Introduction
It has been reported that interest in surgical training has declined over recent years.1–3 Despite a recent increase in surgical training intake in Ireland, the longer-term trends in applications to the core surgical training scheme in Ireland showed a decline in recent years from 263 applicants in 2003 to 115 in 2017.4,5 One study across final year medical students in all Irish medical schools found that only 18% of final year medical students intended to pursue a career in surgery.6 It has also been highlighted that early exposure to surgical specialties is associated with an increased interest in medical students to pursue surgery.7 Although it is difficult for students, especially preclinical students, to obtain early exposure to surgery, involvement in medical student surgical societies has been shown to increase student knowledge of surgical careers8
The declining interest is concerning considering national surgeon shortages have been reported by the American College of Surgeons, and as part of a European healthcare workforce crisis.8,9 The demand for increasing health services and medical staff has also been recognised by Health Service Executive (HSE) Ireland.10 Key factors for these can be attributed to more complexities within healthcare from population ageing, increasing prevalence of risk factors such as obesity, increased migration, and advances in technology. To meet these demands medical professionals and trainees across all specialities including surgery are needed. It has been established that participation or membership to surgical society/surgery interest groups can successfully influence medical students’ interest in surgical careers.11 As part of these groups common events include workshops, panel discussions, mentorship programmes and conferences. Although such events are held across universities on both a national and international scale, the literature on their impact is scant, and no study to date has examined the impact of student-led surgical conferences in the Irish context.12
The University College Cork Surgical Society hosts an annual student-led surgical conference, involving talks from consultant and specialist registrar surgeons as well as practical surgical skills workshops. In January 2023, the University College Cork Surgical Society hosted a two-day conference which included guest speakers from six surgical specialties: cardiothoracic, orthopaedic, maxillofacial, plastic, general surgery and neurosurgery. Guest speakers at the conference spoke about these surgical specialties and the various surgical training pathways and also delivered practical workshops which taught various surgical skills. While this is always perceived to be a positive event and an important educational opportunity its impact had not been formally assessed. In fact, there are limited studies to date which have investigated the effect of a medical student surgical conference on student knowledge of surgical specialties and understanding of training pathways. This is the first study on such a topic in Ireland. As such, this study aimed to address this gap in the literature and evaluate the impact of student-led surgical conferences in Ireland.
Aims and Objectives
Aim
The primary aim of this study was to establish the impact of a student-led surgical conference on student knowledge and interest in surgical training.
Objectives
To determine
-
The change in student’s self-reported knowledge of surgical specialties and training pathways before and after attending the conference.
-
The change in the appeal of various surgical specialties to medical students before and after attending the conference.
-
The major barriers to pursuing a career in surgery perceived by students.
Methods
In January 2023, the University College Cork Surgical Society hosted its annual conference which was directed towards medical students who were interested in surgery. The surgical specialties represented at the conference were cardiothoracic, general, maxillofacial, neurosurgery, orthopaedic and plastic surgery.
The conference took place over two days. The first day involved talks which were delivered by consultant surgeons and specialist registrars from each of the various specialties named above. The talks aimed to, improve student’s knowledge of what each surgical specialty involved, discuss the training pathway to becoming a surgeon in each specialty and highlight aspects of surgical specialties and training which are often not otherwise taught as part of the medical school curriculum. Students were also afforded the opportunity to ask questions to consultants and specialist registrars and to network with fellow students. On the second day of the conference, a number of surgical skills workshops were held to further enhance student understanding of what each surgical specialty involved. These included microsurgery, fracture fixation, burr hole and chest drain placement.
Following successful application for ethical approval from the social research ethics committee in University College Cork an online questionnaire was shared with participants who attended the conference. This study was a retrospective cross-sectional study with both quantitative and qualitative elements from the responses secured from these questionnaires.
Data Collection & Analysis
Following the conference, students who attended the conference were contacted via email and invited to complete an anonymous digital survey. The survey platform used was Microsoft Forms. Responses were completely anonymous. Participants answered questions based on a 5-point Likert scale. Likert scale options ranged from “Very Poor”, “Poor”, “Neutral”, “Good” and “Very good”. The anonymous data were input into SPSS for analysis. The results of the survey were analysed using SPSS.
Exploratory data analysis was used in SPSS to assess the demographics of the respondents with regards to gender, age, year of medical school. To compare the difference between student knowledge of surgical specialties and understanding of the surgical training pathways in Ireland before and after attending the conference, the Likert scale was used. Likert scale responses were converted to numerical equivalents for analyses, using “Very poor” as the designated score of 1 and “Very good” as 5, with the corresponding options in between. As the Likert scale provides ordinal data, Mann-Whitney U tests were conducted to compare the difference between the median scores of student knowledge and understanding of surgical specialties and training pathways before and after attending the conference. Graphs were created using GraphPad Prism.
Results
Participant Demographics
48.9% attendees completed the questionnaire (44/90). Of the attendees, 54.5% (n=24) were female and 45.5% (n=20) were male. 81.8% (n=36) participants were medical students in pre-clinical years and 18.2% (n=8) were medical students in clinical years. 75% (n=33) students attended both the talks and workshops at the conference. 20.5% (n=9) students attended the talks only and 4.5% (n=2) students attended the workshops only.
Previous Experience
27.3% (n=12) students had previously had clinical placement in one of the surgical specialties represented at the conference. 6.8% (n=3) students had previously completed research in surgery, 15.9% (n=7) were currently conducting research in surgery at this time and 77.3% (n=34) students had no experience in research in surgery. 27.3% (n=12) students had attended a surgical conference prior to the University College Cork Surgical Society, 72.7% (n=32) had not.
Knowledge of Surgical Specialties
There was a significant difference between the level of self-reported knowledge of the surgical specialties before and after attending the conference, with a median score of 3 before and 4 after (p <0.001). The proportion of students who reported their knowledge of the surgical specialties was “Very good” increased from 5% (n=2) before the conference to 32% (n=14) after attending the conference. Conversely, 9% (n=4) of student’s reported their knowledge of the surgical specialties was very poor before the conference, compared with 0% (n=0) after attending the conference.
Understanding of Training Pathways
There was a significant difference between the level of understanding before and after attending, with a median score of 2 before and 4 after attending (p <0.001). 32% (n=14) of students reported that their understanding of the surgical training pathways before the conference was very poor. After attending the conference, no student reported that their understanding of the surgical training pathways was very poor. The proportion of students who reported a good or very good understanding of the training pathways increased from 25% (n=11) before the conference to 84% (n=37) after the conference.
Appeal of Surgical Specialties
The total number of responses of which surgical specialties appealed most to students increased from 63 before the conference to 92 after. The surgical specialties which appealed the most to students before the conference were cardiothoracics (n =18), orthopaedics (n=13) and general surgery (n=13). The surgical specialties which appealed the most to students after attending the conference were plastic surgery (n =26), orthopaedic surgery (n=20) and cardiothoracics (n=17). The appeal of plastic surgery increased 2.6-fold, maxillofacial surgery 4-fold and neurosurgery 1.6-fold. The surgical specialties which students reportedly learned the most about from attending the conference were plastic surgery (n=25) followed by neurosurgery (n=18) and maxillofacial surgery (n=16).
Perceived Barriers to Surgical Training
The most frequently reported barrier that students perceived to a career in surgery was the competitiveness of surgery as a career accounting for 36.4% (n=16), closely followed by work life balance at 34.1% (n=15). Other reported barriers included the research requirements for surgical training at 11.4% (n=5), the length of the surgery training pathways at 9.1% (n=4), the academic requirements to surgical training at 4.5% (n=2) and the interview process in surgical training at 2.3% (n=1). 2.3% (n=2)s attendees selected non-specified “Other” perceived barriers. Male and female respondents reported different perceived barriers to a career in surgery. “Work Life Balance” was the major barrier perceived by women at 25% (n=11) and “The competitiveness of surgery as a career” was the major barrier perceived by men at 18.2% (n=8).
Attendee Experience of Conference
100% (n=44) of attendees reported that they would either strongly recommend or recommend the conference to their peers.
Likelihood of Pursuing Career in Surgery
Overall, 39% (n=17) of students reported they were very likely to pursue a career in surgery, 16% (n=7) reported they were likely, 30% (n=13) reported they were neither likely or unlikely to pursue a career in surgery and 16% (n=7) reported it was somewhat unlikely they would pursue a career in surgery. 50% (n=22) of students reported that they were much more likely to pursue a career in surgery after attending the conference. 32% (n=14) reported that they were more likely to pursue a career in surgery after attending and 18% (n=8) reported no change in their likelihood of pursuing a career in surgery after attending. No students reported a decrease in likelihood of pursuing a career in surgery after attending the conference.
Discussion
The impact of student oriented surgical conferences on medical student’s understanding of the surgical training schemes and knowledge of subspecialties has been under reported internationally. This is the first study carried out in Ireland on this topic, and the results show that the impact of such events targeted at undergraduate level should not be underestimated.
Overall results
The results of this study suggest that student led surgical conferences offer numerous potential benefits to students. Self-reported knowledge of the surgical specialties significantly increased from median 3 to 4 before and after the conference. An even greater difference was seen with regards to student’s self-reported understanding of the training pathways which increased significantly from median 2 to 4 after attending the conference. No previous studies have investigated these specific questions; however, the results are in keeping with the hypothesis that medical student surgical conferences have a positive impact on student knowledge and understanding of surgical specialties. The level of understanding of the surgical training pathways amongst students prior to attending the conference is poor.
Before the conference, a total of 63 responses of which specialties appealed the most were collected, with a mean of 1.4 specialties appealing to each student. This rose to a total of 92 responses collected after the conference, reflecting a mean of 2.1 specialties appealing to each attendee. This suggests that amongst students who attended the conference, students were now considering surgical specialties which they had not previously considered as career options. This is one of the main benefits of student surgical conferences, as students are given early exposure to what surgical specialties and their training pathways involve. Indeed, early exposure to the surgical specialties has been well documented as a positive influencing factor in subsequent pursuit of a surgical career.7
Significant changes were seen with regards to which specialties appealed the most to students before and after attending the conference. Before attending, the three most popular specialties were cardiothoracic, orthopaedic and general surgery. After the conference, the three specialties which most appealed to students were plastic surgery, cardiothoracic and orthopaedic surgery. Interestingly, the three surgical specialties which increased the most in appeal before and after the conference were also the same three which students reported they learned the most about at the conference. These were plastic surgery, neurosurgery, and maxillofacial surgery. This result serves to highlight that early exposure and explanation to medical students of what surgical specialties involve can have a major impact in setting their trajectory of career interest. With regards to the slight decrease in appeal in certain surgical specialties such as general and cardiothoracic surgery, this may in fact be due to students learning having misconceptions of what these surgical specialties involved and realising that a different surgical specialty may in fact be more suitable for them personally. Nonetheless, the slight decrease in interest in two of the specialties discussed at the conference potentially reflects a positive impact of educating students what the specialties really involve, hence allowing students to focus on a specialty that is more suited to their individual interests and needs at an earlier time point in their careers.
Barriers and how to alleviate them
There has been extensive investigation into the barriers that are perceived amongst students and junior doctors to pursuing a career in surgery. The results from this study further highlight some of the major perceived barriers to pursuing a career in surgery previously reported amongst medical students. (ideally reference)
“Competitiveness of surgery as a career” and “Work-life balance” were the most frequently reported barriers to training. with more male attendees citing “Competitiveness of surgery as a career” and more female attendees citing “Work-life balance” as the major barrier they perceived. Although these issues have been described as barriers to surgical training in previous literature, the results of this study serve to remind us that these issues are perceived from an early stage in a doctor’s career. This is useful information for surgical training bodies to address efforts to reduce these barriers and to continue current efforts promoting inclusion and diversity within the surgical workforce.
Work-life balance continues to be a prominent and frequently reported reason for not pursuing a career in surgery, and by those within the field. 34.1% (n=15) of our conference attendees cited this as a barrier they see when it comes to choosing surgery as a career. The availability of more flexible training pathways such as Less Than Full-Time Training, part time surgical training and time out of approved training programmes for both personal and professional reasons may address these concerns. Reports from the UK have shown increasing interest in these training pathways especially amongst female trainees. One study found that the vast majority of those opting for less than full-time training was female, accounting for 92.5%.13
The importance of early exposure
Student-led surgical conferences are a useful way of broadening student’s exposure to surgical specialties. They provide a unique opportunity to network and meet surgeons who are at different stages of their careers, and to learn more about what is involved and required when it comes to applying for surgical training positions. A recent study by showed that early exposure ranked as the most influential motivator for applying to surgical training in the UK (44%), followed very closely by professional support.14 Students are given the opportunity to ask questions and further their understanding of what is involved in working in certain specialties in a comfortable environment. This can help promote surgery to students and alleviate any potential biases they may have regarding the surgical work environment which many perceive to be an intimidating field to work in.
Targeting these events at students who are in their pre-clinical years may have the greatest overall impact.12 Many of the clinical year students have already developed an interest in a specific field, and therefore they may be less likely to consider alternative areas. 81.8% (n=36) of our attendees were pre-clinical year students, who have likely the most interest and most to gain from this intervention. Many students cite a limited exposure to surgery during medical school as a significant factor which dissuaded them from further exploring the field of surgery. Interventions such as those discussed above are an effective way of alleviating this barrier.15
The results of this study were encouraging to see the positive impact that student surgical conferences have regarding attendee experience. 93.2% (n=41) of students who attended the conference reported they would strongly recommend the conference to a peer. 3/44 (6.8%) of students said they would recommend the conference to a peer. These results serve to inform surgical societies on both a national and international scale, that student surgical conferences are experienced positively by the target audience. It is certainly encouraging feedback for the UCC Surgical Society and should reinforce the society’s efforts to facilitate an annual student led surgical conference.
Understanding of Surgical Training Pathways
The findings of this study highlight the fact that the surgical training pathway is not well understood by most students at an undergraduate level. Almost one-third of students reported having a very poor understanding of the surgical training scheme prior to attending the conference, which dropped to 0% after attending the conference. Although it is not crucial to understand the details of what is expected when applying to the training scheme at an undergraduate stage, having a prior insight of what to expect post-graduation is advantageous, as it allows for students to understand what will be required from them and subsequently allows students to act as early as possible to plan for the path ahead. This would also enhance the overall standard and quality of candidates who are eventually successful in getting onto the training schemes.
Continuing the promotion of surgery
The event provided an invaluable platform for students, trainees and trainers to network. It also gave students the opportunity to organise elective placements, research projects and to identify potential mentors on any surgical specialties which they may have an interest in. Studies have shown that participating in undergraduate attachments or electives can help promote a more positive perception of surgeons and surgery as a career.16
Limitations
This study describes the experience of a single- centre with relatively small numbers however we anticipate similar studies both nationally and internationally would support and strengthen these findings. A further limitation of this study is while the conference focused on six specialties, it did not include all specialties. This was simply due to availability of personnel from various specialities on the dates of the conference. The conference aims to feature a varied selection of specialties each year.
Conclusion
In conclusion, the results of this study have proven the beneficial impact of student led surgical conferences in an Irish population. The results show that these conferences are educational opportunities to increase student knowledge of the surgical specialties, their understanding of the surgical training pathways and can encourage them to pursue a career in surgery. The study also highlighted the major perceived barriers to students considering a career in surgery. These results support the work of university medical student societies and surgical training bodies to promote and develop further similar events, on both national and international levels.