Inflections in learner sentiment on the culture of surgery

Students’ preconceptions about workplace culture may influence the learning environment in the Surgery clerkship; however, the time at which students develop these sentiments is unclear. We aimed to identify inflections in students’ preconceptions of the culture of surgery, which are relevant to the timing of interventions targeting the surgical learning environment.

Cohorts of students at multiple levels received surveys between July 2021-September 2023 soliciting words associated with, “Culture of Surgery.” We analyzed entries using a Bag-of-Words method, with each word representing a unique token, and determined the most prevalent words. In sentiment analysis, 2 raters independently assigned a positive, neutral, or negative valence to each word, and valence agreement was assessed. We compared proportions of valences and rater agreement among cohorts with Fisher exact tests and determined inflections in sentiment along the learning continuum.

Participants included 50 undergraduates, 111 first-year medical students, and 216 clerks beginning Surgery rotations. “Intense” was the most common word associated with “Culture of Surgery” at all levels. Sentiment analysis comparing pre-medical undergraduate students and first-year medical students revealed profound differences in proportions of words with positive (58.9 vs 13.3%, p < 0.001) and negative (20.0 vs 57.0%, p < 0.001) valences. Non-pre-medical undergraduate students’ word valences were even more frequently positive (71.6%) and less frequently negative (7.1%). Sentiments did not change appreciably among medical students at all levels. The range of rater agreements was 62.3–78.6%.

Prior to medical school, students have predominantly positive sentiments about surgical culture, while negative preconceptions predominate early in medical school and persist into clerkships. Interventions should be designed to encourage surgeons’ contributions to all aspects of undergraduate medical education culture.