Elsevier

Journal of Surgical Education

Volume 67, Issue 4, July–August 2010, Pages 237-248
Journal of Surgical Education

Review
Trends of Surgical Career Selection Among Medical Students and Graduates: A Global Perspective

https://doi.org/10.1016/j.jsurg.2010.05.006Get rights and content

Background

Declining trends in surgery have been well-researched in the North American region, but little is known about the international dynamics affecting this phenomenon. A comprehensive approach to this emerging issue is lacking.

Objectives

Our objective in this study is to explore global trends related to medical student interest in surgical careers. We will also identify factors influencing the choice of surgery as a career and outline practical interventions to nurture interest in these fields, as described in the literature.

Design

We present a focused review of worldwide trends of surgical career selection among medical students of geographically distant and diverse sociocultural backgrounds. A systematic literature search was performed using PubMed. The studies were conducted over the last fifteen years with the study populations scattered over 6 continents.

Results

North American studies have shown a declining trend for medical students to select surgery as a career, but a recent recovery has been observed. However, surgery is still the popular choice of career among Middle Eastern and Far-Eastern Asian men. Sociocultural variants and personal satisfaction are likely influential factors with financial rewards being the least significant. Surgery is also popular in Nigeria despite their increased awareness of risk of HIV/AIDS associated with surgery. A decline in surgery has been observed in Australia, New Zealand, and South Africa. Medical students and graduates of Greece, Switzerland, and the UK mostly prefer nonsurgical careers. Multiple extrinsic and intrinsic factors appear to play a role for such a phenomenon. Specific interventions are now being used to create a rebound effect for such a declining trend observed in most of the regions worldwide.

Conclusions

Global trends show a variation of interest in surgery as a career option throughout the 6 continents. Possible factors affecting this phenomenon are similar among geographically distant and diverse student cultures.

Introduction

Declining trends in surgery have been well-researched in the North American region, but little is known about the international dynamics and factors affecting this phenomenon. A comprehensive approach to this emerging issue is lacking. The goal of this paper is to review the global trends of medical students' and graduates' interest in surgical careers, and identify factors influencing these choices with practical interventions from the current literature. We have included available worldwide evidence that addresses this issue based on the selection criteria as shown in Fig. 1.

An advanced search was performed in PubMed with the phrases “career in surgery AND medical students OR postgraduates AND factors in surgery.” Limits were applied on type of article as Journal Article, and on dates as 1 January 1996 through 31 April 2010 (studies conducted within the last 15 years).

The search returned 114 articles. These were narrowed down by going through each study and its location (subsequently categorized according to the 6 continents: Asia, Africa, Australasia, Europe, and North and South America).

Section snippets

Trends from Asia

In the Middle East, a study done among the medical students of a university in the Kingdom of Jordan (Table 1, 1.1.1) identified general surgery and obstetrics and gynecology as the most preferred specialty among male and female students, respectively. The 2 most influential factors affecting their career selection were intellectual content of the specialty and individual competencies. Jordanian male students preferred surgery based on the lifestyle determinants, such as flexibility of

Extrinsic Factors Affecting Surgical Career Selection (TABLE 2)

Intrinsic Factors Affecting Surgical Career Selection (TABLE 3)

Discussion

Although Asia contributes significantly to the global population, there are relatively few studies based in Asia addressing our area of interest. Existing data suggest that surgical careers are popular among Asian male medical students while obstetrics and gynecology is the popular choice among females.1, 2, 3, 5 This trend may be accounted by the fact that Asian countries in specific geographic regions share similar cultures.

In the South Asian economies and Middle East, most male medical

Conclusions

Global trends show a variation of interest in surgical careers throughout the 6 continents. Studies suggest declining popularity of surgery for the most part with the exception of Greece, Jordan, and Nigeria with a relative rebound seen in the United States.

Possible factors affecting this phenomenon are similar among geographically distant and diverse student cultures. Direct patient care, immediate intervention, and personal interest are the most common positive influential factors. Family

References (39)

  • Y. Khader et al.

    Factors affecting medical students in formulating their specialty preferences in Jordan

    BMC Med Educ

    (2008)
  • A. Zulkifli et al.

    Career preferences of male and female medical students in Malaysia

    Med J Malays

    (1997)
  • N. Huda et al.

    Career preference of final year medical students of Ziauddin Medical University

    Educ Health

    (2006)
  • B.I. Avan et al.

    Factors influencing the selection of surgical specialty among Pakistani medical graduates

    J Postgrad Med

    (2003)
  • E. Al-Faris et al.

    Career choices among Saudi medical students

    Acad Med

    (1997)
  • K.I. Wang et al.

    Analysis of senior medical students' preferences in specialty choice a survey in a medical school in northern Taiwan

    Chang Gung Med J

    (2007)
  • A.N. Ocheke et al.

    The impact of HIV/AIDS epidemic on the choice of specialties among medical students and house officers in Jos, Nigeria

    Niger J Med

    (2008)
  • D. Kahn et al.

    General surgery in crisis—The critical shortage

    S Afr J Surg

    (2006)
  • D. Kahn et al.

    General surgery in crisis—Factors that impact on a career in general surgery

    S Afr J Surg

    (2006)
  • Cited by (45)

    • Psychometric Properties and Calibration of the SPOREEM (Students’ Perception of the Operating Room Educational Environment Measure)

      2021, Journal of Surgical Education
      Citation Excerpt :

      The number of medical students interested in pursuing a career in surgery continues to decline.1-3

    • Factors Attracting or Deterring Female Medical Students in Asia From Pursuing a Surgical Career, and the Impact of Surgical Clerkship, Mentorship, and Role Models: A Multicultural Asian Perspective From a National Prospective Cohort Study

      2021, Journal of Surgical Research
      Citation Excerpt :

      One limitation of this study is that we did not qualitatively probe or interview medical students to obtain clear examples of “gender-related concerns” that they experienced during their stint. However, in studies conducted in the West, female medical students are likely to cite the “old boys’ club” reputation of many surgical departments as well as the “glass ceiling” effect as examples of gender inequality that they perceive during their general surgery clerkship.1-13 Further research is needed to investigate if there are other gender-related factors that are unique to Asia, which discourage female medical students from choosing a surgical career.

    • Push and pull factors, and the role of residents in nurturing medical students’ interest in surgery as a career option in a multicultural Asian context: Results of a prospective national cohort study

      2020, American Journal of Surgery
      Citation Excerpt :

      These trends are arguably worrisome as they forebode a decrease in the pool and quality of applicants for surgical training programs, and may potentially lead to future shortfalls in certain specialties.6 Interestingly, preferences for medical specializations appear to vary across races, with medical students of Caucasian descent less likely to indicate interest in surgical careers as compared to their Asian counterparts.1–5 These ethnic disparities are certainly peculiar, and detailed investigations may afford unique insights that can help to shape current ideas regarding the drivers of declining surgical interests worldwide, and also inform medical education policies in Asian countries.

    View all citing articles on Scopus
    View full text