Medical student experiences based on personal identity characteristics during the surgical clerkship: a survey-based study

Surgical clerkships are key to recruiting talented students into surgery, however disparities in treatment and negative experiences can discourage students from surgical careers. This study investigates how clerkship experiences vary based on identity.

An anonymous, voluntary electronic survey was sent to 3rd and 4th year medical students. It included questions that were answered using a Likert scale regarding learning opportunities, professional relationships, interest in surgery, othering, and mistreatment. Differences between genders and minority identities were evaluated and are reported as mean Likert score [standard deviation].

Participation rate was 49/207. The majority of respondents were women (64%) and did not self identify as visible minorities (VM) (55.1%). There was no significant difference by gender in change in surgical interest before and after clerkship (mean change in score − 0.35 vs. + 0.12, p = 0.11), however, women’s interest in surgery after clerkship was lower (4[2] vs. 2[4]; p = 0.04). For professional relationships, women rated all relationships lower than men. Women also had a lower rating of fitting in (4 [2] vs. 5 [1]; p = 0.02). VM rated relationships with nurses/other (4[1] vs. 4[1]; p = 0.026) lower. Othering included actions that made students feel excluded from the group based on identity. Within the othering category, women had more comments due to gender from faculty/staff (1[3] vs. 1[0]; p = 0.008), residents (1.5[1] vs. 1[0]; p = 0.010), nurses/other (1.5[2.3] vs. 1[0]; p = 0.003), and peers (1[1.8] vs. 1[0]; p = 0.007). Women reported higher rates of mistreatment from patients (1[2] vs. 1[0]; p = 0.021) and faculty/staff (1[1] vs. 1[0]; p = 0.02), and neglect by faculty (1[0] vs. 1[0]; p = 0.025) and residents (1[0] vs. 1[0]; p = 0.026). VM had more misidentification due to race/ethnicity by patients (2[1] vs. 1[0]; p = 0.041) and comments due to gender from faculty/staff (1[0.5] vs. 2[3]; p = 0.010).

This study corroborates the mistreatment reported in surgical training at all levels. Woman trainees report lower quality professional relationships and misidentification based on their identity. These factors negatively impact clerkship experiences and may deter interested students from a surgical career. This highlights the need for diversity and inclusion early on in medical training to retain talented trainees.