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urgeons Can Favorably Influenceareer Choices and Goals for Students

nterested in Careers in Medicineonathan Hernandez, MD, Sam Al-Saadi, MD, Robert Boyle, BS, Desireé Villadolid, MPH,harona Ross, MD, Michele Murr, MD, FACS, Alexander Rosemurgy, MD, FACS

BACKGROUND: This study was undertaken to determine the impact of an academic summer research, shadow-ing, and mentorship program on students interested in medicine and surgery.

STUDY DESIGN: Forty-four (92%) of 48 participants of a summer research, shadowing, and mentorship programreturned blinded questionnaires that focused on the program’s impact on their scholarly skills,career choices, and goals. The program interfaced academic surgeons with students interested incareers in medicine and enabled students to participate in research projects, attend daily lec-tures, and shadow physicians in the operating room, clinic, and hospital. Proficiency in schol-arly skills, before and after the program, was scored by the participants using a Likert scale (0 �none to 10 � proficient).

RESULTS: Ninety-three percent of participants were in or had completed college; only 7% had advanceddegrees. With the program, proficiency in all categories assessed improved considerably, includ-ing medical terminology, abstract writing, statistical analysis, graph and table construction,article writing, and video production. During the last 5 years, participants coauthored 112national presentations (29 video presentations), 46 published abstracts, and 57 peer-reviewedpublished articles. Ninety-two percent developed more favorable opinions of a career in med-icine; 8% believed the experience deterred them from a career in medicine because of lifestyleand studious demands. Seventy-seven percent believed the program promoted a career insurgery; 82% believed it elevated their goals to become leaders in American medicine.

CONCLUSIONS: Shadowing opportunities, mentoring, and didactic teaching of scholarly skills for college andgraduate students foster academic productivity and elevation of career goals. Academic surgeonscan favorably influence career choices and goals for students interested in careers in medicine

and surgery. (J Am Coll Surg 2009;209:62–67. © 2009 by the American College of Surgeons)

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t has become increasingly clear that the current classes ofedical student candidates and medical students value a

ontrollable lifestyle when making career decisions.1-3 Con-rollable lifestyle has been implicated as the reason for theeclining interest by medical students in surgery as a careernd in general surgery in particular.4 We know that men-orship, role modeling, and perceived prestige are also ofritical concern to students when deciding on a particularareer path.5 For a number of medical students, the careerhoice is made before the beginning of medical school,

isclosure Information: Nothing to disclose.

eceived December 30, 2008; Accepted February 13, 2009.rom the Department of Surgery, University of South Florida College ofedicine and Tampa General Hospital, Tampa, FL.orrespondence address: Alexander Rosemurgy, MD, Department of Sur-ery, University of South Florida, Tampa General Hospital, PO Box 1289,

toom F-145, Tampa, FL 33601. email: arosemur@health.usf.edu

622009 by the American College of Surgeons

ublished by Elsevier Inc.

hile the majority of medical students decide on a specialtyefore beginning clerkship rotations.6,7

Although interest in surgery is high among beginningedical students, that interest declines throughout medical

chool. Many students have made career choices before anyxposure to surgery or surgeons, and many more have lim-ted interactions with attending surgeons during what isecoming abbreviated time on the clerkship.8,9 In addition,ome students have cited the behavior witnessed on theirurgical clerkships as key deterring factors to entering aareer in surgery.10 Despite the negative publicity surgeonsnd surgery can sometime receive, the discipline remains inigh regard among most students. Taken together, surgerys a specialty has much to offer its students. It is up to us,he surgeons, the faces of surgery, to give students thisxperience and not to dissuade. Surgeons must get involvedarly in the lives of medical students before clerkship rota-

ion and perhaps before they begin medical school.

ISSN 1072-7515/09/$36.00doi:10.1016/j.jamcollsurg.2009.02.065

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63Vol. 209, No. 1, July 2009 Hernandez et al Surgeons’ Influence on Students

Beginning in 1988, a summer program of medical re-earch, physician shadowing, and mentorship for studentsossibly interested in a career in medicine was begun. Afterlmost 2 decades since beginning this program, it seemsppropriate that we would review the program to evaluateow it has influenced student career choices and impartedkills necessary to promote careers in medicine and surgery.

This study sought to measure the effect of an intensiveummer program of research, shadowing, and mentorshipn the scholarly skills and future career choices of studentsossibly interested in careers in medicine and surgery. Ourypotheses in undertaking this study were that studentsould gain enthusiasm about careers in medicine, and sur-ery in particular, with exposure to practicing and engagedcademic surgeons; that scholarly skills could be learned byovice students; and skills learned could be successfullypplied and would help students focus long-range careeroals.

ETHODShe Division of General Surgery in the Department ofurgery at the University of South Florida has progressivelyeveloped a summer program interfacing academic sur-eons and, to a lesser degree, surgery residents with collegetudents to generally foster interests in medicine, and sur-ery in particular. Specifically, the goals of this programere to teach students about surgical disorders that lead toospitalization, gain an understanding of what it is like toe a surgeon, elevate students’ career goals, and to helpmprove each student’s academic record to aid in applica-ion to medical school.

tudentstudents were solicited through our university premedicalrganizations in the early years of the program. Later, stu-ents outside our university participated as well, as theeputation of the program grew. Requirements for partici-ation included completion of 1 year of undergraduateourse work in good academic standing and the willingnesso devote the time and effort necessary to succeed in aroductivity-driven program. Students who had com-leted their undergraduate degree and had developed alate” interest in medicine were welcome. Eligible and in-erested students were interviewed and, for students inood standing with generally agreeable personalities andlear understandings of our beliefs in the importance ofroductivity, enrollment into the program continued untilur limit was reached. The number of participating stu-ents ranged from 3 in the first summers of the program to2 in the last several years. Students were encouraged to

eturn subsequent summers to build on their experiences. c

rojects initiated one summer could often be continuednto the next. Also, returning students were encouraged tossist new, younger students, particularly with medical vo-abulary. Students generally stopped participation in therogram after their first year of medical school because ofommitments necessary to their formal education.

acultyll students were paired with faculty in the division ofeneral surgery. The number of faculty involved was smallo ensure continuity with the students and ensure that theaculty could develop personal relationships with the stu-ents. It was clearly understood by the faculty and studentshat scholarly productivity was important.

urriculumtudents attended a focused lecture series presented by fac-lty and, to a lesser extent, residents. The lecture seriesocused on diseases and disorders commonly encounteredn general surgery services and diseases and disorders thatere being studied and researched by the students. Stu-ents individually met with faculty nearly daily and met asgroup with faculty on a weekly basis to discuss research

nd scholarly progress and direction. A typical weeklychedule is depicted in Figure 1.

For clinical exposure, students attended clinical confer-nces, attended outpatient clinics, participated in “round-ng” activities, and observed and actively participated in theperating room. Students had the opportunity to take callvernight with residents on the emergency surgery service.

As a major focus of their activities, students participatedn scholarly activities with the faculty. Students partici-ated in project conceptualization, study design, IRB ac-ivities, data acquisition, data analysis, abstract prepara-ion, article preparation, and article presentation. It wasxpected that each student would complete at least oneroject during the course of each summer. Obviously, suchn ambitious goal required considerable preparatory effortsy the faculty and many hours of “behind the scenes” efforty the faculty and support staff. At the end of the summer,he students presented their research at a ceremony at-ended by a broad cross-section of medical school admin-strators, hospital administrators, surgeons, residents, andamily.

rogram evaluationll students who participated in the program before 2007ere contacted with IRB approval and were mailed blindeduestionnaires to be answered anonymously. Data fromuestionnaires were collected and analyzed using Tru-pistat software. Significance was accepted with 95%

onfidence.

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64 Hernandez et al Surgeons’ Influence on Students J Am Coll Surg

ESULTSince 1988, 48 students have participated in our summerrogram of mentoring, research, and shadowing. Of thesetudents, 92% returned questionnaires that detailed theirxperiences and impressions of their time in the program.tudents in college and working to complete an undergrad-ate degree accounted for 42% of the students (Fig. 2); 7%ad advanced degrees.Among the mentoring experience, the research experi-

nce, and the clinical experience, students liked each of thehree experiences equally. Conversely, students least liked,n descending order, early morning meetings, long workours, and laborious aspects of data collection (eg, review-

ng charts). Concepts of “work” during summer vacation,s opposed to learning and participating in clinical activi-ies, were negatively regarded by the students (Table 1).

Students believed that, on entering the program, theyad some, but limited, proficiency in basic scholarly skills,uch as medical writing and video editing (Fig. 3). Con-ersely, they believed that entering into the program theyad more than a cursory ability in statistical analysis, wordrocessing and data presentation, and, most surprisingly,edical terminology. After participating in the program,

hey believed that their skills improved in all areas queriedFig. 3). Improvements in writing and communicationkills were noted by 76% of the students. Improvements inkills were a result of many activities. Students believed thatesearch activities, didactic teaching, and clinical experi-nces were all of benefit. Especially helpful in their researchxperience were activities that actively engaged students, ie,aking and editing movies, writing and editing manu-

Figure 1. Weekly schedule for stude

cripts, data analysis, and managing databases. Engaging p

linical activities were also thought to be particularly ben-ficial, including autopsies and operating room participa-ion (Fig. 4).

Remarkably, 92% believed that the experience resultedn a more favorable opinion of a career in medicine. Inddition, 67% believed that, as a consequence of the expe-ience, they wanted to include research in their medicalareer, and 24% believed the experience changed what theyanted to do in medicine. For 77%, the experience pro-oted a career in surgery. For 82%, the experience elevated

heir career goals to become a leader in American medicine,nd 8% believed the experience deterred them from a ca-eer in medicine.

During the past 5 years, the students participated asoauthors in the publication of 57 peer-reviewed publica-ions. In addition, their work contributed to 112 national

articipating in the summer program.

igure 2. Student degrees when beginning participation in the

rogram.

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65Vol. 209, No. 1, July 2009 Hernandez et al Surgeons’ Influence on Students

r regional presentations, including 29 video presentationsnd 46 published abstracts. Included in the list of presen-ations and publications are peer-reviewed publications in aumber of well-recognized and familiar journals and presen-ations at respected national organizations (Table 2).

ISCUSSIONransformation of young students into candidates for med-

cal careers and the “making” of physicians and surgeonsre, at best, inexact processes. There are ample opportuni-ies for young people to become dissuaded from the rigor-us course. In addition, for those ultimately pursuing aareer in medicine, perceived issues about lifestyle consid-rations can become a dominant factor driving career di-ection.11 In the absence of encouragement from mentorsr role models, particularly ones with whom they havestablished close personal relationships, it is easy and con-enient for students to achieve at the mean, rather than totrive for the highest echelons of medicine and surgery.hrough programs that demand productivity and thereby

ommitment, teaching, learning, and mentoring, young

able 1. Activities Least Liked by Students During Theirrogram Experiencectivity %

id not learn much 0ot enough fun 2nproductive time 16ong hours 18ther* 38

Included responses such as early morning meetings, long drive to work,ifficulty parking, and so on.

able 2. Journals and Meetings Through Which Students’ork Was Presented and/or Published

ournals Society meetings

merican Journal of Surgery Academic Surgical Congressmerican Surgeon American College of Surgeonsnnals of Surgery American Hepato-Pancreato-

Biliary Associationnnals of Surgical Oncology American Surgical Associationastroenterology Pancreas Club

ournal of Gastrointestinal Surgery Society of AmericanGastrointestinal andEndoscopic Surgeons

ournal of Surgical Research Society of LaparoendoscopicSurgery

ournal of the American College ofSurgeons

Society for Surgery of theAlimentary Tract

urgical Endoscopy Society of Surgical Oncologyorld Journal of Surgical Southeastern Surgical

aOncology Congress

tudents can effervesce with enthusiasm for what is possi-le. This study documents that a summer program of shad-wing, mentoring, and research can improve scholarlykills and foster an interest in medicine and surgery. Thistudy also documents that engaged academic surgeons canmpact bright, young, and generally naive students beyondostering interests. This study documents that exposure toroductive academic surgeons motivates bright young stu-ents to pursue careers in medicine and surgery and tolevate career goals beyond the mean.

Students involved in this summer experience were usu-lly without graduate degrees beyond a bachelor degree.any of the students were young enough to not yet have

eceived any degree beyond a high school diploma. Thetudents in this experience did not progress from “no inter-st” in medicine as a career to “very interested.” Rather, alleclared some interest in medicine at the inception of theirxperience with us, and some of the students believedtrong callings to medicine for generally uncertain thoughndoubtedly altruistic reasons from the very beginning.lthough career choices of the students were not necessar-

ly impacted by the program or the experience in a bino-

igure 3. Proficiency in academic areas before and after participa-ion in the program.

igure 4. Student benefit (0 to 10) from engagement of various

ctivities during the program.

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66 Hernandez et al Surgeons’ Influence on Students J Am Coll Surg

ial manner, career choices were greatly impacted by thexperience by defining for the students the nature of med-cine they wanted to practice and the environment inhich they wanted to practice it. Elevation of career goalsas very impressive, although admittedly, to connote that

cquisition of scholarly goals is a “good thing” is judgmen-al and at least modestly self-serving.

The focus on scholarly productivity warrants explana-ion. Given the goals of this research, shadowing, and men-orship program, we focused considerable energy on schol-rly activities, believing that if the students saw a projectrom conceptualization through article preparation, theyould learn volumes about surgical disorders and diseases,

cquire a meaningful sense about the lifestyle of practicingurgeons, and develop close relationships with mentors. In aery real sense, scholarly productivity was used as a surrogatearker of learning, mentorship, and clinical exposure.Students enjoyed clinical activities, research, and theentorship experience equally. They were more favorably

mpacted by pursuits involving interpersonal interaction aspposed to activities they undertook alone. Students en-oyed pursuits in data acquisition, analysis, and presenta-ion; participating in clinical care; and interaction withaculty. Students experienced improvements in written andommunication skills and gained confidence in a host ofctivities. Of all activities, “face time” with faculty was mostalued and ultimately most responsible for a positive expe-ience and scholarly productivities. Students disliked activ-ties that they believed violated their summer vacations,uch as early morning meetings and generally long hours.

This program of research, shadowing, and mentorshipas had a considerable impact on these students. Numer-us abilities and skills were improved, such as medical ter-inology, video movie production, and statistical analysis.

tudents believed their written and communication skillsmproved as they gained confidence in a host of activities.areer choice seemed clearer after being a participant in therogram. Issues of career dysphoria and life uncertaintiesacing these students when starting this program are notradicated by participating in this program. Nonetheless,articipation in programs like this will hopefully begin toelp students resolve confusion and uncertainties aboutareer and professional-life decisions. Notably, career androfessional-life uncertainties are not unique to youngtudents.

Each year the Association of American Medical Collegesandates the completion of a graduation questionnaire by

oth graduating medical students and administrativeeans. Forty percent of these students replied that theirentors and role models had a strong influence on their

areer choice.12 Straus and colleagues13 conducted a sys- m

ematic review to evaluate which aspects influence thehoice of a career in academic medicine. They concludedhat early engagement in the academic climate and contin-ed involvement throughout training including, but not

imited to, creation of student research opportunities andstimulation in and maintenance of academic involve-ent” were most important. This study, similar to our

wn, sought to engender substantial and lasting mentor�entee relationships before the inception of medical

chool with motivated students and faculty. Taken to-ether, premedical students and medical students alike arempressionable and can be favorably influenced by a posi-ive mentoring experience, particularly with exposure tocademia. The mentoring relationship must continue be-ond the student years and into postdoctoral training. Thiseems to be particularly true for young surgeons.

A Blue Ribbon Committee on Surgical Education pro-uced recommendations in response to the 20% attritionate of residents in general surgery training and the pro-ected change in selection of surgical residency by medicaltudents. This report called for innovations in surgical ed-cation. It asked for renewed commitment to the basicciences, early involvement in the junior medical studenturriculum, development of surgical educators as mentors,nd enhancing surgical and academic skill sets.14 Surgery,erhaps more so than other specialties or subspecialties,tands to lose substantially in both accruing and retainingpplicants. In the 2007 National Resident Match Program,00% of the 1,057 general surgery residency positions wereilled, 78% by applicants graduating from medical schoolsn the US.15 If the current trend in attrition continues,

200 of these individuals will not graduate residency aseneral surgeons. Research has shown that many of thesendividuals denote lack of role models as a main reasonor their departure.16

We strongly believe that mentorship is the vital com-onent of this summer program. Although mentoring iserceived as an important part of academic medicine,he evidence to support this perception is not strong.17

e believe that mentorship is the most vital componentf this summer program, fueling its success. We havehown that undergraduate student enthusiasm towardedicine and surgery can be channeled through closeentorship into highly productive and mutually re-arding relationships that both foster interests in aca-emic endeavors and provide the skill sets necessary toe successful in them.The scholarly productivity of this summer program is

xemplary. Because we used scholarly productivity as a surro-ate marker of learning, mentorship, and clinical exposure,

uch was gained and learned by the students. Because uni-

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67Vol. 209, No. 1, July 2009 Hernandez et al Surgeons’ Influence on Students

ersities place expectations of scholarly productivity on aca-emic faculty, publications and presentations resulting fromrograms like this fulfill a major mission for the facultynvolved. The efforts expended by students and faculty in arogram like this cannot and should not be minimized, buthe results justify the sacrifice of summer vacations andompounding already busy faculty workloads.

uthor Contributions

tudy conception and design: Ross, Murr, Rosemurgycquisition of data: Al-Saadi, Boyle, Villadolidnalysis and interpretation of data: Hernandez, Rosemurgyrafting of manuscript: Hernandezritical revision: Rosemurgy

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