Education
Brief intervention by surgeons can influence students toward a career in surgery1

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Abstract

Background. General surgery training programs are experiencing an alarming decrease in applicants. The purpose of the current study was to determine whether exposing students to surgery through a brief intervention early in their medical education could influence perceptions toward surgery as a career choice.

Methods. First-year medical students were asked to rank 19 items coded on a Likert-type scale from 1 (not important) to 8 (very important) regarding their beliefs about surgery as a career both before and after a brief 1-h intervention with a panel of surgeons. Each panelist spoke about his or her professional and personal lives, followed by a question and answer period. Survey data were analyzed by Wilcoxon sign-rank and Spearman rank correlation.

Results. Of 210 first year students, 121 (58%) students voluntarily attended and completed the presurvey and 94 (45%) the post, of which 82 were matched responses. Preintervention responses revealed that career opportunities, intellectual challenge, and the ability to obtain a residency position were positively correlated with surgery (P < 0.007) whereas length of training, lifestyle during residency, lifestyle after training, and work hours during residency were negatively correlated (P < 0.01). The following factors were significantly influenced by the intervention: academic opportunities, patient relationships, prestige, and gender distribution became more important whereas concern about debt and length of training became less important.

Conclusions. Positive encounters with surgeons can favorably influence the perceptions of first-year medical students toward a career in surgery. In addition to addressing lifestyle issues, surgeons can and must make a concerted effort to interact with medical students early in their education and foster their interest throughout their career.

Introduction

Over the past few years, there has been an alarming decrease in the number of medical students matching in general surgery programs [1]. Additionally, this trend is predicted to result in a major shortage in the general surgical workforce [2]. Interest in surgery as a career peaked in 1981, with 12.1% of senior medical students matching in general surgery. Since then, however, there has been a gradual decline over the past two decades, plummeting to just 6.1% in 2001 and 5.3% in 2002 3, 4. In contrast, the surgical subspecialties of orthopedics, urology, and otolaryngology have maintained a stable applicant pool, and such specialties as radiology, anesthesia, and emergency medicine have experienced impressive increases in applicants [5]. Lifestyle issues have emerged as important contributing factors to the decline in students pursuing surgery as a career choice 6, 7. Although changes are being made in residency work hours for all residents, this may not be enough.

Attention has primarily focused on the perceptions of graduating medical students [8], but little is known about perceptions of entering students. The purpose of the current study was 2-fold: first, to understand the perceptions of first-year medical students about the field of surgery and two, to determine whether exposing these students to the discipline of surgery through a brief intervention early in their medical education could influence their perceptions toward surgery as a career choice.

Section snippets

Materials and methods

First-year medical students at the University of Texas-Houston School of Medicine were asked to voluntarily participate in a brief presentation by the Department of Surgery. The format consisted of a preintervention survey, a 1-h intervention, a postintervention survey, and then an informal, small group question-and-answer period. Students were asked to rank 19 items coded on a Likert-type scale from 1 (not important) to 8 (very important) regarding their beliefs about surgery as a career as

Results

Of 210 first year students, 121 (58%, 66 male, 50 female, and 5 not specified) completed the presurvey and 94 (45%) voluntarily attended the intervention and completed the post survey, of which 82 were matched responses. Only matched responses were used for the postsurvey analysis.

On the preintervention survey, factors that correlated with surgery as a career choice by univariate analysis are listed in Table 2 and by multivariable analysis in Table 3. Factors that were influenced by a brief

Discussion

Our study demonstrates that first-year medical students view surgery as a field that provides both career opportunity and intellectual challenge whereas lifestyle issues already prevail. However, through a brief intervention with 5 practicing surgeons, academic opportunities, patient relationships, prestige, and gender distribution became more important whereas concern about debt and length of training became less important.

The University of Texas-Houston is a state-owned university that prides

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1

Presented at the Annual Meeting of the Association for Academic Surgery, Boston, Massachusetts, November 2002.

3

Current address: Department of Surgery, Stanford University, Stanford, CA.

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