Imam Journal of Applied Sciences

ORIGINAL ARTICLE
Year
: 2020  |  Volume : 5  |  Issue : 2  |  Page : 61--67

Umm Al-Qura University Medical Students' and interns' perceptions on surgery and surgical career: A cross-sectional study


Osama A Bawazir1, Omemh Abdullah Bawazeer2,  
1 Department of Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
2 Department of Physics, Collage of Applied Science, Umm Al-Qura University, Makkah, Saudi Arabia

Correspondence Address:
Dr. Osama A Bawazir
Department of Surgery, Faculty of Medicine, Umm Al-Qura University, P.O. Box 715, Makkah 21955
Saudi Arabia

Abstract

Background: The number of applicants to surgical specialties has decreased worldwide. Several factors contribute to this decline, and early intervention is essential to correct students' misconception about surgical training. The aim of this study was to explore the perception of Umm Al-Qura University Medical Students and Interns about surgery and a career in surgery. Methods: We conducted an institutional-based cross-sectional study at Umm Al-Qura Medical College in Makkah to explore 6th year students' and interns' perception about surgical specialties. The participants were divided into four groups: Group 1 (female 6th year; n = 144); Group 2 (male 6th year; n = 133); Group 3 (female intern; n = 81); and Group 4 (male intern; n = 25). Participation was mandatory for students, and the response rate was 100% in Group 1 and 96% (132/138) in Group 2. Participation was optional for interns, and the response rate was 65% (78/120) in Group 3 and 21% (25/118) in Group 4. Results: Eighty-one percent of the participants think that going to the medical school was a wise decision, and the choice of nonsurgical career was more prominent in female interns. Career choice increased significantly after the 6th year, and the likelihood of choice of the surgical career was higher in males (P = 0.045); however, the possibility to choose pediatric surgery was equal between groups (P = 0.122). Most participants think there was insufficient ward training, and they agreed that they had inadequate operative room training. Conclusion: The majority of medical students and interns are willing to pursue a career with a reasonable quality of life regardless of the income or the social status of this career, and a surgical career is still considered a stressful and demanding specialty. We recommend more lectures, hands-on training, and workshops directed toward medical students to increase their knowledge about these potential factors, which could alter their decision when choosing a surgical career.



How to cite this article:
Bawazir OA, Bawazeer OA. Umm Al-Qura University Medical Students' and interns' perceptions on surgery and surgical career: A cross-sectional study.Imam J Appl Sci 2020;5:61-67


How to cite this URL:
Bawazir OA, Bawazeer OA. Umm Al-Qura University Medical Students' and interns' perceptions on surgery and surgical career: A cross-sectional study. Imam J Appl Sci [serial online] 2020 [cited 2020 Sep 20 ];5:61-67
Available from: http://www.e-ijas.org/text.asp?2020/5/2/61/291582


Full Text



 Introduction



The perception of the surgical career is an integral part of the training programs since it may affect the completion of general surgery residency programs, and to improve recruitment and completion of the surgical training, medical students' perception was previously explored.[1],[2] The reported annual attrition rate for general surgery residency programs was estimated to be 5.1%.[3] Several factors prior to career choice may create myths and stereotypes. An example of these stereotypes is the male predominance in surgical posts, despite the acceptance of a high proportion of the females applying to those programs.[4]

The number of general surgery programs applicants has decreased both nationally and internationally[4],[5],[6],[7],[8] and it became essential to motivate the medical students to consider this specialty which will avoid future shortage. Several factors contribute to specialty choice by medical students, including the type of personality, the research opportunity and the relationship with the mentors during the medical study.[9],[10],[11]

There are other factors that may attract the medical students to a specific specialty such as the salary or social position, while long-working hours, the poor balance between life and work, and the fear of lack of respect for surgical residents may work oppositely.[12],[13]

In Saudi Arabia, the majority of final year medical students had lost their interest in applying to surgical residencies. The choice of a specialty starts early during the medical study for many trainees,[14] and if an intervention was not carried out early to target this population, the decline in the number of applicants would continue.

More than 50% of the students choose now to pursue primary care careers,[15] which was attributed to the more time dedicated to primary care modules during the undergraduate studies, in addition to the governmental policies.[16] Consequently, this trend had affected the number of applicants to the surgical career. Some studies found that the students' perception of the surgical environment as cutthroat and hierarchical as one of the most critical factors contributing to the decline in applicants' number.[4]

The undergraduate surgical curriculum has been reduced, which stands against the correction of the students' misconception of surgical careers,[17] and they feel that there are hidden requirements to pursue a surgical specialty.[18]

The aim of this study was to explore the perception of Umm Al-Qura University Medical Students' and interns about surgery and their potential career in surgery.

 Methods



This is an institutional-based cross-sectional study conducted at Umm Al-Qura Medical College in Makkah and was approved by the Ethical Committee. Participants were from Umm Al-Qura University final year medical students and interns. The study did not include students from other colleges and universities. An anonymous, structured questionnaire was developed and edited based on our culture and practice. Questions in the survey offered objective answers with only one valid answer for each question.

The questionnaires were designed using Google Forms and distributed among all the students using their E-mails. The data were collected and entered into Microsoft Excel (Microsoft, California, USA) with confidentiality and anonymity. Data were collected from August to September 2019.

The participants were divided into four groups: Group 1 (female 6th year; n = 144); Group 2 (male 6th year; n = 133); Group 3 (female intern; n = 81); and Group 4 (male intern; n = 25). Participation was mandatory for students, and the response rate was 100% in Group 1 and 96% (132/138) in Group 2. Participation was optional for interns, and the response rate was 65% (78/120) in Group 3 and 21% (25/118) in Group 4.

Statistical analysis

The variables were analyzed using Stata version 14.2 (Stata Corp., College Town, Texas, USA). Continuous variables were presented as mean ± standard deviation and compared between groups using the Kruskal–Wallis test. Categorical variables were presented as number and percent and compared with either Pearson's Chi-square test or Fisher's exact test. P ≤ 0.05 was considered as statistically significant.

 Results



Baseline participants' data are shown in [Table 1]. Marriage was more common among female participants irrespective to their age; however, there was no significant difference in the number of offspring among groups [Table 1]. Most of the participants think that going to the medical school was a wise decision, and the choice of nonsurgical career was more prominent in female interns (Group 3). Career choice increased significantly after the 6th year, and the likelihood of choice of the surgical career was higher in males [Figure 1]; however, the likelihood to choose pediatric surgery was equal between groups (P = 0.0122) [Figure 2].{Table 1}{Figure 1}{Figure 2}

The criteria of specialty choice varied significantly between groups. The participants' response varied widely regarding the effectiveness of the course material and ward training [Figure 3] and [Figure 4]; however, the trend is toward insufficient ward training. The participants agreed that they had inadequate operative room training [Figure 5].{Figure 3}{Figure 4}{Figure 5}

The most common cause to dislike surgical specialty was the stress of surgery, [Table 2] while, assisting in the operation room and gaining clinical experience were the most contributing factors to like surgery [Table 3]. The participants saw the surgeons and surgical faculty as confident and willing to teach; however, their view about surgeon and surgery course varied significantly [Figure 6] and [Figure 7] and [Table 4].{Table 2}{Table 3}{Figure 6}{Figure 7}{Table 4}

 Discussion



The career choices made by medical students and their preference for specialty selection have a lot of influencing factors. There is a suggestion that interest in general surgery amongst medical students and interns had decreased.[5] This perception is supported by the declining numbers of surgical applications in the Saudi Board compared to other specialties.

The motivation of students to pursue a surgical career is affected by nonmedical factors. The balance between work and life; in addition to the lifestyle are highly valued by medical students. These factors, as well as the length of training, have been studied to determine the effect on career choice.[19] Students usually choose their specialty based on the time that can be spent outside their medical practice as well as prestige, remuneration, and length of training.

Negative perceptions

Surgery is associated with challenging lifestyle despite the flexible working options and academic opportunities which drive some students away. In addition, surgery has male-dominance, and attracting female applicants is challenging. The number of female applicants to surgery is low compared to the total number of female students. Lack of connection between female students and female mentors in surgery, as well as the male-dominated culture, are contributing factors deterring females from applying to surgical training programs. Despite the current effort to combat this gender imbalance in surgery, many female students still believe in these negative assumptions and choose nonsurgical specialty. These decisions were based on limited experience and exposure, while the flexibility of a surgical career is often not well-communicated to students.

Studying factors that govern students' decisions to choose their specialty are essential to recruit students into careers compatible with his/her personality and expectations, yet these studies are scarce.[20]

The majority of students participated in our study showed a high interest in pursuing a career in surgery; this is consistent with many studies done in the Middle East, North America, Europe, and Africa.[21],[22],[23],[24] On the other hand, there was a good percentage of students who neither agreed nor disagreed to pursue a career in surgery, probably due to limited exposure of the students to clinical practice, especially in the early academic years of medical college.[25]

In general, the most significant factors favoring to pursue a career in surgery were “hands-on work” followed by “immediate improvement of the patient condition after surgery,” this is similar to what Scott and colleagues reported in their study.[22]

The generation differences between students and attending surgeons were explored by Money and associates. They found that leaders should adopt recruitment strategies catered to the needs of the new generations.[26] The generation that was born after 1980 is characterized by lifestyle flexibility and team-oriented work environments.[27] This generation expects direction, praise, and a forum for vocalizing their opinion. Our participants are part of this generation; therefore, it is expected that they would prefer a communal surgeon.[27]

Another reason for females to deter surgical specialty is the lack of surgical role models.[13] Close teaching and connections to attending female surgeons, may lead to the development of a more accurate understanding of the nature of a surgical career and be better informed when making career decisions.

Students' stereotypes regarding surgeons were explored in another study, and it was found that students described surgeons as self-confident and intimidating, and the field of surgery is competitive and masculine.[4] Our research found the perceptions of surgeons did not address explicit stereotypes, but rather welling to teach and self-confident maybe this related to limited interaction between the student and faculty in real-world and daily surgical practice.

The importance of exposure to surgical specialties

Exposure to surgical fields is deficient in the current medical curriculum, and the students have limited opportunity for practical exposure and understanding of surgical techniques. Consequently, their confidence in surgical skills is decreased. Students need proper contact with mentors and skills to motivate the positive perceptions of a surgical career. It is the responsibility of the societies and universities to expose the students to their field of interest. In another study, hand-on training and simple measures such as exposure to laparoscopic training has enhanced the choice of the surgical career by students and increased their confidence.[28],[29] This intervention has exposed the student with more realistic perception and understanding of a career in surgery.

Limitations

The lack of monitoring the changes in the students' preferences as they pass through clinical years was a major limitation in this cross-sectional study. Although the response rate was good, in the student group but not great in the intern group, a higher number of responses would have been preferred. Another limitation is the restriction of the participants in this research to the students of Umm al Qurra University; it would increase the value of the findings if we included students from other universities across the country which would make generalization the results more feasible.

 Conclusion



The majority of medical students and interns are willing to pursue a career with a reasonable quality of life regardless of the income or the social status of this career, and surgery is still considered a stressful and demanding specialty.

The decision of these students was affected by significant factors such as hands-on work, job satisfaction, lifestyle, and long working hours. We recommend more lectures, hands-on training, and workshops to target medical students to increase their knowledge about these potential factors that could alter their decision when choosing a surgical career.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Kozar RA, Anderson KD, Escobar-Chaves SL, Thiel MA, Brundage SI. Preclinical students: Who are surgeons? J Surg Res 2004;119:113-6.
2Naylor RA, Reisch JS, Valentine RJ. Do student perceptions of surgeons change during medical school? A longitudinal analysis during a 4-year curriculum. J Am Coll Surg 2010;210:527-32.
3Kennedy KA, Brennan MC, Rayburn WF, Brotherton SE. Attrition rates between residents in obstetrics and gynecology and other clinical specialties, 2000-2009. J Grad Med Educ 2013;5:267-71.
4Hill EJ, Bowman KA, Stalmeijer RE, Solomon Y, Dornan T. Can I cut it? Medical students' perceptions of surgeons and surgical careers. Am J Surg 2014;208:860-7.
5Fischer JE. The impending disappearance of the general surgeon. JAMA 2007;298:2191-3.
6Cockerham WT, Cofer JB, Biderman MD, Lewis PL, Roe SM. Is there declining interest in general surgery training? Curr Surg 2004;61:231-5.
7McDonald K, Sutton J. Surgical workforce: An emerging crisis. Bull Am Coll Surg 2009;94:21-6.
8Cofer JB, Burns RP. The developing crisis in the national general surgery workforce. J Am Coll Surg 2008;206:790-5.
9Mehmood SI, Khan MA, Walsh KM, Borleffs JC. Personality types and specialist choices in medical students. Med Teach 2013;35:63-8.
10Berger AP, Giacalone JC, Barlow P, Kapadia MR, Keith JN. Choosing surgery as a career: Early results of a longitudinal study of medical students. Surgery 2017;161:1683-9.
11Pointer DT Jr., Freeman MD, Korndorffer JR Jr., Meade PC, Jaffe BM, Slakey DP. Choosing surgery: Identifying factors leading to increased general surgery matriculation rate. Am Surg 2017;83:290-5.
12Kiker BF, Zeh M. Relative income expectations, expected malpractice premium costs, and other determinants of physician specialty choice. J Health Soc Behav 1998;39:152-67.
13Sanfey HA, Saalwachter-Schulman AR, Nyhof-Young JM, Eidelson B, Mann BD. Influences on medical student career choice: Gender or generation? Arch Surg 2006;141:1086-94.
14Rees-Lee JE, Lee S. Reaching our successors: the trend for early specialisation and the potential effect on recruitment to our speciality. J Plast Reconstr Aesthet Surg 2008;61:1135-8.
15Erzurum VZ, Obermeyer RJ, Fecher A, Thyagarajan P, Tan P, Koler AK, et al. What influences medical students' choice of surgical careers. Surgery 2000;128:253-6.
16Deakin N. Where will the GPs of the future come from? BMJ 2013;346:f2558.
17O'Herrin JK, Lewis BJ, Rikkers LF, Chen H. Medical student operative experience correlates with a match to a categorical surgical program. Am J Surg 2003;186:125-8.
18Hill E, Bowman K, Stalmeijer R, Hart J. You've got to know the rules to play the game: How medical students negotiate the hidden curriculum of surgical careers. Med Educ 2014;48:884-94.
19Bland KI, Isaacs G. Contemporary trends in student selection of medical specialties: The potential impact on general surgery. Arch Surg 2002;137:259-67.
20Kaliyadan F, Amin TT, Qureshi H, Al Wadani F. Specialty preferences of 1st year medical students in a Saudi Medical School – Factors affecting these choices and the influence of gender. Avicenna J Med 2015;5:134-9.
21Mehmood SI, Kumar A, Al-Binali A, Borleffs JC. Specialty preferences: Trends and perceptions among Saudi undergraduate medical students. Med Teach 2012;34 Suppl 1:S51-60.
22Scott AJ, Kahn D. Factors influencing medical students in pursuing a career in surgery: A cross-sectional survey. S Afr J Surg 2017;55:24-30.
23Scott IM, Matejcek AN, Gowans MC, Wright BJ, Brenneis FR. Choosing a career in surgery: Factors that influence Canadian medical students' interest in pursuing a surgical career. Can J Surg 2008;51:371-7.
24Hoffmann H, Dell-Kuster S, Rosenthal R. Medical students' career expectations and interest in opting for a surgical career. Swiss Med Wkly 2014;144:w13932.
25Hochberg MS, Billig J, Berman RS, Kalet AL, Zabar SR, Fox JR, et al. When surgeons decide to become surgeons: New opportunities for surgical education. Am J Surg 2014;207:194-200.
26Money SR, O'Donnell ME, Gray RJ. In the time of significant generational diversity-surgical leadership must step up! Surgeon 2014;12:3-6.
27Rudman LA, Moss-Racusin CA, Phelan JE. Status incongruity and backlash effects: defending the gender hierarchy motivates prejudice against female leaders. J Exp Soc Psychol 2011;48:165-79.
28Sideris M, Papalois A, Theodoraki K, Dimitropoulos I, Johnson EO, Georgopoulou EM, et al. Promoting undergraduate surgical education: Current evidence and Students' Views on ESMSC International Wet Lab Course. J Invest Surg 2017;30:71-7.
29Chiu HY, Kang YN, Wang WL, Huang HC, Wu CC, Hsu W, et al. The effectiveness of a simulation-based flipped classroom in the acquisition of laparoscopic suturing skills in medical students – A pilot study. J Surg Educ 2018;75:326-32.