Elsevier

Annals of Vascular Surgery

Volume 27, Issue 2, February 2013, Pages 225-231
Annals of Vascular Surgery

Clinical Research
Medical Student Career Survey—Vascular Surgery Awareness Initiative

https://doi.org/10.1016/j.avsg.2012.02.012Get rights and content

Background

The objectives of this survey were to identify medical students’ general knowledge of vascular surgery as a career choice on entrance to medical school, and how student perspectives change during their exposure to clinical disciplines. Furthermore, we sought to determine which factors may influence the choice of a particular career path, and to apply this knowledge to improve the recruitment process of medical students into the specialty of vascular surgery.

Methods

A one-time anonymous questionnaire consisting of 21 open and multiple-choice questions was distributed to first- (MS1), second- (MS2), and third-year (MS3) medical students at a large single-campus medical school. Responses were collected and subjected to analysis.

Results

Three hundred thirty-eight medical students responded to the survey (110 MS1, 126 MS2, and 102 MS3). Two hundred thirty-six MS1 and MS2 students had no clinical exposure to vascular surgery. Of 102 MS3 students having completed a general surgery rotation, 38 had exposure to vascular surgery. Of MS1 and MS2 students, 49% would consider vascular surgery. An additional 19% were willing to consider vascular surgery if the length of training was reduced. Twenty-six percent of the clinical students rotated on a vascular surgery service during their clinical general surgery rotation, of which 78% reported a positive experience. Only 26% (10 of 38) still considered vascular surgery as a career at the MS3 level. Thirty-four percent of students would consider vascular surgery if the training was reduced from 7 to 5 years. However, only 5% of MS1 and MS2 (11 of 236) and 9% of MS3 (9 of 102) students were aware of the 0 + 5 training program. As students advanced in medical school, lifestyle (31% MS1 vs. 63% MS3, P < 0.001) and length of training (19% MS1 and 2 vs. 34% MS3, P < 0.001) became a more critical factor in their career choice decision making.

Conclusions

Medical students have minimal knowledge of vascular surgery on entry to medical school; however, many are willing to consider vascular surgery as a career. Lack of exposure in the first 2 years of medical school and lifestyle considerations may be deterrents for students to choosing vascular surgery as a career. To improve the recruitment process, focused education and interaction with preclinical medical students are needed.

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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