Why do students choose careers in surgery?

Factors Affecting Specialty Training Preference Among UK Medical Students (FAST): Protocol for a National Cross-Sectional Survey

BACKGROUND

The UK medical education system faces a complex landscape of specialty training choices and heightened competition. The Factors Affecting Specialty Training Preference Among UK Medical Students (FAST) study addresses the need to understand the factors influencing UK medical students' specialty choices, against a backdrop of increasing challenges in health care workforce planning.

OBJECTIVE

The primary objectives of the FAST study are to explore UK medical students' preferred specialties and the factors that influence these choices. Secondary objectives are to evaluate students' confidence in securing their chosen specialty, to understand how demographic and academic backgrounds affect their decisions, and to examine how specialty preferences and confidence levels vary across different UK medical schools.

METHODS

A cross-sectional survey design will be used to collect data from UK medical students. The survey, comprising 17 questions, uses Likert scales, multiple-choice formats, and free-text entry to capture nuanced insights into specialty choice factors. The methodology, adapted from the Ascertaining the Career Intentions of UK Medical Students (AIMS) study, incorporates adjustments based on literature review, clinical staff feedback, and pilot group insights. This approach ensures comprehensive and nondirective questioning. Data analysis will include descriptive statistics to establish basic patterns, ANOVA for group comparisons, logistic regression for outcome modeling, and discrete choice models for specialty preference analysis.

RESULTS

The study was launched nationally on December 4, 2023. Data collection is anticipated to end on March 1, 2024, with data analysis beginning thereafter. The results are expected to be available later in 2024.

CONCLUSIONS

The FAST study represents an important step in understanding the factors influencing UK medical students' career pathways. By integrating diverse student perspectives across year groups and medical schools, this study seeks to provide critical insights into the dynamics of specialty, or residency, selection. The findings are anticipated to inform both policy and educational strategies, aiming to align training opportunities with the evolving needs and aspirations of the future medical workforce. Ultimately, the insights gained may guide initiatives to balance specialty distribution, improve career guidance, and improve overall student satisfaction within the National Health Service, contributing to a more stable and effective health care system.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55155.

Laparoscopic training workshop to assess medical students' skill acquisition and interest in surgical careers

BACKGROUND

With its minimally invasive approach, laparoscopic surgery has transformed the medical landscape. As the demand for these procedures escalates, there is a pressing need for adept surgeons trained in laparoscopic techniques. However, current training often falls short of catering to medical school education. This study evaluates the impact of a custom-designed laparoscopic training workshop on medical students' surgical skills and career aspirations.

METHODS

This prospective experimental study was conducted at the E-Da hospital in Kaohsiung City, Taiwan. Medical students from Taiwanese medical schools undergoing Clerk 5, Clerk 6, and Postgraduate Year 1 and 2 were invited to participate. Medical students (n = 44) underwent an endoscopic skill training workshop consisting of lectures, box training, and live tissue training. The trainees performed multiple tasks before and after training using our objective evaluation system. The primary outcome was assessed before and after training through a questionnaire assessing the influence of training on students' interest in surgery as a career. The secondary outcome measured improvement in skill acquisition, comparing the task completion time pre- and post-workshop. For the primary outcome, descriptive statistics were used to summarize the questionnaire responses, and paired t-tests were performed to determine significant changes in interest levels post-workshop. For the secondary outcome, paired t-tests were used to compare the time recorded pre- and post-training.

RESULTS

Post-training, participants exhibited significant proficiency gains, with task completion times reducing notably: 97 s (p = 0.0015) for Precision Beads Placement, 88.5 s (p < 0.0001) for Beads Transfer Exercise, 95 s (p < 0.0001) for Precision Balloon Cutting, and 137.8 s (p < 0.0001) for Intracorporeal Suture. The primary outcome showcased an increased mean score from 8.15 pre-workshop to 9.3 post-workshop, indicating a bolstered interest in surgery as a career. Additionally, post-training sentiment analysis underscored a predominant inclination toward surgery among 88% of participants.

CONCLUSION

The custom-designed laparoscopic workshop significantly improved technical skills and positively influenced students' career aspirations toward surgery. Such hands-on training workshops can play a crucial role in medical education, bridging the gap between theoretical knowledge and practical skills and potentially shaping the future of budding medical professionals.

Feasibility of 3-dimensional printed models in simulated training and teaching of transcatheter aortic valve replacement

In the study of TAVR, 3-dimensional (3D) printed aortic root models and pulsatile simulators were used for simulation training and teaching before procedures. The study was carried out in the following three parts: (1) experts were selected and equally divided into the 3D-printed simulation group and the non-3D-printed simulation group to conduct four times of TAVR, respectively; (2) another 10 experts and 10 young proceduralists were selected to accomplish three times of TAVR simulations; (3) overall, all the doctors were organized to complete a specific questionnaire, to evaluate the training and teaching effect of 3D printed simulations. For the 3D-printed simulation group, six proceduralists had a less crossing-valve time (8.3 ± 2.1 min vs 11.8 ± 2.7 min, P < 0.001) and total operation time (102.7 ± 15.3 min vs 137.7 ± 15.4 min, P < 0.001). In addition, the results showed that the median crossing-valve time and the total time required were significantly reduced in both the expert group and the young proceduralist group (all P<0.001). The results of the questionnaire showed that 3D-printed simulation training could enhance the understanding of anatomical structure and improve technical skills. Overall, cardiovascular 3D printing may play an important role in assisting TAVR, which can shorten the operation time and reduce potential complications.

The impact of a shadowing program on medical students' interest in plastic surgery

Given the lack of formal education on plastic surgery services during the preclinical years of medical school, many medical students commonly misunderstand the breadth and depth of the field. Shadowing is highly impactful in shaping students' desire to pursue surgery, but the impact of plastic surgery shadowing remains unexplored. The study design utilized an anonymous web-based survey containing questions surrounding prior interest in surgery, race, gender, medical school progress, and clinical versus OR shadowing. All medical students who participated in an ongoing, voluntary plastic surgery shadowing program over a two-year period were invited to complete the survey. Of the 54 students who shadowed during the study period, 43 (79.6%) returned the survey. Students reported an overall greater impact of OR shadowing than clinic shadowing on their interest in plastic surgery, approaching significance (p = 0.0527). On simple and multivariate regression, the number of times a student shadowed in the OR was the only statistically significant predictor of students' interest in plastic surgery (p = 0.0003). In general, the majority of students reported that their shadowing experience "significantly increased" (24.2%) or "somewhat increased" (45.5%) their interest in pursuing a career in plastic surgery. The impact of shadowing, particularly in the operating room, on students' interest in plastic surgery demonstrates the value of structured shadowing programs. Additionally, given the particularly influential effect of shadowing in the operating room, our results indicate that efforts may benefit most from facilitating student exposure to the hands-on aspects of the field.

Student experiences of professionalism and role models in an oral and maxillofacial surgery internship: A qualitative study

INTRODUCTION

Dental students have a clear concept of professionalism and the importance of role models. Our aim was to determine how dental students experience their first oral and maxillofacial surgery internship in terms of their concept of professionalism and their perception of role models.

METHODS

From June to August 2020, semi-structured telephone interviews were conducted with 22 dental students in their eighth and ninth semesters at the Medical Faculty of the University of Ulm. The interviews were transcribed and evaluated by qualitative content analysis according to Mayring.

RESULTS

The students' concept of dental professionalism was shaped by the elements of a good approach to patients, professional competence, and manual skills. This perception was not changed by the internship. Having a role model was seen as an important learning strategy, and role models were perceived in both positive and negative ways. Role models were perceived as positive if they corresponded to the student's concept of professionalism and as negative if they did not correspond to this concept, especially with regard to social interaction or the approach to patients. Students' reactions to discrepancies between their own moral values and the role models' behaviour were characterised by passivity and withdrawal. With regard to potential future careers, positive internship experiences supported student goals, whereas negative experiences raised doubts about them.

CONCLUSION

Supervising dentists may still underestimate the considerable impact of internships, and their awareness of this impact needs to be increased. Students' reactions to conflicts between reality and their own values do not appear to be constructive. One approach to solving this problem may be to include discussions of professional development in curricula.

The perceived impact of curricular and non-curricular factors on specialty interests and choice during medical school at a single center in the United States

BACKGROUND

Limited information exists regarding how medical students' specialty interests evolve throughout medical school, particularly interest in surgical versus non-surgical specialties. Our objective was to identify medical students' specialty interests before and after medical school and the most important curricular and non-curricular factors that shaped their specialty choice.

METHODS

An online 22-question voluntary, anonymized survey was designed to assess specialty interests and factors impacting specialty choice at a single medical school in the United States. The study was pilot-tested with focus groups. The final questionnaire was distributed to final-year medical students from the Classes of 2020 and 2021. Responses were measured on a 5-point Likert scale (1 = strong negative impact to 5 = strong positive impact).

RESULTS

102 of 184 students (55%) from Class of 2020 and 85 of 174 students (49%) from Class of 2021 participated. Of 187 respondents, the majority (60%) decided on their specialty during third year. 74 of 147 students (50%) pursued a specialty among their initial specialty interests. Students with initial surgical interests were significantly (p < 0.001) less likely to choose surgical specialties (42%) compared to students with initial non-surgical interests choosing non-surgical specialties (79%). Pre-clinical years (3.67 ± 0.96) were perceived to have a significantly (p < 0.001) less positive impact on specialty interests and choice compared to clinical years. Among pre-clinical factors, physician shadowing (3.80 ± 0.83) was perceived to have the significantly (p < 0.001) greatest positive impact. During clinicals, 34% of respondents indicated that order of clerkships impacted specialty choice. 112 of 171 respondents (65%) indicated that mentorship impacted specialty choice. Physicians in the chosen specialty were perceived to have the strongest impact (4.67 ± 0.49). 65 of 171 respondents (38%) indicated that peers impacted specialty choice with classmates (3.98 ± 0.87) and near-peers (3.83 ± 0.74) perceived to have a positive impact.

CONCLUSIONS

Specialty interests changed during medical school for a significant portion of students (50%). Those with initial surgical interests were more likely to change their specialty interests. Pre-clinicals were reported to have less impact on specialty choice compared to clinicals. Implementing factors such as shadowing and physician/peer mentorship, which may positively impact specialty choice, into pre-clinical curricula warrants further investigation.

Medical students and mattering on the surgery clerkship rotation

BACKGROUND

Mattering is a psychosocial construct that describes an individual's perception that they make a difference in the lives of others and that they are significant in the world. The purpose of this study was to explore the current perception of behaviors that impact mattering among third year medical students on their surgery clerkship with the goal of improving the clerkship experience.

METHODS

A qualitative interview study was conducted during the 2019-2020 academic year. Medical students who had completed their surgery clerkship at a single institution volunteered to participate. Qualitative thematic analysis of students' comments during interviews were categorized to the three primary domains of mattering: awareness, importance, and reliance.

RESULTS

Six medical student interviews were conducted and responses were coded for the three primary domains of mattering. Eight subthemes emerged highlighting positive observations that may influence student mattering on the surgery clerkship. Awareness behaviors included acknowledging the student's presence, maintaining eye contact, educators offering students their undivided attention, and getting to know the students as individuals. Importance behaviors included taking time to teach, setting expectations early, and providing timely feedback. Reliance behaviors involve developing trust to match autonomy with experience and depending on students to provide unique information about patient care to the team.

CONCLUSIONS

These findings can help educators recognize the words, actions, and behaviors that make medical students feel they matter on their surgery clerkship. Interventions should continue focus on how to increase the sense of awareness, importance, and reliance for both the students and faculty.

The Need for Improved Recruitment to Neurosurgery Training: A Systematic Review of Enrollment Strategies

Neurosurgery is one of the cornerstones corresponding to a large scope of clinical pathologies and is a highly-regarded surgical specialty. However, there has been a decline in recruits into the neurosurgical residency due to many factors derailing the interest of medical students with an ambition to become neurosurgeons. Some of these issues encompass little or lack of early exposure to neurosurgery, lack of quality mentorship programs, and institutional curriculum entailing prolonged periods of training and study in neurosurgery. Therefore, this systematic review and meta-analysis aim to establish some strategic methodologies for increasing the recruitment to neurological surgery. Neurosurgery is an interestingly exciting specialty that integrates cutting-edge technology allowing for diversified subspecialization with an exceptional degree of variety. Nevertheless, several factors such as the duration of the required training, the kind of lifestyle, lack of early exposure to neurosurgery, and lack of mentors to a vast of medical students across the globe have curtailed the recruitment to neurological surgery. Despite an increased number of female representations in medical surgery, there has been a reported increase in students matching into neurosurgery, although the number is relatively below the expectation due to the factors highlighted earlier. As a result, many studies and surveys have been conducted to identify ways of improving neurosurgical recruitment.

Five electronic databases, including PubMed, Science Direct, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar, MEDLINE, and Cochrane Library, were searched to provide pertinent information to the topic of study in strict compliance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis) guidelines. Meta-analysis was then conducted on the included studies to determine their correlations based on the individual outcomes of each study. A total of 2,134 search results were obtained, screened, and reviewed against the exclusion and inclusion criteria to remain with 12 included studies detailing improving the recruitment to neurosurgical residency. The 12 studies were retrieved for their study characteristics based on the PICO (predetermined patient, intervention, control, and outcome) standards. Most of the studies were surveys (n = 8), retrospective and prospective studies (n = 2), and pilot and multifocal studies making up for the rest (n = 2). Several neurosurgery aspects need consideration to improve the recruitment of medical students to neurosurgical fields. Medical institutions, specialists, and other stakeholders should consider reconstructing the neurosurgical curriculum to ease the prolonged study time as well as to create and encourage structural programs aimed at acquainting medical students in neurosurgery and involving the students in conducting other research projects. In addition, mentorship programs and early exposure of medical students to neurological surgery play a key role in influencing the medical students' interest in choosing neurosurgical career paths.

Gender and Nationality Trends in Manuscripts Published in Prominent Gastroenterology Journals Between 1997 and 2017

BACKGROUND

Gender disparities remain in the field of gastroenterology (GI) despite the decreasing gender gap in the medical field overall. We sought to examine primary and last female authorship as a marker of academic opportunity and advancement to assess the proportion of women publishing in GI over 20 years (1997-2017).

METHODS

In this observational study, we assessed the gender and nationality of primary and last authors of original research manuscripts in three GI journals (Gastroenterology, Gut, and American Journal of Gastroenterology) across a 20-year period in 5-year intervals (in 1997, 2002, 2007, and 2012). We used a validated gender-determining algorithm, genderize.io, to classify gender. Our primary outcome was the proportion of female primary and last authors, with secondary measures assessing trends in gender and nationality.

RESULTS

Through the Genderize.io gender database, we were able to identify the gender for 3,673 (95.9%) of primary author names and 3,504 (95.4%) of last author names in the 3,615 manuscripts evaluated. Overall, there was a significant increase in female primary authors over time, from 18.1% in 1997 to 42.6% in 2017, a 6.0% increase per 5-year period (95% CI 4.8-7.2%). A similar trend was found for female last authors, however, at a slower rate, from 8.3% in 1997 to 24.7% in 2017, a 3.5% increase per 5 years (95% CI 2.5-4.4%). These trends were noted cumulatively, and in each journal individually. Manuscripts with a female last author were more likely to demonstrate a female primary author.

CONCLUSION

Female authorship in high-impact gastroenterology journals has increased over time. Last authorship has lagged primary authorship in female representation and has increased more slowly over time. Interventions to reduce gender disparity in GI research should focus on the transition from first to last authorship.

Association between Participation in a Preclinical Surgery Elective and Future Match into Surgical Residency

BACKGROUND

Since 2013, we have offered a robust "Introduction to Surgery" elective (ITS) for preclinical medical students. The present study investigates whether participants of the ITS elective were more likely to match into surgical residencies than non-ITS participants.

METHODS

This is a retrospective case-control study of medical students from two medical schools in Southern California who participated in the ITS elective and those who did not. Descriptive results and univariate analysis using STATA were utilized to analyze the de-identified data who matched between 2016 and 2021 were included.

RESULTS

Overall, 87 (8.9%) of the 982 matched students participated in the ITS elective, with an increase in participation from 1.2% in 2016 to 13.9% in 2021 (P < .001). Among ITS participants, 49.4% matched into a surgical specialty compared to only 22.9% for non-ITS students (P < .001). There was no difference between ITS and non-ITS students with regards to procedural specialty match (14.9% vs 12.6%, P = .537).

CONCLUSION

ITS participants were more than twice as likely to match into a surgical specialty than non-participants. Future qualitative research will help discern the relative impact of the ITS course versus a student's baseline predisposition to surgery.

Mentored undergraduate operating room teaching during the orthopedic trauma curriculum-No evidence of gender differences

BACKGROUND

In many surgical disciplines, the interest among medical students to pursue a surgical career decreases during their medical studies. The same goes for students after graduation. The aim of our cohort study was to evaluate the operating room (OR) experiences of medical students during our curriculum.

MATERIALS AND METHODS

Over the course of one year 217 senior year medical students were included in our study. All of them took part in our training program for senior year medical students, which consisted of a 1-week clinical rotation including visits to the OR. We developed a Likert-scaled questionnaire, which was evaluated anonymously; free text answers were also possible.

RESULTS

Prior to the analysis of the sex and age differences, we confirmed that the evaluation scale provided a coherent measure of the OR evaluation. As a first proxy, we conducted a series of Spearman correlations which revealed high intercorrelations between all of the six items of the questionnaire, r(154) = 0.53 to r(154) = 0.94, all p < 0.001. These high intercorrelations transferred into a very high consistency of the six questions that evaluate the OR teaching; Cronbach's α = 0.95. There was no main effect of sex, F (1,146) = 2.19, p = 0.141. However, there was a main effect of age, F (2,146) = 3.75, p = 0.026, indicating that older participants evaluated the OR teaching more positively. Finally, there was no correlation between sex and age group, F (2,146) < 1, indicating that the effect of age on the evaluation score was equally pronounced for female and male participants.

DISCUSSION

The aim of this study was to answer the question how mentored OR teaching during the orthopedic trauma curriculum is evaluated by medical students, and whether there are gender-specific differences. For this purpose we prospectively evaluated senior year medical students over a period of 12 months during the orthopedic trauma curriculum with questionnaires. The medical students rated the mentored OR visits mainly positive.

CONCLUSION

Previously published literature as well as our presented data indicate that the interest of medical students in starting a surgical career can only be increased if negative influencing factors are reduced. This includes especially positive communication with medical students and in daily professional interaction.

A New Hybrid Concept, Combining Lectures and Case-Seminars, Resulted in Superior Ratings from Both Undergraduate Medical Students and Teachers

BACKGROUND

Due to declining student ratings, a new teaching method was applied to a course in gastrointestinal diseases for undergraduate medical students. Problem-based learning was replaced with our new concept, consisting of a theory week with traditional lectures and case seminars.

METHODS

In this retrospective study, we compared student-ratings from the problem-based learning era to a new hybrid concept. The students evaluated the concepts by rating (1-6, 6 = best) nine different subject areas. Additional free text comments were possible. Teachers working with both concepts did likewise. Statistical differences between the two periods were studied by Mann Whitney U-test.

RESULTS

The study group consisted 621 students (57% females, total response rate of 52%). Scores for lectures (4.9 vs.3.8) and teaching stimulation and feedback (4.6 vs 3.6, and 3.7 vs 3.4, respectively), and to what extent the contents reflected learning goals (5.2 vs 4.3, p<0.05 for all) were instantly improved, which also prevailed in the following semesters. At the end of the study period, a significant improvement in case seminars (4.8 vs 4.3) and practical training (4.9 vs 3.8, p<0.05 for both) was seen. Free text answers revealed that the students felt more prepared for their clinical rotation. Teachers rated the new hybrid concept higher (4.7 vs 3.5, p<0.05) and especially praised the new lectures.

CONCLUSION

The new learning concept resulted in both improved student-ratings and more satisfied teachers. We believe that the hybrid concept, combining lectures and case-seminars, facilitated learning and improved the learning climate. The subsequent uninterrupted practical training also received improved scores.

Influence of undergraduate medical education exposure to cadaveric dissection on choice of surgical specialty: a national survey of Canadian surgical residents

Background

The number of Canadian Residency Matching Service (CaRMS) applicants ranking surgical specialties as their first choice has declined over the past 20 years; concurrently, there has been a reduction in the number of hours spent teaching undergraduate medical education (UGME) anatomy, particularly with cadaveric dissection. The aim of this study was to determine the factors that most influence selection of a surgical specialty, with specific focus on the impact of UGME anatomy training.

Methods

A 36-item cross-sectional survey was designed by experts in medical education and distributed to all current surgical residents in Canada in October 2018. Responses were recorded on a 5-point Likert scale or by means of list ranking. We analyzed univariable outcomes with a t test for continuous outcomes and the χ² test for dichotomous outcomes.

Results

Of 1493 surgical residents, 228 responded to the survey (response rate 15.3%). Respondents reported experiences on core rotations and elective rotations, and access to a mentor as the most important factors in deciding to pursue a surgical residency. Anatomy training with or without cadaveric dissection was moderately influential in respondents’ first-choice CaRMS discipline (mean Likert scale score 2.97 [standard deviation (SD) 1.34] and 2.87 [SD 1.26], respectively). General surgery residents’ CaRMS applications were more likely to have been influenced by UGME anatomy training than the applications by residents in other surgical specialties (p < 0.001). The impact of UGME anatomy training did not vary between postgraduate years or between male and female residents.

Conclusion

Canadian surgical residents’ decision to apply to a surgical specialty did not seem to be strongly influenced by their UGME anatomy training, with or without cadaveric dissection, but, rather, by factors such as clinical experience and surgical mentorship. Further evaluation of groups that were more positively affected by their UGME anatomy training is warranted.

Surgeons Underestimate the Importance of Surgical Topics for Non-Surgeons: Results of a National Survey

OBJECTIVE

To determine if surgeons and non-surgeons agree on the importance of surgical topics covered in the surgical clerkship to the daily practice of non-surgeons.

DESIGN

An IRB-approved anonymous survey ranking the relative importance of 35 topics drawn from surgical clerkship curricula asking physicians to rank the relative importance of each topic, using a five-point Likert scale, to the daily practice of non-surgeons.

SETTING

Online anonymous survey.

PARTICIPANTS

Convenience sample of practicing physicians and trainees. The survey was offered to physicians in all specialties via social media and professional connections, responders identified their practice specialty.

RESULTS

295 physicians completed the survey. Two hundred thirty-one (85%) were from non-surgical specialties: emergency medicine (EM, n = 100); primary care (PC, n = 71 - included internal medicine, family medicine, and pediatrics); a variety of others (n = 60).  Surgeons and non-surgeons agreed on the relative importance of the acute abdomen, breast disease, inguinal hernias, inflammatory bowel disease, morbid obesity, sinusitis, thyroid and parathyroid disease, and wound care; surgeons believed colorectal cancer and diverticulitis to be more important. Surgeons rated all other topics as less important to non-surgeons than non-surgeons. EM rated most acute problems more important that PC; both groups ranked most topics higher importance to the practice of a non-surgeon than surgeons (p < 0.05).

CONCLUSIONS

Surgeons consistently underestimate the importance non-surgeons place on surgical topics in their practice.  These results reinforce the perceived importance of a wide exposure to surgery in the surgical clerkship to all medical students - but topics could be focused differently depending on acute or non-acute non-surgical care career plans.

Recruiting trainees to surgery in the United States and Canadian system - What strategies are effective?

BACKGROUND

There has been increasing concerns regarding the declining number of medical students entering surgical residencies. The aim of this study is to analyze strategies and outcomes to enhance recruitment to the surgical specialties.

METHODS

A systematic literature PRISMA-based search was performed. Study quality and bias were assessed. Meta-analysis was performed using DerSimonian Laird method.

RESULTS

Of 3288 unique titles identified, 73 studies met inclusion criteria. Median study unique sample size was 84 participants (range 15-910). Subjective interest was reported in 59 studies, while objective match rate was reported by only 21 studies. The cumulative odds of students interested in the studied specialty was 1.98 (95% CI 1.47-2.67, I² = 0%) and in any surgical specialty was 1.40 (95% 1.01-1.95, I² = 37%) after an intervention compared to baseline.

CONCLUSION

While studies show increased odds of "interested in" a surgical specialty, the results may be subject to high selective and confounding biases.

A qualitative study of the perceived value of participation in a new Department of Surgery Research Residents as teachers program

OBJECTIVE

This study aims to understand the perspectives of surgical residents who completed a Research Residents as Teachers Program (RRATP).

METHODS

Our RRATP included a 6 h workshop followed by formal teaching opportunities across one academic year. Resident teachers participated in semi-structured interviews, which were inductively analyzed for prominent themes.

RESULTS

Eight surgical research residents completed the RRATP workshop and taught 330 h (median = 26 h, range: 8-105). Interview participation rate was 100%; kappa was 0.81. Residents reported four themes: 1) increased knowledge of teaching principles with subsequent teaching changes, specific factors that contributed to their development as a teacher, numerous personal benefits to participation, and broad positive consequences for the surgical department including improved culture and patient care.

CONCLUSION

A RRATP can generate a significant number of formal teaching hours by surgical research residents, who perceive a high value of formal education training to themselves and their surgical residency program.

Preparing for Surgery Observerships During Medical School: A Cross-Sectional Study

OBJECTIVE

Observerships are self-organized experiences for medical students to accompany a university affiliated physician in a clinical setting. Our study's objective was to evaluate year 1 and 2 medical students' experience with and preparation methods for surgery observerships at a Canadian medical school.

DESIGN

A cross-sectional online survey of preclerkship students, capturing resources used to prepare for observerships, types of observerships completed, and reasons for participating. Descriptive statistics were used to report demographics, observership types, and preparation methods. Gender differences in observership types were analyzed using two-way analysis of variance.

SETTING

Queen's University.

PARTICIPANTS

All preclerkship medical students (years 1 and 2) were invited to participate.

RESULTS

Of the 64 respondents (64/202), 46 (71.9%) were female and 53 (82.8%) participated in at least 1 surgery observership. The most common observerships were General Surgery (53.8%, 28/53), Obstetrics and Gynecology (50.1%), and Orthopedic Surgery (37.7%). There was no significant difference between genders in the number of surgery versus nonsurgery observerships. Common reasons for participating in surgery observerships included: "may not have opportunities in the future" (52.8%) and "rule in surgery as a career" (50.9%). Majority (64.2%) of students prepared for observerships and spent on average 1.3 ± 0.6 hours preparing. Commonly used resources included class notes (82.4%), and online videos (73.5%). Most respondents (91.0%) who prepared noted preparation was associated with a positive learning experience. Most respondents (67.1%) reported a lack of resources provided on how to prepare.

CONCLUSIONS

Preparing for observerships was associated with a positive experience and most students used class notes and online videos. There was a lack of instructions and resources on how to prepare. Developing appropriate resources for pre-clerkship medical students to prepare may improve overall experiences and increase interest in surgery.

The future of general surgery in Ireland: factors influencing career decisions of medical students

INTRODUCTION

The decline in popularity of general surgery as a career has been well described. A number of factors have been put forward to explain this, for example, trainee burnout and perceived difficulty with work/life balance. The aim of this study was to elucidate the reasons for this among medical students in Ireland.

METHOD

A questionnaire was distributed to clinical year medical students in Ireland using an online survey via SurveyMonkey™. Domains assessed included demographics, career plan and associated rationale. Anonymised responses were collated and evaluated.

RESULTS

There were 307 responses (response 23%). Females accounted for 66% (202). Mean age was 24 years (SD = 2.89). One hundred twelve responses (36%) were contemplating becoming surgeons. One hundred nine-five responses were not considering surgery: however 87 had previously considered. Of the 87, 41 (47%) attributed the decision to work/life balance, 30 (35%) to impact on personal relationships and 10 (11%) blamed unclear career projection. Students interested in surgery were asked to quantify their knowledge of the application process-17 (15%) good, 39 (35%) fair and 56 (50%) poor.

CONCLUSION

A small proportion of respondents plan to pursue a career in general surgery. This is concerning in view of attrition rates through junior years. Although lifestyle factors are significant, clarity regarding training pathways was also reported. Undergraduate education regarding career trajectory, quality of life and practicalities of a career in general surgery may increase applications.

A Tale of Two Campuses? An Analysis of Two Affiliated Medical School Campuses With Different Match Rates in General Surgery

OBJECTIVE

The purpose of this study was to compare factors that contribute to increased match rates into general surgery.

DESIGN

Survey study.

SETTING

University of Kansas School of Medicine Campuses.

PARTICIPANTS

A survey assessing experiences and perceptions during their surgical clerkship was sent to graduating medical students from a single university with a hybrid (academic-affiliated community-based) campus, and an academic campus. Specific questions were asked with regard to residents and attendings, procedural experiences, perceived lifestyle, and general interest in surgery before and after clerkship.

RESULTS

The match rate into general surgery was significantly higher on the hybrid campus (14.7% vs 4.0%, p = 0.215). Factors that were positively correlated with interest in surgery included interactions with attendings (0.86) and residents (0.63), time spent in the OR (0.77), participation in the OR (0.62), and complexity of cases (0.61). Students on the hybrid campus spent more weeks on general surgery services (6 vs 4, p < 0.001). More students from the hybrid campus were "Not interested at all" in surgery prior to their surgery clerkship (26.5% vs 16.0). Significantly more academic students indicated they were "Not interested at all" in surgery after their surgery clerkship (52.0 vs 17.6%), while more students on the hybrid campus indicated they were "extremely interested" (29.4 vs 12.0%, p = 0.005) after their surgery clerkship.

CONCLUSION

The rate of students matching into general surgery between the 2 campuses are different, with the hybrid campus having nearly 4 times the rate of students matching into general surgery. Programs may be able to increase their match rate by allowing students more opportunities to participate in the operating room, spending more time on a general surgery service, and by ensuring that medical students are included as members of the surgical team.

"Bedside Anatomy": A Tool to Contextualize Learning and Introduce Surgical Careers

BACKGROUND

Many medical students cite an unwelcoming culture in surgery and perceive surgeons as arrogant or unfriendly. These perceptions have been reported as factors discouraging medical students from applying to surgical residency programs. This highlights an opportunity early in medical education to address these negative stereotypes and create opportunities for positive interactions with surgeons. We hypothesize that positive experiences with surgical residents and introduction to representative surgical cases early in the medical school curriculum can provide a real-world context for learning anatomy and encourage students to consider a surgical career.

METHODS

We developed and implemented a series of structured, one-hour, cadaver-based sessions cofacilitated by anatomists and surgical residents for medical students during their anatomy didactics. Sessions included common surgical cases and focused on critical thinking and problem-solving skills, while offering opportunities to review cadaver anatomy. Students completed a postcourse survey.

RESULTS

Nine sessions were implemented with involvement of eight surgical residents and 185 students; 83 students completed a postcourse survey (response rate of 45%). A majority of students rated the sessions "very helpful" in terms of highlighting the importance of anatomy in medical education (n = 52, 63%) and providing clinical context (n = 59, 71%). 54% (n = 45) indicated interest in a surgical career and 64% (n = 53) agreed that session participation had increased their interest in surgery.

CONCLUSIONS

Overall, students agreed that sessions provided clinical context for their learning and increased interest in a surgical career. Surgical faculty and residents should engage in preclinical medical education to bridge the basic science and clinical years and introduce positive surgical role models early during medical training.

Impact of a Hands-on Pre-Clinical Neurosurgery Elective Course on Second-Year Medical Student Interest and Attitudes

INTRODUCTION

Medical student involvement opportunities and educational experiences with surgical residents during medical school have been shown to increase the chance of students deciding to specialize in surgical specialties. This study aims to determine the effect of a neurosurgery elective during the second preclinical year on student interest and opinion of neurosurgery.

METHODS

Thirty-nine students completed opinion-based surveys and factual knowledge quizzes during a neurosurgical elective course over 3 iterations, which included lecture and skills lab instruction. Pre- and post-course surveys used the Likert scale, with a score of 1 corresponding to the most negative opinion and a score of 10 corresponding to the most positive opinion, in order to measure various aspects including interest in neurological surgery, understanding of the field, and perception of female inclusion in the field. Weekly pre- and post-lecture quizzes assessed practical knowledge of neurosurgical topics.

RESULTS

A higher percentage of students rated neurosurgery highly as a career possibility (⩾8/10 interest level) post-course (58.6%) compared to pre-course (45.7%). Post-course, students reported a significantly increased mean understanding of neurosurgery on the Likert scale compared to pre-course (6.1 ± 1.7 vs 4.4 ± 2.0; P = .001). Knowledge based-content assessment revealed a significant increase in overall correct answers after lectures (mean_pre = 3.85, mean_post = 5.05, P = .001). Inclusion of female instructors in the second and third iteration of the course resulted in a significant increase in students' perception of female inclusion in the field of neurosurgery (7.6 compared to 5.6, P = .01).

CONCLUSIONS

Early exposure to subspecialties may assist in making important career decisions. The implementation of this neurosurgical elective improved medical students' perception of the field and enhanced knowledge of the lectures and procedures. This study can be used as a framework for implementation of this curriculum at other institutions.

Surgical Exploration and Discovery Program: Early Exposure to Surgical Subspecialties and Its Influence on Student Perceptions of a Surgical Career

OBJECTIVE

Interest in pursuing a surgical career has been declining among North American medical students. Numerous factors are known to influence student interest in pursuing surgery as a career, such as prestige, income potential, and overall lifestyle. Given that many of these factors are rooted in bias, it may be possible to properly address several of these stereotypes through first-hand, early exposure to the field of surgery via the Surgical Exploration and Discovery (SEAD) Program. The purpose of this study is twofold: (1) to investigate whether participation in an intensive, 2-week surgical program may alter student opinion, bias, and/or preconceived assumptions of a career in surgery, and (2) to determine whether these changes in perception, if present, has an impact on student interest in pursuing a surgical career compared to baseline.

DESIGN

This was a prospective cohort study. The analysis cohort consisted of 30 first-year medical students who participated in the 2-week SEAD program. The control group consisted of 29 first-year medical students who did not participate in the SEAD program. Both the SEAD and control groups completed two surveys: (1) an entry survey distributed prior to the start of the SEAD program, and (2) an exit survey distributed upon completion of the SEAD program. The surveys were designed to assess students' motivations for choosing a specialty in medicine, previous surgical experience, as well as perceptions and biases surrounding a surgical career, pre- and post-exposure.

SETTING

Undergraduate Medical Education, Faculty of Medicine, at the University of Ottawa in Ottawa, Ontario, Canada.

PARTICIPANTS

30 medical students in the SEAD group, and 29 in the control group.

RESULTS

Students' perceptions of the lifestyle, call schedule as a staff or resident, diversity of practice and gender changed significantly following the SEAD program compared to students in the control group. Furthermore, students' perceptions of surgeons as intimidating declined following the 2-week program (p = 0.003), however they were more likely to view surgery as a field requiring physical strength (p = 0.022). Overall, there was no significant change with regards to desire to pursue a career in surgery in the treatment group (p = 0.625) or in the control group (p = 1.00).

CONCLUSIONS

Early exposure to surgery through the SEAD program alters student perceptions of surgical specialties, yet it does not significantly influence students to pursue a career in the surgical field. Nonetheless, participation in the SEAD program continues to assist medical students with career decision making.

Development of a "Surgical Shadowing Scheme" to improve undergraduate experiences of surgery

PURPOSE

To establish a sustainable model for a "Surgical Shadowing Scheme" (SSS) and assess how this affects undergraduate attitudes to surgical careers.

PATIENTS AND METHODS

Surgeons at university teaching hospitals associated with UCL Medical School and UCL Partners, United Kingdom, were approached for their willingness to participate in the scheme. Medical students were then invited to apply for the scheme, where students were individually matched to operating theater sessions with surgeons in their specialty of choice. Feedback was subsequently obtained, evaluating experiences of the placement and the effect this had on future career aspirations.

RESULTS

After running for four consecutive years, approximately 220 students have participated in the scheme across a range of surgical units and specialties. A total of 91.5% of the students were pre-clinical (years 1-3), whilst the remainder were clinical (years 4-6). Fifty-four percent were female and 46% male. Eighty-three percent of the students did not have any previous experience of the specialty that they shadowed, and 67% agreed that participating in the scheme had either "increased" or "strongly increased" their desire to pursue a surgical career. Ninety-four percent said they would "recommend" or "strongly recommend" the SSS to a peer. Over a third of students reported scrubbing-up during their placements and 35% of these directly assisted the lead surgeon. Traditionally male-dominated surgical sub-specialties recruited a high proportion of female students.

CONCLUSION

This is the first published example of an established "Surgical Shadowing Scheme" for medical undergraduates. Our SSS has been highly valued by students and indicates that even a single high-quality surgical exposure is sufficient to increase the desire of undergraduates to pursue a surgical career. We hope that this SSS will act as a blueprint for other centers to develop their own shadowing schemes, in turn helping to ensure that surgery continues to inspire and attract the very best candidates for the future.

Musculoskeletal Radiology Teaching at a UK Medical School: Do We Need to Improve?

The United Kingdom is currently facing crisis due to a shortage of radiology consultants despite ever-increasing demand for medical imaging. The specifics of how best to teach radiology has generated increasing interest. This study aims to determine whether musculoskeletal (MSK) radiology teaching at the University of Nottingham (UoN) Medical School is perceived to be satisfactory by medical students, Foundation-Year doctors, and senior medical professionals in preparing students for the demands working as Foundation-Year doctors. Questionnaires were distributed to all medical students and Foundation-Year doctors that graduated from UoN (n = 307). Semi-structured interviews were conducted with consultants and teaching staff (n = 13). Forty-nine percent of preclinical medical students, 43% of clinical students and 27% of Foundation-Year doctors thought MSK radiology teaching was not sufficient in preparing them for the radiology challenges Foundation-Year doctors' face. This difference was statistically significant (P < 0.001). The consensus from senior medical professionals was that MSK Radiology teaching is currently adequate and producing competent students. Interestingly, only 5% of students were considering a career in radiology compared to 34% of Foundation-Year doctors. Overall, there seems to be concern among students regarding MSK radiology teaching and students have a lack of confidence with MSK radiology. Foundation-Year doctors and senior medical professionals do not share this view. This may be due to medical students' lack of clarity on what is required of them. Formal documentation of set learning objectives for MSK radiology throughout the curriculum may address this.

Gender Disparities Within US Army Orthopedic Surgery: A Preliminary Report

INTRODUCTION

Women account for approximately 15% of the active duty US Army, and studies show that women may be at an increased risk of musculoskeletal injury during sport and military training. Nationally, the field of orthopedic surgery comprises 14% women, lagging behind other surgical fields. Demographics for US Military orthopedic surgeons are not readily available. Similarly, demographic data of graduating medical students entering Military Medicine are not reported. We hypothesize that a gender disparity within military orthopedics will be apparent. We will compare the demographic profile of providers to our patients and hypothesize that the two groups are dissimilar. Secondarily, we examine the demographics of military medical students potentially entering orthopedics from the Uniformed Services University of the Health Sciences (USUHS) or the Health Professions Scholarship Program.

METHODS

A census was formed of all US Army active duty orthopedic surgeons to include staff surgeons and residents, as well as US Army medical student graduates and orthopedic patients.

RESULTS

There are 252 Army orthopedic surgeons and trainees; 26 (10.3%) are women and 226 (89.7%) are men. There were no significant demographic differences between residents and staff. Between 2014 and 2017, the 672 members of the USUHS graduating classes included 246 Army graduates. Of those, 62 (25%) were female. Army Health Professions Scholarship Program graduated 1,072 medical students, with women comprising 300 (28%) of the group. No statistical trends were seen over the 4 yr at USUHS or in Health Professions Scholarship Program. In total, 2,993 orthopedic clinic visits during the study period were by Army service members, 23.6% were women.

CONCLUSION

There exists a gender disparity among US Army orthopedic surgeons, similar to that seen in civilian orthopedics. Gender equity is also lacking among medical students who feed into Army graduate medical education programs. The gender profile of our patient population is not reflected by that of providers. Because patients prefer providers of the same gender, this is a limitation to patient satisfaction and access to care for musculoskeletal injuries. Further study is underway to identify perceptions and potential causes of these disparities, including the critical perspective of our patients. In addition to the inherent benefits offered by diversity (e.g., expanding the talent pool and more perspectives for decision-making), ultimately it affords a greater ability to maintain a fit and ready force.

Development of a cumulative teaching score for tracking surgeon performance in undergraduate medical education

Background

Surgeon educators are important in undergraduate medical education (UME). However, teaching activities are undervalued and under-recognized compared with research, resulting in poorer quantity and quality of surgeon teaching. The purpose of this study was to investigate teaching roles available to surgeons and the amount of effort involved.

Methods

A comprehensive review of all possible roles surgeons may take in UME at our institution was assembled. Delphi committee members were asked to evaluate each teaching role on the amount of effort needed per hour. Results were analyzed using descriptive statistics, and a Cronbach α of 0.60 or higher was the threshold to declare consensus.

Results

Twenty-five participants, including physicians, residents and medical students, completed the study. Consensus was reached on the amount of effort needed for each teaching role. These values were used to prototype a cumulative teaching score that can be used to qualitatively quantify surgeon teaching.

Conclusion

Surgeon teaching is important in UME, but not tracked and thus not valued. To improve the quantity and quality of surgeon teaching in UME, we need to track, reward and recognize surgeon teaching activities. The “effort score” we developed to objectively and transparently qualify teaching was able to determine the relative effort needed for each teaching activity in UME at the University of Toronto. Combining the effort score and time committed to each teaching activity will produce a cumulative teaching score for each instructor.

Cross sectional analysis of student-led surgical societies in fostering medical student interest in Canada

BACKGROUND

The objective of this study was to examine how surgery interest groups (SIGs) across Canada function and influence medical students' interest in surgical careers.

METHODS

Two unique surveys were distributed using a cross sectional design. The first was sent to SIG executives and the second to SIG members enrolled at a Canadian medical school in the 2016/17 academic year. The prior focused on the types of events hosted, SIG structure/ supports, and barriers/ plans for improvement. The second questionnaire focused on student experience, involvement, and suggestions for improvement.

RESULTS

SIG executives became involved in SIG through classmates and colleagues (8/17, 47%). Their roles focused on organizing events (17/17, 100%), facilitating student contact with resident/surgeons (17/17, 100%), and organizing funding (13/17, 76%). Surgical skills events were among the most successful and well received by students (15/17, 88%). Major barriers faced by SIG executives during their tenure included time conflicts with other interest groups (13/17, 76%), lack of funding (8/17, 47%), and difficulty booking spaces for events (8,17, 47%). SIGs were found to facilitate improvement in basic surgical skills (μ = 3.89/5 ± 0.70) in a comfortable environment (μ = 4.02/5, ±0.6), but were not helpful with final block examinations (μ = 2.98/5, ±0.80). Members indicated that more skills sessions, panel discussion and shadowing opportunities would be beneficial additions. Overall, members felt that SIGs increased their interest in surgical careers (μ = 3.50/5, ±0.79).

CONCLUSION

Canadian SIGs not only play a critical role in early exposure, but may provide a foundation to contribute to student success in surgery.

Student Factors That Influence Clerkship Grades and Matching Into a Surgical Residency

OBJECTIVE

Evaluate the relationship between medical school factors (including preclinical mentorship, order of clerkships, and clerkship grades) and matching into surgical specialties.

DESIGN

Clerkship information, match data, and data on structured preclinical research obtained from 2010 to 2015 for a single institution was obtained and analyzed using multivariate analysis.

SETTING

University of Michigan Medical School.

PARTICIPANTS

Seven hundred and forty-six students who took both the Internal Medicine and Surgery clerkships between 2010 and 2015 and have since participated in the match.

RESULTS

Among 740 students studied, 243 matched into a surgical field. Higher Shelf scores were associated with higher clerkship grades in Surgery and Internal Medicine. Honors or High Pass in Surgery were associated with matching into a surgical field. Structured preclinical research in Surgery and order of clerkship were not associated with matching into a surgical field.

CONCLUSIONS

Students who went into surgery were more likely to receive Honors or High Pass. Preclinical choices geared toward a surgical specialty (e.g., order of clerkship and structured research) were not associated with matching into a surgical field. These data may help guide school specific advice for students.

Attracting medical students and doctors into surgical training in the UK and Ireland

AIMS

Core surgical training (CST) programmes in the UK have seen a significant reduction in competition ratios over the past five years. This study aimed to determine motivating factors and perceived barriers to pursuing a career in surgery amongst junior doctors in training and medical students attending an annual conference.

METHODS

A self-reported, electronic questionnaire was distributed to medical students, foundation year doctors, and doctors in postgraduate surgical training programmes (DIPST) who attended the Association of Surgeons in Training (ASiT) Conference in 2016. Respondents ranked factors attracting them to a career in surgery and factors that could improve perceptions of surgical careers. Chi-square test was used to test for differences between groups (a = 0.05, R Studio, V3.3.1).

RESULTS

Of 394 respondents (response rate = 50.9%), 44.9% were medical students or foundation doctors ('Pre-CST') and 55.1% were DIPST ('Peri/post-CST'). Practical application of skills (97.4%), enjoyment of the theatre environment (95.4%) and positive experiences in surgical firms (84.7%) were primary driving factors towards a surgical career. Availability of private practice (32.2%), and sustainability of consultant jobs (49.0%) had less influence. For 'Pre-CST' respondents, role models (82.8% pre-CST v 74.9% peri-post CST, p < 0.05) and defined career progression (67.2% pre-CST v 47.0% peri-post CST, p < 0.001) were particularly important. 91% of all respondents agreed that a better balance of training and service within worked hours would improve perceptions of surgery.

CONCLUSION

Addressing the motivating factors and perceived barriers to surgical careers will help bolster recruitment of the future surgical workforce.

Introduction of a learning model for type 1 loop excision of the transformation zone of the uterine cervix in undergraduate medical students: a prospective cohort study

PURPOSE

We address the impact of applying loop electrosurgical excision procedure (LEEP) under direct colposcopic vision teaching to our undergraduates using a self-developed simulation model and a standardized assessment to evaluate the progress of learning.

METHODS

The undergraduate teaching module was composed of a theoretical course on cervical dysplasia, colposcopy, electrosurgery and excisional procedures of the uterine cervix. This was followed by hands-on practical rounds. During the hands-on practice the students performed five "type 1" LEEP under direct colposcopic vision on the self-developed simulator. Based on specimen fragmentation and excision accuracy a score system was established. The students were asked to answer a course evaluation questionnaire.

RESULTS

The accuracy of the excisions showed a statistically significant improvement during the five training procedures (excision depth 7.34 ± 1.60-8.54 ± 1.67 mm, p = 0.0041; deviation from target cone thickness 0.88 ± 1.16-0.13 ± 0.94 mm, p = 0.0116). The fragmentation of the conus decreased (2.57 ± 1.26-1.29 ± 0.60 pieces, p < 0.0001). All this led to a general improvement of the LEEP score (2.59 ± 1.93-0.84 ± 1.03, p = 0.001). The student's questionnaire revealed a subjective satisfaction and improvement of their knowledge in pathomechanism, diagnosis and therapy of cervical pathologies.

CONCLUSION

Undergraduate surgical training, in cervical excisional procedure, is a successful method in improving the students' perception and management of cervical pathologies.

Gender-based analysis of factors affecting junior medical students' career selection: addressing the shortage of surgical workforce in Rwanda

BACKGROUND

There is a strong need for expanding surgical workforce in low- and middle-income countries. However, the number of medical students selecting surgical careers is not sufficient to meet this need. In Rwanda, there is an additional gender gap in speciality selection. Our study aims to understand the early variables involved in junior medical students' preference of specialisation with a focus on gender disparities.

METHODS

We performed a cross-sectional survey of medical students during their clinical rotation years at the University of Rwanda. Demographics, specialisation preference, and factors involved in that preference were obtained using questionnaires and analysed using descriptive statistics and odds ratios.

RESULTS

One hundred eighty-one respondents participated in the study (49.2% response rate) with a female-to-male ratio of 1 to 2.5. Surgery was the preferred speciality for 46.9% of male participants, and obstetrics/gynaecology for 29.4% of females. The main selection criteria for those who had already decided on surgery as a career included intellectual challenge (60.0%), interaction with residents (52.7%), and core clerkship experience (41.8%) for male participants and interaction with residents (57.1%), intellectual challenge (52.4%), and core clerkship experience (52.4%) for female participants. Females were more likely than males to join surgery based on perceived research opportunities (OR 2.7, p = 0.04). Male participants were more likely than their female participants to drop selection of surgery as a speciality when an adverse interaction with a resident was encountered (OR 0.26, p = 0.03).

CONCLUSION

This study provides insight into factors that guide Rwandan junior medical students' speciality preference. Medical students are more likely to consider surgical careers when exposed to positive clerkship experiences that provide intellectual challenges, as well as focused mentorship that facilitates effective research opportunities. Ultimately, creating a comprehensive curriculum that supports students' preferences may help encourage their selection of surgical careers.

The Role of the Operating Room in Medical Student Education: Differing Perspectives of Learners and Educators

OBJECTIVE

The surgical clerkship is an integral part of third-year medical student education. The operating room (OR) is a heavily used setting, but it is unclear whether this setting is as effective as possible. To determine the role of the OR and potential improvements, it is necessary to analyze the perspectives of those involved, including surgeons, residents, and medical students.

DESIGN

An electronic survey was distributed to the surgeons, surgical residents, and third-year medical students associated with Rutgers New Jersey Medical School. The questions were a combination of 5-point Likert scale questions and qualitative responses. The questions assessed the role of the OR, the information taught in the OR, the quality of the teaching and environment, and potential improvements.

RESULTS

Attending surgeons and residents generally rated the OR more positively than medical students did. Medical students desired more hands-on participation and a greater focus on learning technical skills. In addition, most medical students rated the feedback and direct instruction in the OR as "poor." Furthermore, the attending surgeons and medical students disagreed about the main roles of the OR as well as the effectiveness of teaching in the OR. The medical students reported experiencing anxiety and intimidation in the OR and suggested several improvements, such as decreasing the length of the surgical clerkship.

CONCLUSIONS

There is significant disagreement between the surgeons and residents and the medical students regarding the roles and effectiveness of learning in the OR. This may help explain the reported medical student dissatisfaction and frustrations with the surgical clerkship.

[Bootcamp: longitudinal gender-based surgical and clinical skills training]

BACKGROUND

Sex parity of medical students has increased to the degree that approximately 50 % of medical students are women. Orthopedic and trauma surgery, however, has not managed to keep up with this trend and women are still grossly underrepresented.

OBJECTIVES

Description of an innovative longitudinal gender-based surgical and clinical skills training course.

METHODS

An elective 5-day modular skills course is offered for third to fifth year medical students. Module 1 aims at teaching basic surgical and communication skills involving local and regional anesthesia, initial experience with arthroscopy, fracture fixation, emergency measures as well as communication skills training using standardized patients. The subsequent modules cover surgical knowledge and skills of increasing complexity. The main goals are to increase the interest in orthopedic trauma surgery and to reduce concerns regarding discrimination and gender-related issues. Learning outcomes are assessed using a 6-item multiple choice questionnaire (MCQ) and a 3-stage objective structured clinical examination (OSCE) regarding induction of anesthesia, arthroscopy simulation and communication skills.

RESULTS

A total of 52 second year medical students (39 females, 13 males) completed module I. There were no differences between men and women with regard to the MCQ and anesthesia and communication skills; however, male students scored significantly higher in the arthroscopy test. All students rated the course as being highly effective in terms of acquisition of knowledge and skills. Almost all participants would recommend the course to fellow students and 70 % of participants stated they would participate in the advanced courses. Female participants in particular reported a marked increase in interest in orthopedic trauma surgery and less concerns regarding discrimination and gender-related issues.

CONCLUSION

The effectiveness of the approach will have to be proven by further evaluation, especially with respect to assessment of career development and application rates of participants. Adaptation of environmental and working conditions to suit women's needs seem to play an important role in promoting new surgery residents.

The role of same-sex mentorship and organizational support in encouraging women to pursue surgery

INTRODUCTION

While women represent approximately half of all medical students, only 38% of general surgery residents are women. The objective of this study is to explore how access to mentors and organizational support affects career choices.

METHODS

In June of 2016, a survey was sent to medical students at a single institution (n = 472). Questions utilized a 5-point Likert scale. A two-sample t-test was used to evaluate data.

RESULTS

A total of 160 students participated in the survey. Among MS1/MS2 students, women were more likely to rank same-sex role models as a positive influence (mean 3.1 vs. 2.4; p < 0.05). Similar results were seen among MS3/MS4 students (mean 3.6 vs. 2.5; p < 0.05). More women ranked the presence of organizations that support women in surgery as being important (mean 4.6 vs. 4.1; p < 0.05).

CONCLUSION

Exposure to same-sex mentors was highly rated among female participants. These findings encourage the creation of national mentorship programs. Early involvement in organizations can positively influence career choice. Addressing gaps in mentorship opportunities and widening accessibility to national organizations are important in reducing barriers.

Choosing Surgery: Identifying Factors Leading to Increased General Surgery Matriculation Rate

Tulane graduates have, over the past six years, chosen general surgical residency at a rate above the national average (mean 9.6% vs 6.6%). With much of the recent career choice research focusing on disincentives and declining general surgery applicants, we sought to identify factors that positively influenced our students’ decision to pursue general surgery. A 50-question survey was developed and distributed to graduates who matched into a general surgery between the years 2006 and 2014. The survey evaluated demographics, exposure to surgery, and factors affecting interest in a surgical career. We achieved a 54 per cent (61/112) response rate. Only 43 per cent considered a surgical career before medical school matriculation. Fifty-nine per cent had strongly considered a career other than surgery. Sixty-two per cent chose to pursue surgery during or immediately after their surgery clerkship. The most important factors cited for choosing general surgery were perceived career enjoyment of residents and faculty, resident/faculty relationship, and mentorship. Surgery residents and faculty were viewed as role models by 72 and 77 per cent of responders, respectively. This study demonstrated almost half of those choosing a surgical career did so as a direct result of the core rotation experience. We believe that structuring the medical student education experience to optimize the interaction of students, residents, and faculty produces a positive environment encouraging students to choose a general surgery career.

Securing an OTL-HNS residency: how competitive is it? Comparing medical student perceptions to actual Canadian statistics

BACKGROUND

The residency match is an important event in an aspiring physician's career. Otolaryngology - Head and Neck Surgery (OTL-HNS) is a surgical specialty that has enjoyed high numbers of applicants to its residency programs. However, recent trends in Canada show a decline in first-choice applicants to several surgical fields. Factors thought to influence a medical student's choice include role models, career opportunities and work-life balance. The notion of perceived competitiveness is a factor that has not yet been explored. This study sought to compare competitiveness of OTL-HNS, as perceived by Canadian medical students to residency match statistics published yearly by CaRMS (Canadian Residency Matching Service), with the hope of informing future decisions of surgical residency programs.

METHODS

An electronic survey was created and distributed to all medical students enrolled in the 17 Canadian medical schools. After gathering demographic information, students were asked to rank what they perceived to be the five most competitive disciplines offered by CaRMS. They were also asked to rank surgical specialties from most to least competitive. Publically available data from CaRMS was then collected and analyzed to determine actual competitiveness of admissions to Canadian OTL-HNS residency programs.

RESULTS

1194 students, from first to fourth year of medical school, completed the survey. CaRMS statistics over the period from 2008 to 2014 demonstrated that the five most competitive specialties were Plastic Surgery, Dermatology, Ophthalmology, Emergency Medicine and OTL-HNS. Among surgical disciplines, OTL-HNS was third most competitive, where on average 72% of students match to their first-choice discipline. When students were questioned, 35% ranked OTL-HNS amongst the top five most competitive. On the other hand 72%, 74% and 80% recognized Opthalmology, Dermatology and Plastic Surgery as being among the five most competitive, respectively. We found that fourth-year medical students were significantly more knowledgeable about the competitiveness of both OTL-HNS and Plastic Surgery compared to first-year students (p < 0.01).

CONCLUSION

Overall, Canadian medical students may underestimate the competitiveness of OTL-HNS. Furthermore, competitiveness would appear to be a concept that resonates with medical students during the match process.

A 5-Year Update on the Uneven Distribution of Women in Orthopaedic Surgery Residency Training Programs in the United States

BACKGROUND

This study was undertaken to update our report from academic years 2004-2005 through 2008-2009, to include 5 additional years of the Association of American Medical Colleges GME Track data. This study will test the hypothesis that, when compared with the data from 2004-2005 through 2008-2009, there were no substantial changes from 2009-2010 through 2013-2014 in the distribution of orthopaedic surgery residency programs that train female residents and have been accredited by the Accreditation Council for Graduate Medical Education (ACGME).

METHODS

Data for all ACGME-accredited orthopaedic surgery residency training programs in the United States were analyzed for 2009-2010 through 2013-2014, in the same manner as our previous report analyzed data for 2004-2005 through 2008-2009. Programs were classified as having 0, 1, 2, or >2 women in training (i.e., for postgraduate year [PGY]-1 through PGY-5) for each of the 5 academic years. Programs were also analyzed for the percentage of female residents in training and were classified as being above the national average (>20%), similar to the national average (between 10% and 20%), or below the national average (<10%) for each of the 5 academic years.

RESULTS

During the time period of 2004 to 2009, the mean percentage of female trainees in U.S. orthopaedic surgery residency programs was 11.6%, and during the time period of 2009 to 2014, this mean percentage increased to 12.6%. Residency programs in the United States do not train women at an equal rate. In the 5 years examined (2009 to 2014), 30 programs had no female trainees and 49 programs had >20% women enrolled in at least 1 of the 5 years, 8 programs had no female trainees enrolled in any of the 5 years, and 9 programs had >20% women enrolled in each of the 5 years.

CONCLUSIONS

Female medical students continue to pursue orthopaedic surgery as a career at rates lagging behind all other surgical specialties. Not all residency programs train women at equal rates. The period of 2009-2010 through 2013-2014 showed a greater percentage of programs (68%) training ≥2 women than the period of 2004-2005 through 2008-2009 (61%). Obstacles to attracting women to orthopaedic surgery should continue to be identified and to be addressed.

Teaching communication and supporting autonomy with a team-based operative simulator

BACKGROUND

Changing residency structure emphasizes the need for formal instruction on team leadership and intraoperative teaching skills. A high fidelity, multi-learner surgical simulation may offer opportunities for senior learners (SLs) to learn these skills while teaching technical skills to junior learners (JLs).

METHODS

We designed and optimized a low-cost inguinal hernia model that paired JLs and SLs as an operative team. This was tested in 3 pilot simulations. Participants' feedback was analyzed using qualitative methods.

RESULTS

JL feedback to SLs included the themes "guiding and instructing" and "allowing autonomy." Senior Learner feedback to JLs focused on "mechanics," "knowledge," and "perspective/flow." Both groups focused on "communication" and "professionalism."

CONCLUSIONS

A multi-learner simulation can successfully meet the technical learning needs of JLs and the teaching and communication learning needs of SLs. This model of resident-driven simulation may illustrate future opportunities for operative simulation.