Department of Surgery, College of Medicine, University of South Florida, Tampa, FL 33620-7200, USA.
J Am Coll Surg. 2012 Nov;215(5):599-606. doi: 10.1016/j.jamcollsurg.2012.06.416. Epub 2012 Aug 3.
Numerous factors have been linked to surgical career choice, including the quality of third-year surgical clerkship. The vast majority of studies also selectively evaluate one or only a few variables that link to surgical career choice, so relative impact cannot be assessed. This study simultaneously evaluates the majority of variables linked to surgical career choice in previous research so that the relative contributions of each of these variables with respect to surgical career choice can be determined.
Surveys before, during, and after the third-year surgical clerkship included student demographics, background, and values (eg, importance of money, controllable lifestyle), and student reactions to the third-year surgical clerkship. The dependent variables in this study included interest in surgery at the beginning and end of the clerkship and matching into a surgical residency.
Both univariate and multivariate analyses generally supported findings in the literature, but the strengths of these associations reported previously might not have been accurate. In this study, the surgical resident match odds ratio for students starting the clerkship already knowing they wanted to be a surgeon was 22.46; the next highest associations were 4.65 and 3.37, which corresponded to earlier exposure to a surgical specialty and earlier exposure to general surgery, respectively. Differences in career choice for general surgeons and surgical specialists were also explored.
Although the experience of the clerkship is related to career choice, the largest impact of the clerkship is for those already interested in a surgical career. Interest in a surgical career largely develops before the third-year clerkship. Implications of the results for recruiting greater numbers of students into surgical careers are discussed.
许多因素与外科职业选择有关，包括第三年外科实习的质量。绝大多数研究也选择性地评估了与外科职业选择相关的一个或几个变量，因此无法评估相对影响。本研究同时评估了之前研究中与外科职业选择相关的大多数变量，以便确定这些变量中每一个变量相对于外科职业选择的相对贡献。
在第三年外科实习之前、期间和之后进行的调查包括学生的人口统计学、背景和价值观（例如，金钱的重要性、可控制的生活方式），以及学生对第三年外科实习的反应。本研究的因变量包括在实习开始和结束时对手术的兴趣，以及与外科住院医师的匹配情况。
单变量和多变量分析都普遍支持文献中的发现，但之前报道的这些关联的强度可能不准确。在本研究中，对已经知道自己想成为外科医生的学生，外科住院医师匹配的优势比为 22.46；下一个最高的关联是 4.65 和 3.37，分别对应更早地接触外科专业和更早地接触普通外科。还探讨了普通外科医生和外科专家职业选择的差异。
尽管实习经历与职业选择有关，但实习对那些已经对外科职业感兴趣的人的影响最大。对外科职业的兴趣主要在第三年实习之前就已经形成。讨论了这些结果对外科职业吸引更多学生的意义。
