A systematic review of the factors affecting choice of surgery as a career

Abstract

A systematic review of the factors affecting choice of surgery as a careerBackground: Interest in surgical careers among medical students has declined over the past decade. Multiple explanations have been offered for why top students are deterred or rejected from surgical programs, though no consensus has emerged. Methods:We conducted a review of the literature to better characterize what factors affect the pursuit of a surgical career. We searched PubMed and EMBASE and performed additional reference checks. Agency for Healthcare Research and Quality (AHRQ) and Newcastle-Ottawa Education scores were used to evaluate the included data.Results: Our search identified 122 full-text, primary articles. Analysis of this evidence identified 3 core concepts that impact surgical career decision-making: gender, features of surgical education, and student "fit" in the culture of surgery. Conclusion:Real and perceived gender discrimination has deterred female medical students from entering surgical careers. In addition, limited exposure to surgery during medical school and differences between student and surgeon personality traits and values may deter students from entering surgical careers. We suggest that deliberate and visible effort to include women and early-career medical students in surgical settings may enhance their interest in carreers in surgery.Contexte : On constate que l'intérêt pour une carrière en chirurgie a décliné chez les étudiants en médecine depuis une dizaine d'années. Plusieurs raisons ont été invoquées pour expliquer le désintérêt des étudiants talentueux à l'égard des programmes de chirurgie ou leur rejet de ces programmes, sans qu'on en arrive à un consensus.

The effect of an organ procurement experience on preclinical medical student perceptions of transplant surgery

“…One study identified that implementation of a neurosurgical mentorship program, lectures, and creation of research opportunities demonstrated a 3.47‐fold increase in match rates into neurosurgery . Similar results were observed with programs targeted toward ophthalmology, general surgery, and cardiothoracic surgery . We also demonstrated that attitudes toward transplant surgery may be significantly improved with exposure to the field, which we find clinically relevant as only 10% of residents and fellows rotating through the intensive care units (ICU) at a major transplant center reported ever receiving formal instruction about the organ donation process …”

“…23 Similar results were observed with programs targeted toward ophthalmology, general surgery, and cardiothoracic surgery. 1,2,24 We also demonstrated that attitudes toward transplant surgery may be significantly improved with exposure to the field, which we find clinically relevant as only 10% of residents and fellows rotating through the intensive care units (ICU) at a major transplant center reported ever receiving formal instruction about the organ donation process. 25 Limitations of this study include a 56.3% response rate for the post-procurement survey.…”

Application rates to surgical residency programs in Canada

“…The two main factors during medical school that had a positive impact on interest in pursuing a surgical career were early surgical exposure before clerkship and exposure to surgical simulations. 4 While a number of these factors are difficult to modify, early surgical exposure in medical school and improving gender-based issues are potential areas that may be suitable for targeted interventions. Currently, Medical schools are progressively modifying their clerkship structure to accommodate teaching and other academic commitments.…”

“…Despite this growing need, previous publications have suggested that in Canada and the United States applications to surgical residency programs have been decreasing for over a decade, despite increasing medical school enrollment. [2][3][4] Peel and colleagues reported that applications ranking surgical disciplines as a first choice in Canada through the Canadian Resident Matching Service (CaRMS) decreased from 24.7% in 1998 to 17.2% in 2016. 4 This declining trend has drawn concern from surgical program directors who recognize that they may attract fewer competitive medical students to their programs.…”

“…[2][3][4] Peel and colleagues reported that applications ranking surgical disciplines as a first choice in Canada through the Canadian Resident Matching Service (CaRMS) decreased from 24.7% in 1998 to 17.2% in 2016. 4 This declining trend has drawn concern from surgical program directors who recognize that they may attract fewer competitive medical students to their programs. 5,6 There have been a wide range of proposed explanations for the declining number of medical students matriculating into surgical residencies, including lifestyle, overall interest, the duration of training, lack of early surgical exposure, availability of positions upon completion of training and more.…”