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      Declining interest in general surgical training – Challenging misconceptions and improving access at undergraduate level

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          Abstract

          Background

          In recent years, general surgery has faced a decline in applicants for postgraduate training. The St. George's Surgical Society hosted a national surgical conference with an aim to explore the reasons for the decline and to investigate the effectiveness of a one-day intervention on students' perceptions of general surgery and surgical skills.

          Materials and methods

          The conference took place on 20th January 2018 at St. George's, University of London. During the conference, medical students received lectures on “careers in surgery” and small-group workshops introducing students to simulation-based laparoscopic machines. Delegates were invited to complete before and after questionnaires looking at various domains; (1) Perceptions of general surgery, (2) Simulation skills, and (3) Usefulness of the day.

          Results

          There were significant impacts on student perceptions of the speciality such as increases in the views that "general surgery contained the opportunities for personal and professional development" (26%, p = 0.04), and of "general surgery as a rewarding speciality" (26%, p = 0.05). There were also negative changes such as an increase in the perception that “general surgery is female unfriendly” (+32%, p = 0.01). There were positive findings in all aspects relating to the use of laparoscopic simulation.

          Discussion

          The challenges faced in improving access to general surgery has been highlighted. More importantly the benefits of a one day intervention in addressing misconceptions and improving knowledge was seen. This study also shows the benefits of simulation teaching in the undergraduate curriculum.

          Conclusion

          The intervention has improved the perceptions on general surgery, surgical skills and knowledge and provided a platform for engaging students and clinicians.

          Highlights

          • After the conference, delegates were more likely to look at general surgery in a positive light.

          • The perception of surgery being female unfriendly had risen despite a female surgeon led event.

          • Increased view that surgery contained opportunities for personal and professional development.

          • Increased positive perception and decreased negative perceptions of general surgery.

          • The solution to the problem of declining applicants to general surgery lies in grassroots events.

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          Most cited references25

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          Influence of controllable lifestyle on recent trends in specialty choice by US medical students.

          Recent specialty choices of graduating US medical students suggest that lifestyle may be an increasingly important factor in their career decision making. To determine whether and to what degree controllable lifestyle and other specialty-related characteristics are associated with recent (1996-2002) changes in the specialty preferences of US senior medical students. Specialty preference was based on analysis of results from the National Resident Matching Program, the San Francisco Matching Program, and the American Urological Association Matching Program from 1996 to 2002. Specialty lifestyle (controllable vs uncontrollable) was classified using earlier research. Log-linear models were developed that examined specialty preference and the specialty's controllability, income, work hours, and years of graduate medical education required. Proportion of variability in specialty preference from 1996 to 2002 explained by controllable lifestyle. The specialty preferences of US senior medical students, as determined by the distribution of applicants across selected specialties, changed significantly from 1996 to 2002 (P<.001). In the log-linear model, controllable lifestyle explained 55% of the variability in specialty preference from 1996 to 2002 after controlling for income, work hours, and years of graduate medical education required (P<.001). Perception of controllable lifestyle accounts for most of the variability in recent changing patterns in the specialty choices of graduating US medical students.
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            The only girl in the room: how paradigmatic trajectories deter female students from surgical careers.

            Over 60% of UK medical students are female, yet only 33% of applicants to surgical training are women. Role modelling, differing educational experiences and disidentification in female medical students have been implicated in this disparity. We are yet to fully understand the mechanisms that link students' experiences with national trends in career choices. We employ a hitherto unused concept from the theory of communities of practice: paradigmatic trajectories. These are visible career paths provided by a community and are cited by Wenger as potentially the most influential factors shaping the learning of newcomers. We pioneer the use of this theoretical tool in answering the research question: How do paradigmatic trajectories shape female medical students' experiences of surgery and subsequent career intentions? This qualitative study comprised a secondary analysis of data sourced from 19 clinical medical students. During individual, in-depth, semi-structured interviews, we explored these students' experiences at medical school. We carried out thematic analysis using sensitising concepts from communities of practice theory, notably that of 'paradigmatic trajectories'. Female students' experiences of surgery were strongly gendered; they were positioned as 'other' in the surgical domain. Four key processes--seeing, hearing, doing and imagining--facilitated the formation of paradigmatic trajectories, on which students could draw when making career decisions. Female students were unable to see or identify with other women in surgery. They heard about challenges to being a female surgeon, lacked experiences of participation, and struggled to imagine a future in which they would be successful surgeons. Thus, based on paradigmatic trajectories constructed from exposure to surgery, they self-selected out of surgical careers. By contrast, male students had experiences of 'hands-in' participation and were not marginalised by paradigmatic trajectories. The concept of the paradigmatic trajectory is a useful theoretical tool with which to understand how students' experiences shape career decisions. Paradigmatic trajectories within surgery deter female students from embarking on careers in surgery. © 2013 John Wiley & Sons Ltd.
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              Factors influencing US medical students' decision to pursue surgery.

              Interest and applications to surgery have steadily decreased over recent years in the United States. The goal of this review is to collect the current literature regarding US medical students' experience in surgery and factors influencing their intention to pursue surgery as a career. We hypothesize that multiple factors influence US medical students' career choice in surgery.
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                Author and article information

                Contributors
                Journal
                Ann Med Surg (Lond)
                Ann Med Surg (Lond)
                Annals of Medicine and Surgery
                Elsevier
                2049-0801
                10 November 2018
                April 2019
                10 November 2018
                : 40
                : 3-8
                Affiliations
                [a ]St. George's, University of London, London, UK
                [b ]Manchester Royal Infirmary, Manchester, UK
                [c ]Academic Foundation Doctor, Imperial College Healthcare NHS Trust, London, UK
                [d ]St. George's University Hospital NHS Trust, London, UK
                Author notes
                []Corresponding author. St. George's Surgical Society, St. George's University of London, Cranmer Terrace, London, SW17 0RE, UK. m1300624@ 123456sgul.ac.uk
                Article
                S2049-0801(18)30251-6
                10.1016/j.amsu.2018.11.002
                6423304
                30962923
                7117afb5-5732-4005-a5d0-8092c94d7c40
                © 2019 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 17 June 2018
                : 30 October 2018
                : 1 November 2018
                Categories
                Original Research

                education,training,laparoscopy,simulation,surgical pathway
                education, training, laparoscopy, simulation, surgical pathway

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