Factors influencing North American medical students to pursue a career in surgery: a systematic review

Fostering interest in surgical careers is a persistent challenge for surgical educators in North America. The aim of this review was to identify modifiable factors that influence medical students’ decision to pursue a career in surgery.

A systematic search was conducted in Embase, Education Source, Cochrane Central Register of Controlled Trials and MEDLINE, from database inception to July 2022. Studies reporting medical students’ self-reported motivating and deterring factors regarding a career in surgery were included. Methodologic quality was appraised using the Critical Appraisal Skills Programme checklists.

This systematic review contains studies conducted in North America, and was conducted through Queen’s University School of Medicine in Kingston, Ontario, Canada.

A total of 38 publications (n = 8479 students, 50.9% female) were included with 33 (86.8%) quantitative and 5 (13.2%) qualitative studies. A majority of the studies were cross-sectional (n = 34), with two pre-post and two prospective cohort studies. Longitudinal studies followed students from 2 months to 4 years. Most-cited motivating factors were surgical and research mentorship (n = 20), exposure to surgical careers (n = 9) and interactions with staff and residents (n = 9). Deterring factors included negative perceptions about lifestyle in surgery (n = 16), length of training (n = 9), negative interactions with surgeons and residents (n = 4), personality conflicts (n = 4) and lack of mentorship (n = 2).

Mentorship was a key factor influencing medical students’ choice of a career in surgery. Students perceive benefit from assistance in navigating the challenges of a career in surgery, which underscores the importance of early exposure of students to surgeon-educators. The paucity of longitudinal studies limits our ability to determine how students’ perceptions regarding a career in surgery change during their undergraduate training.