A. L. Carroll1, A. Chan1, J. R. Steinberg1, T. S. Bryant1, P. Marin-Nevarez1, T. N. Anderson1,2, S. Bereknyei Merrell2,3, J. N. Lau1,2 1Stanford University,School Of Medicine,Palo Alto, CA, USA 2Stanford University,Surgery ACS Education Institute/Goodman Surgical Education Center, Department Of Surgery,Palo Alto, CA, USA 3Stanford University,Stanford-Surgery Policy Improvement Research And Education (S-SPIRE) Center, Department Of Surgery,Palo Alto, CA, USA
Introduction: Diversity in the surgical workforce is a critical component of improving care for underserved patients. To recruit more diverse surgeons, we must understand how medical students choose their specialty. Prior studies have focused on identifying predictive factors and associations, creating a need for more qualitative research to explore this complex decision-making process. To that end, we investigate how preclinical student values inform the desire to enter a surgical field.
Methods: Medical student researchers performed qualitative analysis of semi-structured focus groups, which they facilitated, along with surgical fellows, during two iterations of a seminar class called Service Through Surgery in the winter of 2018 and 2019. They created the course to increase preclinical exposure to diverse, service-oriented surgeon mentors. Focus group discussion goals included identifying student values and assessing how they inform career decisions, particularly regarding plans to pursue surgery and incorporate service into their career. We utilized a systematic, collaborative, iterative process for transcript analysis, including developing a codebook, assessing interrater reliability (Cohen’s κ score: 0.75), and analyzing themes.
Results: 24 preclinical medical students took part in 7 focus groups. Participants included 16 women (67%) and 8 men (33%). 19 students (79%) were in their first and 5 (21%) were in their second year of medical school. 17 (71%) expressed interest in a surgical field, 5 (21%) wanted to pursue a pure medical specialty, and 2 (8%) were undecided. Many students described values of finding professional fulfillment, spending time with family, and serving their communities and/or underserved populations as most important and agreed that conducting groundbreaking research, working long hours, and finding time for leisure activities were least important. Interestingly, students interested in surgery tended to rank professional fulfillment high and leisure time low when questioned about values. We display student explanations for these value rankings in Figure 1. Additionally, several students were uncertain about finding time and resources to incorporate service into their careers but pointed to the Service Through Surgery class speakers as positive examples to emulate.
Conclusion: Overall, these findings outlining the relationship between preclinical medical student values and career interest form a foundation to create a framework for greater understanding and study of these important interactions. This research also underscores the need for early interventions in medical education to promote diversity and care for the underserved in surgery, like the replicable Service Through Surgery course model.
