Clinical ResearchMedical Student Career Survey—Vascular Surgery Awareness Initiative
Introduction
Vascular surgery (VS) originated as a subspecialty of general surgery, attracting surgeons involved in the treatment of diseases of arteries, veins, and lymphatics. The Society of Vascular Surgery first met in 1947, with only 31 members.1 Since that inaugural meeting, VS has grown and expanded as an independent surgical subspecialty and acquired recognition as such in 1982.2 VS training at that time consisted of successful completion of a 5-year general surgery residency plus 1 to 2 years of additional training in an accredited vascular fellowship program.
Within the past 10 years, many changes have occurred within the field of VS. There has been a sizable decline in the number of desirable applicants from general surgery training programs, as well as stagnation of the overall number of applicants.3 This has occurred despite an increased demand for vascular surgeons, availability of variable practice designs, increased reimbursement as compared with other surgical specialties, expansion of the field to include minimally invasive interventions, and an increase in the number of novel and complex procedures and advancements in patient care.1, 4, 5 Given that the projected future need for vascular surgeons will dramatically increase over the next years, the need for training of adequate numbers in VS is crucial.4
There are several potential explanations for the recent decline in the number of applicants. The shift from solely open surgical procedures to increasing numbers of endovascular interventions, where vascular surgeons face competition from interventional cardiologists, interventional radiologists, and, lately, interventional nephrologists, may have created career uncertainty for those considering the field.6, 7 Vascular patients are also perceived as labor intensive, which makes the practice of VS appear very demanding and perhaps not a time- or cost-effective career choice.
VS training traditionally has been a long and difficult course, creating surgeons broadly trained, with extensive experience, in many areas, which may not pertain to daily practice. The majority of vascular surgeons, although trained in both vascular and general surgery, do not practice general surgery. To make the field more attractive to potential trainees, VS passed primary certification in 2006, which eliminated certification in general surgery as a requirement for the Vascular Surgery Board examination.8 Primary certification has created new training options in VS, such as 4 + 1, 3 + 3, and 0 + 5 training tracks, which are different from a standard 5 + 2 programs (5 years of general surgery and 2 of vascular). New training paradigms are heavily weighted toward recruiting trainees earlier in training than ever before, including during the initial residency match after medical school. This places a higher emphasis on medical students’ knowledge of VS and awareness of training options. Currently, there are 36 integrated VS programs.9 Medical students who are not taught at an institution with an integrated VS surgery training program, or with limited exposure to VS, have little exposure to either traditional or new training algorithms.
Given the changing climate of VS and the dramatic shifts in training, a new approach toward undergraduate medical education is needed. In an attempt to identify which factors are important for recruitment and to measure the awareness of different training models, we surveyed first- (MS1), second- (MS2), and third-year medical students (MS3) of a large single-campus medical school unaffiliated with an integrated VS training program, to identify potential specialty preferences and better understand why students choose career paths.
Section snippets
Methods
A one-time anonymous questionnaire consisting of 21 open and multiple-choice questions (Appendix) was distributed to preclinical (MS1 and MS2) and clinical (MS3) medical students at a large single-campus Midwestern allopathic medical school. The questions pertained to general demographics, specialty inclination before medical school, factors that influenced the students’ specialty choice, and the respondent’s previous experience with and views on VS. To determine which factors contributed most
Results
Three cohorts of medical students were surveyed for a total of 951 recipients, with 338 returned surveys (35%). Preclinical (MS1 and MS2) as well as clinical (MS3) students were included in this study. There was no significant difference between the preclinical and clinical group in terms of the age, gender, or marital status of the students (Table I). When the MS1 and MS3 students were compared with regard to marital status, significantly more MS3 students were found to be married (P < 0.001).
Discussion
With the increased demand for vascular surgeons and decreased recruitment, the vascular surgical community faces a critical workforce shortage. To solidify the position of VS among other specialties and ensure appropriate access to care is available, recruitment must be improved. One solution, which has already been implemented, is to change the training model by attracting applicants directly from medical school. However, this creates a new set of concerns, as medical students are largely
Conclusions
Preclinical medical students have little exposure to VS. It is critical that vascular surgeons reach out to these students while they are at a point in their medical school career where they would be more likely to consider the field. Early exposure to VS through structured programs and didactic teaching as well as increasing the awareness of medical students to the existence of the 0 + 5 training paradigm will help to attract more students into a career in VS. Given the projected future needs
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Cited by (21)
Fourth-Year Medical Students’ Perceptions of Vascular Surgery: Can We Improve the Pipeline?
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Vascular Surgery Curriculum for Medical Students: A National Targeted Needs Assessment
2022, Annals of Vascular Surgery