Abbreviations and acronyms
Cardiothoracic – CT
Introduction
Over the past decade, applications and interest in the surgical training
pathway have plummeted, eventually affecting cardiac surgical
specialties as well. Analysing data from the United States, a gradual
decline in the physician to patient ratio has been documented with
lesser applications being made to the CT surgery training pathway,
despite the medical school seats remaining fairly constant (1). Trends
in applications for thoracic fellowships in comparison to other
subspecialties from 1997 to 2012 showed a decline of more than 50% of
applicants in the training pathway (2). These statistics prove to be
worrisome due to the aging population of the current CT surgeons and
increasing demand for the declining workforce. This in turn places more
pressure to attract a greater number of students to train in
cardiothoracic surgery (3).
A 2005 survey by Brundage et al. found that 45% of the first-year
students were interested in a surgical career but only 7% were matched
to surgical residencies. Reasons attributed to this perceived ‘loss of
interest’ were the length of training, residency lifestyle, hours, call
schedule, and female gender of the student respondent. Although
lifestyle issues remained at the forefront of student concerns, those
who initially portrayed interest particularly liked the intellectual
challenge, career opportunities, financial rewards, and technical skills
that came along with a surgical career (4).
Aforementioned, unlike any other surgical specialty, CT surgery has also
been hit with decreased numbers of applicants. With concerns about a
shortage of CT surgeons in the upcoming decade, several studies have
been conducted to ascertain the reasons behind this regression.
Potentially, strong candidates lose their interest in a career in CT
surgery during medical school and hence do not apply for the training
pathways. Algethami et al. highlighted the need for an adequate
introduction to the field of cardiothoracic surgery, emphasised the need
to increase exposure and to provide close mentorship in order to entice
a wide array of students to pursue a career in cardiothoracic surgery
(5). Moreover, only 15.8% of United Kingdom medical graduates who were
interested in cardiothoracic surgery, chose to pursue further
specialized training. Likewise, in the United States, graduating medical
students are showing a greater preference for other surgical specialties
compared to cardiothoracics (4).
In order to combat this perceived loss of interest, several strategies
have been suggested to target medical students early on in their
careers. Moreover, early exposure, positive, experiences, inspiring role
models, and career insight are key features to be taken into account
while making a specialty choice as a medical student or junior doctor.
Previously, the method of preferentially selecting high-achieving,
resilient, and hard-working individuals early on in their careers and
encouraging them to seek CT surgery was implemented (6). Currently, an
increase in interest in the field has been documented by the application
of stimulation-based technology to augment skills and interest (7).
Increasingly, summer research programs and scholarships have shown to
increase interest among medical students (8, 9). The interest of
students keen on CT surgery as a career must be maintained throughout
medical school by means of appropriate mentorship. Additionally, CT
surgery must be implemented as a part of the undergraduate curriculum in
medical schools in the UK and worldwide. This would improve student
experience and help develop their interest (10).
An understanding of the factors that attract or deter medical students,
junior doctors, and trainees to a career in CT surgery must be acquired
in order to increase applications to the training pathway. Hence, the
primary objective of this review is to scope the level of interest of
medical students, junior doctors, and trainees in cardiothoracic
surgery. Furthermore, we aim to gain further understanding of the
factors that pertain to students developing or losing interest in the
field.
Material and Methods