General surgery and fellowship training: opinions of surgical intern applicants and fellowship directors

Systematic Review of Vascular Surgery Recruitment Strategies for Medical Students and General Surgery Residents

OBJECTIVE

Recruitment into the vascular surgery specialty is an imperative as the specialty faces significant demographic changes. Due to the changing dynamics in vascular surgery training pathways, we sought to review current literature on recruitment strategies and their effectiveness with medical students and general surgery residents.

METHODS

A systematic search, following PRISMA guidelines, was performed by searching MEDLINE, EMBASE, Scopus, CINAHL, and ERIC databases for studies on vascular surgery recruitment methods for medical students and general surgery residents from inception of databases to 12/31/2021. Reports in English discussing recruitment strategies were included. Reports lacking recruitment method data and those with insufficient data were excluded.

RESULTS

Ten reports met inclusion criteria and studied a total of 688 participants. Seven reports (70%) employed simulation, didactic, or online courses. The remaining 30% of studies included data on mentorship, research, or other interventions. Most of the studies (50%) reported data for medical students (MS1-MS4). Interventions specific to residents or both students and residents comprised the other 50% of studies. Simulation and didactic courses increased interest in vascular surgery by a median of 50% (IQR 38) for both medical students and residents. Importantly, without reinforcement, interest was seen to decrease over time.

CONCLUSIONS

Recruitment interventions are useful in increasing student interest in vascular surgery. Early exposure to simulated vascular surgery procedures and mentorship are cited as common reasons for entering the field. Further studies on recruitment strategies focused on long-term outcomes are required.

A focused curriculum in surgical oncology for the third-year medical students

BACKGROUND

Educating medical students in surgical subspecialty fields can be challenging, and the optimal timing and curriculum remain unknown. Despite advocacy for earlier exposure, competing core clerkship rotations often leave little time for subspecialty fields. We report our experience with a novel, short, and focused curriculum in surgical oncology for the third-year medical students.

METHODS

A 2-wk (2009-2010) and a 4-wk (2010-2011) curriculum in surgical oncology were developed for the third-year students at a tertiary-referral cancer center, including formal didactics, rotation in clinical service of students' choosing (breast, gastrointestinal, endocrine, or melanoma), and case-based learning and presentation. Paired pre- and postrotation questionnaires were prospectively completed, including 20 items assessing knowledge and four items assessing experience. Grading was anonymous, and change in score was assessed by Wilcoxon signed-rank test.

RESULTS

Paired questionnaires from 47 students (2-wk rotation, n = 26; 4-wk rotation, n = 21) showed a median improvement of three points (21.4%) from pre- to posttests (P < 0.001). The improvement did not differ by the length of rotation or by the specific clinical service. Nearly all (93%) reported a positive and inspiring experience. The most valuable avenue of learning was reported as the time spent with resident or fellow or attending (92%), followed by self-directed reading (62%) and didactic lectures (28%).

CONCLUSIONS

A short and focused curriculum in surgical oncology, including structured didactics and clinical rotation, had positive impact for the third-year students. Given the increasing work-hour limits, it is important to note that the time spent in the clinical setting continues to be ranked as the most educationally valuable by medical students.

[Insights of young French surgical oncologists: motives and training]

INTRODUCTION

In France, surgical oncology is not recognized as a unique specialty, but as a sub-specialization offered to surgeons in training. To date, their motives and training have not been studied.

MATERIALS AND METHODS

We set a dedicated online survey suggested to 102 surgeons applying for the specific national degree in surgical oncology.

RESULTS

The answer rate was 60%. Responders were constituted of a majority of male (61%), their median age was 31 years. They were mainly residents (33%) and fellows working in university (25%) or non-university (28%) hospitals. Most responders have chosen their organ specialization at the beginning, and their oncologic sub-specialization at the middle of their residency, after a meeting with a senior surgeon. Regarding practical education, 85% used surgical videos, 62% mechanical training devices, 60% animal surgery, and 38% cadaver dissection. Regarding career expectations, 67% would like to work in a cancer centre, 51% in a university hospital, and 26% in a private institution. To explain these choices, 51% referred to research and 65% to teaching interests.

CONCLUSION

This study outlines the role of mentorship and the lack of practical teaching outside the operating room during the training in surgical oncology in France.

Acute-care surgical service: a change in culture

The provision of acute surgical care in the public sector is becoming increasingly difficult because of limitation of resources and the unpredictability of access to theatres during the working day. An acute-care surgical service was developed at the Prince of Wales Hospital to provide acute surgery in a more timely and efficient manner. A roster of eight general surgeons provided on-site service from 08.00 to 18.00 hours Monday to Friday and on-call service in after-hours for a 79-week period. An acute-care ward of four beds and an operating theatre were placed under the control of the rostered acute-care surgeon (ACS). At the end of each ACS roster period all patients whose treatment was undefined or incomplete were handed over to the next rostered ACS. Patient data and theatre utilization data were prospectively collected and compared to the preceding 52-week period. Emergency theatre utilization during the day increased from 57 to 69%. There was a 11% reduction in acute-care operating after hours and 26% fewer emergency cases were handled between midnight and 08.00 hours. There was more efficient use of the entire theatre block, suggesting a significant cultural change. Staff satisfaction was high. On-site consultant-driven surgical leadership has provided significant positive change to the provision of acute surgical care in our institution. The paradigm shift in acute surgical care has improved patient and theatre management and stimulated a cultural change of efficiency.

Vascular surgery training, exposure, and knowledge during general surgery residency: implications for the future

BACKGROUND

Vascular surgery (VS) has been removed from the Canadian general surgery (GS) objectives and has become a primary certificate specialty in the United States, leaving its status in GS uncertain. The purpose of this study was to determine GS residents' perceived competence in VS and to assess their knowledge of VS.

METHODS

GS residents at a university-based program answered (1) a survey of attitudes and experience in VS and (2) a short-answer examination to assess fundamental vascular knowledge.

RESULTS

Twenty-nine of 35 residents participated (83%). Residents reported being inadequately trained in 10 of 13 procedures surveyed despite 6 of these being reported as essential. Although 26 of 29 residents reported an intention to perform vascular procedures, none planned on pursuing a fellowship. The mean examination score was 47%.

CONCLUSIONS

Despite mandatory VS rotations, GS residents feel inadequately trained in VS and have marginal knowledge. Current trainees may lack the skills and abilities to deal with vascular emergencies.

Factors influencing surgical career decisions

OBJECTIVE

The purpose of this project is to evaluate factors that residents consider when choosing a career in surgery or a surgical subspecialty. Once these factors are identified, surgical residency programs may use the information in their recruiting efforts to attract the most qualified applicants for postgraduate surgical training.

DESIGN

A descriptive survey consisting of 20 questions was conducted. Surgical residents were surveyed about student loan debt, career decisions and influencing factors, and demographic data.

SETTING

A 2-page, Institutional Review Board-approved, survey was mailed to program directors of 40 general surgery residency programs. Included in the packet were copies of the survey, a letter to the program director, and a self-addressed prestamped envelope for return of the completed survey. The program directors were asked to have their residents complete the survey during a normally scheduled meeting and to collect and return the surveys.

PARTICIPANTS

General surgery residents in residency programs randomly chosen throughout the country were surveyed. These residents included all postgraduate levels of training.

RESULTS

Among 6 choices for entering a surgical residency, a strong desire to become a surgeon was the response chosen most often by residents. Over 50% of those surveyed indicated that they planned to pursue subspecialty training. Family ties was the most quoted influencing factor for choosing a geographical location for practice. Amount of student loan debt correlated with the perception of medical school being a financially wise decision, yet had little influence on the decision to subspecialize.

CONCLUSIONS

A strong desire and passion for surgery was the predominant reason for choosing a career in surgery in this survey. Only 15% of general surgery residents surveyed intend to join the workforce as general surgeons. With the rising average age of the general population, this implies a significant shortage of general surgeons in the near future.

Pediatric surgical training: an historic perspective, a formula for change

BACKGROUND/PURPOSE

American pediatric surgical education has more than a 65-year history of formalizing the organization and the curriculum of the training process. However, never before have so many simultaneous internal and external forces appeared on the horizon that have the collective potential of influencing the quality of future pediatric surgeons. It is the purpose of this study to identify and detail these opportunities, compare them with the historical past, and propose the beginnings of a strategy to control the destiny. The ultimate goal should be to continue to assure that pediatric surgeons are of the highest attainable quality that will optimize the surgical health of America's children.

METHODS AND RESULTS

Using a current literature review, 7 specific influencing forces have been identified: a declining applicant pool, the generation-X factor, medical economics, early specialization of training, restricted residency work hours, pediatric surgical manpower, and competency-based surgical education. An effective response to these forces is multifactorial, but a first need might be consideration of a new educational oversight organizational structure for pediatric surgery. Thereafter, specific curricular reform is needed to match the strengths of the candidates as well as the training programs. Finally, as a specialty field we must assert the leadership needed to define optimal educational outcomes.

CONCLUSIONS

This report defines the educational history and the contemporary influencing forces, and it proposes a strategy to assure that pediatric surgical education exceeds the needs of America's children into the future.

Audition electives during surgical residency and selection for post-residency fellowship positions

PURPOSE

This study sought to determine the impact of surgical resident elective rotations, termed "audition" electives, upon the selection processes of surgical subspecialty residency positions, and to establish the incidence and character of resident personal contact before selection with the program where they ultimately located in order to appropriately council residents in achieving their educational and professional goals.

METHODS

A national survey of all surgical subspecialty programs for academic year 1999/2000 was conducted to determine whether the current first-year subspecialty residents had been on a clinical rotation of the subspecialty at their institution during their general surgery residency, had participated in research efforts of the specific subspecialty at their institution, and whether the resident's prerequisite general surgery training was obtained at their parent sponsoring institution.

RESULTS

Seventy-two percent of 348 programs responded, representing 396 beginning surgical subspecialty residents for the surveyed academic year. Overall, 73% of first-year surgical subspecialty residents did not have direct prior personal contact with their subspecialty program either through a clinical rotation at the institution or through research as a general surgery resident. Eighty-four percent of first-year surgical subspecialty residents did not complete their general surgery residency at the parent sponsoring institution of the subspecialty program.

CONCLUSIONS

An audition elective does not appear to significantly influence the process of surgical subspecialty resident selection. The findings further validate the fairness of the selection processes.

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.