Factors Influencing the Intention to Pursue Surgery among Female Pre-Medical Students: A Cross-Sectional Study in Pakistan

Diversifying the Surgical Workforce: Understanding Barriers to Inform Solutions

OBJECTIVES

Race and gender concordance between physicians and patients is associated with reductions in healthcare disparities. However, the diversity of the medical workforce does not mirror the population; some of the greatest deficiencies exist in the surgical workforce. We conducted a pilot study focused on early recruitment of diverse college students in our region, with a concurrent needs assessment of their specific barriers to entering the field of surgery.

METHODS

Local college students who self-identified as underrepresented in medicine (URiM) were recruited to attend a symposium hosted by an academic surgery department. Events included a specialty discussion panel, live OR streaming, simulation lab, and breakout sessions covering various topics. The primary aims were to 1: increase interest in surgical careers and 2: conduct a needs assessment to optimize strategies for overcoming perceived barriers to entering surgery. A mixed methods analysis was conducted to assess cohort characteristics, changes in impressions of pursuing a surgical career, barriers to pursuing such careers across five domains, and overall perceptions of the symposium.

RESULTS

Recruitment consisted of emails sent to local college pre-medical society advisors. Of 58 students who attended, 77% were from state universities or community colleges. There were 63.8% who identified as a racial/ethnic minority (38% Latino, 24% Black, 16% Asian, 14% Middle Eastern, 8% mixed), 34.5% as economically-disadvantaged, 34.5% as first-generation college, 25.9% as female, 12.1% as LGBTQ+, and 3.5% as other. Pre-symposium, 93% of attendees intended to apply to medical school, but only 25% had considered surgery as a profession. Post-symposium, this increased to 43% who indicated an intention to pursue surgery, with an additional 52% who were undecided but interested. Across all sections, the mean rating for attendees' knowledge regarding surgical training and careers pre- and post-symposium increased significantly. The most frequently cited barriers were the lack of mentors (50%), concerns about MCAT scores (50%), overall costs (48%), and work/life balance (47%). Thematic analysis identified gratitude for the event and for opportunities to meet surgeons; ongoing needs included shadowing and mentorship matching. The direct costs of the event were approximately $500.

CONCLUSION

This pilot study demonstrated the avidity of an audience with the potential to diversify the surgical workforce. Participant interest in pursuing surgical careers nearly doubled and clear unmet needs were identified to support this group towards this goal. Furthermore, these results were achieved with very little funding or advertising. Work is ongoing to upscale these efforts and determine impact on our surgical workforce.

Gender Differences in Perception of Neurosurgery as a Career Choice in Pakistan: A Nationwide Cross-Sectional Survey

BACKGROUND

A low neurosurgeon-to-patient ratio persists to be a problem in many developing nations including Pakistan. Concurrent gender disparities further exacerbate the challenges posed by the already limited workforce. An understanding of the perceptions of neurosurgery among female early career doctors is crucial in the evolution of the field in terms of both, workforce strength and inclusivity.

METHODS

A cross-sectional study was conducted across public and private medical schools of Pakistan. A close-ended self-administered questionnaire was employed to assess subject-reported challenges and perceptions regarding neurosurgery. Statistical analysis was performed using SPSS, version 28, and P < 0.05 was considered significant. The influence of these perceptions on the choice of neurosurgery as a career was determined by binary logistic regression analysis.

RESULTS

Of the 387 responses received from over 45 institutions across the country, 55.6% were females and 44.4% were male respondents. Compared to men, women were more likely to opt out of neurosurgery due to fear of problems with parenting (P < 0.001), absence of daycare facilities (P < 0.001), lack of female role models (P = 0.001), fear of gender discrimination (P < 0.001), and the mental (P = 0.04) and physical distress (P = 0.008) associated with neurosurgery. Binary logistic regression revealed that these concerns were responsible for an increased likelihood of opting out of neurosurgery among female medical students and intern doctors.

CONCLUSIONS

Significant differences exist in how male and female medical students perceive neurosurgery as a career choice. Interventions including availability of daycare facilities for children, creation of inclusive workplace environment, and promotion of mentorship programs catering to women can help bridge this gap and contribute to evolution of the field of neurosurgery in the developing world.

Investigating factors that influence residency program selection among medical students

BACKGROUNDS

Medical students and interns face several decisions during their career development. One of the most critical decisions they have to make is choosing a residency program that suits their career goals and aspirations. The selection process can be challenging, as several factors can influence the decision-making process. There was limited research on the role of GPA and opportunities in residency program selection. Therefore, this study examines the factors that influence interns' and 5th-year medical students' choices of residency programs.

METHODS

Observational and analytical cross-sectional studies were conducted at King Saud University (KSU) in Riyadh, Saudi Arabia. A sample of 5th-year medical students as well as medical interns was included in the study. This study only includes students who were interested in choosing a residency program in one of these eight domains: Medicine, Family Medicine, Orthopedics, Pediatrics, Radiology, Surgery, Obstetrics/Gynecology, and Ophthalmology.

RESULTS

The total number of students with 5th-year medical students was 205 (60.1%) and the number of students with medical interns was 135 (39.5%). The majority of students (51.0%) had a GPA above 4.5 out of 5, followed by 3.5 to 4.5 among 146 (42.8) students, and only 21 (6.2) had a GPA below 3.5. Those students with less than a 3.5 GPA out of 5 were found not to have any favorite residency program specialties when it came to academic achievement. Furthermore, in the case of those students whose GPA was 3.5 to 4.5, they had a certain mindset when it came to choosing a residency program. A 1.9 times greater likelihood of selecting obstetrics and gynecology (OR = 1.9, p = 0.19) was achieved by students with GPAs between 3.5 and 4.5, followed by a 1.5 times greater probability of selecting radiology (OR = 1.5; p = 0.55). High achievers, ophthalmology (OR = 1.7; p = 0.32) and surgery (OR = 1.4; p = 0.31) were the most popular residency programs. A student with a high GPA (mean score = 7.3) also chooses his or her career based on better opportunities than a student with a low GPA (mean score = 6.8).

CONCLUSIONS

The study highlights the correlation between academic achievement and preferred specialties for future careers among medical students. While the study's findings should be considered in the context of various other factors such as lifestyle, social life, and income can influence students' preferred specialties for residency programs.

The Role of Gender-Concordant Mentorship in Women Premedical Students' Perception and Pursuit of Surgical Careers

OBJECTIVE

Evaluate the impact of a 6-month structured mentorship program between women premedical student mentees paired with women medical students and surgical residents on mentees' interests and perceptions of surgical careers.

DESIGN

Prospective qualitative and quantitative study.

SETTING

This study took place at the Boston University School of Medicine, a single institution tertiary care hospital.

PARTICIPANTS

Self-identified women premedical students at Boston University were eligible for inclusion in this program (n=90). Participants were recruited and grouped with self-identified women medical student (n=52) and resident (n=19) mentors. Participants were provided with a monthly curriculum to guide discussions. Mentees completed pre- and postprogram surveys with 5-point Likert scale questions regarding interest and exposure to surgery, role models and mentorship, and effect of COVID-19 on their career interests. Pre- and postprogram responses were compared using a Wilcoxon rank sum test.

RESULTS

Of the 90 mentees, 63 (70%) completed preprogram surveys, and 53 (59%) completed postprogram surveys. Survey respondents indicated statistically significant increased exposure to positive role models (preprogram mean 3.15, postprogram mean 4.06, p=0.0003), increased exposure to women role models (preprogram 2.30, postprogram 3.79, p<0.0001), increased access to dedicated mentors (preprogram 2.11, postprogram 3.75, p<0.0001), and increased availability of support persons to answer their questions and concerns about careers in surgery (preprogram 3.03, postprogram 3.85, p=0.001). There was also a statistically significant increase in the reported effect that exposure to gender-concordant role models in surgery had on participants' decisions to consider a surgical career (preprogram 3.58, postprogram 4.23, p=0.001).

CONCLUSION

This 6-month structured mentorship program for undergraduate premedical students increased mentees' exposure to positive women role models and mentors, and increased mentee's interest in pursuing a surgical career. This emphasizes the need for structured gender-concordant mentorship programs early in women's careers to encourage pursuit of surgical careers in an otherwise men-dominated field.

Sex-based Disparities Among Surgical Faculty Positions Across Medical Colleges in Pakistan

INTRODUCTION

Despite women being under-represented in academic surgery, there is no publicly accessible repository describing the distribution of surgeons by sex and specialty in Pakistan. This short report aims to fulfill this gap by describing female representation across surgical faculty positions in medical colleges across Pakistan.

METHODS

This cross-sectional study was conducted in 2021 across medical universities in Pakistan. A dual mode of data collection was employed, whereby data regarding sex, academic designation, and subspecialty of surgical faculty was retrieved via emails to representative faculty from medical colleges, and from medical colleges' websites.

RESULTS

A total of 97/114 (85.1%) medical colleges across Pakistan were included, providing us with data of 2070 surgical faculty. Overall, only 10.3% of surgical faculty were women, with women comprising 14.1% of assistant professors, 9.3% of associate professors, and only 5.7% of professors. Most women surgical faculty were assistant professors (63.1%), with only 17.8% being professors. Sindh (14.3%) and Punjab (9.7%) had the greatest percentage of women across surgical faculty overall, while Khyber Pakhtunkhwa had the lowest (6.5%). Apart from breast surgery (100%), pediatric surgery (29.4%), ophthalmology (15.0%) and general surgery (11.6%), women did not represent more than 10% of surgical faculty for any surgical subspecialty.

CONCLUSION

In Pakistan, there is a blatant lack of female representation across all faculty positions and in most surgical specialties, with imbalances more pronounced in the relatively under-developed Khyber Pakhtunkhwa and Balochistan. These sex disparities may aggravate the surgical disease burden and adversely impact surgical prospects for women across the country.