Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

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... 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 medi- cal 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 wor- rying 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. Keywords: Students � Thoracic surgery � Medical education responsible. With particular reference to the UK, since 2000, sev- INTRODUCTION eral major events have brought cardiothoracic surgery into the Despite previously being regarded as a highly popular and com- public eye, namely the Bristol Heart Scandal and the publication of surgeon-specific mortality data (SSMD) [1]. The current cohort petitive speciality, recent data have suggested that cardiothoracic surgery has become dramatically less popular among UK junior of UK medical students is likely to be well aware of these events doctors since the turn of the millennium [1]. Presently, only 32% and may hold negative opinions of the specialty as a result. of current trainees and 18% of those completing cardiothoracic Furthermore, an expansion of interventional cardiac procedures training graduated from a UK medical school [1]. This mirrors has led some to describe the speciality as ‘dying’ which may also similar recruitment problems recently observed into residency impact student perceptions [5]. programmes in the USA [2]. Recent changes in the recruitment of UK cardiothoracic train- The factors precipitating this decline are yet to be delineated; ees has seen selection of candidates now taking place in the 2nd however, they represent an important topic for consideration postgraduate year of training, meaning that applicants will have given the shortages of cardiothoracic surgeons that are predicted only recently graduated from medical school. Therefore, this over coming decades [3]. It is likely that a combination of factors national survey of undergraduate surgical societies was con- including societal measures [1], a changing demographic of med- ducted with the aim of elucidating the current interests of UK ical students and lack of engagement with students [4] are medical students to pursue a career in cardiothoracic surgery and to determine the factors that positively or negatively affect Presented at the Annual Meeting of the Society for Cardiothoracic Surgeons (SCTS) of Great Britain and Ireland, Glasgow, UK, 18–20 March 2018. this decision. The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. ADULT CARDIAC Downloaded from https://academic.oup.com/icvts/article/27/4/525/4973030 by DeepDyve user on 15 July 2022 526 R. Preece et al. / Interactive CardioVascular and Thoracic Surgery MATERIALS AND METHODS Table 1: Proportions of student responses to ‘What career path do you currently believe you are most likely to pursue?’ 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 web- Selected specialty Overall 5th year Females Males site [6]. Subsequently, a 29-item online questionnaire was cohort (%) students (%) (%) (%) designed on the LimeSurvey and then distributed to each surgical Cardiothoracic surgery 10.8 4.7 10.3 11.5 society before dissemination to their respective membership via Ear, nose and throat surgery 4.3 6.3 2.0 7.4 e-mail or social media outlets. Students from all years of medical General practice 6.8 7.8 7.9 5.4 General surgery 9.9 10.9 9.4 10.8 school were able to participate (including those undertaking a 1- Medicine 37.5 43.8 40.4 33.1 year intercalated degree). The survey was available for 2 months Neurosurgery 5.1 3.1 3.0 8.1 (October to November 2017) prior to closure. Only fully com- Obstetrics and gynaecology 3.4 6.3 5.9 0.0 pleted responses were included in the final analysis. Paediatric surgery 3.7 3.1 4.4 2.7 The questionnaire consisted of 5 question groups; (i) demo- Plastic surgery 5.4 3.1 6.9 3.4 Psychiatry 3.7 3.1 3.4 4.1 graphics, (ii) current career intentions, (iii) previous exposure to Trauma and orthopaedics 7.7 4.7 5.4 10.8 surgery, (iv) experiences and perceptions of cardiothoracic sur- Urology 1.1 3.1 0.5 2.0 gery and (v) factors affecting student interest in cardiothoracic Vascular surgery 0.6 0.0 0.5 0.7 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 their main career ambition was the greatest of all specialties 17 individual factors on student desire to pursue a career in car- screened. Although the proportion of women and men choosing diothoracic surgery was assessed via a 5-point Likert scale (rang- cardiothoracic surgery as their desired career goal was similar ing from strongly deterring to strongly attractive). A factor was (10.3% and 11.5%, respectively), less women (25.6%) considered determined to be either considerably attractive or deterring for it as a career option when compared with men (39.1%). students if more than 60% of the cohort reported the factor to Of the students considering a career in cardiothoracic surgery, be strongly attractive/attractive or strongly deterring/deterring. 74.5% stated that they intended to practice in the UK in the A Microsoft Excel 2007 package was used to perform simple future. When asked whether they knew which sub-specialty they analysis of the data obtained. Although the whole cohort was would like to undertake in the future, 24.5% identified adult car- analysed, a separate subgroup analysis of the final year medical diac surgery as their most desired sub-specialty, 23.7% chose students was performed to obtain the perceptions of students paediatric cardiothoracic surgery and 10% opted for thoracic imminently about to commence clinical practice and also to surgery. 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 Previous exposure to surgery Committee (study reference SGREC17.0014). In our total cohort, 73.9% had spent no time on a dedicated car- diothoracic surgical placement. One-third (35.9%) of the final RESULTS year students had spent some time on a cardiothoracic firm dur- ing their time at medical school; however, the length of place- Demographics ment was typically less than 2 weeks (29.7%). This was in the context of 98.4% of the final year students having undertaken at In total, 352 medical students from 28 medical schools across the least 2 weeks of other surgical attachments. In the total cohort, UK responded to the survey; 57.7% of respondents were women 15.1% reported that they had scrubbed in to observe a cardio- and 42.0% were men; and 83.8% of respondents were aged 18– thoracic operation at some point in their undergraduate training. 25 years, 9.1% were aged 26–29 years and 7.1% were older than Ultimately, 75% of all students and 81.3% of the final year stu- 30 years. Responses were well distributed across year groups: dents felt they had received inadequate exposure to cardiothora- 18.5% of respondents were in their 1st year of medical school; cic surgery during their undergraduate medical curriculum. 16.5% in the 2nd year; 23.6% in the 3rd year; 18.8% in the 4th Indeed, 86.1% of students felt that experiences during their year and 18.2% in their 5th (final) year; 4.4% of respondents were undergraduate placements were important in determining future undertaking an intercalated degree at the time of the survey. career ambitions. Current career intentions Experiences and perceptions of cardiothoracic surgery Overall, 31.2% of students claimed that they were still considering a career in cardiothoracic surgery, and 10.8% of the total cohort A minority of students (4.5%) reported having a mentor in cardi- claimed that cardiothoracic surgery was their top career choice, ranking as the second most popular specialty (Table 1). However, othoracic surgery; 26.1% reported having access to the details of a cardiothoracic surgeon should they wish to find out more subgroup analysis of the final year cohort revealed lower levels about the speciality or get involved in research; and 13.4% of stu- 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% dents reported having attended a cardiothoracic conference or decrease in the proportion selecting cardiothoracic surgery as career day. Of the remainders who had not attended a Downloaded from https://academic.oup.com/icvts/article/27/4/525/4973030 by DeepDyve user on 15 July 2022 R. Preece et al. / Interactive CardioVascular and Thoracic Surgery 527 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 (%) Neither Attractive (%) Strongly deterring (%) deterring nor attractive attractive (%) (%) Intellectual challenge 0.6 4.0 23.0 48.6 23.8 Skilful/artistic nature of surgery 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 lives 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/research 0.9 2.6 27.5 50.0 19.0 Competition for jobs/training posts 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 globally 0.5 0.3 19.9 46.9 32.4 Limited geographical locations of UK centres to train/work 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 Attractive factor. Deterring factor. SSMD: surgeon-specific mortality data. conference, this was mainly due to students not being aware of DISCUSSION any events for students (59%), not being interested in cardio- thoracic surgery (23.9%) and to a lesser extent logistical (9.5%) This study has shown that within UK undergraduate surgical soci- and cost (5.6%) issues. Indeed, 43.1% of students were unaware eties, there remains an active interest from students to pursue of the structure of the current training pathway for cardiothora- cardiothoracic surgery as a future career. With approximately cic surgery. 11% of the total cohort examined identifying the speciality as Overall, 48.9% of students were aware that cardiothoracic sur- their top career choice and one-third expressing a general inter- geons were subject to the publication of SSMD, and 79.7% of est in pursuing the specialty, it is reasonable to assume that those who were aware claimed that this did not deter them from ample interest from UK undergraduates exists to ensure adequate a career in cardiothoracic surgery. Also, 41.5% had knowledge of workforce provision in the UK for the foreseeable future. previous scandals in cardiothoracic surgery (e.g. Bristol Children’s Furthermore, with the growing expansion of women within UK Heart Scandal), and 86.3% were not discouraged by this. When medical schools [7], it is encouraging to see healthy levels of questioned whether they were aware of the opinion that ‘cardio- interest among female students, with a similar proportion to thoracic surgery is a dying speciality’, 44% had heard the mantra their male counterparts expressing cardiothoracic surgery to be with 43.9% agreeing with it and 56.1% disagreeing. their career of choice (10.3%). Indeed, the specialty was the most popular of all the surgical sub-specialties among this gender cohort. Factors affecting interest in cardiothoracic surgery However, despite this healthy interest expressed by the total cohort, it is deeply concerning that subgroup analysis of the final Of the 17 factors assessed for their influence on student interest in year cohort revealed a dramatic reduction in interest levels. The pursuing cardiothoracic surgery, 5 factors were considered to be reduction in the final year students selecting cardiothoracic sur- considerably attractive characteristics, 2 were rated as considerably gery as their desired career choice to less than 5% was the great- deterring and the remaining factors were equivocal (Table 2). est reduction seen in any of the surgical specialties assessed. As Of the 5 variables deemed to attract students to a career in cardi- UK trainees now apply for cardiothoracic training very early into othoracic surgery, the most attractive factor was the promise of their 2nd year of postgraduate training [8], it is alarming that being able to save or significantly influence people’s lives, with interest from students appears to be taking a negative trajectory 87.2% students reporting this as either attractive/strongly attractive. en route to the point of application. Given that there are very few Other positive influences were the intellectual challenge associated cardiothoracic jobs available for UK trainees in postgraduate with the speciality (72.4%), the skilful and artistic nature of the sur- gery (75.9%), the opportunity to innovate and research within the ‘foundation’ years 1 and 2 [9], it is difficult to perceive that this speciality (69.0%) and the chance to practice globally (79.3%). decline would reverse among UK graduates prior to applications The 2 factors deterring the pursuit of a career in cardiothoracic and may indeed continue to decline. Of concern, only one-third of the final year students had surgery were perceived competition levels for training posts and rotated through a cardiothoracic firm and just 15% had scrubbed jobs (66.2%) and the limited number of geographical locations to train or practise within the UK (63.1%). in to a cardiac operation. Therefore, it is unsurprising that more The other 10 factors determined to not be significantly attrac- than 80% of the surgically orientated students in this study were tive or deterring within the cohort are detailed in Table 2. disappointed with the exposure to the speciality they had ADULT CARDIAC Downloaded from https://academic.oup.com/icvts/article/27/4/525/4973030 by DeepDyve user on 15 July 2022 528 R. Preece et al. / Interactive CardioVascular and Thoracic Surgery received at medical school. This is a cause for concern given that Interestingly, although material factors such as lack of equipment experience on placements has been shown to be influential in and limited training positions were cited as reasons for not pur- future career decision making by allowing students exposure to suing a career in cardiothoracic surgery in this developing coun- the typical diagnostic and intellectual challenges of a speciality try, the same themes of junior trainees perceiving that they had and interaction with potential role models [10]. Eighty-six percent received little exposure to the speciality either as a junior surgeon of the students in this study felt that experience on placements (63%) or as medical students (58.8%) were still present. had been important for selecting their career. From an extracurricular perspective, only 13% had attended a Limitations cardiothoracic careers day or conference, and this was mainly due to a lack of awareness of any student courses available This main limitation of this study utilizing an optional survey (60%). Therefore, although courses such as the ‘Annual National methodology would be the possibility for an over-representation Careers Day’ are now being provided by the Society for of students interested in cardiothoracic surgery among its Cardiothoracic Surgery of Great Britain (SCTS), inadequate publi- respondents. Furthermore, there was a large proportion of stu- city is being provided to students at a local level. This is of inter- dents in our cohort who chose medicine as their desired career est as student exposure to courses such as these have been pathway (38%); however, this likely reflects the membership of shown to improve interest in the speciality [4]. Given that men- modern UK surgical societies. torship 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 CONCLUSION they had the details to contact a cardiothoracic surgeon about research or clinical experience if desired. A reasonable propor- This study has shown that among UK surgically minded medical tion of students in our study (5%) reported having a dedicated students, there remains an active interest to pursue a career in mentor in the speciality. cardiothoracic surgery. However, throughout the course of their Prior concerns have been raised that declining recruitment to undergraduate training, there is a worrying decline in student the specialty from UK graduates may stem from several conten- interest in the speciality. This appears to be related to a lack of tious issues that have previously cast a negative perception on exposure to the specialty both within undergraduate medical cardiothoracics in the public domain [1]. Namely, the publication school curricula and also through extracurricular opportunities. of SSMD and previous scandals are particularly thought to have This has resulted in students becoming disappointed with their an impact on the decisions of current junior trainees. Our study has shown that although 50% of students were aware of these experience of the speciality which draws concern for future events, approximately 80% of students reported that this did not workforce planning given the close proximity of training applica- dissuade them from pursuing a career in cardiothoracics. tion deadlines to the point of graduation (just >12 months). The Furthermore, as the mantra that ‘cardiothoracic surgery is a dying impact of numerous controversial topics within the speciality speciality’ is often discussed within the medical community since that have been previously highlighted in the public domain the rise of interventional cardiology procedures [5], it was (SSMD and scandals) appear to not have had a marked impact encouraging to hear that 80% of the students were either not on student interest. Medical schools and national societies need aware or did not agree with that statement. In fact, the potential to engage further with medical students and highlight the attrac- to innovate within the specialty was one of the factors found to tions of the speciality and allay any concerns to ensure that inter- attract students toward the specialty. It would appear, therefore, est in the specialty is maintained until graduation. 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 car- Conflict of interest: none declared. diac surgery. This study has shown that students are generally drawn to the REFERENCES speciality by the appeal of being able to utilize the skilful and intellectual nature of the clinical work to influence a person’s life. [1] Westaby S, Baig K, De Silva R, Unsworth-White J, Pepper J. Recruitment It is reasonable to assume, therefore, that increasing student to UK cardiothoracic surgery in the era of public outcome reporting. Eur exposure to the specialty through both undergraduate curricula J Cardiothorac Surg 2015;47:679–83. and extracurricular courses would reinforce these attractive fac- [2] Salazar JD, Ermis P, Laudito A, Lee R, Wheatley GH, Paul S et al. tors. Through increasing mentorship and support, students could Cardiothoracic surgery resident education: update on resident recruit- address the factors that appear to be deterring them such as per- ment and job placement. Ann Thorac Surg 2006;82:1160–5. [3] Grover A, Gorman K, Dall TM, Jonas R, Lytle B, Shemin R et al. Shortage ceived competition levels. of cardiothoracic surgeons is likely by 2020. Circulation 2009;120: Although few other studies have sought to assess the interest 488–94. levels of medical students specifically, a survey of surgical resi- [4] Bridgeman A, Findlay R, Devnani A, Lim D, Loganathan K, McElnay P dents in the USA showed similar results to this study with 6% et al. Inspiring the next generation of cardiothoracic surgeons: an easily committing their future career to cardiothoracic surgery and 26% reproducible, sustainable event increases UK undergraduate interest in the specialty. Interact CardioVasc Thorac Surg 2016;22:106–8. reporting a general interest in the specialty [12]. Job security and [5] Yaffee D, Williams M. Cardiac Surgery and the Future. http://www.acc. availability along with demanding work schedules were fre- org/latest-in-cardiology/articles/2015/09/09/08/44/cardiac-surgery- quently reported as shortcomings of the specialty by respond- and-the-future (20 February 2018, date last accessed). ents. These figures also seem to be reflected on a more global [6] Royal College of Surgeons England. https://www.rcseng.ac.uk/careers-in- context. A study of junior trainees in Nigeria revealed that 8% surgery/medical-students/surgical-societies/ (20 February 2018, date last were committed to specializing in cardiothoracic surgery [13]. accessed). Downloaded from https://academic.oup.com/icvts/article/27/4/525/4973030 by DeepDyve user on 15 July 2022 R. Preece et al. / Interactive CardioVascular and Thoracic Surgery 529 [7] General Medical Council. State of Medical Education and Practice in the [10] Bland KI, Isaacs G. Contemporary trends in student selection of medical specialties: the potential impact on general surgery. Arch Surg 2002;137: UK: 2017 Report. https://www.gmc-uk.org/publications/somep2017.asp 259–67. (20 February 2018, date last accessed). [11] Berger A, Giacalone J, Barlow P, Kapadia M, Keith J. Roles of mentorship [8] McElnay PJ, George J, Lodhia J, Moffat D, Patel A, Sinha S et al. How to and research in surgical career choice: longitudinal study of medical stu- Apply Successfully for an ST1 Training Post in Cardiothoracic Surgery. dents. Plast Reconstr Surg Glob Open 2016;4:e783. BMJ Careers. http://careers.bmj.com/careers/advice/How_to_apply_ [12] Vaporciyan AA, Reed CE, Erikson C, Dill MJ, Carpenter AJ, Guleserian KJ et al. successfully_for_an_ST1_training_post_in_cardiothoracic_surgery (20 Factors affecting interest in cardiothoracic surgery: survey of North American February 2018, date last accessed). general surgery residents. J Thorac Cardiovasc Surg 2009;137:1054–62. [9] Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS). [13] Kesieme EB, Abubakar U, Olusoji O, Inuwa IM, Kefas J, Anumenechi N. Workforce Report 2015. https://scts.org/workforce-report-2015/ (20 Factors affecting interest in cardiothoracic surgery among junior surgical February 2018, date last accessed). residents in Nigeria. Cardiovasc J Afr 2017;28:293–7. ADULT CARDIAC 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

Download PDF
5 pages

Loading next page...
 
/lp/ou_press/are-we-losing-future-talent-a-national-survey-of-uk-medical-student-EcdqDNxPhi

References (8)

Publisher
Oxford University Press
Copyright
Copyright © 2022 European Association for Cardio-Thoracic Surgery
eISSN
1569-9285
DOI
10.1093/icvts/ivy119
Publisher site
See Article on Publisher Site

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 medi- cal 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 wor- rying 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. Keywords: Students � Thoracic surgery � Medical education responsible. With particular reference to the UK, since 2000, sev- INTRODUCTION eral major events have brought cardiothoracic surgery into the Despite previously being regarded as a highly popular and com- public eye, namely the Bristol Heart Scandal and the publication of surgeon-specific mortality data (SSMD) [1]. The current cohort petitive speciality, recent data have suggested that cardiothoracic surgery has become dramatically less popular among UK junior of UK medical students is likely to be well aware of these events doctors since the turn of the millennium [1]. Presently, only 32% and may hold negative opinions of the specialty as a result. of current trainees and 18% of those completing cardiothoracic Furthermore, an expansion of interventional cardiac procedures training graduated from a UK medical school [1]. This mirrors has led some to describe the speciality as ‘dying’ which may also similar recruitment problems recently observed into residency impact student perceptions [5]. programmes in the USA [2]. Recent changes in the recruitment of UK cardiothoracic train- The factors precipitating this decline are yet to be delineated; ees has seen selection of candidates now taking place in the 2nd however, they represent an important topic for consideration postgraduate year of training, meaning that applicants will have given the shortages of cardiothoracic surgeons that are predicted only recently graduated from medical school. Therefore, this over coming decades [3]. It is likely that a combination of factors national survey of undergraduate surgical societies was con- including societal measures [1], a changing demographic of med- ducted with the aim of elucidating the current interests of UK ical students and lack of engagement with students [4] are medical students to pursue a career in cardiothoracic surgery and to determine the factors that positively or negatively affect Presented at the Annual Meeting of the Society for Cardiothoracic Surgeons (SCTS) of Great Britain and Ireland, Glasgow, UK, 18–20 March 2018. this decision. The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. ADULT CARDIAC Downloaded from https://academic.oup.com/icvts/article/27/4/525/4973030 by DeepDyve user on 15 July 2022 526 R. Preece et al. / Interactive CardioVascular and Thoracic Surgery MATERIALS AND METHODS Table 1: Proportions of student responses to ‘What career path do you currently believe you are most likely to pursue?’ 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 web- Selected specialty Overall 5th year Females Males site [6]. Subsequently, a 29-item online questionnaire was cohort (%) students (%) (%) (%) designed on the LimeSurvey and then distributed to each surgical Cardiothoracic surgery 10.8 4.7 10.3 11.5 society before dissemination to their respective membership via Ear, nose and throat surgery 4.3 6.3 2.0 7.4 e-mail or social media outlets. Students from all years of medical General practice 6.8 7.8 7.9 5.4 General surgery 9.9 10.9 9.4 10.8 school were able to participate (including those undertaking a 1- Medicine 37.5 43.8 40.4 33.1 year intercalated degree). The survey was available for 2 months Neurosurgery 5.1 3.1 3.0 8.1 (October to November 2017) prior to closure. Only fully com- Obstetrics and gynaecology 3.4 6.3 5.9 0.0 pleted responses were included in the final analysis. Paediatric surgery 3.7 3.1 4.4 2.7 The questionnaire consisted of 5 question groups; (i) demo- Plastic surgery 5.4 3.1 6.9 3.4 Psychiatry 3.7 3.1 3.4 4.1 graphics, (ii) current career intentions, (iii) previous exposure to Trauma and orthopaedics 7.7 4.7 5.4 10.8 surgery, (iv) experiences and perceptions of cardiothoracic sur- Urology 1.1 3.1 0.5 2.0 gery and (v) factors affecting student interest in cardiothoracic Vascular surgery 0.6 0.0 0.5 0.7 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 their main career ambition was the greatest of all specialties 17 individual factors on student desire to pursue a career in car- screened. Although the proportion of women and men choosing diothoracic surgery was assessed via a 5-point Likert scale (rang- cardiothoracic surgery as their desired career goal was similar ing from strongly deterring to strongly attractive). A factor was (10.3% and 11.5%, respectively), less women (25.6%) considered determined to be either considerably attractive or deterring for it as a career option when compared with men (39.1%). students if more than 60% of the cohort reported the factor to Of the students considering a career in cardiothoracic surgery, be strongly attractive/attractive or strongly deterring/deterring. 74.5% stated that they intended to practice in the UK in the A Microsoft Excel 2007 package was used to perform simple future. When asked whether they knew which sub-specialty they analysis of the data obtained. Although the whole cohort was would like to undertake in the future, 24.5% identified adult car- analysed, a separate subgroup analysis of the final year medical diac surgery as their most desired sub-specialty, 23.7% chose students was performed to obtain the perceptions of students paediatric cardiothoracic surgery and 10% opted for thoracic imminently about to commence clinical practice and also to surgery. 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 Previous exposure to surgery Committee (study reference SGREC17.0014). In our total cohort, 73.9% had spent no time on a dedicated car- diothoracic surgical placement. One-third (35.9%) of the final RESULTS year students had spent some time on a cardiothoracic firm dur- ing their time at medical school; however, the length of place- Demographics ment was typically less than 2 weeks (29.7%). This was in the context of 98.4% of the final year students having undertaken at In total, 352 medical students from 28 medical schools across the least 2 weeks of other surgical attachments. In the total cohort, UK responded to the survey; 57.7% of respondents were women 15.1% reported that they had scrubbed in to observe a cardio- and 42.0% were men; and 83.8% of respondents were aged 18– thoracic operation at some point in their undergraduate training. 25 years, 9.1% were aged 26–29 years and 7.1% were older than Ultimately, 75% of all students and 81.3% of the final year stu- 30 years. Responses were well distributed across year groups: dents felt they had received inadequate exposure to cardiothora- 18.5% of respondents were in their 1st year of medical school; cic surgery during their undergraduate medical curriculum. 16.5% in the 2nd year; 23.6% in the 3rd year; 18.8% in the 4th Indeed, 86.1% of students felt that experiences during their year and 18.2% in their 5th (final) year; 4.4% of respondents were undergraduate placements were important in determining future undertaking an intercalated degree at the time of the survey. career ambitions. Current career intentions Experiences and perceptions of cardiothoracic surgery Overall, 31.2% of students claimed that they were still considering a career in cardiothoracic surgery, and 10.8% of the total cohort A minority of students (4.5%) reported having a mentor in cardi- claimed that cardiothoracic surgery was their top career choice, ranking as the second most popular specialty (Table 1). However, othoracic surgery; 26.1% reported having access to the details of a cardiothoracic surgeon should they wish to find out more subgroup analysis of the final year cohort revealed lower levels about the speciality or get involved in research; and 13.4% of stu- 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% dents reported having attended a cardiothoracic conference or decrease in the proportion selecting cardiothoracic surgery as career day. Of the remainders who had not attended a Downloaded from https://academic.oup.com/icvts/article/27/4/525/4973030 by DeepDyve user on 15 July 2022 R. Preece et al. / Interactive CardioVascular and Thoracic Surgery 527 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 (%) Neither Attractive (%) Strongly deterring (%) deterring nor attractive attractive (%) (%) Intellectual challenge 0.6 4.0 23.0 48.6 23.8 Skilful/artistic nature of surgery 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 lives 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/research 0.9 2.6 27.5 50.0 19.0 Competition for jobs/training posts 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 globally 0.5 0.3 19.9 46.9 32.4 Limited geographical locations of UK centres to train/work 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 Attractive factor. Deterring factor. SSMD: surgeon-specific mortality data. conference, this was mainly due to students not being aware of DISCUSSION any events for students (59%), not being interested in cardio- thoracic surgery (23.9%) and to a lesser extent logistical (9.5%) This study has shown that within UK undergraduate surgical soci- and cost (5.6%) issues. Indeed, 43.1% of students were unaware eties, there remains an active interest from students to pursue of the structure of the current training pathway for cardiothora- cardiothoracic surgery as a future career. With approximately cic surgery. 11% of the total cohort examined identifying the speciality as Overall, 48.9% of students were aware that cardiothoracic sur- their top career choice and one-third expressing a general inter- geons were subject to the publication of SSMD, and 79.7% of est in pursuing the specialty, it is reasonable to assume that those who were aware claimed that this did not deter them from ample interest from UK undergraduates exists to ensure adequate a career in cardiothoracic surgery. Also, 41.5% had knowledge of workforce provision in the UK for the foreseeable future. previous scandals in cardiothoracic surgery (e.g. Bristol Children’s Furthermore, with the growing expansion of women within UK Heart Scandal), and 86.3% were not discouraged by this. When medical schools [7], it is encouraging to see healthy levels of questioned whether they were aware of the opinion that ‘cardio- interest among female students, with a similar proportion to thoracic surgery is a dying speciality’, 44% had heard the mantra their male counterparts expressing cardiothoracic surgery to be with 43.9% agreeing with it and 56.1% disagreeing. their career of choice (10.3%). Indeed, the specialty was the most popular of all the surgical sub-specialties among this gender cohort. Factors affecting interest in cardiothoracic surgery However, despite this healthy interest expressed by the total cohort, it is deeply concerning that subgroup analysis of the final Of the 17 factors assessed for their influence on student interest in year cohort revealed a dramatic reduction in interest levels. The pursuing cardiothoracic surgery, 5 factors were considered to be reduction in the final year students selecting cardiothoracic sur- considerably attractive characteristics, 2 were rated as considerably gery as their desired career choice to less than 5% was the great- deterring and the remaining factors were equivocal (Table 2). est reduction seen in any of the surgical specialties assessed. As Of the 5 variables deemed to attract students to a career in cardi- UK trainees now apply for cardiothoracic training very early into othoracic surgery, the most attractive factor was the promise of their 2nd year of postgraduate training [8], it is alarming that being able to save or significantly influence people’s lives, with interest from students appears to be taking a negative trajectory 87.2% students reporting this as either attractive/strongly attractive. en route to the point of application. Given that there are very few Other positive influences were the intellectual challenge associated cardiothoracic jobs available for UK trainees in postgraduate with the speciality (72.4%), the skilful and artistic nature of the sur- gery (75.9%), the opportunity to innovate and research within the ‘foundation’ years 1 and 2 [9], it is difficult to perceive that this speciality (69.0%) and the chance to practice globally (79.3%). decline would reverse among UK graduates prior to applications The 2 factors deterring the pursuit of a career in cardiothoracic and may indeed continue to decline. Of concern, only one-third of the final year students had surgery were perceived competition levels for training posts and rotated through a cardiothoracic firm and just 15% had scrubbed jobs (66.2%) and the limited number of geographical locations to train or practise within the UK (63.1%). in to a cardiac operation. Therefore, it is unsurprising that more The other 10 factors determined to not be significantly attrac- than 80% of the surgically orientated students in this study were tive or deterring within the cohort are detailed in Table 2. disappointed with the exposure to the speciality they had ADULT CARDIAC Downloaded from https://academic.oup.com/icvts/article/27/4/525/4973030 by DeepDyve user on 15 July 2022 528 R. Preece et al. / Interactive CardioVascular and Thoracic Surgery received at medical school. This is a cause for concern given that Interestingly, although material factors such as lack of equipment experience on placements has been shown to be influential in and limited training positions were cited as reasons for not pur- future career decision making by allowing students exposure to suing a career in cardiothoracic surgery in this developing coun- the typical diagnostic and intellectual challenges of a speciality try, the same themes of junior trainees perceiving that they had and interaction with potential role models [10]. Eighty-six percent received little exposure to the speciality either as a junior surgeon of the students in this study felt that experience on placements (63%) or as medical students (58.8%) were still present. had been important for selecting their career. From an extracurricular perspective, only 13% had attended a Limitations cardiothoracic careers day or conference, and this was mainly due to a lack of awareness of any student courses available This main limitation of this study utilizing an optional survey (60%). Therefore, although courses such as the ‘Annual National methodology would be the possibility for an over-representation Careers Day’ are now being provided by the Society for of students interested in cardiothoracic surgery among its Cardiothoracic Surgery of Great Britain (SCTS), inadequate publi- respondents. Furthermore, there was a large proportion of stu- city is being provided to students at a local level. This is of inter- dents in our cohort who chose medicine as their desired career est as student exposure to courses such as these have been pathway (38%); however, this likely reflects the membership of shown to improve interest in the speciality [4]. Given that men- modern UK surgical societies. torship 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 CONCLUSION they had the details to contact a cardiothoracic surgeon about research or clinical experience if desired. A reasonable propor- This study has shown that among UK surgically minded medical tion of students in our study (5%) reported having a dedicated students, there remains an active interest to pursue a career in mentor in the speciality. cardiothoracic surgery. However, throughout the course of their Prior concerns have been raised that declining recruitment to undergraduate training, there is a worrying decline in student the specialty from UK graduates may stem from several conten- interest in the speciality. This appears to be related to a lack of tious issues that have previously cast a negative perception on exposure to the specialty both within undergraduate medical cardiothoracics in the public domain [1]. Namely, the publication school curricula and also through extracurricular opportunities. of SSMD and previous scandals are particularly thought to have This has resulted in students becoming disappointed with their an impact on the decisions of current junior trainees. Our study has shown that although 50% of students were aware of these experience of the speciality which draws concern for future events, approximately 80% of students reported that this did not workforce planning given the close proximity of training applica- dissuade them from pursuing a career in cardiothoracics. tion deadlines to the point of graduation (just >12 months). The Furthermore, as the mantra that ‘cardiothoracic surgery is a dying impact of numerous controversial topics within the speciality speciality’ is often discussed within the medical community since that have been previously highlighted in the public domain the rise of interventional cardiology procedures [5], it was (SSMD and scandals) appear to not have had a marked impact encouraging to hear that 80% of the students were either not on student interest. Medical schools and national societies need aware or did not agree with that statement. In fact, the potential to engage further with medical students and highlight the attrac- to innovate within the specialty was one of the factors found to tions of the speciality and allay any concerns to ensure that inter- attract students toward the specialty. It would appear, therefore, est in the specialty is maintained until graduation. 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 car- Conflict of interest: none declared. diac surgery. This study has shown that students are generally drawn to the REFERENCES speciality by the appeal of being able to utilize the skilful and intellectual nature of the clinical work to influence a person’s life. [1] Westaby S, Baig K, De Silva R, Unsworth-White J, Pepper J. Recruitment It is reasonable to assume, therefore, that increasing student to UK cardiothoracic surgery in the era of public outcome reporting. Eur exposure to the specialty through both undergraduate curricula J Cardiothorac Surg 2015;47:679–83. and extracurricular courses would reinforce these attractive fac- [2] Salazar JD, Ermis P, Laudito A, Lee R, Wheatley GH, Paul S et al. tors. Through increasing mentorship and support, students could Cardiothoracic surgery resident education: update on resident recruit- address the factors that appear to be deterring them such as per- ment and job placement. Ann Thorac Surg 2006;82:1160–5. [3] Grover A, Gorman K, Dall TM, Jonas R, Lytle B, Shemin R et al. Shortage ceived competition levels. of cardiothoracic surgeons is likely by 2020. Circulation 2009;120: Although few other studies have sought to assess the interest 488–94. levels of medical students specifically, a survey of surgical resi- [4] Bridgeman A, Findlay R, Devnani A, Lim D, Loganathan K, McElnay P dents in the USA showed similar results to this study with 6% et al. Inspiring the next generation of cardiothoracic surgeons: an easily committing their future career to cardiothoracic surgery and 26% reproducible, sustainable event increases UK undergraduate interest in the specialty. Interact CardioVasc Thorac Surg 2016;22:106–8. reporting a general interest in the specialty [12]. Job security and [5] Yaffee D, Williams M. Cardiac Surgery and the Future. http://www.acc. availability along with demanding work schedules were fre- org/latest-in-cardiology/articles/2015/09/09/08/44/cardiac-surgery- quently reported as shortcomings of the specialty by respond- and-the-future (20 February 2018, date last accessed). ents. These figures also seem to be reflected on a more global [6] Royal College of Surgeons England. https://www.rcseng.ac.uk/careers-in- context. A study of junior trainees in Nigeria revealed that 8% surgery/medical-students/surgical-societies/ (20 February 2018, date last were committed to specializing in cardiothoracic surgery [13]. accessed). Downloaded from https://academic.oup.com/icvts/article/27/4/525/4973030 by DeepDyve user on 15 July 2022 R. Preece et al. / Interactive CardioVascular and Thoracic Surgery 529 [7] General Medical Council. State of Medical Education and Practice in the [10] Bland KI, Isaacs G. Contemporary trends in student selection of medical specialties: the potential impact on general surgery. Arch Surg 2002;137: UK: 2017 Report. https://www.gmc-uk.org/publications/somep2017.asp 259–67. (20 February 2018, date last accessed). [11] Berger A, Giacalone J, Barlow P, Kapadia M, Keith J. Roles of mentorship [8] McElnay PJ, George J, Lodhia J, Moffat D, Patel A, Sinha S et al. How to and research in surgical career choice: longitudinal study of medical stu- Apply Successfully for an ST1 Training Post in Cardiothoracic Surgery. dents. Plast Reconstr Surg Glob Open 2016;4:e783. BMJ Careers. http://careers.bmj.com/careers/advice/How_to_apply_ [12] Vaporciyan AA, Reed CE, Erikson C, Dill MJ, Carpenter AJ, Guleserian KJ et al. successfully_for_an_ST1_training_post_in_cardiothoracic_surgery (20 Factors affecting interest in cardiothoracic surgery: survey of North American February 2018, date last accessed). general surgery residents. J Thorac Cardiovasc Surg 2009;137:1054–62. [9] Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS). [13] Kesieme EB, Abubakar U, Olusoji O, Inuwa IM, Kefas J, Anumenechi N. Workforce Report 2015. https://scts.org/workforce-report-2015/ (20 Factors affecting interest in cardiothoracic surgery among junior surgical February 2018, date last accessed). residents in Nigeria. Cardiovasc J Afr 2017;28:293–7. ADULT CARDIAC

Journal

Interactive CardioVascular and Thoracic Surgery – Oxford University Press

Published: Oct 1, 2018

Keywords: perception; students, medical; cardiothoracic surgery; surgical procedures, operative; schools, medical; college students

There are no references for this article.