Are we losing future talent? A national survey of UK medical student interest and perceptions of cardiothoracic surgery

Are we losing future talent? A national survey of UK medical student interest and perceptions of... Abstract OBJECTIVES Cardiothoracic surgery appears to have become a significantly less popular career option among UK medical graduates. This study aimed to elucidate the current levels of interest in pursuing a career in cardiothoracic surgery among surgically orientated UK medical students and to determine the factors underlying this decision. METHODS An online cross-sectional survey generated using the LimeSurvey was distributed to the surgical societies of all 32 UK medical schools. This assessed current career intentions, previous experience and perceptions of cardiothoracic surgery and the factors that attract or deter them to the speciality. RESULTS A total of 352 responses were obtained. Although 31% of the total cohort was considering a career in cardiothoracic surgery, only 14% of the final year students were. Seventy-five percent felt that they had received inadequate exposure to cardiothoracic surgery during their undergraduate curriculum, with 74% having spent no time on a dedicated cardiothoracic placement. Extracurricular exposure to the specialty was poor with 13% having attended a cardiothoracic conference/careers day. Approximately 50% of students were aware of the publication of surgeon-specific mortality data and previous scandals affecting the speciality; however, 80% claimed that this did not deter them. The main factor attracting students was the ability to significantly influence or save lives, whereas the main deterring factor was perceived competition levels. CONCLUSIONS Although there remains healthy interest among UK students to pursue a career in cardiothoracic surgery, there is a worrying decline in desire over the course of medical school which appears to stem from a lack of engagement with the specialty both within undergraduate curricula and through extracurricular events. Students , Thoracic surgery , Medical education INTRODUCTION Despite previously being regarded as a highly popular and competitive speciality, recent data have suggested that cardiothoracic surgery has become dramatically less popular among UK junior doctors since the turn of the millennium [1]. Presently, only 32% of current trainees and 18% of those completing cardiothoracic training graduated from a UK medical school [1]. This mirrors similar recruitment problems recently observed into residency programmes in the USA [2]. The factors precipitating this decline are yet to be delineated; however, they represent an important topic for consideration given the shortages of cardiothoracic surgeons that are predicted over coming decades [3]. It is likely that a combination of factors including societal measures [1], a changing demographic of medical students and lack of engagement with students [4] are responsible. With particular reference to the UK, since 2000, several major events have brought cardiothoracic surgery into the public eye, namely the Bristol Heart Scandal and the publication of surgeon-specific mortality data (SSMD) [1]. The current cohort of UK medical students is likely to be well aware of these events and may hold negative opinions of the specialty as a result. Furthermore, an expansion of interventional cardiac procedures has led some to describe the speciality as ‘dying’ which may also impact student perceptions [5]. Recent changes in the recruitment of UK cardiothoracic trainees has seen selection of candidates now taking place in the 2nd postgraduate year of training, meaning that applicants will have only recently graduated from medical school. Therefore, this national survey of undergraduate surgical societies was conducted with the aim of elucidating the current interests of UK medical students to pursue a career in cardiothoracic surgery and to determine the factors that positively or negatively affect this decision. MATERIALS AND METHODS In this cross-sectional observational study, a complete list of undergraduate surgical societies for all 32 UK medical schools was obtained from the Royal College of Surgeons England website [6]. Subsequently, a 29-item online questionnaire was designed on the LimeSurvey and then distributed to each surgical society before dissemination to their respective membership via e-mail or social media outlets. Students from all years of medical school were able to participate (including those undertaking a 1-year intercalated degree). The survey was available for 2 months (October to November 2017) prior to closure. Only fully completed responses were included in the final analysis. The questionnaire consisted of 5 question groups; (i) demographics, (ii) current career intentions, (iii) previous exposure to surgery, (iv) experiences and perceptions of cardiothoracic surgery and (v) factors affecting student interest in cardiothoracic surgery. Each student’s current career ambitions and previous experience on surgery (both cardiothoracic-specific experience and surgery in general) were, therefore, elucidated. The impact of 17 individual factors on student desire to pursue a career in cardiothoracic surgery was assessed via a 5-point Likert scale (ranging from strongly deterring to strongly attractive). A factor was determined to be either considerably attractive or deterring for students if more than 60% of the cohort reported the factor to be strongly attractive/attractive or strongly deterring/deterring. A Microsoft Excel 2007 package was used to perform simple analysis of the data obtained. Although the whole cohort was analysed, a separate subgroup analysis of the final year medical students was performed to obtain the perceptions of students imminently about to commence clinical practice and also to determine whether there were any noticeable differences in the career intentions of senior medical students. Ethical approval for this study was obtained from the St. George’s Research Ethics Committee (study reference SGREC17.0014). RESULTS Demographics In total, 352 medical students from 28 medical schools across the UK responded to the survey; 57.7% of respondents were women and 42.0% were men; and 83.8% of respondents were aged 18–25 years, 9.1% were aged 26–29 years and 7.1% were older than 30 years. Responses were well distributed across year groups: 18.5% of respondents were in their 1st year of medical school; 16.5% in the 2nd year; 23.6% in the 3rd year; 18.8% in the 4th year and 18.2% in their 5th (final) year; 4.4% of respondents were undertaking an intercalated degree at the time of the survey. Current career intentions Overall, 31.2% of students claimed that they were still considering a career in cardiothoracic surgery, and 10.8% of the total cohort claimed that cardiothoracic surgery was their top career choice, ranking as the second most popular specialty (Table 1). However, subgroup analysis of the final year cohort revealed lower levels of interest with 4.7% identifying it as their desired specialty of choice and 14.1% still considering it as a career option. This 6.1% decrease in the proportion selecting cardiothoracic surgery as their main career ambition was the greatest of all specialties screened. Although the proportion of women and men choosing cardiothoracic surgery as their desired career goal was similar (10.3% and 11.5%, respectively), less women (25.6%) considered it as a career option when compared with men (39.1%). Table 1: Proportions of student responses to ‘What career path do you currently believe you are most likely to pursue?’ Selected specialty  Overall cohort (%)  5th year students (%)  Females (%)  Males (%)  Cardiothoracic surgery  10.8  4.7  10.3  11.5  Ear, nose and throat surgery  4.3  6.3  2.0  7.4  General practice  6.8  7.8  7.9  5.4  General surgery  9.9  10.9  9.4  10.8  Medicine  37.5  43.8  40.4  33.1  Neurosurgery  5.1  3.1  3.0  8.1  Obstetrics and gynaecology  3.4  6.3  5.9  0.0  Paediatric surgery  3.7  3.1  4.4  2.7  Plastic surgery  5.4  3.1  6.9  3.4  Psychiatry  3.7  3.1  3.4  4.1  Trauma and orthopaedics  7.7  4.7  5.4  10.8  Urology  1.1  3.1  0.5  2.0  Vascular surgery  0.6  0.0  0.5  0.7  Selected specialty  Overall cohort (%)  5th year students (%)  Females (%)  Males (%)  Cardiothoracic surgery  10.8  4.7  10.3  11.5  Ear, nose and throat surgery  4.3  6.3  2.0  7.4  General practice  6.8  7.8  7.9  5.4  General surgery  9.9  10.9  9.4  10.8  Medicine  37.5  43.8  40.4  33.1  Neurosurgery  5.1  3.1  3.0  8.1  Obstetrics and gynaecology  3.4  6.3  5.9  0.0  Paediatric surgery  3.7  3.1  4.4  2.7  Plastic surgery  5.4  3.1  6.9  3.4  Psychiatry  3.7  3.1  3.4  4.1  Trauma and orthopaedics  7.7  4.7  5.4  10.8  Urology  1.1  3.1  0.5  2.0  Vascular surgery  0.6  0.0  0.5  0.7  Table 1: Proportions of student responses to ‘What career path do you currently believe you are most likely to pursue?’ Selected specialty  Overall cohort (%)  5th year students (%)  Females (%)  Males (%)  Cardiothoracic surgery  10.8  4.7  10.3  11.5  Ear, nose and throat surgery  4.3  6.3  2.0  7.4  General practice  6.8  7.8  7.9  5.4  General surgery  9.9  10.9  9.4  10.8  Medicine  37.5  43.8  40.4  33.1  Neurosurgery  5.1  3.1  3.0  8.1  Obstetrics and gynaecology  3.4  6.3  5.9  0.0  Paediatric surgery  3.7  3.1  4.4  2.7  Plastic surgery  5.4  3.1  6.9  3.4  Psychiatry  3.7  3.1  3.4  4.1  Trauma and orthopaedics  7.7  4.7  5.4  10.8  Urology  1.1  3.1  0.5  2.0  Vascular surgery  0.6  0.0  0.5  0.7  Selected specialty  Overall cohort (%)  5th year students (%)  Females (%)  Males (%)  Cardiothoracic surgery  10.8  4.7  10.3  11.5  Ear, nose and throat surgery  4.3  6.3  2.0  7.4  General practice  6.8  7.8  7.9  5.4  General surgery  9.9  10.9  9.4  10.8  Medicine  37.5  43.8  40.4  33.1  Neurosurgery  5.1  3.1  3.0  8.1  Obstetrics and gynaecology  3.4  6.3  5.9  0.0  Paediatric surgery  3.7  3.1  4.4  2.7  Plastic surgery  5.4  3.1  6.9  3.4  Psychiatry  3.7  3.1  3.4  4.1  Trauma and orthopaedics  7.7  4.7  5.4  10.8  Urology  1.1  3.1  0.5  2.0  Vascular surgery  0.6  0.0  0.5  0.7  Of the students considering a career in cardiothoracic surgery, 74.5% stated that they intended to practice in the UK in the future. When asked whether they knew which sub-specialty they would like to undertake in the future, 24.5% identified adult cardiac surgery as their most desired sub-specialty, 23.7% chose paediatric cardiothoracic surgery and 10% opted for thoracic surgery. Previous exposure to surgery In our total cohort, 73.9% had spent no time on a dedicated cardiothoracic surgical placement. One-third (35.9%) of the final year students had spent some time on a cardiothoracic firm during their time at medical school; however, the length of placement was typically less than 2 weeks (29.7%). This was in the context of 98.4% of the final year students having undertaken at least 2 weeks of other surgical attachments. In the total cohort, 15.1% reported that they had scrubbed in to observe a cardiothoracic operation at some point in their undergraduate training. Ultimately, 75% of all students and 81.3% of the final year students felt they had received inadequate exposure to cardiothoracic surgery during their undergraduate medical curriculum. Indeed, 86.1% of students felt that experiences during their undergraduate placements were important in determining future career ambitions. Experiences and perceptions of cardiothoracic surgery A minority of students (4.5%) reported having a mentor in cardiothoracic surgery; 26.1% reported having access to the details of a cardiothoracic surgeon should they wish to find out more about the speciality or get involved in research; and 13.4% of students reported having attended a cardiothoracic conference or career day. Of the remainders who had not attended a conference, this was mainly due to students not being aware of any events for students (59%), not being interested in cardiothoracic surgery (23.9%) and to a lesser extent logistical (9.5%) and cost (5.6%) issues. Indeed, 43.1% of students were unaware of the structure of the current training pathway for cardiothoracic surgery. Overall, 48.9% of students were aware that cardiothoracic surgeons were subject to the publication of SSMD, and 79.7% of those who were aware claimed that this did not deter them from a career in cardiothoracic surgery. Also, 41.5% had knowledge of previous scandals in cardiothoracic surgery (e.g. Bristol Children’s Heart Scandal), and 86.3% were not discouraged by this. When questioned whether they were aware of the opinion that ‘cardiothoracic surgery is a dying speciality’, 44% had heard the mantra with 43.9% agreeing with it and 56.1% disagreeing. Factors affecting interest in cardiothoracic surgery Of the 17 factors assessed for their influence on student interest in pursuing cardiothoracic surgery, 5 factors were considered to be considerably attractive characteristics, 2 were rated as considerably deterring and the remaining factors were equivocal (Table 2). Table 2: Extent to which students rated factors to either attract or deter them from a career in cardiothoracic surgery Specific factor relating to cardiothoracic surgery  Strongly deterring (%)  Deterring (%)  Neither deterring nor attractive (%)  Attractive (%)  Strongly attractive (%)  Intellectual challengea  0.6  4.0  23.0  48.6  23.8  Skilful/artistic nature of surgerya  1.4  7.1  15.6  45.5  30.4  High intensity/pressure  10.8  31.0  25.6  23.2  9.4  Prestige associated with speciality  1.1  5.1  38.9  37.5  17.4  Ability to influence/save livesa  0.6  0.0  12.2  46.0  41.2  Length of training (>8 years)  14.5  37.8  42.9  3.9  0.9  Increasing sub-specialization to cardiac/thoracic surgery  5.4  19.3  46.0  24.1  5.2  Opportunity for innovation/researcha  0.9  2.6  27.5  50.0  19.0  Competition for jobs/training postsb  22.5  43.8  27.3  5.1  1.4  Opportunity for meaningful work/life balance  12.2  14.5  19.3  36.6  17.4  Publication of SSMD  6.8  18.2  67.3  6.8  0.9  Previous scandals (e.g. Bristol Heart)  2.6  15.9  81.3  0.2  0.0  Opportunity to practice globallya  0.5  0.3  19.9  46.9  32.4  Limited geographical locations of UK centres to train/workb  11.9  51.1  32.7  3.7  0.6  Perception to be male dominated  13.9  25.2  54.0  4.8  2.1  Perception cardiothoracic surgeons are arrogant/narcissistic  19.6  31.5  47.1  0.6  1.2  Pay/financial reward  0.3  1.7  41.4  44.3  12.3  Specific factor relating to cardiothoracic surgery  Strongly deterring (%)  Deterring (%)  Neither deterring nor attractive (%)  Attractive (%)  Strongly attractive (%)  Intellectual challengea  0.6  4.0  23.0  48.6  23.8  Skilful/artistic nature of surgerya  1.4  7.1  15.6  45.5  30.4  High intensity/pressure  10.8  31.0  25.6  23.2  9.4  Prestige associated with speciality  1.1  5.1  38.9  37.5  17.4  Ability to influence/save livesa  0.6  0.0  12.2  46.0  41.2  Length of training (>8 years)  14.5  37.8  42.9  3.9  0.9  Increasing sub-specialization to cardiac/thoracic surgery  5.4  19.3  46.0  24.1  5.2  Opportunity for innovation/researcha  0.9  2.6  27.5  50.0  19.0  Competition for jobs/training postsb  22.5  43.8  27.3  5.1  1.4  Opportunity for meaningful work/life balance  12.2  14.5  19.3  36.6  17.4  Publication of SSMD  6.8  18.2  67.3  6.8  0.9  Previous scandals (e.g. Bristol Heart)  2.6  15.9  81.3  0.2  0.0  Opportunity to practice globallya  0.5  0.3  19.9  46.9  32.4  Limited geographical locations of UK centres to train/workb  11.9  51.1  32.7  3.7  0.6  Perception to be male dominated  13.9  25.2  54.0  4.8  2.1  Perception cardiothoracic surgeons are arrogant/narcissistic  19.6  31.5  47.1  0.6  1.2  Pay/financial reward  0.3  1.7  41.4  44.3  12.3  a Attractive factor. b Deterring factor. SSMD: surgeon-specific mortality data. Table 2: Extent to which students rated factors to either attract or deter them from a career in cardiothoracic surgery Specific factor relating to cardiothoracic surgery  Strongly deterring (%)  Deterring (%)  Neither deterring nor attractive (%)  Attractive (%)  Strongly attractive (%)  Intellectual challengea  0.6  4.0  23.0  48.6  23.8  Skilful/artistic nature of surgerya  1.4  7.1  15.6  45.5  30.4  High intensity/pressure  10.8  31.0  25.6  23.2  9.4  Prestige associated with speciality  1.1  5.1  38.9  37.5  17.4  Ability to influence/save livesa  0.6  0.0  12.2  46.0  41.2  Length of training (>8 years)  14.5  37.8  42.9  3.9  0.9  Increasing sub-specialization to cardiac/thoracic surgery  5.4  19.3  46.0  24.1  5.2  Opportunity for innovation/researcha  0.9  2.6  27.5  50.0  19.0  Competition for jobs/training postsb  22.5  43.8  27.3  5.1  1.4  Opportunity for meaningful work/life balance  12.2  14.5  19.3  36.6  17.4  Publication of SSMD  6.8  18.2  67.3  6.8  0.9  Previous scandals (e.g. Bristol Heart)  2.6  15.9  81.3  0.2  0.0  Opportunity to practice globallya  0.5  0.3  19.9  46.9  32.4  Limited geographical locations of UK centres to train/workb  11.9  51.1  32.7  3.7  0.6  Perception to be male dominated  13.9  25.2  54.0  4.8  2.1  Perception cardiothoracic surgeons are arrogant/narcissistic  19.6  31.5  47.1  0.6  1.2  Pay/financial reward  0.3  1.7  41.4  44.3  12.3  Specific factor relating to cardiothoracic surgery  Strongly deterring (%)  Deterring (%)  Neither deterring nor attractive (%)  Attractive (%)  Strongly attractive (%)  Intellectual challengea  0.6  4.0  23.0  48.6  23.8  Skilful/artistic nature of surgerya  1.4  7.1  15.6  45.5  30.4  High intensity/pressure  10.8  31.0  25.6  23.2  9.4  Prestige associated with speciality  1.1  5.1  38.9  37.5  17.4  Ability to influence/save livesa  0.6  0.0  12.2  46.0  41.2  Length of training (>8 years)  14.5  37.8  42.9  3.9  0.9  Increasing sub-specialization to cardiac/thoracic surgery  5.4  19.3  46.0  24.1  5.2  Opportunity for innovation/researcha  0.9  2.6  27.5  50.0  19.0  Competition for jobs/training postsb  22.5  43.8  27.3  5.1  1.4  Opportunity for meaningful work/life balance  12.2  14.5  19.3  36.6  17.4  Publication of SSMD  6.8  18.2  67.3  6.8  0.9  Previous scandals (e.g. Bristol Heart)  2.6  15.9  81.3  0.2  0.0  Opportunity to practice globallya  0.5  0.3  19.9  46.9  32.4  Limited geographical locations of UK centres to train/workb  11.9  51.1  32.7  3.7  0.6  Perception to be male dominated  13.9  25.2  54.0  4.8  2.1  Perception cardiothoracic surgeons are arrogant/narcissistic  19.6  31.5  47.1  0.6  1.2  Pay/financial reward  0.3  1.7  41.4  44.3  12.3  a Attractive factor. b Deterring factor. SSMD: surgeon-specific mortality data. Of the 5 variables deemed to attract students to a career in cardiothoracic surgery, the most attractive factor was the promise of being able to save or significantly influence people’s lives, with 87.2% students reporting this as either attractive/strongly attractive. Other positive influences were the intellectual challenge associated with the speciality (72.4%), the skilful and artistic nature of the surgery (75.9%), the opportunity to innovate and research within the speciality (69.0%) and the chance to practice globally (79.3%). The 2 factors deterring the pursuit of a career in cardiothoracic surgery were perceived competition levels for training posts and jobs (66.2%) and the limited number of geographical locations to train or practise within the UK (63.1%). The other 10 factors determined to not be significantly attractive or deterring within the cohort are detailed in Table 2. DISCUSSION This study has shown that within UK undergraduate surgical societies, there remains an active interest from students to pursue cardiothoracic surgery as a future career. With approximately 11% of the total cohort examined identifying the speciality as their top career choice and one-third expressing a general interest in pursuing the specialty, it is reasonable to assume that ample interest from UK undergraduates exists to ensure adequate workforce provision in the UK for the foreseeable future. Furthermore, with the growing expansion of women within UK medical schools [7], it is encouraging to see healthy levels of interest among female students, with a similar proportion to their male counterparts expressing cardiothoracic surgery to be their career of choice (10.3%). Indeed, the specialty was the most popular of all the surgical sub-specialties among this gender cohort. However, despite this healthy interest expressed by the total cohort, it is deeply concerning that subgroup analysis of the final year cohort revealed a dramatic reduction in interest levels. The reduction in the final year students selecting cardiothoracic surgery as their desired career choice to less than 5% was the greatest reduction seen in any of the surgical specialties assessed. As UK trainees now apply for cardiothoracic training very early into their 2nd year of postgraduate training [8], it is alarming that interest from students appears to be taking a negative trajectory enroute to the point of application. Given that there are very few cardiothoracic jobs available for UK trainees in postgraduate ‘foundation’ years 1 and 2 [9], it is difficult to perceive that this decline would reverse among UK graduates prior to applications and may indeed continue to decline. Of concern, only one-third of the final year students had rotated through a cardiothoracic firm and just 15% had scrubbed in to a cardiac operation. Therefore, it is unsurprising that more than 80% of the surgically orientated students in this study were disappointed with the exposure to the speciality they had received at medical school. This is a cause for concern given that experience on placements has been shown to be influential in future career decision making by allowing students exposure to the typical diagnostic and intellectual challenges of a speciality and interaction with potential role models [10]. Eighty-six percent of the students in this study felt that experience on placements had been important for selecting their career. From an extracurricular perspective, only 13% had attended a cardiothoracic careers day or conference, and this was mainly due to a lack of awareness of any student courses available (60%). Therefore, although courses such as the ‘Annual National Careers Day’ are now being provided by the Society for Cardiothoracic Surgery of Great Britain (SCTS), inadequate publicity is being provided to students at a local level. This is of interest as student exposure to courses such as these have been shown to improve interest in the speciality [4]. Given that mentorship and research experience, especially during the early years of medical school, are important in encouraging surgical careers [11], it is encouraging to see that one-quarter of students felt that they had the details to contact a cardiothoracic surgeon about research or clinical experience if desired. A reasonable proportion of students in our study (5%) reported having a dedicated mentor in the speciality. Prior concerns have been raised that declining recruitment to the specialty from UK graduates may stem from several contentious issues that have previously cast a negative perception on cardiothoracics in the public domain [1]. Namely, the publication of SSMD and previous scandals are particularly thought to have an impact on the decisions of current junior trainees. Our study has shown that although 50% of students were aware of these events, approximately 80% of students reported that this did not dissuade them from pursuing a career in cardiothoracics. Furthermore, as the mantra that ‘cardiothoracic surgery is a dying speciality’ is often discussed within the medical community since the rise of interventional cardiology procedures [5], it was encouraging to hear that 80% of the students were either not aware or did not agree with that statement. In fact, the potential to innovate within the specialty was one of the factors found to attract students toward the specialty. It would appear, therefore, that students have an awareness of the thriving sub-specialties such as thoracic, congenital and aortic surgery and are stimulated by the current controversies surrounding the field of adult cardiac surgery. This study has shown that students are generally drawn to the speciality by the appeal of being able to utilize the skilful and intellectual nature of the clinical work to influence a person’s life. It is reasonable to assume, therefore, that increasing student exposure to the specialty through both undergraduate curricula and extracurricular courses would reinforce these attractive factors. Through increasing mentorship and support, students could address the factors that appear to be deterring them such as perceived competition levels. Although few other studies have sought to assess the interest levels of medical students specifically, a survey of surgical residents in the USA showed similar results to this study with 6% committing their future career to cardiothoracic surgery and 26% reporting a general interest in the specialty [12]. Job security and availability along with demanding work schedules were frequently reported as shortcomings of the specialty by respondents. These figures also seem to be reflected on a more global context. A study of junior trainees in Nigeria revealed that 8% were committed to specializing in cardiothoracic surgery [13]. Interestingly, although material factors such as lack of equipment and limited training positions were cited as reasons for not pursuing a career in cardiothoracic surgery in this developing country, the same themes of junior trainees perceiving that they had received little exposure to the speciality either as a junior surgeon (63%) or as medical students (58.8%) were still present. Limitations This main limitation of this study utilizing an optional survey methodology would be the possibility for an over-representation of students interested in cardiothoracic surgery among its respondents. Furthermore, there was a large proportion of students in our cohort who chose medicine as their desired career pathway (38%); however, this likely reflects the membership of modern UK surgical societies. CONCLUSION This study has shown that among UK surgically minded medical students, there remains an active interest to pursue a career in cardiothoracic surgery. However, throughout the course of their undergraduate training, there is a worrying decline in student interest in the speciality. This appears to be related to a lack of exposure to the specialty both within undergraduate medical school curricula and also through extracurricular opportunities. This has resulted in students becoming disappointed with their experience of the speciality which draws concern for future workforce planning given the close proximity of training application deadlines to the point of graduation (just >12 months). The impact of numerous controversial topics within the speciality that have been previously highlighted in the public domain (SSMD and scandals) appear to not have had a marked impact on student interest. Medical schools and national societies need to engage further with medical students and highlight the attractions of the speciality and allay any concerns to ensure that interest in the specialty is maintained until graduation. Conflict of interest: none declared. REFERENCES 1 Westaby S, Baig K, De Silva R, Unsworth-White J, Pepper J. Recruitment to UK cardiothoracic surgery in the era of public outcome reporting. Eur J Cardiothorac Surg  2015; 47: 679– 83. Google Scholar CrossRef Search ADS PubMed  2 Salazar JD, Ermis P, Laudito A, Lee R, Wheatley GH, Paul S et al.   Cardiothoracic surgery resident education: update on resident recruitment and job placement. Ann Thorac Surg  2006; 82: 1160– 5. Google Scholar CrossRef Search ADS PubMed  3 Grover A, Gorman K, Dall TM, Jonas R, Lytle B, Shemin R et al.   Shortage of cardiothoracic surgeons is likely by 2020. Circulation  2009; 120: 488– 94. Google Scholar CrossRef Search ADS PubMed  4 Bridgeman A, Findlay R, Devnani A, Lim D, Loganathan K, McElnay P et al.   Inspiring the next generation of cardiothoracic surgeons: an easily reproducible, sustainable event increases UK undergraduate interest in the specialty. Interact CardioVasc Thorac Surg  2016; 22: 106– 8. Google Scholar CrossRef Search ADS PubMed  5 Yaffee D, Williams M. Cardiac Surgery and the Future. http://www.acc.org/latest-in-cardiology/articles/2015/09/09/08/44/cardiac-surgery-and-the-future (20 February 2018, date last accessed). 6 Royal College of Surgeons England. https://www.rcseng.ac.uk/careers-in-surgery/medical-students/surgical-societies/ (20 February 2018, date last accessed). 7 General Medical Council. State of Medical Education and Practice in the UK: 2017 Report. https://www.gmc-uk.org/publications/somep2017.asp (20 February 2018, date last accessed). 8 McElnay PJ, George J, Lodhia J, Moffat D, Patel A, Sinha S et al.   How to Apply Successfully for an ST1 Training Post in Cardiothoracic Surgery. BMJ Careers. http://careers.bmj.com/careers/advice/How_to_apply_successfully_for_an_ST1_training_post_in_cardiothoracic_surgery (20 February 2018, date last accessed). 9 Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS). Workforce Report 2015. https://scts.org/workforce-report-2015/ (20 February 2018, date last accessed). 10 Bland KI, Isaacs G. Contemporary trends in student selection of medical specialties: the potential impact on general surgery. Arch Surg  2002; 137: 259– 67. Google Scholar PubMed  11 Berger A, Giacalone J, Barlow P, Kapadia M, Keith J. Roles of mentorship and research in surgical career choice: longitudinal study of medical students. Plast Reconstr Surg Glob Open  2016; 4: e783. Google Scholar CrossRef Search ADS   12 Vaporciyan AA, Reed CE, Erikson C, Dill MJ, Carpenter AJ, Guleserian KJ et al.   Factors affecting interest in cardiothoracic surgery: survey of North American general surgery residents. J Thorac Cardiovasc Surg  2009; 137: 1054– 62. Google Scholar CrossRef Search ADS PubMed  13 Kesieme EB, Abubakar U, Olusoji O, Inuwa IM, Kefas J, Anumenechi N. Factors affecting interest in cardiothoracic surgery among junior surgical residents in Nigeria. Cardiovasc J Afr  2017; 28: 293– 7. Google Scholar CrossRef Search ADS PubMed  © The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Interactive CardioVascular and Thoracic Surgery Oxford University Press

Are we losing future talent? A national survey of UK medical student interest and perceptions of cardiothoracic surgery

Loading next page...
 
/lp/ou_press/are-we-losing-future-talent-a-national-survey-of-uk-medical-student-EcdqDNxPhi
Publisher
Oxford University Press
Copyright
© The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
ISSN
1569-9293
eISSN
1569-9285
D.O.I.
10.1093/icvts/ivy119
Publisher site
See Article on Publisher Site

Abstract

Abstract OBJECTIVES Cardiothoracic surgery appears to have become a significantly less popular career option among UK medical graduates. This study aimed to elucidate the current levels of interest in pursuing a career in cardiothoracic surgery among surgically orientated UK medical students and to determine the factors underlying this decision. METHODS An online cross-sectional survey generated using the LimeSurvey was distributed to the surgical societies of all 32 UK medical schools. This assessed current career intentions, previous experience and perceptions of cardiothoracic surgery and the factors that attract or deter them to the speciality. RESULTS A total of 352 responses were obtained. Although 31% of the total cohort was considering a career in cardiothoracic surgery, only 14% of the final year students were. Seventy-five percent felt that they had received inadequate exposure to cardiothoracic surgery during their undergraduate curriculum, with 74% having spent no time on a dedicated cardiothoracic placement. Extracurricular exposure to the specialty was poor with 13% having attended a cardiothoracic conference/careers day. Approximately 50% of students were aware of the publication of surgeon-specific mortality data and previous scandals affecting the speciality; however, 80% claimed that this did not deter them. The main factor attracting students was the ability to significantly influence or save lives, whereas the main deterring factor was perceived competition levels. CONCLUSIONS Although there remains healthy interest among UK students to pursue a career in cardiothoracic surgery, there is a worrying decline in desire over the course of medical school which appears to stem from a lack of engagement with the specialty both within undergraduate curricula and through extracurricular events. Students , Thoracic surgery , Medical education INTRODUCTION Despite previously being regarded as a highly popular and competitive speciality, recent data have suggested that cardiothoracic surgery has become dramatically less popular among UK junior doctors since the turn of the millennium [1]. Presently, only 32% of current trainees and 18% of those completing cardiothoracic training graduated from a UK medical school [1]. This mirrors similar recruitment problems recently observed into residency programmes in the USA [2]. The factors precipitating this decline are yet to be delineated; however, they represent an important topic for consideration given the shortages of cardiothoracic surgeons that are predicted over coming decades [3]. It is likely that a combination of factors including societal measures [1], a changing demographic of medical students and lack of engagement with students [4] are responsible. With particular reference to the UK, since 2000, several major events have brought cardiothoracic surgery into the public eye, namely the Bristol Heart Scandal and the publication of surgeon-specific mortality data (SSMD) [1]. The current cohort of UK medical students is likely to be well aware of these events and may hold negative opinions of the specialty as a result. Furthermore, an expansion of interventional cardiac procedures has led some to describe the speciality as ‘dying’ which may also impact student perceptions [5]. Recent changes in the recruitment of UK cardiothoracic trainees has seen selection of candidates now taking place in the 2nd postgraduate year of training, meaning that applicants will have only recently graduated from medical school. Therefore, this national survey of undergraduate surgical societies was conducted with the aim of elucidating the current interests of UK medical students to pursue a career in cardiothoracic surgery and to determine the factors that positively or negatively affect this decision. MATERIALS AND METHODS In this cross-sectional observational study, a complete list of undergraduate surgical societies for all 32 UK medical schools was obtained from the Royal College of Surgeons England website [6]. Subsequently, a 29-item online questionnaire was designed on the LimeSurvey and then distributed to each surgical society before dissemination to their respective membership via e-mail or social media outlets. Students from all years of medical school were able to participate (including those undertaking a 1-year intercalated degree). The survey was available for 2 months (October to November 2017) prior to closure. Only fully completed responses were included in the final analysis. The questionnaire consisted of 5 question groups; (i) demographics, (ii) current career intentions, (iii) previous exposure to surgery, (iv) experiences and perceptions of cardiothoracic surgery and (v) factors affecting student interest in cardiothoracic surgery. Each student’s current career ambitions and previous experience on surgery (both cardiothoracic-specific experience and surgery in general) were, therefore, elucidated. The impact of 17 individual factors on student desire to pursue a career in cardiothoracic surgery was assessed via a 5-point Likert scale (ranging from strongly deterring to strongly attractive). A factor was determined to be either considerably attractive or deterring for students if more than 60% of the cohort reported the factor to be strongly attractive/attractive or strongly deterring/deterring. A Microsoft Excel 2007 package was used to perform simple analysis of the data obtained. Although the whole cohort was analysed, a separate subgroup analysis of the final year medical students was performed to obtain the perceptions of students imminently about to commence clinical practice and also to determine whether there were any noticeable differences in the career intentions of senior medical students. Ethical approval for this study was obtained from the St. George’s Research Ethics Committee (study reference SGREC17.0014). RESULTS Demographics In total, 352 medical students from 28 medical schools across the UK responded to the survey; 57.7% of respondents were women and 42.0% were men; and 83.8% of respondents were aged 18–25 years, 9.1% were aged 26–29 years and 7.1% were older than 30 years. Responses were well distributed across year groups: 18.5% of respondents were in their 1st year of medical school; 16.5% in the 2nd year; 23.6% in the 3rd year; 18.8% in the 4th year and 18.2% in their 5th (final) year; 4.4% of respondents were undertaking an intercalated degree at the time of the survey. Current career intentions Overall, 31.2% of students claimed that they were still considering a career in cardiothoracic surgery, and 10.8% of the total cohort claimed that cardiothoracic surgery was their top career choice, ranking as the second most popular specialty (Table 1). However, subgroup analysis of the final year cohort revealed lower levels of interest with 4.7% identifying it as their desired specialty of choice and 14.1% still considering it as a career option. This 6.1% decrease in the proportion selecting cardiothoracic surgery as their main career ambition was the greatest of all specialties screened. Although the proportion of women and men choosing cardiothoracic surgery as their desired career goal was similar (10.3% and 11.5%, respectively), less women (25.6%) considered it as a career option when compared with men (39.1%). Table 1: Proportions of student responses to ‘What career path do you currently believe you are most likely to pursue?’ Selected specialty  Overall cohort (%)  5th year students (%)  Females (%)  Males (%)  Cardiothoracic surgery  10.8  4.7  10.3  11.5  Ear, nose and throat surgery  4.3  6.3  2.0  7.4  General practice  6.8  7.8  7.9  5.4  General surgery  9.9  10.9  9.4  10.8  Medicine  37.5  43.8  40.4  33.1  Neurosurgery  5.1  3.1  3.0  8.1  Obstetrics and gynaecology  3.4  6.3  5.9  0.0  Paediatric surgery  3.7  3.1  4.4  2.7  Plastic surgery  5.4  3.1  6.9  3.4  Psychiatry  3.7  3.1  3.4  4.1  Trauma and orthopaedics  7.7  4.7  5.4  10.8  Urology  1.1  3.1  0.5  2.0  Vascular surgery  0.6  0.0  0.5  0.7  Selected specialty  Overall cohort (%)  5th year students (%)  Females (%)  Males (%)  Cardiothoracic surgery  10.8  4.7  10.3  11.5  Ear, nose and throat surgery  4.3  6.3  2.0  7.4  General practice  6.8  7.8  7.9  5.4  General surgery  9.9  10.9  9.4  10.8  Medicine  37.5  43.8  40.4  33.1  Neurosurgery  5.1  3.1  3.0  8.1  Obstetrics and gynaecology  3.4  6.3  5.9  0.0  Paediatric surgery  3.7  3.1  4.4  2.7  Plastic surgery  5.4  3.1  6.9  3.4  Psychiatry  3.7  3.1  3.4  4.1  Trauma and orthopaedics  7.7  4.7  5.4  10.8  Urology  1.1  3.1  0.5  2.0  Vascular surgery  0.6  0.0  0.5  0.7  Table 1: Proportions of student responses to ‘What career path do you currently believe you are most likely to pursue?’ Selected specialty  Overall cohort (%)  5th year students (%)  Females (%)  Males (%)  Cardiothoracic surgery  10.8  4.7  10.3  11.5  Ear, nose and throat surgery  4.3  6.3  2.0  7.4  General practice  6.8  7.8  7.9  5.4  General surgery  9.9  10.9  9.4  10.8  Medicine  37.5  43.8  40.4  33.1  Neurosurgery  5.1  3.1  3.0  8.1  Obstetrics and gynaecology  3.4  6.3  5.9  0.0  Paediatric surgery  3.7  3.1  4.4  2.7  Plastic surgery  5.4  3.1  6.9  3.4  Psychiatry  3.7  3.1  3.4  4.1  Trauma and orthopaedics  7.7  4.7  5.4  10.8  Urology  1.1  3.1  0.5  2.0  Vascular surgery  0.6  0.0  0.5  0.7  Selected specialty  Overall cohort (%)  5th year students (%)  Females (%)  Males (%)  Cardiothoracic surgery  10.8  4.7  10.3  11.5  Ear, nose and throat surgery  4.3  6.3  2.0  7.4  General practice  6.8  7.8  7.9  5.4  General surgery  9.9  10.9  9.4  10.8  Medicine  37.5  43.8  40.4  33.1  Neurosurgery  5.1  3.1  3.0  8.1  Obstetrics and gynaecology  3.4  6.3  5.9  0.0  Paediatric surgery  3.7  3.1  4.4  2.7  Plastic surgery  5.4  3.1  6.9  3.4  Psychiatry  3.7  3.1  3.4  4.1  Trauma and orthopaedics  7.7  4.7  5.4  10.8  Urology  1.1  3.1  0.5  2.0  Vascular surgery  0.6  0.0  0.5  0.7  Of the students considering a career in cardiothoracic surgery, 74.5% stated that they intended to practice in the UK in the future. When asked whether they knew which sub-specialty they would like to undertake in the future, 24.5% identified adult cardiac surgery as their most desired sub-specialty, 23.7% chose paediatric cardiothoracic surgery and 10% opted for thoracic surgery. Previous exposure to surgery In our total cohort, 73.9% had spent no time on a dedicated cardiothoracic surgical placement. One-third (35.9%) of the final year students had spent some time on a cardiothoracic firm during their time at medical school; however, the length of placement was typically less than 2 weeks (29.7%). This was in the context of 98.4% of the final year students having undertaken at least 2 weeks of other surgical attachments. In the total cohort, 15.1% reported that they had scrubbed in to observe a cardiothoracic operation at some point in their undergraduate training. Ultimately, 75% of all students and 81.3% of the final year students felt they had received inadequate exposure to cardiothoracic surgery during their undergraduate medical curriculum. Indeed, 86.1% of students felt that experiences during their undergraduate placements were important in determining future career ambitions. Experiences and perceptions of cardiothoracic surgery A minority of students (4.5%) reported having a mentor in cardiothoracic surgery; 26.1% reported having access to the details of a cardiothoracic surgeon should they wish to find out more about the speciality or get involved in research; and 13.4% of students reported having attended a cardiothoracic conference or career day. Of the remainders who had not attended a conference, this was mainly due to students not being aware of any events for students (59%), not being interested in cardiothoracic surgery (23.9%) and to a lesser extent logistical (9.5%) and cost (5.6%) issues. Indeed, 43.1% of students were unaware of the structure of the current training pathway for cardiothoracic surgery. Overall, 48.9% of students were aware that cardiothoracic surgeons were subject to the publication of SSMD, and 79.7% of those who were aware claimed that this did not deter them from a career in cardiothoracic surgery. Also, 41.5% had knowledge of previous scandals in cardiothoracic surgery (e.g. Bristol Children’s Heart Scandal), and 86.3% were not discouraged by this. When questioned whether they were aware of the opinion that ‘cardiothoracic surgery is a dying speciality’, 44% had heard the mantra with 43.9% agreeing with it and 56.1% disagreeing. Factors affecting interest in cardiothoracic surgery Of the 17 factors assessed for their influence on student interest in pursuing cardiothoracic surgery, 5 factors were considered to be considerably attractive characteristics, 2 were rated as considerably deterring and the remaining factors were equivocal (Table 2). Table 2: Extent to which students rated factors to either attract or deter them from a career in cardiothoracic surgery Specific factor relating to cardiothoracic surgery  Strongly deterring (%)  Deterring (%)  Neither deterring nor attractive (%)  Attractive (%)  Strongly attractive (%)  Intellectual challengea  0.6  4.0  23.0  48.6  23.8  Skilful/artistic nature of surgerya  1.4  7.1  15.6  45.5  30.4  High intensity/pressure  10.8  31.0  25.6  23.2  9.4  Prestige associated with speciality  1.1  5.1  38.9  37.5  17.4  Ability to influence/save livesa  0.6  0.0  12.2  46.0  41.2  Length of training (>8 years)  14.5  37.8  42.9  3.9  0.9  Increasing sub-specialization to cardiac/thoracic surgery  5.4  19.3  46.0  24.1  5.2  Opportunity for innovation/researcha  0.9  2.6  27.5  50.0  19.0  Competition for jobs/training postsb  22.5  43.8  27.3  5.1  1.4  Opportunity for meaningful work/life balance  12.2  14.5  19.3  36.6  17.4  Publication of SSMD  6.8  18.2  67.3  6.8  0.9  Previous scandals (e.g. Bristol Heart)  2.6  15.9  81.3  0.2  0.0  Opportunity to practice globallya  0.5  0.3  19.9  46.9  32.4  Limited geographical locations of UK centres to train/workb  11.9  51.1  32.7  3.7  0.6  Perception to be male dominated  13.9  25.2  54.0  4.8  2.1  Perception cardiothoracic surgeons are arrogant/narcissistic  19.6  31.5  47.1  0.6  1.2  Pay/financial reward  0.3  1.7  41.4  44.3  12.3  Specific factor relating to cardiothoracic surgery  Strongly deterring (%)  Deterring (%)  Neither deterring nor attractive (%)  Attractive (%)  Strongly attractive (%)  Intellectual challengea  0.6  4.0  23.0  48.6  23.8  Skilful/artistic nature of surgerya  1.4  7.1  15.6  45.5  30.4  High intensity/pressure  10.8  31.0  25.6  23.2  9.4  Prestige associated with speciality  1.1  5.1  38.9  37.5  17.4  Ability to influence/save livesa  0.6  0.0  12.2  46.0  41.2  Length of training (>8 years)  14.5  37.8  42.9  3.9  0.9  Increasing sub-specialization to cardiac/thoracic surgery  5.4  19.3  46.0  24.1  5.2  Opportunity for innovation/researcha  0.9  2.6  27.5  50.0  19.0  Competition for jobs/training postsb  22.5  43.8  27.3  5.1  1.4  Opportunity for meaningful work/life balance  12.2  14.5  19.3  36.6  17.4  Publication of SSMD  6.8  18.2  67.3  6.8  0.9  Previous scandals (e.g. Bristol Heart)  2.6  15.9  81.3  0.2  0.0  Opportunity to practice globallya  0.5  0.3  19.9  46.9  32.4  Limited geographical locations of UK centres to train/workb  11.9  51.1  32.7  3.7  0.6  Perception to be male dominated  13.9  25.2  54.0  4.8  2.1  Perception cardiothoracic surgeons are arrogant/narcissistic  19.6  31.5  47.1  0.6  1.2  Pay/financial reward  0.3  1.7  41.4  44.3  12.3  a Attractive factor. b Deterring factor. SSMD: surgeon-specific mortality data. Table 2: Extent to which students rated factors to either attract or deter them from a career in cardiothoracic surgery Specific factor relating to cardiothoracic surgery  Strongly deterring (%)  Deterring (%)  Neither deterring nor attractive (%)  Attractive (%)  Strongly attractive (%)  Intellectual challengea  0.6  4.0  23.0  48.6  23.8  Skilful/artistic nature of surgerya  1.4  7.1  15.6  45.5  30.4  High intensity/pressure  10.8  31.0  25.6  23.2  9.4  Prestige associated with speciality  1.1  5.1  38.9  37.5  17.4  Ability to influence/save livesa  0.6  0.0  12.2  46.0  41.2  Length of training (>8 years)  14.5  37.8  42.9  3.9  0.9  Increasing sub-specialization to cardiac/thoracic surgery  5.4  19.3  46.0  24.1  5.2  Opportunity for innovation/researcha  0.9  2.6  27.5  50.0  19.0  Competition for jobs/training postsb  22.5  43.8  27.3  5.1  1.4  Opportunity for meaningful work/life balance  12.2  14.5  19.3  36.6  17.4  Publication of SSMD  6.8  18.2  67.3  6.8  0.9  Previous scandals (e.g. Bristol Heart)  2.6  15.9  81.3  0.2  0.0  Opportunity to practice globallya  0.5  0.3  19.9  46.9  32.4  Limited geographical locations of UK centres to train/workb  11.9  51.1  32.7  3.7  0.6  Perception to be male dominated  13.9  25.2  54.0  4.8  2.1  Perception cardiothoracic surgeons are arrogant/narcissistic  19.6  31.5  47.1  0.6  1.2  Pay/financial reward  0.3  1.7  41.4  44.3  12.3  Specific factor relating to cardiothoracic surgery  Strongly deterring (%)  Deterring (%)  Neither deterring nor attractive (%)  Attractive (%)  Strongly attractive (%)  Intellectual challengea  0.6  4.0  23.0  48.6  23.8  Skilful/artistic nature of surgerya  1.4  7.1  15.6  45.5  30.4  High intensity/pressure  10.8  31.0  25.6  23.2  9.4  Prestige associated with speciality  1.1  5.1  38.9  37.5  17.4  Ability to influence/save livesa  0.6  0.0  12.2  46.0  41.2  Length of training (>8 years)  14.5  37.8  42.9  3.9  0.9  Increasing sub-specialization to cardiac/thoracic surgery  5.4  19.3  46.0  24.1  5.2  Opportunity for innovation/researcha  0.9  2.6  27.5  50.0  19.0  Competition for jobs/training postsb  22.5  43.8  27.3  5.1  1.4  Opportunity for meaningful work/life balance  12.2  14.5  19.3  36.6  17.4  Publication of SSMD  6.8  18.2  67.3  6.8  0.9  Previous scandals (e.g. Bristol Heart)  2.6  15.9  81.3  0.2  0.0  Opportunity to practice globallya  0.5  0.3  19.9  46.9  32.4  Limited geographical locations of UK centres to train/workb  11.9  51.1  32.7  3.7  0.6  Perception to be male dominated  13.9  25.2  54.0  4.8  2.1  Perception cardiothoracic surgeons are arrogant/narcissistic  19.6  31.5  47.1  0.6  1.2  Pay/financial reward  0.3  1.7  41.4  44.3  12.3  a Attractive factor. b Deterring factor. SSMD: surgeon-specific mortality data. Of the 5 variables deemed to attract students to a career in cardiothoracic surgery, the most attractive factor was the promise of being able to save or significantly influence people’s lives, with 87.2% students reporting this as either attractive/strongly attractive. Other positive influences were the intellectual challenge associated with the speciality (72.4%), the skilful and artistic nature of the surgery (75.9%), the opportunity to innovate and research within the speciality (69.0%) and the chance to practice globally (79.3%). The 2 factors deterring the pursuit of a career in cardiothoracic surgery were perceived competition levels for training posts and jobs (66.2%) and the limited number of geographical locations to train or practise within the UK (63.1%). The other 10 factors determined to not be significantly attractive or deterring within the cohort are detailed in Table 2. DISCUSSION This study has shown that within UK undergraduate surgical societies, there remains an active interest from students to pursue cardiothoracic surgery as a future career. With approximately 11% of the total cohort examined identifying the speciality as their top career choice and one-third expressing a general interest in pursuing the specialty, it is reasonable to assume that ample interest from UK undergraduates exists to ensure adequate workforce provision in the UK for the foreseeable future. Furthermore, with the growing expansion of women within UK medical schools [7], it is encouraging to see healthy levels of interest among female students, with a similar proportion to their male counterparts expressing cardiothoracic surgery to be their career of choice (10.3%). Indeed, the specialty was the most popular of all the surgical sub-specialties among this gender cohort. However, despite this healthy interest expressed by the total cohort, it is deeply concerning that subgroup analysis of the final year cohort revealed a dramatic reduction in interest levels. The reduction in the final year students selecting cardiothoracic surgery as their desired career choice to less than 5% was the greatest reduction seen in any of the surgical specialties assessed. As UK trainees now apply for cardiothoracic training very early into their 2nd year of postgraduate training [8], it is alarming that interest from students appears to be taking a negative trajectory enroute to the point of application. Given that there are very few cardiothoracic jobs available for UK trainees in postgraduate ‘foundation’ years 1 and 2 [9], it is difficult to perceive that this decline would reverse among UK graduates prior to applications and may indeed continue to decline. Of concern, only one-third of the final year students had rotated through a cardiothoracic firm and just 15% had scrubbed in to a cardiac operation. Therefore, it is unsurprising that more than 80% of the surgically orientated students in this study were disappointed with the exposure to the speciality they had received at medical school. This is a cause for concern given that experience on placements has been shown to be influential in future career decision making by allowing students exposure to the typical diagnostic and intellectual challenges of a speciality and interaction with potential role models [10]. Eighty-six percent of the students in this study felt that experience on placements had been important for selecting their career. From an extracurricular perspective, only 13% had attended a cardiothoracic careers day or conference, and this was mainly due to a lack of awareness of any student courses available (60%). Therefore, although courses such as the ‘Annual National Careers Day’ are now being provided by the Society for Cardiothoracic Surgery of Great Britain (SCTS), inadequate publicity is being provided to students at a local level. This is of interest as student exposure to courses such as these have been shown to improve interest in the speciality [4]. Given that mentorship and research experience, especially during the early years of medical school, are important in encouraging surgical careers [11], it is encouraging to see that one-quarter of students felt that they had the details to contact a cardiothoracic surgeon about research or clinical experience if desired. A reasonable proportion of students in our study (5%) reported having a dedicated mentor in the speciality. Prior concerns have been raised that declining recruitment to the specialty from UK graduates may stem from several contentious issues that have previously cast a negative perception on cardiothoracics in the public domain [1]. Namely, the publication of SSMD and previous scandals are particularly thought to have an impact on the decisions of current junior trainees. Our study has shown that although 50% of students were aware of these events, approximately 80% of students reported that this did not dissuade them from pursuing a career in cardiothoracics. Furthermore, as the mantra that ‘cardiothoracic surgery is a dying speciality’ is often discussed within the medical community since the rise of interventional cardiology procedures [5], it was encouraging to hear that 80% of the students were either not aware or did not agree with that statement. In fact, the potential to innovate within the specialty was one of the factors found to attract students toward the specialty. It would appear, therefore, that students have an awareness of the thriving sub-specialties such as thoracic, congenital and aortic surgery and are stimulated by the current controversies surrounding the field of adult cardiac surgery. This study has shown that students are generally drawn to the speciality by the appeal of being able to utilize the skilful and intellectual nature of the clinical work to influence a person’s life. It is reasonable to assume, therefore, that increasing student exposure to the specialty through both undergraduate curricula and extracurricular courses would reinforce these attractive factors. Through increasing mentorship and support, students could address the factors that appear to be deterring them such as perceived competition levels. Although few other studies have sought to assess the interest levels of medical students specifically, a survey of surgical residents in the USA showed similar results to this study with 6% committing their future career to cardiothoracic surgery and 26% reporting a general interest in the specialty [12]. Job security and availability along with demanding work schedules were frequently reported as shortcomings of the specialty by respondents. These figures also seem to be reflected on a more global context. A study of junior trainees in Nigeria revealed that 8% were committed to specializing in cardiothoracic surgery [13]. Interestingly, although material factors such as lack of equipment and limited training positions were cited as reasons for not pursuing a career in cardiothoracic surgery in this developing country, the same themes of junior trainees perceiving that they had received little exposure to the speciality either as a junior surgeon (63%) or as medical students (58.8%) were still present. Limitations This main limitation of this study utilizing an optional survey methodology would be the possibility for an over-representation of students interested in cardiothoracic surgery among its respondents. Furthermore, there was a large proportion of students in our cohort who chose medicine as their desired career pathway (38%); however, this likely reflects the membership of modern UK surgical societies. CONCLUSION This study has shown that among UK surgically minded medical students, there remains an active interest to pursue a career in cardiothoracic surgery. However, throughout the course of their undergraduate training, there is a worrying decline in student interest in the speciality. This appears to be related to a lack of exposure to the specialty both within undergraduate medical school curricula and also through extracurricular opportunities. This has resulted in students becoming disappointed with their experience of the speciality which draws concern for future workforce planning given the close proximity of training application deadlines to the point of graduation (just >12 months). The impact of numerous controversial topics within the speciality that have been previously highlighted in the public domain (SSMD and scandals) appear to not have had a marked impact on student interest. Medical schools and national societies need to engage further with medical students and highlight the attractions of the speciality and allay any concerns to ensure that interest in the specialty is maintained until graduation. Conflict of interest: none declared. REFERENCES 1 Westaby S, Baig K, De Silva R, Unsworth-White J, Pepper J. Recruitment to UK cardiothoracic surgery in the era of public outcome reporting. Eur J Cardiothorac Surg  2015; 47: 679– 83. Google Scholar CrossRef Search ADS PubMed  2 Salazar JD, Ermis P, Laudito A, Lee R, Wheatley GH, Paul S et al.   Cardiothoracic surgery resident education: update on resident recruitment and job placement. Ann Thorac Surg  2006; 82: 1160– 5. Google Scholar CrossRef Search ADS PubMed  3 Grover A, Gorman K, Dall TM, Jonas R, Lytle B, Shemin R et al.   Shortage of cardiothoracic surgeons is likely by 2020. Circulation  2009; 120: 488– 94. Google Scholar CrossRef Search ADS PubMed  4 Bridgeman A, Findlay R, Devnani A, Lim D, Loganathan K, McElnay P et al.   Inspiring the next generation of cardiothoracic surgeons: an easily reproducible, sustainable event increases UK undergraduate interest in the specialty. Interact CardioVasc Thorac Surg  2016; 22: 106– 8. Google Scholar CrossRef Search ADS PubMed  5 Yaffee D, Williams M. Cardiac Surgery and the Future. http://www.acc.org/latest-in-cardiology/articles/2015/09/09/08/44/cardiac-surgery-and-the-future (20 February 2018, date last accessed). 6 Royal College of Surgeons England. https://www.rcseng.ac.uk/careers-in-surgery/medical-students/surgical-societies/ (20 February 2018, date last accessed). 7 General Medical Council. State of Medical Education and Practice in the UK: 2017 Report. https://www.gmc-uk.org/publications/somep2017.asp (20 February 2018, date last accessed). 8 McElnay PJ, George J, Lodhia J, Moffat D, Patel A, Sinha S et al.   How to Apply Successfully for an ST1 Training Post in Cardiothoracic Surgery. BMJ Careers. http://careers.bmj.com/careers/advice/How_to_apply_successfully_for_an_ST1_training_post_in_cardiothoracic_surgery (20 February 2018, date last accessed). 9 Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS). Workforce Report 2015. https://scts.org/workforce-report-2015/ (20 February 2018, date last accessed). 10 Bland KI, Isaacs G. Contemporary trends in student selection of medical specialties: the potential impact on general surgery. Arch Surg  2002; 137: 259– 67. Google Scholar PubMed  11 Berger A, Giacalone J, Barlow P, Kapadia M, Keith J. Roles of mentorship and research in surgical career choice: longitudinal study of medical students. Plast Reconstr Surg Glob Open  2016; 4: e783. Google Scholar CrossRef Search ADS   12 Vaporciyan AA, Reed CE, Erikson C, Dill MJ, Carpenter AJ, Guleserian KJ et al.   Factors affecting interest in cardiothoracic surgery: survey of North American general surgery residents. J Thorac Cardiovasc Surg  2009; 137: 1054– 62. Google Scholar CrossRef Search ADS PubMed  13 Kesieme EB, Abubakar U, Olusoji O, Inuwa IM, Kefas J, Anumenechi N. Factors affecting interest in cardiothoracic surgery among junior surgical residents in Nigeria. Cardiovasc J Afr  2017; 28: 293– 7. Google Scholar CrossRef Search ADS PubMed  © The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

Interactive CardioVascular and Thoracic SurgeryOxford University Press

Published: Apr 16, 2018

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off