J. T. Unkart1, C. M. Reid1, J. M. Baumgartner1, A. M. Wallace1, C. J. Kelly1 1University Of California, San Diego,La Jolla, CA, USA
Introduction: Students who come from disadvantaged backgrounds are more likely return to practice in these areas. Due to the emphasis on training more primary care physicians for underserved areas, we hypothesized that students who indicate themselves as ‘disadvantaged’ on their AMCAS application are less likely to pursue surgical training.
Methods: We performed a review of a UCSD medical school admissions database on students graduating during 2005-2014. Students were stratified into ‘disadvantaged’ and ‘non-disadvantaged’ groups. Data was recorded on age at entry, undergraduate science GPA, total MCAT scores, gender, surgery clerkship grade, USMLE step 1 score, and residency match into a surgical field at graduation. The primary endpoint, a comparison of the proportion of students matching into a surgical field between the two groups, was assessed with X2 test. Multivariate logistic regression was performed to assess factors that predict the choice of general surgery versus another surgical field.
Results: Of the 1140 students enrolled and graduated, 219 (19.2%) students reported ‘disadvantaged’ on their application. One hundred fifty-eight (13.9%) of students chose a surgical field. Students from the disadvantage group were older at entry (24.4 years vs. 23.2 years (p<0.001)), and had lower GPA (3.59 vs. 3.75 (p <0.001) and total MCAT scores (30.1 vs. 33.7 (p<0.001)). Twenty-seven (12.3%) of the 219 disadvantaged students chose a surgical career versus 130 (14.1%) of the 921 non-disadvantaged students (p=0.56). Amongst the surgical specialties chosen, general surgery was selected 57 (36.3%), orthopedic surgery 54 (34.4%), ENT 14 (8.9%), urology 14 (8.9%), neurosurgery 11 (7.0%), plastic surgery 6 (3.8%) and vascular surgery 1 (0.6%) time. On final multivariate logistic model, female gender (OR 3.9 (1.9-8.3), p <0.01), disadvantaged status (OR 2.8 (1.1-7.1), p=0.03), and USMLE step 1 score >227 (OR 0.43 (0.21-0.88), p=0.02) were significantly associated with choosing general surgery versus another surgical specialty.
Conclusion: The percentage of students that pursue surgical specialties from our institution is similar to percentages previously reported. While the disadvantaged cohort at our institution was older and had lower undergraduate GPA and MCAT scores, the proportion of disadvantaged students matching into a surgical specialty was not statistically different from the non-disadvantaged group. In order to address the future shortage of general surgeons in underserved areas, increasing enrollment of ‘disadvantaged’ students may alleviate the surgical desert.