Student assistantships in orthopedic surgery

In Germany it has been shown that the tendency of medical students to start a surgical residency sinks during medical school from 21% in the first to 13% in the ninth semester [15]. It is expected that Germany is going to face a perceptible lack of young trauma and orthopedic surgeons. It is therefore of great importance to counteract this shortage by recruiting new young talent, already during the medical studies [9]. Previous studies have presented different approaches to achieve this. For example, intensified and practical curricular courses and teaching [4, 10, 16], extracurricular activities, events and grants [5, 11, 17] and student curricula [5, 8]. In addition, it has been proposed that student jobs in trauma and orthopedic surgery departments as surgery and ward assistants can have a positive effect on the motivation of students to start a career in the field [13].

Since August 2017, the Department of Orthopedics, Trauma and Plastic Surgery of the University of Leipzig has offered medical students from the third year of studies the opportunity to work as student assistant. The students’ tasks included assisting in the operating room, taking blood samples and inserting peripheral venous catheters, providing support on the wards, in the central emergency room and the surgical outpatient clinics.

The following study tries to show what influence the experience during student jobs has on career choices of medical students who work in the department of orthopedic and trauma surgery as surgery and ward assistants.

Surgical specialties in Germany are already facing a shortage of residents [1]. It seems obvious that the groundwork to counteract this trend should be laid during the medical studies, especially when considering the fact that the interest in surgical residencies among medical students in Germany diminishes continuously as they progress through their studies [15]. This could be explained by the image of its physically demanding nature, long working hours, high stress levels, and the extended training period required, which can impact the work-life balance [18]. This underlines the need for sustainable measures to retain and potentially increase the number of medical students pursuing surgical residencies. In an evaluation by Kasch et al. the authors stated that personnel acquisition starts early in the medical field and that by improving the internship experience, students might be attracted towards a certain medical field and postgraduate specialist training [7]. As a possibility to early personnel acquisition, it has been suggested that student jobs can be a method of young talent recruitment [13]. This study examined how student roles as ward and operating room assistants in an orthopedic surgery department impacted medical students’ career choices and highlighted the benefits they gained from this position.

Firstly, the study showed that 50% of participants who had completed their medical studies selected a surgical specialty for residency, with most opting for orthopedic surgery. Given that previous research indicates that only 13% of medical students in Germany express interest in a surgical residency by the end of the ninth semester, this represents a significantly higher percentage [15]; however, this number must also be acknowledged with caution as most of the participants stated that they were interested in orthopedic surgery before they started the student job. There might have therefore been a certain selection bias.

Secondly, it was shown that apart from the practical year, the experiences gained during the student job had the strongest influence on participants’ future career choices. Student assistant roles had a moderately positive influence on participants’ career choices. While not a strong endorsement, this indicates that many participants found these roles to be helpful in shaping their career interests and guiding them toward a specific field of specialization. Nevertheless, most of the participants would recommend the student job to other students.

Furthermore, it was shown that engaging as a student assistant has provided the participants with substantial practical experience. The respondents stated that they have profited the most from the student job as it has helped them to learn practical skills on the ward, such as blood sampling, peripheral intravenous catheters, etc. Furthermore, it was shown that it has helped students to learn practical skills in the operating room, to better understand clinical processes and to learn skills at the level of clinical-practical communication and organization. The position proved less effective in fostering scientific activity and in developing the specialized skills required for comprehensive orthopedic and trauma-specific examinations.

The results of this study show that structured student assistant positions can be an effective tool to foster interest and practical skills in surgical specialties. To fully leverage the potential of such positions, several aspects should be considered in their design. A variety of tasks are crucial as combining activities in the operating room and on the ward provides students with comprehensive insights into daily clinical work and processes. Awareness of this effect as well as the shortcomings in current recruitment methods for young talent is crucial to improving strategies for attracting and retaining young doctors in the field [6]. Previously it has been shown that student’s exposure to surgery positively influences their interest in surgery [18]. After exposure students were more aware of what impact surgery has for patients and ensures that surgery enables a work-life balance [12]. Therefore, the student job may be a good option to introduce students to the surgical lifestyle and diminishing prejudgements that might exist for surgical residencies and thereby fostering stronger connections with the field. Zambare et al. have also shown that focused preclinical surgical exposure changes the student’s perceptions of surgery [19]. They have shown that surgical exposure can improve the perception of the length and difficulty of surgical training, gender inclusivity and patient-centered care, which in turn can increase their interest in surgical fields [19].

Moreover, mentorship programs could serve as a valuable addition, enabling experienced physicians to guide students and provide them with a deeper understanding of the specialty. Schmidt et al. have identified mentorship and experience in surgery as possible factors that can help attract medical students to peruse a surgical career [14]. Incorporating scientific activities, such as small research projects, could further help develop a broader range of skills. Furthermore, regular feedback on the students’ performance and development should be offered. This can help to support students’ learning progress.

To effectively position these programs they should be closely aligned with existing measures for recruiting young talent, such as the upcoming curricular reforms [2, 3]. For instance, integrating student assistant programs with enhanced curricular teaching or extracurricular workshops could create a more cohesive and supportive framework to attract students to surgical specialties. By linking these initiatives, institutions can maximize the impact of both structured practical experiences and broader educational reforms.

For broader implementation of such incentives, standardization is however necessary. Centralized guidelines, supported by professional societies, such as the German Society for Orthopedics and Trauma Surgery (DGOU), could establish minimum requirements and recommended contents. Another important step would be fostering interdisciplinary collaboration, where similar assistant programs could be introduced in other surgical and nonsurgical fields. Finally, regular evaluation of these programs is crucial. Using standardized surveys and feedback, the programs can be continuously improved and adapted to the needs of students.

There are several limitations to this study. Firstly, this was a monocentric study and the sample size was relatively small, so that the sample may not represent the broader population of medical students in Germany. In addition, interest in a surgical career could be biased as most participants stated that they had been interested in orthopedic surgery before working as a student assistant. Additionally, the study only focusses on assistantships in orthopedic surgery and no other surgical fields. While some of the knowledge acquired in this study can be translated, there might be differences that are specific to other surgical fields. In addition, the study only focuses on a single institution and may not account for variations in student experiences or recruitment practices across different medical schools in Germany. Therefore, multicentric studies also including medical students doing assistantships in different surgical fields are needed to verify and generalize the presented results. Additionally, the study relies on self-reported data, which can be subject to bias, such as recall bias or social desirability bias, where participants may overstate the influence of their student assistant experience on their career decisions.

The findings suggest that structured student assistantships in orthopedic surgery departments may play a vital role in countering the decline in interest in surgical careers among medical students. It has been shown that these student jobs can foster practical technical skills in the operating room and on the ward, learning skills at the level of clinical practical communication and organization and better understand clinical processes. Offering student assistant jobs can therefore also be useful in terms of recruiting junior staff for our specialty.