Medical Student Perceptions of Academic Surgery: Rose-Colored Glasses or Jaded Prism?

• Published in: Journal of surgical education Vol. 81; no. 3; pp. 373 - 381
• Main Authors: Yudien, Mikhal A., Brooks, Ari D., Aarons, Cary B.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2024
• Subjects: Attitude; Career Choice; Clinical Clerkship; Education, Medical, Undergraduate - methods; Female; General Surgery - education; Humans; Male; medical student perception; representation; Schools, Medical; stereotypes; Students, Medical; Surgeons; surgery; surgical culture; surgical education; Surveys and Questionnaires; surgical culture; stereotypes; Practice-Based Learning and Improvement; surgical education; Professionalism; Interpersonal and Communication Skills; representation; medical student perception; surgery
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2023.11.020

•Medical students hold negative stereotypes about surgeons and surgery.•Students develop more positive associations with surgery during clerkship rotations.•Notions of egotism, male-predominance, and toxic culture remain despite exposure.•Change in perception of surgery may be stratified by gender identification. Stereotypes of surgeons are pervasive and play a role in medical students’ decisions about pursuing a surgical career. This study aimed to determine: (1) how medical students’ perceptions of surgery and surgeons changed following exposure to surgery during clerkship rotations; and (2) if gender and racial/ethnic identification played a role in this process. In this mixed-method study, clerkship students at one U.S. medical school were asked to anonymously contribute words and phrases that they associated with surgery to an online “word cloud” at the beginning and end of their 12-week surgery clerkship. In addition, an end-of-year, anonymous survey of their perceptions was administered and analyzed using a Grounded Theory approach. Of 154 students invited to complete the online survey, analysis of 24 completed surveys suggested that students believe surgical culture to be toxic, with unfriendly attitudes, strict hierarchy, and lack of work-life balance. Analysis of 678 Word Cloud responses, however, indicated that the frequency of complimentary responses increased following surgery clerkships (25% vs 36%; z = −3.26; p = 0.001), while the proportion of responses describing surgery/surgeons as male-dominated, egotistical, and scary decreased (5% vs 1%, z = 2.86, p = 0.004; 9% vs 4%, z = 2.78, p = 0.005; 3% vs 0.3%, z = 2.56, p = 0.011, respectively). The association between surgeons and being White disappeared entirely. Female students were more likely than male students to state that their perceptions did not change following exposure (40% vs 0%; z = 2.19; p = 0.029). With exposure to surgery, students’ preconceived notions may be positively influenced. However, students continue to hold negative perceptions, and this effect may be stratified by gender identification. Institutions should work to address these perceptions in pre-clerkship years to attract a more diverse pool of future surgeons.