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