determinants of choosing a career in surgery

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.


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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)


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)


No 226 (16.8) 1.0*

Yes 59 (30.3) 1.78 (1.20–2.62)


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)


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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)


No 72 (10.6) 1.0*

2nd/3rd choice 126 (23.5) 2.25 (1.61–3.13)


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)


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)


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)


No 78 (8.7) 1.0*

2nd/3rd choice 77 (23.9) 2.00 (1.39–2.89)


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)


2.9 (1.3) 1.25 (1.08–1.45)

Age

Years 23.5 (2.6) 0.93 (0.87–1.00)



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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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determinants of choosing a career in surgery

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