B.M. Dacier1,2, J. Mejia1,3, A.N. Jones1, T. Dey1, C.A. Burks1,4, M.A. Romero Arenas5, G. Ortega1,6 1Brigham and Women’s Hospital, Center For Surgery And Public Health, Boston, MASSACHUSETTS, USA 2Dartmouth-Hitchcock Medical Center, Department Of Surgery, Lebanon, NEW HAMPSHIRE, USA 3Tufts University School of Medicine, Boston, MA, USA 4Harvard Medical School, Department Of Otolaryngology-Head And Neck Surgery, Boston, MASSACHUSETTS, USA 5Weill Cornell Medical College, Department Of Surgery, New York, NY, USA 6Harvard Medical School, Department Of Surgery, Boston, MASSACHUSETTS, USA
Introduction: The United States continues to diversify, but the surgical workforce has been slow to follow. Multifaceted, targeted interventions are needed to increase diversity in surgery. Identifying influences on career choice is a first step. This study uses unsupervised learning to identify phenotypes of graduating medical students through shared demographic, social, and professional factors that influence their decision to pursue a career in surgery.
Methods: We performed a retrospective cohort study including graduating medical students who completed the AAMC Medical School Graduation Questionnaire between 2011-2020 and designated Surgery or surgical subspecialties as their intended area of practice. K modes hierarchical clustering identified 4 unique subgroups of medical students, based on similarities and differences across 13 variables: race/ethnicity, sex, outstanding pre-medical school or medical school loans, plans to work in an underserved area, clerkship quality, lifestyle factors, career factors, and mentorship.
Results: Of 129,799 respondents, 19.7% (n=25,565) indicated surgery as their intended area of practice. Across all four clusters, most had unpaid medical school loans (73.7-79.9%), had no outstanding pre-med loans (63.6-68%), rated their surgical clerkship as excellent (66.9-70.7%), and were strongly influenced by mentors to pursue surgery (56.0-65.6%).
Cluster 1 (n=6365) had the highest proportion of students who identify as Black (4.7%), Hispanic (8.5%), Other/Unknown (6.4%), and female (44.4%) amongst all clusters. Most (56.0%) were undecided on working in underserved areas. Lifestyle and career factors had no influence (Table 1).
Cluster 2 (n=5788) was predominantly male (61.5%) and White (65.4%). Most did not plan to work in underserved areas (43.3%), and lifestyle and career factors had a minor influence on specialty choice.
Cluster 3 (n=7333) was predominantly male (70.8%) and White (64.5%). Nearly half (49.5%) did not plan to work in underserved areas. Lifestyle factors moderately influenced their decision to pursue surgery, as did salary potential and specialty competitiveness.
Cluster 4 (n=6079) was mostly male (70.6%) and White (61.1%) and had the most students who identify as Asian (21.4%). Most (59.9%) were undecided regarding working in underserved areas. Work/life balance, family plans, and salary potential strongly influenced their career choice.
Conclusion: Hierarchical clustering identified similarities and differences amongst 4 groups of graduating medical students planning to pursue a career in surgery using personal, lifestyle, and career factors. More qualitative studies are needed to identify influences on different demographic cohorts’ decision to pursue a career in surgery.