Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Neurosurgery, Albany Medical College, Albany, NY, USA.
Clin Neurol Neurosurg. 2022 Jul;218:107293. doi: 10.1016/j.clineuro.2022.107293. Epub 2022 May 17.
It is of paramount importance that the United States (U.S.) physician and surgical workforce reflects its changing population demographics. The authors characterized factors contributing to graduating medical students' decision to pursue a residency in Neurosurgery to assess opportunities for recruitment and retainment of graduates interested in working with underserved populations.
Data from the Association of American Medical Colleges (AAMC) Student Record System (SRS), and the AAMC Graduation Questionnaire (GQ) were collected on a national cohort of U.S. medical students from 2012 through 2017. Data including self-reported sex, race/ethnicity, age at matriculation, degree program, intention to practice in underserved area, total debt, scholarships, volunteer activities and medical electives was analyzed using chi-squared tests and multivariate logistic regression models.
The study included 48,096 graduating medical students surveyed by GQ and SRS, 607 (1.26%) of whom reported an intention to pursue Neurosurgery (Neurosurgery cohort). Compared to students pursuing other specialties, the Neurosurgery cohort had fewer students identify as female (18.95% vs. 48.18%, p < 0.001), and report an intention to work with underserved populations (11.37% vs. 26.37%, p < 0.001). In addition, Black/African-American students were significantly more like to indicate intention to pursue Neurosurgery compared to White students (aOR=1.51, 95% CI:1.01-2.24). Moreover, within the Neurosurgery cohort, Black/African-American (aOR=7.66, 95% CI:2.87-20.45), Hispanic (aOR=4.50, 95% CI:1.40-14.51) and female students (aOR=2.44, 95% CI:1.16-5.12) were more likely to report an intention to practice in underserved urban and rural areas, compared to their peers.
Our study identified several key demographic and academic factors influencing intention to pursue a neurosurgical career, and work with underserved populations. Our data provides an opportunity for further discussions on the residency selection process and seeks to empower residency programs to diversify the neurosurgical workforce, tackle health disparities and improve patient care for the entire US population.
美国（U.S.）医生和外科医生队伍反映其不断变化的人口结构至关重要。作者分析了导致医学毕业生决定从事神经外科住院医师的因素，以评估对服务不足人群有兴趣的毕业生的招聘和留用机会。
本研究通过美国医学院协会（AAMC）学生记录系统（SRS）和 AAMC 毕业问卷（GQ）收集了 2012 年至 2017 年期间全国范围内的美国医学生的资料。使用卡方检验和多变量逻辑回归模型对包括自我报告的性别、种族/族裔、入学时的年龄、学位课程、在服务不足地区执业的意向、总债务、奖学金、志愿活动和医学选修课程在内的数据进行了分析。
该研究纳入了 48096 名接受 GQ 和 SRS 调查的医学毕业生，其中 607 人（1.26%）表示有从事神经外科的意向（神经外科组）。与从事其他专业的学生相比，神经外科组的女性学生比例较低（18.95% vs. 48.18%，p<0.001），并且报告有从事服务不足人群工作的意向（11.37% vs. 26.37%，p<0.001）。此外，与白人学生相比，黑人/非裔美国学生更有可能表示有从事神经外科的意向（优势比[OR]=1.51，95%置信区间[CI]：1.01-2.24）。此外，在神经外科组中，黑人/非裔美国学生（OR=7.66，95% CI：2.87-20.45）、西班牙裔（OR=4.50，95% CI：1.40-14.51）和女性学生（OR=2.44，95% CI：1.16-5.12）更有可能表示有从事服务不足的城市和农村地区工作的意向，与他们的同龄人相比。
我们的研究确定了几个影响从事神经外科职业和服务不足人群工作意向的关键人口统计学和学术因素。我们的数据为进一步讨论住院医师选拔过程提供了机会，并旨在赋予住院医师项目权力，使神经外科劳动力多样化，解决健康差异问题，并改善美国全体人口的患者护理。
