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.     

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.     

Operating room assist: surgical mentorship and operating room experience for preclerkship medical students

BACKGROUND: Despite the importance of preclerkship experiences, surgical education has essentially remained confined to the third-year operating room experience. According to experience-based learning theory, the acquisition of new clinical knowledge is a dynamic process of social enculturation and professional identity development that requires active participation, clinical applicability, and direct interaction with doctors and other members of the medical team. In conjunction with a previously described surgical skills elective, we created a new clinical elective in which preclerkship medical students were assigned a surgical mentor and invited into the operating room to assist in surgeries. METHODS: The elective paired 36 first-year students with 24 surgeons and instructed students to participate in at least 2 surgeries over the 3-month elective period. Students, surgeons, and operating room nurses filled out questionnaires after each surgery. RESULTS: Although 6 students failed to enter the operating room, 30 students scrubbed and gowned for a total of 62 procedures during the elective period. Although most students reported the operating room to be a comfortable learning environment in which they were actively included, students consistently underrated their performance and contribution to the surgical team compared with the surgeons' and nurses' ratings. With 75% of students who reported using a previously learned surgical skill during each surgery, this elective succeeded in allowing preclerkship medical students the opportunity to participate actively in the operating room. CONCLUSIONS: Early surgical exposure is critical for attracting student interest in careers in surgery. We believe that these early clinical experiences, combined with strong mentorship from the surgical faculty, will eventually lead to greater success during clerkships and greater interest in surgery as a career.     

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.     

Influences on medical student career choice: gender or generation?

HYPOTHESIS: We hypothesized that increased enrollment of female medical students and different priorities of the current generation of students would be important influences on the declining interest in surgical careers. DESIGN: Students scored statements on surgical careers on 5-point Likert scales regarding agreement and whether these statements encouraged them to pursue a career in surgery. Data were analyzed using the Mann-Whitney U test. Qualitative comments were iteratively coded using a constant comparative method. SETTING: Nine US medical schools. PARTICIPANTS: A Web-based survey on the Association for Surgical Education server was e-mailed to medical students. A total of 1300 of the 1365 respondents stated their sex. MAIN OUTCOME MEASURES: The survey asked questions pertaining to surgical life, surgical residency, surgeons as influence, equity, family, and other influences. RESULTS: A total of 680 (52%) of the 1300 respondents were male. Men and women disagreed about whether surgeons lead well-balanced lives (68% and 77%, respectively) and saw this as a deterrent. A total of 35% of women (3% men; P<.001) were discouraged by a lack of female role models. Compared with students unlikely to study surgery, lower percentages of male (74% vs 65%) and female students (85% vs 58%) likely to study surgery agreed that career choice was influenced by their decision to have a family (P=.01 for men, P<.001 for women). Of medical students who agreed that their skill sets were compatible with surgical careers, similar percentages were likely (30% men vs 24% women) and unlikely (49% men vs 54% women) to study surgery. All differences between men and women were less apparent when students likely to study surgery were compared with students unlikely to study surgery. CONCLUSIONS: The decision to have a family was a more significant influence for women than men, but family and lifestyle priorities were also important to male students, supporting our hypothesis that generation and gender are both important influences on career choices.     

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.     

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.     

Surgical inclination and anatomy teaching at the University of Auckland

BACKGROUND: Medical graduate interest in surgery has declined and medical students are less capable in anatomy than they once were. Declining interest in surgery is because of factors, including growing number of women entering medical school. There has been less emphasis in teaching anatomy at various medical schools in recent years. The aim of this study is to quantify surgical inclination in Auckland medical students to assess whether gender differences exist in surgical inclination and determine confidence in anatomy knowledge and resources used by Auckland medical students. METHOD: Survey design was cross-sectional and included 25-point questionnaire using Likert scale response ranking and tick box replies. Two hundred and eighteen surveys were emailed to functioning addresses of fourth and fifth year students at University of Auckland, School of Medicine, New Zealand. RESULTS: Response rate was 71.6%. Twenty per cent of students were found to be surgically inclined (95% confidence interval, 0.15-0.26). The proportion of surgically inclined men was significantly higher than women (P < 0.05). Thirty-three per cent of all respondents (95% confidence interval, 0.26-0.41) felt their knowledge of anatomy was adequate to practice medicine safely. Textbooks and atlases were most commonly used to learn anatomy (P < 0.05). Radiology was the least commonly used method to learn anatomy (P < 0.05). Eighty-seven per cent (95% confidence interval, 0.81-0.92) of respondents agreed that revisiting dissection during surgical attachments would be helpful. CONCLUSION: Men are significantly more likely to be surgically inclined than women at the University of Auckland. A significantly greater proportion of students felt that their knowledge of gross anatomy was inadequate for safe medical practice. Students use traditional methods to learn anatomy more commonly than radiological methods. The majority of students surveyed would like to revisit cadaver dissection during clinical attachments in surgery.     

The training needs and priorities of male and female surgeons and their trainees

BACKGROUND: Over the past decade, interest in general surgery careers has declined and the number of female medical school graduates has increased. This study was performed to identify the needs of both male and female surgical trainees and to guide design of training programs because attracting medical students to, and maintaining residents in, general surgery training programs can be difficult without a clear understanding of the training needs and priorities of both men and women. We hypothesized that men and women would express similar training priorities, yet have subjectively different experiences. STUDY DESIGN: Medical students, surgical residents, fellows, and fully trained surgeons affiliated with at least one of four major surgical societies were asked to complete a level-specific survey located on the American College of Surgeons Web site. RESULTS: There were 4,308 respondents (76% men). Men and women selected similar reasons for choosing a surgical career and residency program and criteria critical to a successful residency program, with women placing greater emphasis on clerkship experience and faculty diversity. There were no statistically significant differences between the men and women's perceptions of their own training. Although, when asked to evaluate whether certain aspects of training were comparable for male and female residents, women were statistically less likely to agree that their experiences were comparable with those of their male colleagues. CONCLUSIONS: Male and female surgical residents, fellows, and trained surgeons identified almost identical training needs and priorities yet women perceived disparate treatment.     

Attending, house officer, and medical student perceptions about teaching in the third-year medical school general surgery clerkship

BACKGROUND: There has been declining interest in surgery among medical students and one reason might be the third-year clerkship experience. The aim of this study was to clarify the perceptions and expectations of attendings, residents, and medical students on the clerkship experience. STUDY DESIGN: A survey was distributed to all general surgery attendings, the entire general surgery house staff, and an entire third year medical school class inclusive of the 2001-2002 academic year at a single institution. Statistic analysis consisted of chi-square and Kruskal-Wallis-ANOVA on ranks with Dunn's test for multiple comparisons. A p < 0.05 was significant. RESULTS: Responses were obtained from 59 attending surgeons (50%), 38 surgical residents (32%), and 107 medical students (66%). Of this student cohort, 35% were planning to choose a surgical specialty as a career. Agreement was high among faculty, students, and residents about factors considered important in evaluation, expectations of skills, and level of skills needed before the clerkship. Medical students desired more hours of instruction, believed they performed fewer procedures per week, and thought that feedback was poor compared with the opinions of faculty and residents (p < 0.002). Nearly 50% of medical students believed they were an inconvenience to the service; 30% of house officers and 27% of faculty (p < 0.001) believed this also. Almost all faculty and residents, however, wanted medical students on the service (> 95%). Faculty believed residents did a better job teaching than either the students or residents themselves did (p < 0.001), and students thought that residents were the primary source of education in patient care. CONCLUSIONS: Considerable differences exist between faculty, surgical resident, and medical student perceptions and expectations of medical student education. Structured direct faculty contact, definition of medical student roles on the surgical team, and more consistent feedback can be rapidly improved.     

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.     

A mentorship-based preclinical elective increases exposure,confidence, and interest in surgery

Background

The predicted shortage of surgeons is of growing concern with declining medical student interest in surgical careers. We hypothesized that earlier exposure to operative experiences and the establishment of resident mentors through a preclinical elective would enhance student confidence and interest in surgery.

Methods

We developed a preclinical elective in surgery, which served as an organized curriculum for junior medical students to experience surgery through a paired resident-mentorship model. We assessed student exposure and confidence with clinical activities before and after the elective (N = 24, 100% response rate). We compared these students with a cohort of peers not enrolled in the elective (N = 147, 67% response rate).

Results

We found significantly improved confidence (2.8 vs 4.4) and clinical exposure (2.4 vs 4.3) before versus after the elective, with precourse scores equal to matched peers.

Conclusions

This elective incorporates elements that have been shown to positively influence student decision making in surgical career choice. The mentorship model promotes residents as educators, whereas the elective provides a means for early identification of students interested in surgery.     

Outreach in surgery at the undergraduate level: an opportunity to improve surgical interest among women?

Medical career choice is often formed at the premedical level, thus surgeons must reach out to undergraduates to enhance interest in surgery. Because there is a predominance of women among undergraduates (57%), this outreach also serves as an opportunity to introduce women to a surgical career. We developed an undergraduate course ("Surgery 99") offering course credit for participation in clinical research projects in surgery, shadowing surgeons in the operating room, and receiving mentorship for a surgical career. Six surgeons (50% women) served as course instructors. The final exam was a thesis with oral presentation. For enrollment, 132 students applied and 13 were accepted each quarter. Eleven students (85%) were women. None of the students had prior exposure to surgery. All but one student (93%) found the experience met or exceeded their expectations. Upon exit, knowledge attained was ranked highest, followed by observation in the operating room, and clinical research experience. All found that the course affirmed their decision to attend medical school and promoted their interest in surgery residency. We demonstrate a successful model for outreach in surgery at the undergraduate level that can positively influence interest in a surgical career, especially among women.     

How medical students define surgical mentors

BACKGROUND: Current literature does not define ideal qualities of surgical mentors. We sought to define mentoring qualities desired by medical students in attending and resident surgeons. METHODS: We conducted a survey asking third-year medical students to identify the best attending surgeon and resident surgeon mentors during their surgical clerkship and to explain their selections. Comments were systematically evaluated using content analysis. RESULTS: The survey response rate was 94.8%. Attending surgeon mentors were described by 84 students; 70 students described resident surgeon mentors. Students most frequently described the "teacher" role for attending surgeons. For resident surgeon mentors, students most often ranked the "person" role. Students prioritized characteristics or attributes within roles differently for attending and resident surgeon mentors. CONCLUSIONS: Medical students' expectations of attending and resident surgeon mentors differ. Emphasis on behaviors consonant with identified characteristics may improve mentoring of medical students by surgeons and increase interest in surgical 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.     

Women surgeons. Results of the Canadian Population Study.

OBJECTIVE: A national survey of women surgeons in Canada was undertaken to evaluate their ability to combine career with personal and family life. SUMMARY BACKGROUND DATA: Despite increasing numbers of women entering the medical profession, women continue to select nonsurgical careers. Although there are many reports regarding women in medical specialties there is little information available regarding women who choose surgical careers. Such data will be useful in increasing the enrollment of women in surgical training programs. METHODS: A 93-item questionnaire was mailed in July 1990 to the 459 eligible female surgeons. The survey was conducted using a modified Dillman 5-step computerized method. The study was closed in May 1991. RESULTS: Of the 459 surgeons who were located, 419 (91.3%) responded. Most surgeons (65.5%) were married. Only 6.5% were separated or divorced. The majority married another professional (91.4%). One quarter married another surgeon. Of all women who married at least once, 70.9% had at least one child. Most surgeons delayed child bearing until after they had completed their surgical training. The majority of respondents were in active surgical practice (82.3% full-time, 6.0% part-time). The most common surgical subspecialty was obstetrics and gynecology (40.9%), followed by ophthalmology (21.2%), and general surgery (12.1%). Surgeons were rarely dissatisfied (4-9%) with career, marriage, health, friendships, financial status, and hobbies. Overall, 88.3% were happy with their decision to pursue a career in surgery. CONCLUSIONS: Women surgeons practicing in Canada are able to combine productive careers with rewarding family lives and are satisfied with their decision to do so despite the compromises involved.     

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.     

Minimally invasive surgery

Minimally invasive surgery (MIS), or laparoscopic surgery, plays a vital role in residency training in a number of surgical disciplines including general surgery, surgical oncology, colorectal surgery, pediatric surgery, and thoracic surgery. The tremendous patient demand for MIS over the past 2 decades has resulted in surgeons rapidly embracing this technique. Many general surgery residencies cover basic laparoscopy within their residency program; however, the experience with more advanced cases is more variable. This career resource guides the interested medical student and physician to opportunities for fellowship training in MIS. It includes a discussion of the specialty, training requirements, grant funding, research fellowships, and pertinent societies.