Department of Surgery, University Surgical Cluster, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Am J Surg. 2020 Dec;220(6):1549-1556. doi: 10.1016/j.amjsurg.2020.04.036. Epub 2020 Apr 30.
Studies in Caucasian populations suggest that interest among medical students in pursuing a surgical career is dwindling. We sought to investigate these trends and to evaluate the impact of resident teaching in a multiethnic Asian population.
Between 2015 and 2017, 1780 Singaporean third- and fifth-year medical students completed a structured anonymized questionnaire following the completion of an 8-week general surgery rotation. Medical students' impressions of their faculty and resident mentors were analyzed using hierarchical multilevel mixed-effects models.
Respondents' opinions of general surgery improved from 3.31 ± 0.91 points to 4.03 ± 0.83 points on a 5-point Likert scale (P < 0.0001). Medical students were more likely to regard their interaction with residents as a "pull" factor compared to their interaction with faculty members (74.7% vs 65.6%; P < 0.0001). Our analyses revealed 9 statistically-significant "pull" factors and 5 "push" factors which attract or deter Asian medical students from a career in surgery. Comparing the pedagogical qualities of resident and faculty mentors, we found that residents surpassed faculty mentors in 9 domains, had comparable appraisal scores on 3 domains, and fared worse than faculty on 8 domains. Importantly, residents fared better at promoting interest in a surgical career (P = 0.0006) and influencing the career aspirations of medical students (P < 0.0001) compared with faculty members.
To our knowledge, this is the largest study from a Southeast Asian country providing representative sample numbers. With this knowledge of pull and push factors, the surgical clerkship can be improved by emphasizing pull factors and preparing students to cope with the push factors. Finally, our findings suggest that roping in residents as mentors to medical students may improve the pipeline of students interested in pursuing surgery after medical school.
研究表明，在白种人群体中，医学生对从事外科职业的兴趣正在逐渐减少。我们试图调查这些趋势，并评估在多民族亚洲人群中住院医师教学的影响。
在 2015 年至 2017 年期间，1780 名新加坡三、五年级医学生在完成 8 周普通外科轮转后完成了一份结构化的匿名问卷。使用分层多级混合效应模型分析医学生对其教师和住院医师导师的印象。
受访者对普通外科的评价从 3.31±0.91 分提高到 4.03±0.83 分（5 分制，P<0.0001）。与与教师的互动相比，医学生更倾向于将与住院医师的互动视为“吸引力”因素（74.7%比 65.6%；P<0.0001）。我们的分析揭示了 9 个具有统计学意义的“吸引力”因素和 5 个“排斥”因素，这些因素吸引或阻止亚洲医学生从事外科职业。比较住院医师和教师导师的教学质量，我们发现住院医师在 9 个领域超过了教师，在 3 个领域的评价分数相当，在 8 个领域的表现不如教师。重要的是，住院医师在促进对外科职业的兴趣（P=0.0006）和影响医学生的职业抱负方面表现优于教师（P<0.0001）。
据我们所知，这是来自东南亚国家的最大规模研究，提供了有代表性的样本数量。了解这些吸引力和排斥力因素后，可以通过强调吸引力因素并让学生为应对排斥力因素做好准备来改善外科实习。最后，我们的发现表明，让住院医师作为导师来指导医学生可能会增加对医学生毕业后从事外科手术感兴趣的学生人数。
