determinants of choosing a career in surgery
TRANSCRIPT
2011; 33: 1011–1017
Determinants of choosing a career in surgery
IAN SCOTT1, MARGOT GOWANS1, BRUCE WRIGHT2 & FRASER BRENNEIS3
1University of British Columbia, Canada, 2University of Calgary, Canada, 3University of Alberta, Canada
Abstract
Introduction: Student choice is an important determinant of the specialty mix of practicing physicians in Canada. Understanding
student characteristics at medical school entry that are associated with a student choosing a residency in surgery can assist surgical
educators in supporting medical students interested in surgery and in serving health human resources needs.
Methods: From 2002 to 2004, data was collected from entering students in 15 classes at eight of 16 Canadian medical schools.
Surveys included questions on career choice, attitudes to practice, and socio-demographics. Students were followed prospectively
with survey data linked to their residency choice. Multiple logistic regression analysis was used to identify entry characteristics
that predicted a student’s ultimate choice of a surgical career.
Results: Eight entry variables predicted whether a student named surgery (including obstetrics) as their top residency choice:
having surgery as their top career choice, having a relative or friend in a surgical career, having undertaken volunteer work with
sports teams, an interest in narrow scope of practice, greater interest in medical the social patient problems, an interest in urgent
care, and younger age were identified as predictors of a surgical career choice.
Discussion: Surgical educators may wish to attend to the factors that we found that predicted students selecting a surgical
residency as their top career choice at medical school exit in order to foster and support students interested in the surgical
disciplines during medical school. In addition, these factors could be used to identify students interested in a surgical career
at medical school entry.
Background
Concerns exist over the adequacy the Canadian surgical
workforce and its ability to meet the future surgical needs of
the people it serves (Marschall & Karimuddin 2003; Shipton
et al. 2003; Macadam et al. 2007). As the population continues
to grow and age, demands on the health system are expected
to increase (Human Resources and Skills Development Canada
2010). With a current surgical workforce of 8226 (CIHI 2009)
already working near full capacity, and with the aging of this
workforce, the ability of the Canadian Health Care System
to provide adequate surgical services will be challenged
(Chan 2002; Shipton et al. 2003). A number of Canadian
surgical organizations have highlighted this looming shortage
(Comeau 2004; Macadam et al. 2007; Howell 2008). This
situation is mirrored in the United States where decreasing
numbers of students are pursuing surgical careers (Bland &
Isaacs 2002) and where a surgeon shortage is already
impacting service provision (Sheldon et al. 2008; Williams &
Ellison 2008).
To relieve this and other predicted shortages of physicians,
Canadian medical schools have expanded their entering
cohort so they by 2009 they were graduating 1200 more
medical students than a decade earlier (2349 vs. 1149) (CaRMS
2010a). There have also been increases in the number of
postgraduate surgical residency positions from 227 positions
in 1999 to 434 positions in 2009 but this absolute increase is
in fact a relative drop in the percentage of surgical positions
offered to graduates (19.1% to 16.7% of all residency positions
between 1999 and 2009).
Aims
Within this context of increasing needs of surgical providers
and a relative drop of positions for surgical trainees, one can
ask two fundamental questions:
. What are the characteristics of today’s trainees (and thus
what characteristics will the surgeons of tomorrow have)?
Practice points
. Students who choose a residency in surgery are youn-
ger, unconcerned about a short post-graduate training
period, have friends and family practicing surgery, have
volunteered with sports teams, have a narrow scope of
practice as well as an interest in medical problems and
urgent care and entered medical school with an interest
in surgery compared to their peers.
. Students who switch to selecting a residency in surgery
at the end of medical school have many attributes that
are similar to those students who had surgery as their
top career at medical school entry.
. Students who wish to be surgeons at medical school
graduation are much more likely to be women than the
current cohort of practicing surgeons.
Correspondence: I. Scott, Department of Family Practice, David Strangway Building, Suite 300-5950 University Boulevard, University of British
Columbia, Vancouver, British Columbia, V6T 1Z3, Canada. Tel: 604 827 4194; fax: 604 822 6950; email: [email protected]
ISSN 0142–159X print/ISSN 1466–187X online/11/121011–7 � 2011 Informa UK Ltd. 1011DOI: 10.3109/0142159X.2011.558533
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. Can we predict who will be more interested in a career
in surgery at the outset of medical training?
The answer to this second question would allow educators
to target students to encourage them to consider a career
in surgery thus ensuring an adequate pool of students
interested in surgery at the residency match.
Method
A 41-item survey was distributed to first year students in
15 classes at eight out of a possible 16 Canadian medical
schools within 2 weeks of commencement of their medical
studies between 2002 through 2004. The study included
three entry classes from the University of British Columbia
(2002–2004); two each from the University of Calgary (2003–
2004), the University of Toronto (2003–2004), McMaster
University (2003–2004), Queen’s University (2003–2004), and
the University of Western Ontario (2003–2004); and one each
from the University of Alberta (2002) and the University of
Ottawa (2003). This convenience sample of half of the medical
schools in Canada was generated from personal contacts and
interest from these schools in participating in this study.
Different sampling periods occurred at different schools
because some schools that started with this research dropped
out after 1 or more years.
1941 students (93.8%) eligible for inclusion in sample
2070 students, excluding international students, in 15 medical school classes, invited
to participate in study
129 students (6.2%) retrospectively excluded from sample as they did not
graduate with their entry class
1771 of these students completed entry survey (91.2% of eligible sample)
134 students anonymous thus could not link CaRMS data
1637 students (84.3% eligible sample) included name on survey allowing linkage to
CaRMS data
109 of these students completed entry survey (84.5% of those excluded)
CaRMS match data only unavailable for 8 students
CaRMS career choice and match data linked for 1618
students
CaRMS career choice and match data unavailable for 11 students
51 students failed to state clear career preference at entry to
medical school thus excluded from analyses
1550 valid surveys (79.9% of eligible sample) available for
analysis
17 students named career choice which could not be
accurately classified by authors (eg. sports medicine
could be either family medicine or orthopedics) thus
excluded from analyses
1542 valid surveys with complete data (79.4% of eligible
sample)
Figure 1. Recruitment and follow-up of cohort.
Table 1. Demographic and attitudinal associations with a surgical residency choice on exit from medical school.
Surgical specialty Other specialty
n¼ 360 n¼ 1182 p
Gender (% male) 51.1 39.5 50.001
Age (years) 23.4 24.2 50.001
Relationship status (% single) 75.5 69.5 0.028
Premedical education (% postgraduate) 17.2 18.4 0.624
Parental education (% postgraduate university educated) 50.3 42.8 0.013
Family/friends in surgery (%) 18.6 10.8 50.001
Family/friends in any field of medicine (%) 42.8 37.8 0.091
Home town population (% 550,000) 21.4 21.6 0.940
Rural childhood (450%) 21.9 21.7 0.935
Parents in rural community (%) 23.1 23.4 0.908
Volunteer work with cognitive disabilities (%) 24.2 29.8 0.039
Volunteer work with sports (%) 51.4 45.5 0.051
I. Scott et al.
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Entry survey items were determined after an extensive
literature review and consultation process. Survey compre-
hensiveness, appropriateness, and subsequent piloting were
undertaken prior to commencement of the study with the
survey tool modified as appropriate (Wright et al. 2004; Scott
et al. 2008). A 5-point Likert scale was used with a range from
1 (no influence) to 5 (major influence). Students reported the
extent to which their career interests on entry to medical
school were influenced by each of 27 different attitudinal
items. Socio-demographic data and career choice data was
also collected.
At the end of their studies, students enter into the (CaRMS
2010b) match. This organization matches medical students
with residency programs. Students provide Canadian Resident
Matching Service (CaRMS) with their rank list of careers
and locations along with their residency application. We
matched students entry career choice and their entry ques-
tionnaire results with their final career choice through an
independent third party, the Canadian Post-M.D. Education
Registry (CAPER 2010).
SPSS version16.0 (SPSS Inc. Chicago, USA) was used to
perform data analysis. Residency career choices were split
into two groups: surgical and non-surgical. Surgical specialties
included General Surgery, Cardiac and Thoracic Surgery,
Neurosurgery, Obstetrics and Gynecology, Ophthalmology,
Otolaryngology, Orthopedic Surgery, Plastic Surgery, and
Urology (CIHI 2009). A number of our analyses were repeated
with and without Obstetrics and Gynecology included as
a surgical specialty to capture the influence of this surgical
discipline on our results. Non-surgical specialties included
but were not limited to Family Medicine, Internal Medicine,
Psychiatry, Emergency Medicine, and Pediatrics. Demographic
associations with residency choice were identified using t-tests
for age and cross-tabulation with the chi squared test-statistic
for all other variables. Principal components factor analysis
was performed to condense the 27 attitudinal career influences
measured at entry into a smaller number of coherent factors.
Items were to demonstrate a minimum factor loading of 0.6.
Factors with an eigenvalue greater than 1 were retained. T-tests
were used to identify differences in the resulting factors
according to career choice. With all variables identified by
univariate analyses entered into the model, logistic regression
was used to determine the predictors of a surgical residency
choice. P-values less than or equal to 0.05 were considered
to be statistically significant.
This research was approved by the UBC research ethics
board certificate H06-03313.
Results
Of the 1949 eligible students who graduated from the 15
participating classes, 1542 students contributed to the final
analysis (Figure 1). Of these 1542 students, 360 (23.3%) named
a surgical residency as first choice on their CaRMS application.
This proportion was not different from all students selecting
a surgical specialty in the national cohort of students gradu-
ating from medical school over the same time (23.3%
vs. 22.7%; �2¼ 0.367, df¼ 1, p¼ 0.545) (CaRMS 2010b). The
specific surgical specialties chosen by these 360 students
were general surgery (n¼ 87), obstetrics and gynecology
(n¼ 75), orthopedic surgery (n¼ 61), urology (n¼ 36), plastic
surgery (n¼ 34), ophthalmology (n¼ 28), otolaryngology
(n¼ 21), neurosurgery (n¼ 12), and cardio and thoracic
surgery (n¼ 6).
Of the 360 students applying for a surgical residency, 162
(45.0%) had named a surgical specialty as their preferred
career, 288 (80.0%) had included a surgical specialty as one of
their top three career options and 324 (90.0%) indicated having
considered a surgical specialty as a possible option at medical
school entry. In contrast, of the 1182 students choosing
Table 2. The factors and underlying influences.
Loading Mean (SD) Eigenvalue Alpha or r
Factor 1 – medical lifestyle X. Flexibility outside of medicine 0.802 3.65 (1.11) 3.20 �¼0.83
V. Acceptable hours of practice 0.784 3.41 (1.25)
W. Flexibility inside of medicine 0.756 3.84 (1.03)
N. Acceptable on-call schedule 0.742 3.34 (1.21)
Y. Keeping options open 0.681 3.58 (1.09)
Factor 2 – societal orientation U. Health promotion important 0.692 3.63 (1.17) 2.79 �¼0.73
L. Long term relationship with patients 0.679 3.31 (1.23)
F. Focus on patients in the community 0.681 3.32 (1.23)
S. Social commitment 0.637 3.29 (1.26)
Factor 3 – prestige K. High income potential 0.752 2.16 (1.17) 2.67 �¼0.72
J. Adequate income to eliminate debt 0.708 2.14 (1.31)
M. Status among colleagues 0.694 1.91 (1.05)
T. Stable/secure future 0.636 1.79 (1.10)
Factor 4 – hospital orientation G. Focus on urgent care 0.758 2.95 (1.25) 2.31 �¼0.68
E. Focus on in-hospital care 0.726 2.88 (1.29)
I. Results of interventions immediately available 0.679 3.08 (1.23)
Factor 5 – scope of practice A. Wide variety of patient problems �0.701 3.61 (1.89) 1.74 r¼�0.50
B. Narrow variety of patient problems* 0.820 2.74 (1.27)
Factor 6 – role model Z. Meaningful past experience with physician 0.847 2.96 (1.45) 1.71 r¼ 0.59
Q. Emulate a physician 0.856 2.51 (1.43)
Items not loading into any factor C. Good match to this career, D. Interesting patient population, H. Focus on non-urgent care, O. Dislike for
uncertainty, P. Prefer medical to social problems, R. Research interest, AA. Short postgraduate training
Notes: *‘‘Narrow variety of patient problems’’ recoded in reverse order thereby producing a factor that reflected a varied scope of practice.
Determinants of choosing a career in surgery
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non-surgical residencies, 165 (14.0%) had named a surgical
specialty as their preferred career, 575 (48.6%) had included
a surgical specialty as one of their top three options and
876 (74.1%) indicated having considered a surgical specialty
as a possible option at medical school entry.
While 95% (n¼ 71) of applicants to obstetrics in our study
were female, females comprised only 36.8% (n¼ 105) of
applicants to other surgical residencies, thus overall women
contributed 48.9% (n¼ 176) of applicants to surgical careers.
Univariate analysis found a number of demographic
variables to differ significantly between surgical residency
applicants and those students applying for other residencies
(Table 1). Surgery applicants were on average younger, more
likely to be single, had more educated parents and family or
close friends practicing surgery, as well as being less likely
to have volunteered with people with cognitive disabilities.
Factor analysis on the 27 attitudinal variables measured
at entry to medical school, yielded six factors containing
20 variables. The factors were named by the authors based
on their component variables – ‘‘Medical lifestyle,’’ ‘‘Social
Orientation,’’ ‘‘Prestige,’’ ‘‘Hospital Orientation,’’ ‘‘Varied
Scope of Practice’’, and ‘‘Role Model’’ (Wright et al. 2004;
Scott et al. 2008). These six factors collectively explained
53.4% of variance in the responses. Alpha coefficients,
estimating internal consistency of each factor were calculated
(Table 2). Seven items failed to load on any of the factors
and continued to be treated as separate variables in the
subsequent analyses. Univariate analysis found five of the six
factors and five of the additional attitudinal influences
measured to differ significantly between surgical residency
applicants and those students applying for other residencies
(Table 3).
By entering all variables identified by univariate analysis
as being associated with career choice in surgery, logistic
regression produced a model that correctly classified in 69.4%
of cases whether or not a student would select a surgical
specialty career on exit from medical school (specificity 70.3%,
sensitivity 66.4%) (Table 4).
A concern with this model was the potential confounding
effect of inclusion of obstetrics and gynecology, a specialty
with 95% female applicants, as one of the surgical specialties.
Only 36.8% of applicants to the other surgical specialties were
female (Range 20% to 53% depending on specialty). Logistic
regression analysis was therefore repeated excluding those
students choosing a career in obstetrics. The resulting logistic
regression model identified whether or not a student would
select a surgical specialty career (non-obstetrics) on exit from
medical school in 71.8% of cases (specificity 73.0%, sensitivity
66.7%) (Table 5).
Table 3. Demographic and attitudinal associations with a surgicalcareer choice on exit from medical school.
Surgicalspecialtyn¼ 360
Otherspecialtyn¼ 1182 p
Factor 1 – medical lifestyle 3.34 3.63 50.001
Factor 2 – societal orientation 3.08 3.49 50.001
Factor 3 – prestige 2.10 1.97 0.015
Factor 4 – hospital orientation 3.26 2.89 50.001
Factor 5 – varied scope of practice 3.11 3.53 50.001
Factor 6 – role model 2.83 2.71 0.124
Item C – good match to this career 2.14 2.19 0.537
Item D – interesting patient population 4.17 4.30 0.018
Item H – focus on non-urgent care 2.41 2.75 50.001
Item O – dislike for uncertainty 2.21 2.13 0.214
Item P – prefer medical to social problems 3.04 2.39 50.001
Item R – research interest 2.59 2.32 0.001
Item AA – short postgraduate training 1.57 2.00 50.001
Table 4. Logistic regression analysis of factors associated witha surgical residency choice (when obstetrics classified as a
surgical specialty).
Surgical residencyn (%) or Mean (SD) Adjusted OR (95% CI)
Surgical specialty career choice on entry
No 74 (10.8) 1.0*
1st choice 162 (49.5) 5.27 (3.64–7.64)
2nd/3rd choice 124 (23.4) 2.18 (1.57–3.03)
Relative/friend in surgical specialty
No 293 (21.8) 1.0*
Yes 67 (34.4) 1.59 (1.11–2.29)
Volunteer with sports
No 175 (21.4) 1.0*
Yes 185 (25.6) 1.32 (1.01–1.72)
Factor 5 – varied scope of practice
3.1 (1.1) 0.86 (0.76–0.98)
Item P – medical vs. social problems
3.0 (1.4) 1.21 (1.09–1.36)
Item H – non-urgent care
2.4 (1.1) 0.85 (0.74–0.96)
Item AA – short post-graduate training
1.6 (0.9) 0.87 (0.75–1.00)
Age
Years 23.4 (2.8) 0.95 (0.91–1.00)
Parental education
5Postgrad 179 (20.9) 1.0*
Postgrad 181 (26.3) 1.29 (0.99–1.69)
Note: *Reference category.
Table 5. Logistic regression analysis of factors associated witha surgical residency choice (when obstetrics excluded from
the surgical specialties).
Surgical residencyn (%) or Mean (SD) Adjusted OR (95% CI)
Surgical specialty career choice on entry
No 82 (8.8) 1.0*
1st choice 123 (47.5) 4.99 (3.34–7.47)
2nd/3rd choice 80 (22.9) 2.08 (1.44–2.99)
Relative/friend in surgical specialty
No 226 (16.8) 1.0*
Yes 59 (30.3) 1.78 (1.20–2.62)
Item P – medical vs. social problems
3.2 (1.3) 1.24 (1.10–1.40)
Item H – non-urgent care
2.3 (1.1) 0.80 (0.69–0.92)
Gender
Male 180 (27.6) 1.0*
Female 105 (11.8) 0.58 (0.43–0.78)
Note: *Reference category.
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Between entry to medical school and exit from medical
school a total of 198 students (12.8%) switched from their
initial career choice to surgery while 165 students (10.7%)
switched from their initial career choice away from surgery for
a net loss of 33 students. Logistic regression produced a model
that could accurately identify whether or not a student would
switch from their initial career choice to selecting surgery as
their top residency choice in 64.4% of cases (specificity 63.9%,
sensitivity 66.7%) (Table 6). Again, logistic regression analysis
was repeated with those students choosing a career in
obstetrics excluded from the surgical sample. The resulting
logistic regression model identified whether or not a student
would switch to a surgical specialty career (non-obstetrics)
on exit from medical school in 68.0% of cases (specificity
68.1%, sensitivity 67.0%) (Table 7).
Conclusions
Few studies have identified variables that predict a student
selecting a career in surgery. We have developed a model that
predicts with good accuracy (70%) those students who, based
on their entry characteristics, would choose a career in surgery
(defined by their top career choice in the residency match).
A total of eight variables, measured on entry to medical school,
were identified as being predictive of a career choice in a
surgical specialty on exit from medical school. Four of the
strongest predictors of a surgical career choice – career
interests in surgery on entry to medical school, having close
family or friends practicing a surgical specialty, having done
volunteer work with sports, and expressing an interest in
medical more than social problems – also predicted if a student
would change career interests from a non-surgical career on
entry to medical school to a surgical residency choice upon
graduation.
In this study, when obstetrics was included as a surgical
specialty, women made up nearly half of all students interested
in a surgical career. This increase in the number of women
selecting a career in surgery represents a change from
the current demographic makeup of practicing surgeons in
Canada (which includes obstetricians and gynecologists)
where only 20% are female (CIHI 2009). When obstetrics
and gynaecology was excluded from the surgical specialty
category male gender was a strong predictor of a career in
surgery (though not when obstetrics was included as a surgical
career). This association between male gender and a surgical
career choice supports the findings of numerous other reports
using both univariate (Baxter et al. 1996; Ek et al. 2005;
Tambyraja et al. 2008) and multivariate analysis (Brundage
et al. 2005; Andriole et al. 2006; Sobral 2006; Maiorova et al.
2008). Male gender was also found to be a significant predictor
of switching to a surgical career choice when obstetrics was
excluded). In our study males were 30% more likely to switch
their careers towards surgery which supports with the work
of Novielli who found that males were three times more likely
than females to change interests toward surgery during their
medical studies (Novielli et al. 2001).
The most powerful predictor of a surgical residency choice
in our study was a student’s stated career interest on entry to
medical school. About 45% of the students choosing a surgical
residency had maintained a surgical specialty as their primary
interest throughout medical school, and a further 35% had
included a surgical specialty as either their 2nd or 3rd choice
of career of entry to medical school. Both ranks of interest
were independent predictors of an exit career choice in
surgery. While endorsing the findings of a number of earlier
studies (Babbott et al. 1988; Kozar et al. 2004), the notion that a
surgical career choice commonly originates prior to entry to
medical school is not universally accepted (Novielli et al. 2001;
Compton et al. 2008). Compton et al. found that as few as 24%
of those initially interested in surgery maintained this interest
throughout medical school (Compton et al. 2008).
Table 6. Multivariable logistic regression analysis of factors foundto be significantly associated with switching to a residency choicefrom a non-surgical career choice on entry to medical school (when
obstetrics classified as a surgical specialty).
Switch to surgical residencyn (%) or Mean (SD)
Adjusted OR(95% CI)
Surgical specialty career choice on entry
No 72 (10.6) 1.0*
2nd/3rd choice 126 (23.5) 2.25 (1.61–3.13)
Relative/friend in surgical specialty
No 161 (15.0) 1.0*
Yes 37 (26.2) 1.81 (1.16–2.82)
Volunteer with sports
No 89 (13.9) 1.0*
Yes 109 (19.0) 1.50 (1.08–2.08)
Item P – medical vs. social problems
2.8 (1.3) 1.20 (1.05–1.38)
Factor 5 – varied scope of practice
3.3 (1.2) 0.86 (0.73–1.01)
Age
Years 23.4 (2.7) 0.94 (0.88–1.00)
Note: *Reference category.
Table 7. Multivariable logistic regression analysis of factors foundto be significantly associated with switching to a residency choicefrom a non-surgical career choice on entry to medical school (when
obstetrics excluded from the surgical specialties).
Switch to surgical residencyn (%) or Mean (SD) Adjusted OR (95% CI)
Surgical specialty career choice on entry
No 78 (8.7) 1.0*
2nd/3rd choice 77 (23.9) 2.00 (1.39–2.89)
Relative/friend in surgical specialty
No 124 (11.5) 1.0*
Yes 31 (22.0) 2.04 (1.26–3.29)
Gender
Male 85 (17.6) 1.0*
Female 70 (9.5) 0.61 (0.42–0.89)
Item H – focus on non-urgent care
2.4 (1.1) 0.83 (0.69–1.00)
Item P – medical vs. social problems
2.9 (1.3) 1.25 (1.08–1.45)
Age
Years 23.5 (2.6) 0.93 (0.87–1.00)
Note: *Reference category.
Determinants of choosing a career in surgery
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Our study also demonstrated that a surgical specialty as
2nd or 3rd choice of career of entry to medical school
was strongly predictive of changing from a non-surgical to
a surgical career choice. These finding support the notion
expressed two decades ago by Carline and Greer (1991) that
students enter medical school with ‘‘a variety of acceptable
specialties’’ and generally chose between these as they
progress through their studies.
Another strong predictor of a surgical career choice
identified in this study was having family or close friends
practicing surgery independent of whether obstetrics was
included as a surgical career choice. While Pinchot et al. (2008)
showed this to be true of entry career interests only, the
inclusion of surgical friends as well as family in our model may
have increased the importance of this variable in predicting
students choosing a surgical career on exit from medical
school.
Our study showed that a greater interest in medical than
social problems was predictive of a surgical career choice.
While this specific association has not been previously
reported, an interest in the acute care of patients has been
linked to a surgical career choice (Maiorova et al. 2008). While
only a weak predictor in our study, the length of postgraduate
training has been cited in several publications as being
inversely associated with a surgical career choice (Erzurum
et al. 2000; Cochran et al. 2003; Wendel et al. 2003; Brundage
et al. 2005).
Student’s age, lack of interest in varied scope of practice
and having undertaken volunteer work with sports were
identified as predictors of a surgical career choice. In addition,
high parental education almost reached statistical significance.
These associations with surgical career choice at medical
school exit have not been identified by other investigators.
Our study’s large sample size may have allowed the identifi-
cation of these additional variables that were not as strongly
associated with a career choice in surgery as some of the other
variables we identified.
While our study confirmed numerous other associations
with a surgical career choice seen in previous studies
(Baxter et al. 1996; Erzurum et al. 2000; Azizzadeh et al.
2003; Cochran et al. 2003; Minor et al. 2003; Wendel et al.
2003; Brundage et al. 2005; Ek et al. 2005; Sanfey et al. 2006;
Maiorova et al. 2008; Scott et al. 2008; Tambyraja et al. 2008)
the strong association between entry career interests and
residency choice identified by logistic regression analysis in
this study likely rendered the predictive influence of many of
these other variables insignificant. For example, lifestyle,
commonly identified by univariate analysis as a surgical
career deterrent (Baxter et al. 1996; Erzurum et al. 2000;
Azizzadeh et al. 2003; Cochran et al. 2003; Minor et al. 2003;
Wendel et al. 2003; Brundage et al. 2005; Ek et al. 2005; Sanfey
et al. 2006; Scott et al. 2008) was not identified as a significant
predictor of a surgical career choice in our logistic regression
model. This finding contrasts with the findings of Maiorova
et al. (2008) who used logistic regression to show lifestyle was
a significant deterrent to a surgical career choice. However
their study did not include entry career choice as an
independent variable and it is likely that in our model the
effect of lifestyle is captured by either our array of other
demographic and attitudinal variables or the student’s surgical
career choice on medical school entry.
In summary, students who choose a surgical residency
at medical school exit are younger, are unconcerned about
a short post-graduate training period, have friends and family
practicing surgery, have volunteered with sports teams, have
an interest in a narrow scope of practice, have an interest in
medical problems, and urgent care as well as a greater desire
to practice surgery compared to their peers at medical school
entry. In addition, it appears that future surgical training
programs will likely have much higher proportion of women
in them compared to the current cohort of practicing surgeons
based on the gender mix of those students applying to surgical
residency programs.
With a number of Canadian and US surgical organizations
highlighting a current or looming surgeon shortage, the
findings of this study allow surgical educators to target
students in order to encourage them to consider a career in
surgery. In addition, health human resource planners may
even work to preferentially admit students with the attributes
we identified in our study to medical school or target those
students admitted with the attributes we identified for
mentoring and thereby ensure an adequate supply of surgery
interested students for the residency match.
Strengths and limitations
An advantage of our study is that it utilized multivariable
methods. This has been advocated by others but is not always
seen in the literature (Senf et al. 2003). While univariate
analyses found numerous variables to be significantly associ-
ated with a surgical career choice, when placed together in a
logistic regression model we have observed their relative
importance decrease or disappear. The resulting predictive
model, based on variables present on entry to medical school,
has potential use in selective recruitment of students to
medical school according to population health needs or to
identify students in medical school who are predisposed
to a career in surgery.
A potential limitation is that we looked at attitudes present
at entry to medical school which may differ markedly from
attitudes developed throughout medical school. A further
challenge with comparing studies that address a career in
surgery is that different studies define differently what careers
are included under the rubric of surgery. Finally, this study
took place in a Canadian context that surveyed for a discrete
period of time from select regions of Canada thus limiting the
generalizability of the findings.
Acknowledgments
The authors thank Sandra Banner and Jim Boone at CaRMS
for providing the career choice data and to Steve Slade at
CAPER for linking this data with the entry survey.
Declaration of interest: The authors report no conflicts
of interest. The authors alone are responsible for the content
and writing of the article.
I. Scott et al.
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Notes on contributors
IAN SCOTT, MD, MSc, is an associate professor in the Department of
Family Practice at the University of British Columbia and is the director
of undergraduate family practice programs in the medical school. He is also
the chair of the College of Family Physicians of Canada undergraduate
medical education committee.
MARGOT GOWANS, BSc, is a researcher in the Department of Family
Practice at the University of British Columbia. She has a background
in medical social science research and a passion for statistics.
BRUCE WRIGHT, MD, is presently the associate dean of UME at the
University of Calgary. He is an associate professor in the Department of
Family Medicine. His academic interests are in assessing and managing
curriculum change, career choice of medical students, and medical
education in developing countries.
FRASER BRENNEIS, MD, is an associate professor in the Department
of Family Medicine and vice-dean Education for the Faculty of Medicine &
Dentistry at the University of Alberta.
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