Med Students Who Shadow Surgeons Keener on Surgery

Source: MedPage Today


Published: Aug 10, 2013 | Updated: Aug 12, 2013

By Sarah Wickline, Contributing Writer, MedPage Today
Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner



Medical student interest in critical care surgery has fallen since the 1980s, but shadowing surgeons on a busy night bolstered enthusiasm in a small group, researchers found.

Greater interest in pursuing a surgical match was reported by medical students after shadowing general and trauma surgeons for at least one night in an urban, level one trauma center (P<0.005). Compared with only 22% of the previous year’s graduating class, 40% of participants from the shadowing program expressed intent to pursue a surgical match, according to Elliott R. Haut, MD, of Johns Hopkins University, and colleagues.

“Increasing student interest in trauma surgery is possible through voluntary participation in trauma shadowing experience with engaged residents and dedicated surgical faculty,” Haut and colleagues wrote online in JAMA Surgery.

The researchers cited recent data, which suggested that by the third-year clerkship it may be too late in the medical school process to draw attention towards a surgical specialty.

Since the 1980s, the rate of medical students entering general surgery has dropped by half to only 6.6%, according to the Association of American Medical Colleges.

Data from the National Resident Matching Program in 2011 showed a marked disparity between U.S. medical school graduates choosing other surgical fellowships over critical care with only 25% of colorectal surgery spots left unfilled compared with 64% of critical care spots.

“Although most students were only slightly influenced toward a career in trauma surgery, a select few students had dramatic increases in their interest,” Haut and colleagues wrote.

To test a possible way to spark greater interest in general and trauma surgical matches, the researchers invited 126 first-year medical students to voluntarily shadow trauma residents, fellows, and attending surgeons at the Johns Hopkins Hospital — an urban, level one trauma center.

Outfitted with scrubs, a trauma pager, and call-room accommodations, the students were invited to observe resuscitations, acute care surgery consults, surgical procedures, and ICU and ward rounds with practicing surgeons.

After 3 years, but before graduation or receiving a residency match, the students were asked to fill out an anonymous web-based survey. Roughly half, 68, of the original group responded to the survey.

Even though the majority of students shadowed only once, 13 did so more than once, and a few shadowed up to four separate occasions.

Twenty-five of the students had previous trauma experience as an emergency department volunteer, medical technician, or paramedic. Prior to this shadowing program, 44 of the students had not completed any hospital clerkships.

For the most part, students gave positive feedback about their shadowing experience, stating “Best experience of first year — bar none,” and “Reminded me why I came to medical school.” The most common negative feedback was boredom on a slow night with no trauma patients to treat.

On average, the students were exposed to 2.4 trauma patients (standard deviation 1.5, range 0-6), 1.1 general surgery patients (SD 1.4, range 0-6), 0.5 trauma operations (SD 0.7, range 0-3), and 0.3 general surgery operations (SD 0.5, range 0-2). Overall, 13 of the students witnessed a patient die.

On a 10-point scale, with 10 indicating the highest level of interest, each student rated his or her level of attraction to surgery. Among students that had not initially planned on going into any surgical specialty, 48 reported that participating in the shadowing program increased their interest in trauma surgery significantly (P<0.005) from 4.4 (SD 2.4) points to 5.3 (SD 2.5) points.

Interest in general surgery also increased significantly after shadowing (P<0.05) from 5.5 (SD 2.6) points to 5.9 (SD 2.5) points. A serious increase (>4 points) was reported by three of the students interested in trauma surgery. They had all seen at least three trauma patients and one trauma surgical procedure, and said that they were satisfied with the teaching they received.

Forty percent of the students stated that they intended to match into some type of surgery, and 16% planned to match into general surgery. Reports from the graduating class from the previous year indicated only 22% intended to match into surgery, and only 8% specified general surgery.

“A voluntary overnight shadowing program improves medical students’ perception of trauma surgery and increases their reported likelihood to apply into a surgical residency,” Haut and colleagues concluded.

Haut and colleagues indicated the low response rate and recall bias as possible limitations to the study.

No outside funding sources were used. The study authors declared no conflicts of interest.

Primary source: JAMA Surgery

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