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

BACKGROUND

While gender disparities in surgery are documented worldwide, it is unclear to what extent women consider surgery as a career before embarking on their medical school journey. This study aimed to report the percentage of pre-medical women in Pakistan who intend to eventually specialize in surgery and assess the factors motivating and deterring this decision.

METHODS

An online survey was conducted among female pre-medical (high school) students across Pakistan. Multivariable logistic regression was performed to determine motivating and deterring factors associated with the intention to pursue surgery.

RESULTS

Out of 1219 female high-school students, 764 (62.7) intended to join medical school. Among these 764, only 9.8% reported an exclusive intent to pursue surgery, while just 20.3% reported considering other specialties in addition to surgery. Significant motivators to pursue surgery exclusively were the intellectual satisfaction of pursuing surgery (adjusted odds ratio: 2.302), having opportunities to travel internationally for work (2.300) and use cutting-edge technology (2.203), interest in the specialty of surgery (2.031), the social prestige of becoming a surgeon (1.910), and considering one's personality well-suited to surgery (1.888). Major deterrents included the lack of interest in surgery (adjusted odds ratio: 3.812), surgical education and training being too difficult (2.440) and lengthy (1.404), and the risk of aggressive behavior from patients (2.239).

CONCLUSION

Even before entering medical school, most female pre-medical students have already decided against considering a future surgical career. Deterrents likely stem from women being pressured to conform to deep-seated societal expectations to dedicate their time and energy to domestic responsibilities.

Today's doctors: What do men and women value in a training post?

OBJECTIVES

Recent studies suggest that traditional male-female differences may be changing in terms of what is valued in a medical career but there have been no studies directly quantifying the relationship between gender and stated career-related preferences. To address this gap, we examined the differences between male and female doctors in terms of the strength of their work-related preferences at the point of eligibility to enter residency or specialty training in the UK.

METHODS

This was a quantitative study using a survey incorporating a discrete choice experiment (DCE). Respondents were asked a series of questions in which they had to choose between two or more scenarios, differing in terms of attributes. The attributes were: location; familiarity with specialty; culture of the working and learning environment; earnings; working conditions, and opportunities for professional development. The main outcome measure was willingness to accept compensation to forgo a desirable attribute within a training position. Conditional logistic regression models were run separately for males and females.

RESULTS

A total of 5005 out of 6890 (73%) Foundation Year 2 doctors completed the DCE. The relative value of each attribute was similar for males and females, with location most valued and familiarity with the specialty least valued. There was a pattern of female respondents valuing the move between the best and worst levels of each training attribute more than men, and significantly more than men in respect of the importance of working culture.

CONCLUSIONS

This study adds to existing knowledge in terms of quantifying gendered values in respect of training or residency preferences. That men value a supportive working culture significantly less than women is well established. However, our findings that location, working conditions and working culture are increasingly important to both men and women, suggests that traditional gender norms may be changing. This intelligence can inform gender-responsive workforce planning and innovation, and future research.

Five myths about unacceptable behaviour in surgical education

Recent evidence of the occurrence of discrimination, bullying and sexual harassment in surgery and more generally within healthcare has led to widespread discussion about the effects of unacceptable behaviour in surgical education and practice. Despite accumulating evidence of the adverse effects of unacceptable behaviour in clinical practice, not only on health care professionals but on patient care and outcomes, many surgeons and other health care professionals continue to embrace false perceptions about appropriate professional behaviour, interactions and approaches to teaching within surgical departments and more generally within healthcare institutions. This article explores five misperceptions about unacceptable behaviour in surgical education and provides evidence that supports a change in practice.

Identifying and exploring factors influencing career choice, recruitment and retention of anaesthesia trainees in the UK

BACKGROUND

Many acute hospital specialties are experiencing low recruitment and high attrition of trainees. Understanding what is important to current trainees is critical in terms of identifying and addressing factors which adversely affect recruitment and retention.

OBJECTIVES

To identify and explore factors involved in anaesthetic trainees' career decision making.

METHODS

This was a mixed methods study using a questionnaire survey (assessing how influential 18 different factors were when choosing anaesthetics, using a five-point Likert scale), supplemented by semi-structured interviews, carried out in August-December 2014, in Scotland, UK.

RESULTS

42/68 (62%) completed responses were received, representing over half of all core (58%) and Acute Care Common Stem (65%) trainees across Scotland. Overall, questionnaire data indicated that the following were most important in career decision making: perceived job satisfaction among those already in the specialty, structured training, the nature of the work (practical, varied, immediate outcomes). Thirteen interviews were carried out. These highlighted that prior positive exposure and experience with anaesthetists encouraged trainees into the specialty. Enthusiastic, supportive colleagues and structured training (including clear milestones, regular teaching and feedback) were considered to enhance the quality of training. Sustainable working conditions, flexibility within programme and out-of-programme opportunities were valued. Respondents reported concerns about the impact of increasing service delivery demands on training quality.

CONCLUSIONS

Many of the elements important to today's anaesthetics trainees are related to positive learning and working environments. This fits with research findings from other professional groups. These findings can inform the development of programmes which cultivate trainee commitment to, and enthusiasm for, anaesthetics.