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Factors Influencing Osteopathic Medical Students’ Decision to Pursue a Surgical Specialty
Keever, K. [2]
Kiernan, R. N. [2]
Monaco, A. [3]
Pino, M. [6]
Saggio, G. [5]

Journal: Journal of Osteopathic Medicine Date: 2021/12, 121(12):Pages: A65-A66. doi: Subito , type of study: cross sectional study

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2021-2000/html)

Keywords:

career choice [55]
cross sectional study [867]
medical students [666]
osteopathic medicine [2064]
specialization [18]
surgical care [63]
USA [1717]

Abstract:

Context: Classically, the osteopathic medical profession has trained students towards primary care careers. Previous studies found clinical exposure as a key factor in osteopathic medical students (OMS) decision to focus on primary care. However, there are OMS who end up applying to surgical specialties. Studies on allopathic students have shown clerkships and mentorship as important for pursuing surgical specialties. It is unknown what factors are important to OMS pursuing surgical specialties. Objective: To investigate perceived barriers of OMS applying to or already matched to surgical residency programs compared to those in non-surgical programs. These barriers are important to explore as while osteopathic medical schools classically train students to primary care careers, some OMS do apply to surgical specialties. This study can potentially serve as a tool to the medical school administration to better serve this cohort of OMS needs. Methods: From March to June 2021, 1,525 students from an osteopathic medical school and its branch campus were emailed to fill out a questionnaire on their perceptions of what factors influence their ability to match into their residency choice. Participation was voluntary and the email was sent to third and fourth year OMS as well as graduates. The survey was administered electronically on the anonymous and secure web application RedCap. Three follow-up reminders were sent to the participants. Institutional review board (IRB) approval for this cross-sectional study was obtained from the New York Institute of Technology’s IRB. The questionnaire consisted of 49 questions and covered aspects of the residency application based on a review of the literature. Questions included residency interest, boards scores, clinical grades, mentorship, hospital affiliations, and research. Responses were rated on a 4-point Likert scale ranging from 1 (“strongly disagree”) to 4 (“strongly agree”). Other variables such as demographics and year of match or anticipated match were also collected. Respondents were divided into Surgical and Non-Surgical groups with Surgical specialties including general, orthopedic, otolaryngology, neurological, thoracic, plastic, urological, and vascular surgery as well as obstetrics and gynecology. Statistical analyses were calculated using IBM SPSS ver. 27, and p values 0.05 were considered significant. Descriptive statistics for categorical data were reported as absolute frequencies/percentages and analyzed by a chi-square test. Continuous variables are reported as medians/interquartile ranges and are analyzed by a student’s t-test. Currently there is no literature that explores an osteopathic medical students’ decision to pursue general surgery or a sub-surgical specialty. By obtaining this data, we hope that it will be used to better inform both OMS and osteopathic medical schools on what is needed to prepare for residency. Results: A total of 221 completed surveys were received (14.5%) response rate with 77% of respondents being labelled as non-surgical and 23% being labelled as surgical. Respondents were split almost evenly between male (49%) and female (51%) with the distribution of males and females being uneven in the surgical group, with 67% of respondents being female. Distribution of females in the non-surgical group was 47%. The majority of respondents were White (67%), Asian (55%), or Black (5%), and 3.6% were Hispanic or Latino. Both surgical and nonsurgical groups found their clinical rotations important in their decision to pursue their residency (96% vs. 89%; p=0.18) with both groups having moderate interest in their specialty before starting medical school (67% vs. 58%; p=0.26). USMLE Step 1/COMLEX Level 1 scores were important to both groups (87% vs. 81%; p=0.51) with USMLE Step 2/COMLEX Level 2 scores being more important to the surgical group (94% vs. 76%; p<0.05). Additionally, surgical group was more likely to take both USMLE and COMLEX compared to the non-surgical group (88% vs. 67%; p<0.05). Both groups thought having a mentor in the field they applied to would be helpful (100% vs. 96%; p=0.20) with 55% of the surgical and 45% of the non-surgical (p=0.21) having a mentor and 45% surgical and 32% non-surgical (p=0.14) unable to find a mentor. The ability to do research was more important to the surgical group (89% vs. 67%; p<0.05) with the ability to publish papers more important to the surgical group (71% vs. 44%; p<0.001). Both groups believed that hospital affiliations with their school were important (56% vs. 63%; p=0.50). Conclusion: Our study shows that for surgical versus non-surgical OMS, there were clear differences in perceived barriers to matching to their preferred specialty. Unsurprisingly, students interested in surgery weighted board examinations and research as more important than non-surgical specialties. While both groups found USMLE Step 1/COMLEX Level 1 scores to be important, the surgical group perceived USMLE Step 2/COMLEX Level 2 to be important for matching to their preferred residency specialty. Likewise, the surgical group perceived the ability to do research as well as the number of publications they author to be important when compared to the non-surgical group. Consistent with studies previously conducted on OMS in primary care fields as well as allopathic students in surgical fields, mentorship and clinical experience were perceived as important to both groups. This study had several limitations including that the survey was only administered to OMS at one school and its branch campus. Additionally, there were less surgical respondents then non-surgical respondents which is to be expected at an osteopathic medical school. Interestingly, there were more female than male surgical respondents despite the fact that there are more male versus female surgical residents, potentially contributing to a selection bias in our results. Despite these limitations, this study highlights how osteopathic medical schools can better serve the needs of OMS applying to surgical specialties by allowing OMS to potentially participate in research electives as well as the student body as a whole by establishing mentorship programs to improve OMS ability to match to the residency of their choice.

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