What influences medical students' choice of surgical careers

Importance of future motivation for skill acquisition among medical students undergoing endoscopic forceps training

BACKGROUND

In recent years, surgical procedures have shifted from open thoracotomy and laparotomy to minimally invasive endoscopic surgery, making endoscopic forceps training essential. In our department, we teach endoscopic forceps training to medical students in dry laboratories. We examined differences in the skill acquisition of medical students undergoing endoscopic forceps training.

METHODS

Ninety-eight fourth-grade students at Kagoshima University Graduate School of Medicine underwent endoscopic forceps training every day in a dry laboratory during a two-week period in our department. Before the start of the training, we administered a questionnaire. We focused on the differences in skill acquisition levels between the first and second halves of the training period.

RESULTS

Twenty-eight of the 63 male students and 9 of the 35 female students aspired to become surgeons (hereafter: "aspiring surgeon group"). All students showed a significant improvement in their skill acquisition from the first to the second half (p < 0.001). At the start of training, there was no difference in skill acquisition between the 37 in the aspiring surgeon group and the other students. However, during the second half of the training, the aspiring surgeons acquired skills significantly faster (p = 0.007). Among them, male aspiring surgeons, in particular, acquired skills significantly faster. Focusing on the speed of skill acquisition, there was no correlation between sex (p = 0.18) or sports activity (p = 0.64) and improvement in endoscopic forceps skills.

CONCLUSIONS

In dry laboratory endoscopic forceps training among medical students, all participants showed skill improvement with repeated practice. However, aspiring surgeons demonstrated significantly faster improvement, likely due to clear goal setting. As demonstrated in this study, goal-setting in student education may be associated with skill acquisition.

Introducing Novel Surgical Clinical Correlations Into an Undergraduate Medical Anatomy Course

Anatomy education is a hallmark of many preclinical medical school curricula, but students are often unable to identify the clinical relevance of anatomy and its applications. Vertical curricula that integrate clinical concepts into the preclinical basic science years and vice versa have been shown to benefit student learning and increase educational enjoyment. This study explores second-year medical students' perceptions of the integration of clinical surgical concepts and surgical faculty into a preclinical digestive system (GI) anatomy course. The GI anatomy course at Rutgers New Jersey Medical School was modified to build on traditional anatomy content by correlating it directly with clinical surgical content. This included a novel, focused anatomy and surgery correlations booklet and surgical videos relevant to anatomical topics. Additionally, practicing general surgeons came to the anatomy lab to interact with the students and provide further clinical relevance. Survey data were collected regarding students' perceptions of integrating surgical concepts and surgeons into the anatomy curriculum, and exploring factors influencing their interest in a surgical career. The data revealed that students valued both the correlations booklet and interacting with surgeons in the anatomy lab. When ranked on a five-point Likert scale, students found both surgeons in the laboratory (M = 4.15, SD = 0.86) and the surgical correlation booklet (M = 3.52, SD = 0.51) helped them in learning the anatomy curriculum. The data did not suggest a direct relationship between interacting with surgeons in the anatomy lab and student surgical career interest. Instead, students reported additional experiences (i.e., shadowing and preceptorships) and anatomical dissection as influencing their career decisions. This study provides further evidence for the benefits of a vertical medical school curriculum by integrating clinical content and formal interactions with clinicians during the preclinical curriculum. The findings also demonstrate that further research should be completed to understand the factors influencing student interest in a surgical career.

Empowering Futures: The Impact of Surgical Research Pipeline Programs on Undergraduate Career Development

PURPOSE

Surgical research pipeline programs provide a unique insight into academic surgery, offering a distinctive opportunity for aspiring future surgeons and medical professionals to identify suitable mentorship. The objective of this study was to determine the impact of an academic summer research, shadowing, and mentorship program on undergraduate students with interest in the fields of medicine and surgery.

METHODS

We conducted a convergent mixed methods study on undergraduate students who participated in the Surgery Undergraduate Research Experience (SURE) program from 2017 to 2022, excluding the 2020 cohort as their experience was highly impacted by COVID-19. SURE, program connected academic surgeons with students interested in medicine, involving them in research, lectures, and clinical shadowing. Students completed questionnaires and participated in semi-structured focus group interviews to assess the program's impact on their career goals.

RESULTS

Twenty-five undergraduate students completed the self-administered survey with a response rate of 51.0% and 5 participated in the focus group interviews. Among the participants, 12 (48.0%) students were currently enrolled in medical school, while an equal proportion had taken their Medical College Admission Test (MCAT) and were in the process of applying to medical school. 88.0% believed that their involvement in the program significantly increased their interest in academic surgery and empowered them to pursue a career in medicine. 84.0% reported that the program helped them find the right mentorship and guidance, while 80.0% reported increased proficiency in research skills. These quantitative findings were further substantiated by qualitative data obtained through focus group interviews. From these interviews, 4 noticeable emergent themes highlighted by the participants included the significance of right mentorship, a deeper understanding of healthcare and surgical career paths, increased research literacy, and career development.

CONCLUSION

Early exposure to surgical practices and mentorship significantly enhanced the enthusiasm of undergraduate students toward a surgical career while expanding their comprehension of surgical professions. Investing in such pipeline programs can exert a positive influence on undergraduate students' perceptions of surgical careers, thereby creating new avenues of opportunity for them.

Current level of rheumatology teaching amongst undergraduate medical students: a systematic literature review

Data from the British Society of Rheumatology demonstrate a lack of exposure to rheumatology for medical students, potentially impacting career choice. We conducted a Systematic Literature Review (SLR) on quantity, type and quality of rheumatology teaching for undergraduate medical students. This SLR was registered on PROSPERO (CRD42023472169). Articles published in English-language until February 2024 were included. Information was extracted on demographics, method(s) and hours for rheumatology teaching, and students' and educators' feedback, where reported. Eight cross-sectional studies were included, published between 1981 and 2024. Studies were conducted in UK (3); USA (2); Australia (1); Pan-European (1) and Uganda (1). Year of rheumatology teaching at medical school was reported in four studies (three UK; one USA). The three UK studies taught rheumatology in the latter years of study; in the USA study, rheumatology was taught every year. Duration of exposure to rheumatology was 15-96 h per student. Reported teaching methods included lecture-based, rheumatology inpatient service, shadowing consultations and patient education. Student feedback was available in one (UK based) study- four students felt they had limited exposure to rheumatology; eight considered it "niche". Factors identified for poor exposure to rheumatology included lack of full-time rheumatologists on the school's faculty; lack of specialty training programmes in local hospitals; greater emphasis on acute specialties (e.g. emergency medicine). Exposure to and student awareness of clinical rheumatology has markedly decreased over time. Given the ageing population and increase in multimorbidity, there is a need to increase exposure and encourage entry to rheumatology training. Key Points • There are clear differences between the methods of rheumatology teaching between institutions and countries. • Teaching hours dedicated to undergraduate rheumatology education have overall markedly decreased over time, resulting in variable student awareness of the depth and breadth of this speciality. • The overall lack of exposure to rheumatology in undergraduate programmes has been associated with a lack of uptake of rheumatology as a career amongst medical students globally. • Our results indicate a need for a minimum required number of hours of teaching dedicated to rheumatology, delivered by specialists as well as a standardised undergraduate curriculum of competencies to better reflect the needs of our increasingly ageing and multimorbid population.

Serve Coffee, Hold Clamps, Do Not Complain: Student Perceptions and Experiences Regarding Surgery

OBJECTIVE

To explore medical students' perceptions and experiences regarding the surgery clerkship and surgeons.

DESIGN

Between November 2021 and February 2022, an anonymous prepost survey study was performed among 2 consecutive cohorts of medical students. The survey was taken 6 weeks prior to the surgery clerkship and repeated shortly after the surgery clerkship.

SETTING

Single-center prepost survey study.

PARTICIPANTS

Medical students studying at Erasmus Medical Center entering a 6-week surgery education block directly followed by a ten-week surgery clerkship.

RESULTS

The preclerkship response rate was 100% (n=145). One out of 5 students considered a surgical career (21%). Half of the students expected to be negatively treated (55%), mainly in terms of hierarchy and offensive language. The postclerkship response rate was 70% (n=101). Interest in a surgical career increased significantly from 21% to 50% (p<0.001). Thirteen students (13%) reported being negatively treated during their surgery clerkship, mainly in terms of poor supervision of their learning process and nonconstructive feedback.

CONCLUSIONS AND RELEVANCE

Stereotypes of surgeons and the surgical clerkship are strongly prevalent among medical students. Half of the students enter the surgery clerkship with negative perceptions. Fortunately, the surgery clerkship debunked prejudices and increased interest in surgery. Poor supervision and feedback during the surgery clerkship were experienced as negative treatment, emphasizing the importance of cultivating a safe learning climate.

The die-hards, negotiators and migrants: Portraits of doctors' career pathways through specialisation

INTRODUCTION

Global workforce shortages in medical specialties strain healthcare systems, jeopardising patient outcomes. Enhancing recruitment strategies by supporting professional identity (PI) development may be one way to address this workforce gap-yet little research has explored this topic. The goal of the current study was to explore specialty-specific recruitment through considering PI. As proposed causes of workforce shortages in anatomical pathology (AP) bear similarities to many other specialties, this study uses the field of AP as a model for specialist PI development and asks: (1) why, how and when do doctors choose to pursue AP training and (2) what can be learned from this for recruitment to AP and other specialties?

METHODS

A qualitative research approach was undertaken using narrative inquiry. Interviews with junior doctors interested in AP, AP registrars and AP consultants from Australia and New Zealand were interpreted as stories via 're-storying'. Narrative synthesis of participants' collective stories identified chronological key events (i.e. 'turning points') in choosing AP.

RESULTS

Narrative synthesis resulted in identification of three portraits entering medical specialist training: (1) die-hards, deciding upon initial exposure; (2) negotiators, choosing after comparing specialties; and (3) migrants, seeking to move away from non-pathology specialties. The negotiators and migrants cemented their decision to pursue AP as a postgraduate doctor, whereas the die-hards made this decision during medical school.

CONCLUSIONS

Given the similarities in portrait traits between AP and other specialties across the literature, our results suggest ways to support specialty recruitment using PI development. We propose a medical specialist recruitment framework to support the PI development of doctors with die-hard, negotiator and migrant traits. Use of this framework could enhance current specialty-specific recruitment approaches, particularly in fields challenged by workforce shortages.

Surgical experiences of final-year undergraduates and the impact on their career aspiration stratified by sex/gender

Objectives

Surgical undergraduate training takes place in a male-dominated work environment that struggles with recruitment problems. Experiences of cultural and sex/gender-specific barriers of women in surgery have been reported worldwide. Overall, the experiences that students have in coping with the emotional impact of surgery as a profession are thought to be crucial to their subsequent career choices. We investigated whether students' self-reported experiences differed by sex/gender in terms of frequency and content, and whether they were related to their career aspirations.

Methods

In Germany, the final year represents the last part of the undergraduate medical study program. At the Mannheim Medical Faculty, a 12-week surgical training is mandatory. After completing their surgical training, the students were asked about their experiences and their later career aspirations. These experiences were analysed using quantitative content analysis. The relationship between the quality of experience and career aspirations as well as sex/gender differences were statistically measured.

Results

In the 475 questionnaires analysed (response rate 52%), the number of positive and negative mentions does not differ by sex/gender. However, male students feel more actively involved and female students feel poorly briefed and think that supervisors are less interested in their training. A significant influence on career aspirations was found in the performance category for female and male students, and in the supervision category for female students.

Conclusion

The positive experiences that students gain while performing surgical activities have an impact on their subsequent career choices. In particular, a good settling-in period and encouragement to actively participate could help to attract more women to surgery.

The state of vascular surgery education in the United States

With the growing proportion of elderly population in the US and a relatively fixed supply of well-trained vascular surgeons, there is a serious concern that we will be facing a shortage of vascular surgery workforce in the near future. One of the main reasons why there is a shortage of vascular surgeons in the US is due to the fact that many students don't get exposed to this field throughout their student lives and a recent survey of medical students from a non-urban tertiary care academic institution showed that early exposure of the medical students to the surgical careers is correlated with an increased interest in the surgical field. This review of the state of vascular surgery education in the US at the undergraduate level describes in detail the importance of an early introduction to vascular surgery in the education curricula, the current state of the education, potential avenues to improve the exposure of students to the field of vascular surgery and the importance of this effort in matching the increasing need for vascular surgeons for an aging population which is likely to require dedicated care by vascular surgeons of the future. At the present time, the two pathways by the Accreditation Council for Graduate Medical Education (ACGME) to obtain dedicated vascular surgery training in the US include either enrolling in a two year clinical fellowship after completion of general surgery training or to match in a five year vascular surgery integrated residency program after successful completion of medical degree.

Factors Influencing the Preference of Medical Students at Umm Al-Qura University for Otorhinolaryngology-Head and Neck Surgery as a Future Specialty: A Cross-Sectional Study

BACKGROUND

Otorhinolaryngology (ORL) specialists treat patients of different ages, ranging from elderly patients with head and neck tumors to neonates with respiratory problems. No studies have been conducted to explore the factors that affect the preference for ORL among Umm Al-Qura University students. We aimed to investigate factors and motivators influencing medical students at Umm Al-Qura University in Makkah, Saudi Arabia, who choose to pursue a career in ORL-head and neck surgery.

METHODS AND MATERIALS

This cross-sectional study was conducted over two months in 2023 among 439 students in the pre-clinical, clinical, and internship years of the Faculty of Medicine at Umm Al-Qura University, Saudi Arabia. We shared a Google Forms questionnaire (Google, Inc., Mountain View, CA) and explored factors associated with interest in ear, nose, and throat (ENT) as a future specialty. We used Pearson's chi-square test to arrive at the results.

RESULTS

A total of 339 (77.2%) participants were female. Participants were evenly divided between pre-clinical years (213 (48.5%)) and clinical years (207 (47.2%)), with a smaller percentage in the internship category (19 (4.3%)). ORL involvement was reported in 159 (36.2%) of the participants.

CONCLUSION

The surgical specialty of ORL focuses mostly on conditions affecting the head, neck, nose, and ears. Since students found this specialty fascinating, we recommend that senior doctors make a greater effort to enlighten doctors-in-training about this field of expertise through lectures and campaigns at hospitals and universities.

Addressing Barriers to Entry and Retention of Women in Interventional Vascular Specialties With Proposed Solutions: A Scientific Statement From the American Heart Association

Representation of women in interventional vascular fields (interventional cardiology, interventional radiology, and vascular surgery) lags behind that in other specialties. With women representing half of all medical school graduates, encouraging parity of women in these fields needs to start in medical school. Barriers to pursuing careers in vascular intervention include insufficient exposure during core clerkships, early mentorship, visibility of women in the field, length of training, lifestyle considerations, work culture and environment, and concerns about radiation exposure. This scientific statement highlights potential solutions for both the real and perceived barriers that women may face in pursuing careers in vascular intervention, including streamlining of training (as both interventional radiology and vascular surgery have done with a resultant increase in percentage of women trainees), standardization of institutional promotion of women in leadership, and professional and industry partnerships for the retention and advancement of women.

A Mentorship-Based Surgery Clerkship: A Prospective Study Investigating Student Satisfaction

BACKGROUND

Interest in general surgery has steadily decreased among medical students due to negative perceptions of surgeons, a lack of meaningful clerkship involvement, and inadequate mentorship. We implemented a novel mentorship-based surgery clerkship (MBSC) in which each student was matched with a resident mentor with the goals of enhancing student learning experience, meaningfulness, and interest in surgery. We hypothesized that students participating in the MBSC would report increased confidence in surgical competencies, exposure to surgical faculty, and positive perception of surgery, with no detriment to clerkship grades.

METHODS

Mentors were instructed to provide the following when asked by the student: (1) weekly feedback; (2) personalized goals; (3) daily cases; (4) specific videos; (5) presentation subjects; (6) operating room skills coaching. A 5-point Likert Scale survey was distributed to the students pre and post clerkship, and median differences in Likert Scale Score pre and post mentorship were compared between mentored and control groups using the unpaired Wilcoxon's test. This was a two-arm, nonrandomized trial comparing traditional curriculum with the mentored program.

RESULTS

The total sample size was n = 84. When comparing mentored to control, Wilcoxon's analysis showed greater post clerkship increases in confidence in operating room etiquette (P = 0.03), participating in rounds (P = 0.02), and suturing (P < 0.01). There were greater increases in perceived surgeon compassion (P = 0.04), respectfulness (P < 0.01), and teaching ability (P < 0.01). Median scores for meaningfulness overall (P = 0.01) and as measured as a feeling of positively impacting a patient (P = 0.02) were also increased when comparing mentored to control. More students were encouraged by a surgeon to pursue surgery (P = 0.01) and consider a surgery career themselves (P = 0.02).

CONCLUSIONS

An MBSC increases meaningfulness, confidence, skills, and exposure in various surgical competencies. Compared to nonmentored students, MBSC students have more positive perceptions of surgeons and are more likely to pursue surgery.

Representation of Women Authorship in the Top 5 Transplantation Journals in the United States

BACKGROUND

In the United States, only 13% of transplant surgeons are women. We evaluated gender distribution and trends of American authorship over the past 10 y in high-impact solid organ transplantation journals to gain insight into the current status of women authorship in transplantation.

METHODS

Original articles from 2012 to 2021 from the 5 highest-impact solid organ transplantation journals were extracted from Scopus. First and last author's gender was predicted using Genderize.io. Data of first and last authors, article type and topic, location, citation, and funding metrics were analyzed. Chi-square, logistic regression, and trend tests were performed where appropriate. Statistical significance was set at <0.05.

RESULTS

Women's first and last authorship increased over time among all journals. There was an increase in women first authors in the American Journal of Transplantation and in senior women authors in Liver Transplantation and Transplantation . Significant differences in gender authorship in lung, intestine, pancreas, general, and islet cell transplantation were found. Women's last authorship was associated with 1.69 higher odds of having a woman first author when adjusting for year and journal. There was an increase in the rate of women's first and last author collaborations over the years. Women last authors had 1.5 higher odds of being funded by the National Institutes of Health over the years.

CONCLUSIONS

Despite an increase in women transplant surgeons and physicians, the gap in women authorship in transplantation persists. Women's last authorship was associated with higher odds of having a woman first author, pointing to the importance of mentorship for women joining the transplant academia.

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.

Attractiveness and gender dynamics in surgical specialties: a comparative analysis of French medical graduates (2017-2022)

BACKGROUND

French medical graduates undertake a national examination at the end of their studies with a subsequent national ranking. Specialty is then chosen by each candidate according to their ranking. This study aims to describe the attractiveness of surgical specialties and the evolution of the male-female distribution among French medical graduates (FMG) from 2017 to 2022.

METHODS

Our database included the candidates' ranking, sex and choice of specialty from 2017 to 2022. It included all French medical graduates from 2017 to 2022 and all French medical schools. A linear regression was performed to predict future trends. Dependent variables were mean rankings and the percentage of women. The independent variable was year of application. A Pearson correlation was performed to examine any relationship with mean workweek.

RESULTS

A total number of 5270 residents chose a surgical programme between 2017 and 2022. The number of residents who were assigned their desired surgical programme held stable at 878 surgical residents per year. Plastic and reconstructive surgery remained the most frequently chosen surgical programme. Thoracic and cardiovascular surgery was the least frequently chosen surgical programme between 2017 and 2022. The mean ranking for a candidate choosing a surgical programme rose significantly by 9% from 2017 to 2022 (p < 0.01). Neurosurgery exhibited the greatest fall as a surgical specialty as its rankings decreased by 163.6% (p < 0.01). Maxillo-facial surgery was the only specialty with a statistically significant increase in its rankings by 35.9% (p < 0.05). The overall proportion of women was 51.1%. Obstetrics-and-gynecology was the highest represented specialty among female candidates, with a mean of 83.9% of women. Orthopedic surgery was the lowest represented, being composed of a mean of 28.6% of women. The number of female surgical residents increased significantly over the six-year period, by 7.6% (p < 0.01).

CONCLUSIONS

More and more medical school graduates decide not to choose surgery for their residency programme. Some specialties continue to be attractive while many are losing their appeal. While there does appear to be progress towards gender equity, further investigation is necessary to assess its actual implementation.

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 impact of gendered experiences on female medical students' specialty choice: A systematic review

BACKGROUND

Women make up 50% of American medical school graduates, yet are not equally represented in the vast spectrum of medical specialties. Many fields within medicine remain male dominated. This systematic review will explore social factors that affect female medical students' specialty choice.

HYPOTHESIS

Gendered experiences influence the specialty choice of female medical students, resulting in their concentration in a specific cohort of specialties.

METHODS

Studies were gathered by searching MEDLINE/Pubmed and EBSCOhost for sociological factors that impact female medical students' specialty choice.

RESULTS

34 articles were selected for this systematic review. Factors that contribute to gender segregation within medical specialties include gender discrimination, socialization, lifestyle considerations, negative perceptions of male-dominated medical specialties and lack of female role models.

CONCLUSION

This systematic review supported the hypothesis that gendered experiences impact women's medical specialty choice, and thus result in their concentration in specialties such as family medicine, pediatrics and obstetrics and gynecology.

The state of general surgery residents in Italy after COVID-19 outbreak: a nationwide cross-sectional study

INTRODUCTION

A significant reorganization of working activities including those of teaching hospitals occurred after COVID-19 outbreak, leading to the need to re-assess the current status of training after the pandemic. This study aimed to investigate the state of general surgery (GS) residency in Italy. The impact of COVID-19 on GS residents was also assessed.

METHODS

Between October and November 2020, an anonymous online survey was distributed to GS residents across Italy. Email addresses were provided by the Regional Committees of the Italian Polyspecialistic Society of Young Surgeons. The residents completed a set of questions regarding their training schedule and three standardized questionnaires to measure burnout and psychological distress.

RESULTS

Overall, 1709 residents were contacted and 648 completed the survey. Almost two-thirds of the residents (68.4%, n = 443) reported to not reach the minimum annual operative case volume. According to ordinal logistic regression analysis, two of the most perceived effects of COVID-19 by trainees on training were reduction of surgical activities (OR = 2.21, p < 0.001) and increased concerns about future employment (OR = 1.14, p = 0.025). Loss of training opportunities was also associated with a significant increase of distress (OR = 1.26, p = 0.003) but not with burnout.

CONCLUSIONS

This study provided a snapshot of the situation of GS residents in Italy after COVID-19 outbreak. Reduction of activities due to pandemic highlighted the need to improve the level of surgical education in our country by implementing all the new available tools for training and ensuring at the same time the well-being of the residents.

Diversity in American Society of Transplant Surgeons Governance: Equitable but Unequal

OBJECTIVES

The diversity in the governance of the American Society of Transplant Surgeons has not been described. We aimed to quantify the present state of its leadership as a baseline to inform future research.

MATERIALS AND METHODS

Lists of leaders on the American Society of Transplant Surgeons Council, the COVID-19 Strike Force, and 20 different American Society of Transplant Surgeons committees were obtained from the Society's website. Demographic and training information for the members were compiled through internet searches and analyzed.

RESULTS

The American Society of Transplant Surgeons Council included 15 members, with 20% women. It was 93.3% non-Hispanic White. The COVID-19 Strike Force included 12 surgeons, 16.7% of whom were female, with 75% non-Hispanic White. Of the 198 committee members, 23.7% were women, 68.7% were nonHispanic White, 16.6% were Asian, 8.1% were Hispanic, and 6.6% were Black. Among female committee members, underrepresented minorities comprised 23.6%. Committee chairs included 23% women, 23% underrepresented minorities, and 2.3% minority women. International medical graduates were more likely men (P = .02).

CONCLUSIONS

Representation of women in the American Society of Transplant Surgeons leadership has kept pace with their membership in the transplant surgery workforce. There is a deficiency of female under - represented minorities in leadership positions at the Society. Further interventions are required to recruit underrepresented minorities to transplant surgery, catalog their footprint in the workforce, and champion their role as leaders within the American Society of Transplant Surgeons.

Near-Peer Teaching in Conjunction with Flipped Classroom to Teach First-Year Medical Students Basic Surgical Skills

BACKGROUND

There is increasing evidence that students are completing medical school with insufficient surgical education. Near-peer tutoring and flipped classroom formatting may be used to enhance learning while simultaneously relieving faculty burden of teaching. Here, we qualitatively evaluate a 3-month course that integrates the use of near-peer teaching and flipped classroom formatting, with the goal of increasing first-year medical students' self-perceived confidence in performing basic sutures and knot-ties as well as interest in surgery.

METHODS

Twenty-one first-year medical students participated in a suturing and knot-tying course led by senior medical students. The course consisted of 2-h sessions held every 2 weeks for a total of five sessions. Students were sent publicly available videos prior to each session by which to learn the upcoming techniques and received live feedback from instructors during sessions. Questionnaires were completed pre-course and post-course.

RESULTS

Compared to pre-course ratings, post-course ratings of self-perceived confidence to perform various knot-ties and sutures all increased significantly (p < 0.05). All students stated that the course strengthened their desire to pursue a career in surgery. Student feedback of the course was overall positive.

CONCLUSIONS

Near-peer teaching can be used in conjunction with flipped classroom to increase first-year medical students' self-perceived confidence in surgical suturing and knot-tying as well as interest in surgery. This curriculum may serve as an outline for student-led courses at other institutions.

"Why would you want to do that?"Surgical Interns Reflect on Discouragement From Entering Surgical Fields

INTRODUCTION

Decreasing numbers of medical students are choosing to pursue surgical careers. This study highlights individual experiences of surgical interns receiving discouragement from pursuing surgery as a career.

METHODS

We interviewed 24 incoming surgical interns from 7 institutions and 7 surgical subspecialties about their experiences with discouragement from surgery.

RESULTS

All surgical interns discussed experiencing discouragement from pursuing surgery as a career. Family, friends, the general public, and medical professionals, including surgeons, served as sources of discouragement. Reasons for discouragement fell into 3 main themes: The Surgeon and Surgical Culture, The Sacrifices, and The Sexism. Despite its pervasiveness, participants reconciled the discouragement received.

DISCUSSION

Discouragement from surgery is pervasive and centered around surgeon stereotypes and perceptions of surgical culture, significant personal sacrifices required, and traditional gender-related expectations. These results highlight the importance of individual surgeons' comments on student experience and can be used to improve the perception of surgery amongst prospective interns.

Are Undergraduates Familiar with Nephrology as a Medical Specialty? A Single Site Survey of Undergraduate Students

Background

Over the past decade, nephrology has experienced a 43% decline in the number of fellowship applicants. Previous studies examining why residents choose a fellowship program cite lack of exposure as a main factor having an effect against a career in nephrology; however, no studies have surveyed the undergraduate population to inquire whether they recognize nephrology as a medical specialty compared with other medical specialties. We conducted a survey at a primarily undergraduate institution in the Southeast United States to test whether undergraduate students identified the word "nephrology."

Methods

A total of 274 undergraduates responded to a survey that requested them to select every medical specialty that they recognized by name (15 real specialties and one fictitious specialty). Demographics regarding sex, race, collegiate level, high school location, premedical track, and household income were collected. Correlations between survey findings and rates of application and average salary per specialty were assessed.

Results

Out of 15 medical specialties, nephrology (29%) and pulmonology (40%) were the least recognized. Pediatrics (97%) and surgery (97%) ranked highest. Sex, race, collegiate level, and household income were not different between those students who recognized "nephrology" and those who did not. Premedical students were about twice as likely to have recognized nephrology versus nonpremedical students (49% versus 22%, respectively; P<0.001). STEM majors were about twice as likely to identify nephrology versus non-STEM majors (40% versus 20%, respectively; P<0.001). The proportion of undergraduate students who recognized a specific medical specialty significantly correlated only with the number of US applicants per fellowship position across different medical specialties in 2020 (P<0.05).

Conclusions

On the basis of word association alone, nephrology is the one of the least recognized specialties by undergraduates. The discrepancy between nephrology and other specialties highlights a gap in name recognition at an early career stage, even among premedical students.

The Effect of COVID-19 on the Medical School Experience, Specialty Selection, and Career Choice: A Qualitative Study

OBJECTIVE

While COVID-19 had a profound impact on healthcare, its effects on medical students are less clear. This study explored the effects of COVID-19 safety measures on medical students' specialty selection and career choices. It further considers the potential differential effects of COVID by gender.

DESIGN

Between June and November 2020 at a Midwestern medical university, medical students with an anticipated graduation in 2021 through 2023 participated in virtual focus group sessions, which explored students' transition to remote learning during COVID-19, perception of gender bias within medical education, and personal and professional goals. Nine focus groups were held, with two to six students per session (n = 22). Focus groups were video recorded, transcribed verbatim, and data were deidentified. Transcripts were coded and analyzed using consensual qualitative analysis to identify themes.

RESULTS

Our analysis captured 3 themes: (1) Impact of Institutional Decision-Making due to COVID-19, (2) Impact of Unstructured Time on Professional and Personal Decision Making, and (3) Impact of Societal Pressures, Gender Bias, and Mentorship on Career Planning.

CONCLUSIONS

COVID-19 disrupted important learning opportunities for medical students. Mentorship and shadowing are critical in helping students make career and specialty decisions, particularly for women. The loss of these opportunities may have lasting career impacts for all students.

Medical Students' Exposure to Plastic Surgery: A Cross-sectional Review of Scholarly and Academic Opportunities

Specialty exposure is most influential in a medical student's decision to pursue plastic surgery training. We aimed to understand what opportunities exist for students through national plastic surgery organizations.

Methods

The American Board of Plastic Surgery, American Society of Plastic Surgeons, and The Aesthetic Society provide online lists of related organizations. Cross-referencing lists yielded 47 unique organizations. Screening for presence of annual meeting and relevance to student and resident education yielded 14 organizations. Bylaws/web-domains were reviewed for information related to the annual meeting, leadership opportunities, membership, grants, and travel scholarships. If available, previrtual/in-person and virtual meeting prices were collected. Lastly, discrepancies between webpage information and phone/email correspondence were noted.

Results

All (100%) organizations welcomed students at annual meetings. Eleven promoted student presentation/submission. Average student registration fee was $109.3 ± SD$136.5 compared with $181.20 ± SD$157.20 for residents. Of organizations providing previrtual and virtual pricing (n = 10, 71.4%), there was an average price reduction in student registration of $92 (range: $0-375). Average student membership was $31.70/year ± SD $45.50 compared with $38.80 per year ± SD $65.90 for residents. The percentages of organizations offering student research grants, travel scholarships, and national student leadership were 21.4% (n = 3), 35.8% (n = 5), and 28.6% (n = 4) respectively. No organizations had student chapters/committees. All organizations (100%) contained at least one discrepancy between webpage/bylaw and email/phone.

Conclusions

Our results suggest that although national opportunities seem to be limited, a role exists for further engagement, with interested students eager to take the initiative. Virtual conferences present a lower-cost alternative for students and residents.

Ophthalmology as a career choice among medical students: a survey of students at a Canadian medical school

BACKGROUND

There is a lack of investigations into the factors that lead medical students to pursue increasingly competitive post-graduate training programs. We sought to determine the factors that influence medical students' opinions on ophthalmology as a career and on ophthalmological medical education.

METHODS

An anonymous 36-question survey was distributed to all medical students across the four program years at the Schulich School of Medicine and Dentistry as a non-probabilistic convenience sample. Survey results were analyzed using Mann-Whitney U tests to determine significant differences between study sub-populations. Multivariate regression analysis was performed to identify correlates for positive views towards ophthalmology.

RESULTS

81% of questions had a mean positive response amongst the students. Students held negative views regarding the amount of exposure to ophthalmology in medical school. The greatest differences in opinion regarding ophthalmology were seen between those with more exposure and interest in ophthalmology compared to their counterparts with less. Regression analysis identified interest in ophthalmology as a significant correlate to a positive opinion in the field.

CONCLUSIONS

Our survey demonstrates that while most students had positive views about ophthalmology, some aspects were viewed negatively. Students felt there was a lack of exposure, both educationally and clinically to ophthalmology, which may contribute to some misconceptions of the field. Early exposure appeared to be critical to forming positive opinions of ophthalmology and could be emphasized in medical education.

Diversity among transplant surgery fellowship program directors: a call to action

BACKGROUND

The diversity among general surgery residency, HPB and other fellowship program directors has been previously analyzed. However, the diversity in abdominal transplant surgery fellowship program directors remains unknown.

METHODS

Abdominal transplant fellowship programs and the corresponding program directors were identified from the American Society of Transplant Surgeons website. Demographic and training information for the members was compiled through internet searches and analyzed.

RESULTS

72 program directors were included. 83.33% were male. 63.9% were non-Hispanic White, 25% were Asian, along with 5.56% Hispanic and Black each. Male program directors were more likely to be Associate Professor (p = 0.041), while females were more likely to be Assistant Professor (p = 0.021). 66% of female program directors were non-Hispanic White.

CONCLUSION

Transplant surgery fellowship programs are primarily led by male and non-Hispanic White surgeons. Female representation as leaders is on par with their membership in the transplant surgery workforce. There is a deficiency of both male and female underrepresented minorities in program director positions.

Factors Influencing Career Decisions and Satisfaction Among Newly Practicing Ophthalmologists

PURPOSE

To describe the career choices of newly practicing ophthalmologists and explore factors influencing career decisions and satisfaction.

METHODS

A cross-sectional study was conducted using data from an electronic survey of ophthalmologists who completed training within the prior 5 years. The survey included questions about demographic information, medical education, current practice, factors affecting career choices, and career satisfaction. Statistical comparisons were made based on gender, type of practice, subspecialty training, and practice area.

RESULTS

Surveys were completed by 696 (32%) newly practicing ophthalmologists, including 276 (40%) women, 179 (29%) academicians, and 465 (67%) subspecialists. A higher proportion of female respondents entered academics than male respondents (36% vs 26%, P = .009). Female and male respondents pursued fellowship training with similar frequency (64% vs 68%, P = .32), but men were more likely to seek vitreoretinal fellowships (30% vs 11%, P < .001) and women were more likely to undertake fellowships in pediatric ophthalmology (21% vs 8%, P < .001), uveitis (10% vs 2%, P = .002), and neuro-ophthalmology (6% vs 2%, P = .042). A total of 514 (83%) respondents reported being happy with work life.

CONCLUSIONS

The career choices of newly practicing ophthalmologists differ based on gender, type of practice, subspecialty training, and practice area. Many factors affect career decisions, and they have varying influence on subgroups within ophthalmology. Ophthalmologists have high levels of career satisfaction. This information may prove useful when developing workforce strategies to meet future eye care needs. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Medical Student Career Choice: Who Is the Influencer?

BACKGROUND

While many factors influence medical student career choice, interactions with attending and resident physicians during clinical rotations are particularly important. To evaluate the influence of attending and resident physicians on medical students' career choices, particularly for those pursuing surgical careers, we quantified their respective influence in the context of other known influences.

METHODS

Rising fourth-year medical students and new graduates were given an IRB-exempt, 14-item online survey. Descriptive statistics were performed on the demographic information. Chi-square analysis was used, as were Kruskal-Wallis and Mann-Whitney analyses on the Likert responses (α = 0.05).

RESULTS

Survey response was 24%. Students pursuing general surgery rated residents greater than or equal to attendings on 7 of 8 key mentoring characteristics. Of students choosing a different specialty than the one they intended to pursue upon entering medical school, the influence of residents was cited by 100% of the students pursuing general surgery, compared to 59% of the entire cohort. Identification of a role model and perceived personality fit were significantly more important than other factors (P < 0.0001). Students pursuing general surgery rated the importance of identifying a role model and perceived personality fit greater than their peers.

CONCLUSIONS

Residents have greater influences on medical students' career choice compared to attendings. Students pursuing a surgical specialty, particularly general surgery, considered the influence of role models and perceived personality fit to be the most important factors in their specialty decision. These findings provide valuable insights to improve student experiences and career recruitment in surgical specialties, particularly general surgery.

Transplant surgery departmental leaders do not represent workforce demographics especially among women and underrepresented minorities - A retrospective analysis

INTRODUCTION

The diversity among surgical directors for liver, kidney, and pancreas transplant departments has not been previously evaluated. We aim to quantify the sex and racial demographics of transplant department leaders and assess the impact on patient outcomes.

METHODS

Demographics were collected for 116 liver, 192 kidney, and 113 pancreas transplant directors using Organ Procurement and Transplantation Network (OPTN) directory and program websites. Scientific Registry of Transplant Recipients (SRTR) 5-tier program outcomes rankings were obtained for each program and matched to leader demographics. A retrospective analysis of transplant recipients from 2010 to 2019 was performed using the United Network for Organ Sharing (UNOS) database.

RESULTS

91.5% of transplant surgical directors were male. 55% of departments had a Non-Hispanic White leader. Asian, Hispanic and Black transplant chiefs were at the helm of 23.3%, 9%, and 5% of divisions respectively. Multivariate cox regression analysis did not identify any differences in patient outcomes by transplant director demographics.

CONCLUSION

There is a paucity of female and URM leaders in transplant surgery. Initiatives to promote research, mentorship, and career advancement opportunities for women and URM are necessary to address the current leadership disparity.

A National Survey on the characteristics of Iranian General Practitioners and Their Preferred Specialty: A Need to Transition toward Preventive Medicine

Background:

The shortage and unbalanced distribution of physicians has adverse effects on the provision of equitable services at all levels of health care and especially at the prevention and primary care levels. The choice of specialty can seriously change the structure and composition of the physician workforce. Therefore, this study aimed to investigate the relationship between background characteristics of Iranian general practitioners' (GPs) and their preferred specialty fields.

Methods:

In this mixed-method study, first, 12 medical doctors participated in a nominal group technique to determine the most important background characteristics that affect GPs' preferences for specialty selection. In the second phase, we conducted a survey among 680 GPs in six provinces from different geographic regions. We gathered data using a researcher-made checklist and analyzed them using an adjusted multivariate regression.

Results:

The adjusted analysis showed that being female, being married, being in an older age group, having children, graduation from universities located in the provincial centers, and decision for living and practicing in the less-populated areas were significantly associated with the Iranian GPs' preferences for non-surgical specialties.

Conclusions:

This study provided evidence that could inform national health workforce policy-makers to avoid unbalanced distribution of physicians and accordingly to ensure the provision of equitable services at all levels of healthcare and especially at the primary care level. Other effective factors on the selection of specialty should be evaluated at the national level using specific surveys and econometrics studies such as discrete selection experiment to move toward preventive medicine.

Attracting the Best Students to a Surgical Career

The predicted shortage of surgeons in the future workforce is already occurring in rural areas and is expected to worsen. US allopathic medical school graduates have been losing interest in surgery for the past 40 years. The residency match remains unaffected because of foreign and osteopathic applicants. Negative myths regarding surgeon training, lifestyle, and personality persist among medical students, proving to be a powerful deterrent to students who might consider a surgical career. Proven strategies for making surgery more attractive to students are not always used and can be as simple as getting early exposure to students before clinical rotations.

Sex Differences in Academic Productivity Across Academic Ranks and Specialties in Academic Medicine: A Systematic Review and Meta-analysis

IMPORTANCE

Despite equal numbers of men and women entering medical school, women are underrepresented in the upper echelons of academic medicine and receive less compensation and research funding. Citation-related publication productivity metrics, such as the h-index, are increasingly used for hiring, salary, grants, retention, promotion, and tenure decisions. Exploring sex differences in these metrics across academic medicine provides deeper insight into why differences are observed in career outcomes.

OBJECTIVE

To systematically examine the available literature on sex differences in h-index of academic faculty physicians across all medical specialties and all levels of academic rank.

DATA SOURCES

Medical literature with the term h-index found in PubMed and published between January 1, 2009, and December 31, 2018, was used.

STUDY SELECTION

A PICOS (Population, Intervention, Comparison, and Outcomes), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses), and MOOSE (Meta-analysis of Observational Studies in Epidemiology) selection protocol was used to find observational studies that published h-indexes for faculty physicians that were stratified by sex. Studies were excluded if they were review articles, retracted, or unavailable online. Ultimately, 14 of 786 studies (1.78%) met the inclusion criteria.

DATA EXTRACTION AND SYNTHESIS

Data from 9 studies across 16 specialties were examined using weighted random-effects meta-analyses. Five studies were excluded because of overlapping specialties with another study or because they were missing appropriate statistics for the meta-analysis. Four of these studies were included in qualitative synthesis to bring the total to 13 studies.

MAIN OUTCOMES AND MEASURES

The primary study outcome was the h-index.

RESULTS

The meta-analysis included 10 665 North American unique academic physicians across 9 different studies from the years 2009 to 2018. Of the 10 665 physicians, 2655 (24.89%) were women. Summary effect sizes for mean h-indexes of men and women and mean h-index difference between men and women were determined for all faculty physicians and at each academic rank. Overall, female faculty had lower h-indexes than male faculty (mean difference, -4.09; 95% CI, -5.44 to -2.73; P < .001). When adjusting for academic rank, female faculty still had lower h-indexes than male faculty at the ranks of assistant professor (mean difference, -1.3; 95% CI, -1.90 to -0.72; P < .001), associate professor (mean difference, -2.09; 95% CI, -3.40 to -0.78; P = .002), and professor (mean difference, -3.41; 95% CI, -6.24 to -0.58; P = .02).

CONCLUSIONS AND RELEVANCE

In this systematic review and meta-analysis, women had lower h-indexes than men across most specialties and at all academic ranks, but it is unclear why these differences exist. These findings suggest that future investigation should be conducted regarding the causes of lower h-indexes in women and that interventions should be developed to provide a more equitable environment for all physicians regardless of sex.

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.

Perception, Academic Performance, Gender Judgment and Barriers among Surgeons' Career Progression in Jeddah, Saudi Arabia: A Cross-Sectional Study

INTRODUCTION

Gender discrimination continues to be an issue in different surgical subspecialties, especially in Saudi Arabia, where no studies have been conducted so far on female surgeons in academia, on gender discrimination, and on job satisfaction. Considering the increasing number of women enrolling for surgery programs in Jeddah, Saudi Arabia, this study aims to examine their perceptions about and equity in working as surgeons.

METHODS

Following the STROCSS criteria, cross-sectional analyses were conducted of survey data from a multicentric online questionnaire in 2019/2020. A representative sample of medical interns and surgeons (n = 100) from Saudi Arabia responded out of 400 from the 4th iteration.

RESULTS

Females were 53%; most participants were less than 40 years. Women ranked assistant professors were fewer than men (2% vs. 11%). The number of publications by females vs. males was 2.58 +/- 2.68 vs. 11.37 +/- 20.53 (p = 0.002). Surgery was not considered a profession conducive to family life according to more than half the women citing lack of flexible/part-time training or work (26/53, or 49%). However, only 1/5, or 9/47 (19.1%), of men thought there was gender attitude/bias; men also had more variety in surgical career choices. Further, most patients preferred male surgeons ( p = 0.026). Both females (30/53 or 56.6%) and males (25/47 or 53.2%) agreed that the best response to an offensive question was to ignore it. Decision in choosing their specialty was influenced mostly by career and promotion prospects, enthusiasm, and commitment (females: 31/53 or 58.5% and males: 17/47 or 36.2%) with p = 0.026.

CONCLUSIONS

The findings reveal the persisting discrepancies based on gender in the surgical field in Saudi Arabia. A nationwide movement limiting working hours, encouraging medical students to enter surgery, and upholding women in leadership positions can help in overcoming this situation.

Oral and Maxillofacial Surgery - the future is in our collective hands. Re: Editorial: Our specialty, our future, is the writing on the wall?

We offer a response to the Editorial 'Our Specialty, Our Future, Is the Writing on the Wall?' by Newman et al¹ and suggest opportunities to support recruitment, retention and education in Oral and Maxillofacial Surgery.

Hospital characteristics preferred by medical students for their residency programs: A nationwide matching data analysis

BACKGROUND

In 2004, Japan introduced a mandatory 2-year postgraduate training program for graduating medical students with a super-rotation curriculum. A national matching system was established to determine the hospital residency programs best suited for the students. We examined the hospital characteristics preferred by applicants for residencies.

METHODS

A nationwide cross-sectional study was conducted. Data on salaries, bonuses, and number of accepted ambulances were compiled from the Residency Electronic Information System. Information on the prefectural population, urban area, and number of senior residents (postgraduate years 3-5) for specialty training was extracted from data published on the web page. The ratio of the number of first-choice applicants to recruitment capacity (matching ratio) for each program was compared between the characteristics of the hospitals and prefectures.

RESULTS

A strong linear relationship was observed between the number of first-choice applications and the allocated number of resident positions (correlation coefficient, .72). The matching ratio was greater in community hospitals (2.10 times compared with university hospitals; 95% confidence interval [CI], 1.75-2.53), in hospitals with higher numbers of accepted ambulance cases (1.05 times per 1000 annually; 95% CI, 1.03-1.08), and in hospitals that served a larger prefectural population (1.05 times per million; 95% CI, 1.02-1.08).

CONCLUSIONS

Financial incentives do not seem to attract residency applicants. Applicants prefer non-university hospitals located in populous areas and those that accept larger number of ambulance cases. To recruit junior residents, an emergency department may need to have higher activity with larger numbers and variety of cases.

Supplementary Regional Anatomy Teaching by Surgeons Enhances Medical Students Mastery of Anatomical Knowledge and Positively Impacts Their Choice of Future Career

BACKGROUND

Anatomy is fundamental to the practice of medicine and surgery. Anatomy is also increasingly being taught by basic medical scientists or postclinical practice surgeons, thereby potentially detaching it from ongoing clinical realities.

OBJECTIVE

To evaluate whether supplementing regional anatomy teaching using surgeons enhances medical students' mastery of anatomical knowledge and how it impacts their choice of a future career.

DESIGN

This was a descriptive study.

SETTING

An integrated tuition model in which basic regional anatomy was supplemented with clinical correlates taught by surgeons was devised and implemented at Jinan University Medical School.

PARTICIPANTS

Soon after the third-year medical students finished dissecting each region (e.g., head and neck, limbs, etc.) of the human body, the surgeons from relevant specialties and sub-specialties were invited to give clinical application lectures. A self-administered questionnaire was used to evaluate all the students' perceptions of the integrated teaching model, perceived mastery of anatomical knowledge and determinants of future career choice.

RESULTS

More than half of the students believe that regional anatomy is more closely related to surgery than systemic anatomy. Over 70% of the students have a positive attitude towards this teaching model where surgeons supplement regional anatomy with clinical correlates, and 98% of the students are in favor of integrating human body structural knowledge into clinical problems to learn anatomy. In addition, 78% of the students believe that the surgeons' participation in the teaching of regional anatomy helps them better understand human body structures and their clinical significance. However, some of their responses point towards the clinical correlate disconnection from the basic anatomy content. Furthermore, the majority of the students plan to become clinical doctors. After studying regional anatomy, the proportion of students who elected to be surgeons decreased slightly. However, the number of students who affirmatively planned to become surgeons in the future increased slightly, and 90% of these students were able to specify a chosen and preferred subspecialty of surgery.

CONCLUSIONS

Surgeons' involvement in regional anatomy is of major benefit to students in understanding the human anatomy and its clinical significance, as well as positively impact on the decision to pursue a career in surgery.

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.

Optimizing the fellowship interview process: Perspectives from applicants and program directors of the comprehensive endocrine surgery fellowship program

BACKGROUND

Approximately 80% of general surgery residents undertake some form of fellowship training. Our objective was to characterize goals and burdens of the interview process among applicants to Comprehensive Endocrine Surgery Fellowship programs.

METHODS

Participants included trainees from 2013 to 2019. Results for ranking questions are presented as a mean rank reported out of the total number of selections.

RESULTS

Response rate was 54% (n = 75). The most important goal for interviews was meeting the faculty (mean rank 2.4/9), followed by "behind the scenes information" and "make a good impression" (mean rank 3.6 and 3.7, respectively). The most substantial burden for the applicant was expense (mean rank 2.1/7), followed by time away from residency (mean rank 3.1/7). The economic burden of 51% of the applicants was $2,500 to $7,500. Geographic location and expense were the top 2 reasons applicants declined offers of interviews. Despite the process, 76% of respondents indicated that no improvements to the interview process are necessary. Alternative strategies such as videoconferencing or centralized interviews received little support (<10%).

CONCLUSION

Despite identifying several burdens, survey respondents believed that in-person interviews are an integral component of the fellowship application process. Indeed, 70% of applicants do not have a first-choice program before interviews, and meeting the faculty is ranked as the greatest priority goal. Our data illustrate the importance of individual specialties evaluating and optimizing their own processes for fellowship interviews.

A Report on the Representation of Women in Academic Plastic Surgery Leadership

BACKGROUND

The year 2017 marked the first year women comprised a majority of U.S. medical school matriculants. While more women are pursuing surgical training, within plastic surgery, there is a steady attrition of women advancing in leadership roles. The authors report the current status of women in academic plastic surgery, from trainees to chairwomen and national leadership positions.

METHODS

The Electronic Residency Applications Service, San Francisco Match, National Resident Matching Program, Association of American Medical Colleges, American Council of Academic Plastic Surgeons, Plastic Surgery Education Network, and professional websites for journals and national societies were accessed for demographic information from 2007 to 2017.

RESULTS

The number of female integrated pathway applicants remained stable (30 percent), with an increased proportion of female residents from 30 percent to 40 percent. There was an increase in female faculty members from 14.6 percent to 22.0 percent, an increase of less than 1 percent per year. Twelve percent of program directors and 8.7 percent of department heads were women. Nationally, major professional societies and administrative boards demonstrated a proportion of female members ranging from 19 percent to 55 percent (average, 27.7 percent). The proportion of female committee leaders ranged from 0 percent to 50 percent (average, 21.5 percent). Only six societies have had female presidents. No major journal had had a female editor-in-chief. The proportion of female editorial board members ranged from 1 percent to 33 percent (average, 16.1 percent).

CONCLUSIONS

The authors' study shows a leak in the pipeline at all levels, from trainees to faculty to leadership on the national stage. This report serves as a starting point for investigating reasons for the underrepresentation of talented women in plastic surgery leadership.

Satisfaction From Plastic Surgery Residency: A National Survey

BACKGROUND

Plastic surgery residency programs in Israel have undergone several changes over the years, but the perspectives and satisfaction of the residents have not been investigated.

METHODS

An anonymous national survey of plastic surgery residents in Israel was performed. Demographic, professional, and education variables were summarized using descriptive statistics, and findings were related to self-reported satisfaction levels using univariate analysis.

RESULTS

The response rate was 75.9%. Response rates to surgery and education-related items were as follows: 60% performed 5 to 15 surgeries/month; 60.3% performed fewer than 5 surgeries/month as the primary surgeon; 57.3% and 77.8%, respectively, received surgical and academic instruction from fewer than half the attending physicians; 33.9% and 32.3%, respectively, had little or no in-hospital exposure to aesthetic surgeries. The average overall satisfaction rate was 3.33/5. Ten variables were significantly associated with increased satisfaction: total number of surgeries performed (P = 0.01); active participation in complex procedures (P = 0.0009); performing preoperative and postoperative management for one's patients (P = 0.016); marking one's patients preoperatively (P = 0.037); managing complications of one's patients (P = 0.0027); receipt of surgical instruction (P = 0.0035); receipt of academic medical instruction (P < 0.0001); sense that the training will provide the proper professional level (P < 0.0001) and independence (P = 0.0002); and subjective correspondence between demands and capabilities (P = 0.0004).

CONCLUSIONS

This study identifies several factors associated with plastic surgery resident satisfaction. It highlights factors that warrant changes by plastic surgery departments and faculty to improve resident training and increase their satisfaction. The questionnaire can also serve as a diagnostic and follow-up tool.

An Undergraduate Surgery Interest Group: Introducing Premedical Students to the Practice of Surgery

PURPOSE

Early exposure and surgical mentorship can augment interest in surgery. We evaluate the effect and feasibility of offering education and mentorship opportunities in surgery to premedical students at our institution through an undergraduate surgery interest group (USIG).

MATERIALS AND METHODS

We conducted a 1-year assessment of our USIG and reviewed its organizational structure, funding resources, media promotion, and educational activities. Our USIG hosted introductory-level surgical skills workshops, guest lectures by surgeons, and various facility tours. To assess participants' interests, as well as the influences on them to pursue a surgical profession, we analyzed pre- and post-event questionnaires. Similar questionnaires were completed by medical students in our medical student surgery interest group to compare any differences in perception between premedical and medical students.

RESULTS

Our USIG currently has 378 undergraduate student members, with a higher proportion of women than in our medical student surgery interest group (P < 0.003). Neurosurgery was the most popular career choice among undergraduate participants. Participants reported the highest satisfaction with suturing and high-fidelity trauma surgery skills workshops. Undergraduate participants indicated that their intrinsic interest in the sciences is the highest motivation to pursue a surgical profession. Resident lifestyle and social obligations of a surgical career were actually positive influences for undergraduate participants; in contrast, medical students viewed those variables as negative factors.

CONCLUSION

Our USIG was met with enthusiasm by premedical students and faculty alike. Participation strengthened premedical students' interest in pursuing surgery and increased their understanding of the surgical profession. Early mentorship may positively influence premedical students' perception of surgical careers. USIG is economically feasible and time-efficient; we encourage other academic institutions and educators to consider investing in similar interest groups.

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.

Does exposure to anatomy education in medical school affect surgical residency applications? An analysis of Canadian residency match data

Background

The time dedicated to teaching gross anatomy, including cadaveric dissection, has been decreasing in North American medical schools. The impact of this trend on surgical residency applications is unknown. We sought to identify trends in surgical residency applications in Canada and to determine if medical schools with more gross anatomy instruction and mandatory cadaveric dissection produced more applicants ranking surgical residency programs as their first choice.

Methods

Canadian Resident Matching Service (CaRMS) data from 1997 to 2016 were analyzed. A questionnaire was distributed to Canadian medical schools requesting current and historic information on their anatomy curricula and the number of hours of anatomy instruction.

Results

The survey response rate was 35% (6 of the 17 Canadian medical schools responded); partial data were available for 16 (94%) of the 17 Canadian medical schools. A total of 4.3% of graduating students ranked general surgery as their first choice in the CaRMS match and 17.2% ranked any surgical program first. Over time, the percentage of graduating students who ranked surgical programs as their first choice decreased (p < 0.001). Three schools were significantly more likely than the others to produce graduates ranking general surgery as their first choice. Between 2012 and 2016 the percentage of graduating students ranking surgical programs first was significantly higher (2.2%, p = 0.024) in schools with mandatory cadaver dissection. There was no correlation between the number of hours of gross anatomy instruction and the percentage of graduates ranking any surgical program or a general surgical program first.

Conclusion

The number of applications to surgical programs has decreased in Canada over the past 20 years. Certain schools are more likely than others to produce graduates ranking general surgery as their first choice. Programs with mandatory cadaver dissection produced more graduates favouring surgical programs.