into improving future fellowship training and/or the future of the subspecialty. METHODS: Regional anesthesia fellows educated during a 20-year period (1983-2002) were asked to complete a comprehensive survey that detailed their training, current professional setting, and use of regional anesthesia, and how they foresee the future of regional anesthesia. A separate survey of academic anesthesiology chairs assessed the role of and need for regional anesthesiologists in teaching departments. RESULTS: Twelve regional anesthesia fellowship programs in the United States and Canada provided contact information on 176 former fellows. The survey response rate from those practicing in North America was 49% (77/156). Two of the 12 responding institutions have trained 68% of regional anesthesia fellows. Of respondents, 61% are or have been in academic practice. Regional anesthesia remains an integral part of most respondents' current practice, as evidenced by significant use of regional techniques, active involvement in subspecialty societies, and participation in continuing medical education programs. Academic chairs indicate that fellowship-trained regional anesthesiologists play important roles in resident education and are in demand by academic departments. CONCLUSIONS: This report details how regional anesthesia fellows from 1983 to 2002 were trained and how they currently practice and examines their insights regarding the strengths and weaknesses of past and future regional anesthesia education.     

Age differences in strain and emotional reactivity to stressors in professional careers

While age differences of workers gain increasing importance because of demographic changes in most industrialized countries, age differences in stress experience and resistance have been rarely addressed. In this initial empirical study, we explore the general relationship of age and strain as a function of three processes: (1) older workers might experience less strain because of better coping strategies; (2) older workers might experience more strain because of higher vulnerability; or (3) age and strain might be curvilinearly related with highest strain reported by middle‐age workers. Using both general and experience‐based measures, strain and emotional reactivity to stressful job events were reported by 274 workers aged between 18 and 65 years. Results showed an inverted U‐shaped relationship between age and strain experience. Copyright © 2010 John Wiley & Sons, Ltd.     

Nurturing of surgical careers by the wellington surgical interest club

The Royal Australasian College of Surgeons (RACS) has recently introduced the new Surgical Education and Training programme. The purpose of this was, in part, to help address the anticipated shortage of surgeons in the future, by streamlining the surgical training programme. The formation of the Wellington Surgical Interest Club (WSIC), a student‐led initiative, had several complementary goals. These included the desire to identify potential candidates for a career in surgery, promote a surgical career to students especially women, help students acquire basic surgical skills early, inform students about surgical careers, promote student involvement in surgical research and to create an effective mentorship model during undergraduate and junior surgical training. The strengths of WSIC are its goals, which are similar to those of the RACS with regard to promoting surgery as a career option; its easy reproducibility at other medical institutions; its ability to focus on issues of relevance to both students and junior doctors; and being a bridging solution at a time when early exposure to surgical specialties is both desired and necessary.