Decline in popularity of general surgery as a career choice in North America: review of postgraduate residency training selection in Canada, 1996-2001

Abstract There has been a perception that fewer medical students are currently pursuing careers in general surgery. To investigate the validity of this premise we reviewed the Canadian Residency Matching Service (CaRMS) database from 1996 to 2001 and identified recent trends in graduates’ selections. Three surgical specialties–general surgery, orthopedic surgery, obstetrics and gynecology—were chosen for analysis as “poor lifestyle” specialties. They were compared to anesthesia, diagnostic radiology, and ophthalmology, which were chosen as representative “good lifestyle” specialties. Linear regression and chi-square analyses were performed to identify significant changes in applications to each specialty. A negative trend in first-choice applications to all three “poor lifestyle” specialties was observed, whereas all three “good lifestyle” specialties experienced increased first-choice applicants. Potential factors influencing medical student residency selection are discussed, emphasizing the reduced number of first-choice applicants to general surgery. Electronic Publication     

Impact of mandatory resident work hour limitations on medical students' interest in surgery

BACKGROUND: The number of US medical students applying for general surgery residency has been declining. Recent studies have shown that the issue of "controllable lifestyle" has become a critical factor in medical students' decision-making process. We postulate that widespread implementation of resident work hour limitations would bolster medical students' interest in pursuing surgical careers. STUDY DESIGN: Students from New York University School of Medicine were surveyed about their attitudes toward work hour limitations and its effect on their interest in pursuing a surgical residency. One hundred thirty-two students participated. RESULTS: Nearly 95% of respondents believed that work hour limitations were a positive change and, if all other factors were equal, they would choose a training program that used work hour limitations over one that did not. The most common reasons cited in favor of limits were improvements in resident lifestyle (42%) and patient safety (34%). Fifty-three percent of respondents indicated that presence of work hour limitations alone would increase their interest in considering a surgical residency and only 2% of medical students indicated that it would lessen their interest in surgery. Not surprisingly, intellectual interest in a specialty was the most important factor in choosing a residency for 86% of students. Nevertheless, work hour limitations were designated a higher priority than future salary by 55% of medical students. CONCLUSIONS: The presence of work hour limitations has a positive impact on medical students' interest in surgery. Widespread implementation of work hour limitations may bolster the number of applications for surgical residency.     

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.     

Financial returns on specialty training for surgeons

BACKGROUND: Because of recent changes in physician reimbursement and managed care penetration, we wanted to examine the financial returns that medical students might anticipate when considering different careers. METHODS. We used standard financial techniques to calculate the return on educational investment for 5 surgical specialties (general surgery, otolaryngology, ophthalmology, orthopedic surgery, and urology) and primary care medicine between 1992 and 1998. RESULTS: The annual yield on specialty training fell for all specialties examined, from an average of 15% to 3% for primary care specialties, and from an average of 36% to 19% for surgical specialties. The difference in the average future hourly income between a given specialty and general practice decreased for all surgical specialties (for general surgery, from $12.03 in 1992 to $9.89 in 1998; otolaryngology, from $21.37 to $5.56; ophthalmology, from $14.12 to $7.15; orthopedic surgery, from $21.16 to $18.91), except urology (from $13.81 in 1992 to $14.84 in 1998). Returns became negative for primary care medicine, dropping from $1.72 to -$1.21. CONCLUSION: Efforts to create a "level playing field" within medicine have resulted in decreased returns on educational investment across all specialties. Financial returns and the incentives they create should be carefully considered as part of health care reform.     

Choosing general surgery: insights into career choices of current medical students

HYPOTHESIS: The number of unfilled general surgery programs in the United States increased from 4 in 1999 to 41 in 2001. This study seeks to determine if changes in student attitudes occurring during their medical school careers and during the third-year general surgery clerkship contribute to a decline in interest in a surgical career. DESIGN: Prospective survey of medical students at a public medical school in California. PARTICIPANTS AND METHODS: Each medical student received a survey via the Internet. Responses were anonymous. Once quantified, chi(2) analysis was used for comparison and analysis of survey results. Comparisons were made between individual class years and on the basis of whether the respondent completed the third-year general surgery clerkship. RESULTS: Of 368 surveys sent, 232 (63%) were successfully completed and included in the study. Comparison of students' attitudes before and after completion of their general surgery clerkship showed that following surgical course exposure more students believed surgery lacked breadth of expertise, limitations over stress, control over one's time, regularity of schedule, adequacy of leisure time, and income commensurate to workload (P<.05). These results are also consistent in comparisons between individual class years. CONCLUSIONS: Data suggest that medical students seem to be more concerned with issues of "controllable lifestyle" such as adequacy of family and/or leisure time, high level of stress, and amount of work and commitment. The erosion of income differential between demanding and less taxing specialties was also an important cause cited for the flagging interest in surgical disciplines.     

Do the best students go into general surgery?

BACKGROUND: Recent match trends by medical graduates have revealed a declining interest in general surgery. Our study evaluates the academic strength of recent graduates to determine the quality of those matching to general surgery residencies. METHODS: All third-year students rotating through the 8-week surgical clerkship from July 1998-June 2000 (n = 291) were followed at the University of Wisconsin Medical School. Each student completed 4 weeks of general surgery and 4 weeks of surgical subspecialties. Match data provided residency choices and students were divided into general surgery (GS), surgical subspecialty (SS), and nonsurgical (NS) residencies. Student performance was based upon National Board of Medical Experiences (NBME) surgery exam, class rank and Alpha Omega Alpha (AOA) status. RESULTS: Students at our institution scored at the national mean on the NBME exam. GS team, session, and timing of GS rotation had no relationship to exam score. Total number of operative cases observed was inversely related to exam performance (P = 0.02). Of students entering a GS career, most scored below the mean on the NBME exam, 46% graduated in the bottom two thirds of the class, and only 6% of AOA members entered a GS residency. CONCLUSION: Although many of the strongest medical students select surgical residencies, they choose to enter SS careers and not GS careers.     

Why do students choose careers in surgery?

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.     

Evaluation of a system designed to enhance the resident selection process

The purpose of this research was to evaluate the use and effectiveness of the Universal Medical Student Performance Profile System in enhancing the resident selection process. The Universal Medical Student Performance Profile System involved the use of a standardized student evaluation form completed by surgery clerkship directors to summarize student performance. These student profile forms were then forwarded to general surgery program directors to whom each student applied. Twenty-five surgery clerkship directors volunteered to complete student profile forms on students pursuing surgical careers for the classes of 1986 and 1987. Program directors who had accepted students in their programs on whom these standardized evaluation forms had been completed were asked to complete a similar form based on the graduate's first year of residency performance. Findings showed statistically significant relationships in several assessment categories between clerkship and program directors' ratings. A survey of program directors showed they agreed with the concept of a standardized medical student evaluation form and found the student profile forms helpful in making decisions on resident selection. We concluded form this baseline study that the use of a standardized student evaluation form will have limited predictive validity, unless clerkships improve efforts to standardize clerkship objectives, expectations, and performance measures.     

Do medical school surgical rotations influence subspecialty choice?

BACKGROUND: A comprehensive exposure to general surgery is essential for medical students pursuing careers in surgery. Occasionally, students applying for surgical residency positions must choose a subspecialty field prior to starting their residency training. Often, this decision is heavily based on their experience on various surgical clerkships. MATERIALS and METHODS: To determine if surgical clerkships influence subspecialty choice, we surveyed medical students who interviewed for general surgery training over a 2-year period at The Johns Hopkins Hospital. RESULTS: Of 211 surveys sent, 146 were returned (66%). The mean age of the students was 26 +/- 0 years with 21% being female. Students anticipating subspecialization in cardiothoracic, plastic, pediatric, and transplant surgery saw significantly more operations in their respective fields. Similar trends were seen in vascular surgery and surgical oncology. Despite the apparent differences in exposure to subspecialty operations, all students saw equal numbers of hernia repairs and laparoscopic cholecystectomies. CONCLUSIONS: While medical students pursuing careers in surgery have equal exposure to general surgery, their anticipated subspecialty field highly correlated with their operative exposure to that field. Thus, medical school surgical rotations appear to highly influence subspecialty choice.     

Innovative introduction to surgery in the preclinical years

BACKGROUND: Lack of exposure to surgery in the preclinical years of medical school contributes to students' negative opinions of the field and to low application rates to categorical surgical programs. METHODS: Forty preclinical medical students attended a series of 16 seminars and practice sessions covering the gamut of surgical specialties and basic technical skills. Students were given a Likert format survey before and after taking the course. RESULTS: Students gave high ratings to course content (4.26/5) and lecturers (4.54/5). Students' confidence in their surgical skills doubled (1.45/5 to 3/5, P < .0001), and their perceived readiness for the surgical clerkship increased by 73% (1.63/5 to 2.82/5, P = .007). CONCLUSIONS: The preclinical years offer a promising venue for improving medical student interest and performance in surgery.     

Exposure to plastic surgery during undergraduate medical training: A single-institution review

BACKGROUND:Applications to surgical residency programs have declined over the past decade. Even highly competitive programs, such as plastic surgery, have begun to witness these effects. Studies have shown that early surgical exposure has a positive influence on career selection.OBJECTIVE:To review plastic surgery application trends across Canada, and to further investigate medical student exposure to plastic surgery.METHODS:To examine plastic surgery application trends, national data from the Canadian Resident Matching Service database were analyzed, comparing 2002 to 2007 with 2008 to 2013. To evaluate plastic surgery exposure, a survey of all undergraduate medical students at the University of Toronto (Toronto, Ontario) during the 2012/2013 academic year was conducted.RESULTS:Comparing 2002 to 2007 and 2008 to 2013, the average number of national plastic surgery training positions nearly doubled, while first-choice applicants decreased by 15.3%. The majority of Canadian academic institutions experienced a decrease in first-choice applicants; 84.7% of survey respondents indicated they had no exposure to plastic surgery during their medical education. Furthermore, 89.7% believed their education had not provided a basic understanding of issues commonly managed by plastic surgeons. The majority of students indicated they receive significantly less plastic surgery teaching than all other surgical subspecialties. More than 44% of students not considering plastic surgery as a career indicated they may be more likely to with increased exposure.CONCLUSION:If there is a desire to grow the specialty through future generations, recruiting tactics to foster greater interest in plastic surgery must be altered. The present study suggests increased and earlier exposure for medical students is a potential solution.     

Attracting medical students to surgical residency programs

With the goals of creating a better match between medical students and general surgery programs and providing a program that is desirable to medical students who are interested in pursuing careers in surgery, a survey was designed to categorize student interests and to determine what factors are used in choosing a general surgery program. The survey focused on the reasons that surgical resident candidates select a program. Each statement was rated for importance on a 5-point scale, and then the top 10 statements were ranked in order of importance. The survey was distributed to 19 community hospitals, 23 university programs, and medical students interviewing for surgical residency. A total of 286 surveys were returned from 18 programs and medical students. The statements with the three highest ratings were "amount of operative exposure," "diversity of operative cases," and "perceived relationships among faculty and residents." "Amount of operative exposure," "diversity of operative cases," and "ability to pursue fellowship training after residency" received the top rankings. There was a significant difference between men and women in the ratings of three statements. However, there was no difference with the ranking of the statements. There was also a significant difference between residents early and late in their training on ratings of five statements and on the ranking of two statements. The ratings of six statements were significantly different between community and university programs. A significant difference between types of program was also found with the rankings of four statements. There was a difference between small and large programs on two ratings of statements and one ranking. This data provides a useful resource for programs and candidates in preparing for candidate/residency selection.     

Contemporary trends in student selection of medical specialties: the potential impact on general surgery

HYPOTHESIS: Lifestyle is a priority among senior medical students when selecting a career specialty. The trend toward controllable lifestyle vs noncontrollable lifestyle specialties is affecting the number of students desiring a career in general surgery. DESIGN: The Medical Student Graduation Questionnaire is published and distributed by the Association of American Medical Colleges to all US medical schools for senior medical students to complete before graduation. The results from the survey are published each year in the All Schools Report. We evaluated these reports to track the percentage of students pursuing a career in general surgery during the past decade. The National Resident Matching Program also publishes a report each year outlining the match results. We reviewed these results from 1978 through 2001 and used them to determine the percentage of students choosing to enter general surgery. MAIN OUTCOME MEASURES: First choice of specialty among graduating senior students from US medical schools; positions matched by US and foreign medical students and students from osteopathic medical schools; factors that influenced the decision-making process in choice of specialty; and factors that influenced students to change their mind from one career to another. RESULTS: An established trend of decreasing interest in general surgery exists and has the potential to affect the number of positions that are filled each year in the match. Linear projections confirm that, should the current trend continue (negative slope; P =.01), by 2005 only 4.8% of US graduating senior medical students will be interested in general surgery. This established trend of decreasing interest in general surgery, which began in the early 1980s, did not affect the match until 2001, when the number of positions offered exceeded the number of students interested in general surgery. At present, the specialty of general surgery is at risk for significant numbers of positions remaining unfilled. Our match projections estimate that for 2005, only 76.6% of positions will be filled by US senior students (negative slope; P =.001). CONCLUSIONS: If the trend continues, the students matching in general surgery will not be as competitive as in years past, and there will be a potential shortage of these specialists in the United States.     

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.     

Choosing a career in surgery: factors that influence Canadian medical students' interest in pursuing a surgical career

Background

Interest in both general surgery and surgical subspecialties has been declining among Canadian medical students. Studies have shown that a student''s desire to practise surgery is largely determined before entry into medical school. As part of a larger study of students'' career preferences throughout medical school, we sought to identify the level of interest in surgical careers and the factors that influence a student''s interest in pursuing a surgical career.

Methods

We surveyed students from 18 different classes at Canadian medical schools at the commencement of their studies between 2001 and 2004. We asked the students to list their top career choices and the degree to which a series of variables influenced their choices. We also collected demographic data. We performed a factor analysis on the variables.

Results

Of 2420 surveys distributed, 2168 (89.6%) were completed. A total of 21.0% of respondents named a surgical specialty as their first choice of career. We found that male students were more likely to express interest in a surgical specialty than female students, who were more likely to express interest in either family medicine or a medical specialty. Compared with students interested in a career in family medicine, those interested in a surgical or medical specialty were younger, more likely to be single and more likely to be influenced by prestige when making their career choices. Students interested in a career in surgery were less influenced by medical lifestyle and a varied scope of practice, less likely to demonstrate a social orientation and more likely to be hospital-oriented than students interested in either family medicine or a medical specialty. Male students interested in a career in surgery were more hospital-oriented and less likely to demonstrate a social orientation than female students interested in surgical careers.

Conclusion

We identified 5 factors and a number of demographic variables associated with a student''s interest in a surgical career.     

Why do students choose careers in surgery?

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 sought to determine what factors influenced medical students in choosing surgical careers. Methods: Third year medical students who completed their surgical clerkship in the 2001-2002 academic year (n = 83) 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%. 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 in 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%) (p < 0.05). The number of hours spent on rotation (call, rounds) was the leading experience associated with a decreased interest in a surgical career (p < 0.05). 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 two-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 3^rd year surgical clerkship.     

Career change: in quest of a controllable lifestyle

Over the past decade, top medical students are selecting "controllable lifestyle" (CL) specialties at an increasing rate. CL specialties include anesthesiology, dermatology, emergency medicine, neurology, ophthalmology, pathology, psychiatry, and radiology. The choice of "noncontrollable lifestyle" (NCL) specialties such as family practice, internal medicine, obstetrics/gynecology, and pediatrics was negatively affected by this trend. The effect of CL on the selection of surgical training by top medical students was variable. The purpose of this study was to determine if CL is a factor in career change by young surgeons during and after residency. Graduates of the University of Kentucky College of Medicine from 1975 to 1983 (n = 796) were questioned regarding the specialty they entered after graduation and whether they remained in that specialty as of March, 1988. NCL and surgery specialties showed a net loss of practitioners during the study period (P less than 0.005) and CL showed a net gain (P less than 0.005). When physicians changed specialties, the direction of change occurred from NCL and surgery to CL (P less than 0.05). Change from CL to NCL and surgery occurred infrequently.     

Does a general surgery clerkship influence student perceptions of surgeons and surgical careers?

BACKGROUND: Student perceptions of surgeons and surgical careers may influence their decision to pursue a surgical career. We evaluated the impact of a general surgery clerkship on medical student perceptions of surgeons and surgical careers and of the clerkship on student interest in surgical careers. METHODS: We conducted voluntary pre- and postclerkship surveys of third-year medical students who were enrolled in their required general surgery clerkship and used 5-point Likert scale rankings to capture agreement with declarative statements (1 = strongly agree; 5 = strongly disagree). T-tests were used to evaluate both paired and individual items. RESULTS: Students indicated that their surgical clerkship improved their opinion of surgeons (2.47; P <.001). Several perceptions changed after the clerkship. First, students agreed more strongly that surgeons were compassionate physicians (ranking, 2.87 vs 2.53; P =.003) and that patients respected surgeons (ranking, 1.84 vs 1.62; P =.026). Acknowledgment of career satisfaction by students increased (ranking, 2.57 vs 2.22; P =.008). Students more strongly disagreed that "surgeons [were] respectful of other physicians" (ranking, 3.29 vs 3.62; P =.009). Interest in surgical careers did not change significantly during the clerkship (ranking, 2.83 vs 2.68; P =.218). CONCLUSIONS: Medical student perceptions of surgeons and surgical careers generally improve during the surgical clerkship. However, student impressions of surgeons' collegial behavior and commitment to teaching deteriorate significantly during the surgical clerkship.     

Factors influencing career choice among medical students interested in surgery

PURPOSE: The number of applicants to general surgery programs has recently declined. We set out to determine factors that influence career choice among medical students. METHODS: Design: survey; Setting: university medical center; Participants: fourth-year medical students; Intervention: distribution and completion of the survey. Participants ranked 18 items coded on a Likert scale from 1 (not important) to 8 (very important). These factors were career opportunities, academic opportunities, experience on core rotation/subinternship, role model(s) in that specialty (mentors), length of training required, lifestyle during residency, work hours during residency, ability to obtain residency position, concern about loans/debt, call schedule, lifestyle after training, work hours after training, financial rewards after training, intellectual challenge, patient relationships/interaction, prestige, future patient demographics, and gender distribution in the specialty. Students were asked to provide gender, career choice, number of programs they applied to, and the number of programs at which they were interviewed. RESULTS: A total of 111 of the 160 surveys distributed were returned (69%). A total of 48 of the students were men, 31 were women, and 32 did not identify their gender. Nineteen students were interested in pursuing a career in surgery or a surgical subspecialty. Factors predicting surgery as a career choice were career opportunities (p < 0.04) and prestige (p < 0.003). Lifestyle during residency (p < 0.0007), work hours during residency (p < 0.008), and quality of patient/physician relationships (p < 0.05) were all significantly negatively correlated with the choice of a surgical career. Students pursuing a surgical career applied to greater than 31 programs compared with 11 to 15 for the nonsurgical students (p < 0.0001). CONCLUSIONS: Prestige and career opportunities are more important to students seeking surgical residencies. Concerns about lifestyle and work hours during residency and perceived quality of patient/physician relationships were deterrents to surgery as a career choice. These issues may need to be addressed to increase the number of applicants to surgical programs.