ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Ann Thorac Surg 2009;87:1816-1819. doi:10.1016/j.athoracsur.2009.03.007
© 2009 The Society of Thoracic Surgeons
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Eric S. Weiss
Nishant D. Patel
Diane E. Alejo
Torin P. Fitton
Jason A. Williams
Christopher J. Barreiro
Lois U. Nwakanma
Stephen C. Yang
Duke E. Cameron
Vincent L. Gott
William A. Baumgartner
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Allen, J. G.
Right arrow Articles by Baumgartner, W. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Allen, J. G.
Right arrow Articles by Baumgartner, W. A.
Related Collections
Right arrow Education

Original Articles: Adult Cardiac

Inspiring Medical Students to Pursue Surgical Careers: Outcomes From Our Cardiothoracic Surgery Research Program

Jeremiah G. Allen, MDa, Eric S. Weiss, MDa, Nishant D. Patel, BAa, Diane E. Alejo, BAa, Torin P. Fitton, MDa, Jason A. Williams, MDa, Christopher J. Barreiro, MDa, Lois U. Nwakanma, MDa, Stephen C. Yang, MDb, Duke E. Cameron, MDa, Vincent L. Gott, MDa, William A. Baumgartner, MDa,*

a Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
b Division of Thoracic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland

Accepted for publication March 6, 2009.

* Address correspondence to Dr Baumgartner, Division of Cardiac Surgery, The Johns Hopkins University School of Medicine, Blalock 618, 600 N Wolfe St, Baltimore, MD 21287 (Email: wbaumgar{at}jhmi.edu).

Presented at the Poster Session of the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.


   Abstract
Top
 Abstract
Introduction
 Material and Methods
 Results
 Comment
 Acknowledgments
 References
 
Background: The past several years have witnessed a dramatic decline in the number of general surgery residents pursuing cardiothoracic surgery residency training. We believe that attracting individuals to pursue surgical careers should begin during the formative years of medical education. We implemented a program to introduce first-year medical students to cardiothoracic surgery and laboratory research.

Methods: In 2003, we began a program providing an introduction to cardiothoracic laboratory research and surgery for medical students. Students are competitively selected for our three-part 8-week summer program. First, students are paired with a cardiothoracic surgery attending for shadowing in clinic and the operating room. Second, students actively participate in large-animal operations in the laboratory. Finally, students complete a clinical research project under the direction of a laboratory resident and faculty mentor. These projects are the students' own. They are responsible for presenting their findings to the division of cardiac surgery at the end of the program.

Results: Since 2003, 18 students have completed the program. Each one has completed a project, collectively resulting in 39 peer-reviewed manuscripts. One student has published 28 peer-reviewed manuscripts. Of 10 students eligible for residency, 8 have applied in general surgery or surgical subspecialty (3 general, 2 plastic, 2 cardiothoracic, and 1 neurosurgery).

Conclusions: Implementing a program to introduce medical students to clinical and laboratory surgery has been successful, as measured by academic productivity. Eighty percent of eligible students entered a surgical field. Programs like these serve to stimulate interest in our specialty.


   Introduction
Top
 Abstract
 Introduction
Material and Methods
 Results
 Comment
 Acknowledgments
 References
 
During the last 15 years, the field of cardiothoracic (CT) surgery has experienced a dramatic change in both its practice and scope within the greater medical community. With the introduction and surge of interventional cardiology in the 1980s and subsequent decline in the volume of coronary interventions performed by CT surgeons, perceptions of the field have changed within the specialty, among other health-care professionals, and within the lay public. Decreases in operative case volumes and reimbursement throughout the past decade have severely impacted job satisfaction among practicing CT surgeons, most notably among recent graduates [1, 2].

Concomitant, and likely associated, with these changes has been a sharp decline in the number of general surgery applicants applying to CT residencies, such that in 2005, for the first time, there were fewer applicants than positions available [1]. The number of applicants has continued to steadily decline since that time. According to National Residency Match Program data, in the 2008 application cycle there were only 87 matches of 96 applicants for a total of 130 positions; leaving 36 thoracic surgery programs only partially matched [3].

These disturbing trends are accompanied by numerous articles asserting the difficulties of recent CT graduates in finding employment, dissatisfaction with their career choice, and opinions that the total number of CT residency spots should be decreased [1, 2, 4]. It is also clear that recent years have witnessed a distinct change in both the demographics and values of medical students and residents. Each year brings continued increases in the number of female medical school graduates, a smaller percentage of who seek training in surgical subspecialties [5]. As well, new doctors are increasingly placing a greater importance on life outside of the hospital [6, 7].

All of these facts serve to further dissuade medical students from pursuing CT surgery. Moreover, the length of CT training (on average 8.6 years [1]), serves to further discourage medical students who now focus overwhelmingly on shorter training and better lifestyles when choosing their area of specialty [6, 7]. Pilot programs now exist for integrated 6-year CT residencies that match directly out of medical school. However, the difficulty in attracting top-quality applicants to these, as well as traditional CT fellowship positions, remains.

Despite the evident decline in the popularity of CT surgery as a specialty among general surgery residents, the need for CT surgeons appears to be on the rise. Many have predicted a coming shortage of CT surgeons in the near future [4, 8]. This prediction is related both to the advanced age of many practicing CT surgeons and the progression of the baby-boomer population into older age.

In the context of these turbulent times, we first began a program designed to attract medical and premedical students to surgery, and specifically to the specialty of CT surgery [9]. Since 2003, undergraduates and medical students have participated in structured curricula that expose them to CT surgery in the context of clinical practice, clinical research, operative skills training and large-animal operations, and active mentorship with our faculty, residents, and fellows. In 2006, we presented details of this program in this journal [9]. Herein, we present early results from the first 5 years of our medical student CT research program.


   Material and Methods
Top
 Abstract
 Introduction
 Material and Methods
Results
 Comment
 Acknowledgments
 References
 
Program Specifics
In the summer of 2003, the CT surgery laboratory at the Johns Hopkins Hospital began a formal 8-week program for medical students at the Johns Hopkins School of Medicine, aimed at providing an intensive, focused experience in CT clinical and basic science research. Students are taught early operative skills and exposed to mentors within the division at the resident, fellow, and attending levels. Before this program, occasional medical students participated in an unstructured manner in active projects in the CT laboratory. This program involves active participation in both basic science laboratory projects (which usually involve large-animal operations—providing hands-on surgical skills training) and the independent completion of a clinical research project under the mentorship of a cardiac surgery research fellow and a faculty member. Given that the summer between the first and second years of medical school is scheduled free time at our medical school, this program was conceived to provide the opportunity for focused academic pursuits and experiences in CT surgery, without requiring that specific time be taken off from regular coursework. As well, medical students at the Johns Hopkins School of Medicine performing any summer research between their first and second years are eligible for a stipend from the Dean's office; however, no additional stipend is given for students participating in our program.

The program accepts 3 medical students annually in the spring after a competitive application process facilitated by the current CT surgery research fellows. Interest is generated by our previous years' students giving positive feedback to the current first-year class and through e-mails to the first-year class describing the details of the program. Projects are developed by the faculty and research fellows to address a defined question using retrospective clinical data gathered continuously by our Cardiac Surgery Data Center. Each of the students is paired with a faculty mentor who helps to guide their clinical projects. After being accepted into the program, students meet with their mentors to discuss what background reading and literature searches will be helpful for their specific project. It is the policy of our division that students have the opportunity to be first author on any publication that arises directly from their work, and further, be allowed to present their findings at national meetings. These projects are therefore truly the students' own, with the faculty and fellows providing guidance along the way. Both institutional review board approval for clinical projects and animal care and use committee approval for animal projects are obtained before the beginning of the summer program.

As outlined in Figure 1, the 8 weeks of the program are quite intensive and focused around completion of the clinical project, including database construction, statistical methodology, and preparation of their oral presentation and manuscript. However, interspersed into the student's experience is the daily work of the CT laboratory. This involves the students being trained in basic operative skills and assisting with large-animal operations, as well as attending lectures and journal clubs focused on research methodology and various topics in CT surgery.


Figure 1
View larger version (12K):
[in this window]
[in a new window]

  		Fig 1. Timeline for 8-week medical student summer research program.

 
Although the program formally ends after the 8 summer weeks, most students continue to be mentored within the Divisions of Cardiac and Thoracic surgery. In addition, students continue work on the publication of their manuscripts and presentations of their projects at national meetings, throughout medical school. Many continue to involve themselves with other projects after their initial experience with the summer program. This ongoing research involvement serves as a framework for students to stay involved with their mentoring faculty member and to form a relationship through which career advice can be given and a continued interest in CT surgery can be nurtured.


   Results
Top
 Abstract
 Introduction
 Material and Methods
 Results
Comment
 Acknowledgments
 References
 
Since 2003, 18 medical students have completed our summer CT surgery research program. These students have coauthored a total of 39 peer-reviewed journal articles, presented 41 abstracts at national meetings, and coauthored 2 book chapters (Table 1), while still in medical school. Of note, we have included all publications in the field of CT surgery coauthored by these students, even if the initial work was not done during the 8 weeks of their program. Eleven (61%) have coauthored a journal article and 9 (50%) have presented their work at a national meeting. Excluding those students from summer 2008 (who have not had time to present or have their articles in press at this time), the percentage of students publishing a manuscript or presenting a paper at a meeting are 73% and 60%, respectively; a total of 12 of 15 students (80%) either presented at a national meeting or coauthored a journal article.


View this table:
[in this window]
[in a new window]

  		Table 1 Publications of Students Completing Our Summer Research Program in Cardiac Surgery by Individual and Year
 
Of the 18 students, 10 have applied to residency. Eight (80%) of those have applied in a field of surgery and 2 (20%) have applied specifically in CT surgery (Table 2). It is important to note that those students who have entered a general surgery residency, but not a CT surgery dedicated track, are only included in the general surgery category. Although we fully expect them to enter a CT residency through the traditional post–general surgery track, we have not included them until they have applied for a CT residency position. Of note, our coauthor (N.D.P.), who was a summer student in 2005, has coauthored a total of 28 peer-reviewed journal articles and has been involved with 29 abstracts presented at national meetings.


View this table:
[in this window]
[in a new window]

  		Table 2 Career Paths Chosen by Residency Eligible Summer Students
 

   Comment
Top
 Abstract
 Introduction
 Material and Methods
 Results
 Comment
Acknowledgments
 References
 
In this study, we have presented early results from our dedicated summer program for medical students. We initially created the program to provide students early exposure to CT surgery. The results have shown that both students and our division have benefited from this program. Specifically, the 18 students who have entered the program have been academically productive, and many have chosen careers in the surgical subspecialties.

Academic Productivity
The productivity of our students has far exceeded our expectations. Although the total numbers of peer-reviewed journal articles (n = 39) and abstracts presented at national meetings (n = 41) are dominated by one outstanding individual (N.P.; Table 1), the percentage of students who presented or published a journal article is significant at 80% (when excluding students from summer 2008, as noted above). In these numbers, we included all those papers and abstracts that the students have coauthored in the field of CT surgery during medical school. This accounts for the impact of their continued involvement in the Divisions of Cardiac and Thoracic surgery, inspired by their initial experiences in our summer program. This is also illustrative of the ongoing mentorship by our faculty and fellows, which is an integral part of guiding medical students into surgery.

An important component to the academic productivity of our students is the motivation provided by experiencing the publication of their own work, in most cases for the first time. The laboratory is committed to having first-authorship responsibility and recognition lie with the student for his or her own project. We have been successful in this endeavor for the most part. Because shepherding an article through the publication process inevitably involves more time than the 8-week program allows, the ongoing involvement of students with the fellows and faculty is highly encouraged and has been successful.

Career Choices
With the imminent shift of CT surgical training from a fellowship of general surgery to an independent integrated program (applied to directly from medical school), attracting promising medical students to CT surgery becomes even more crucial. In this aspect, our program has also had tremendous success, with 80% of our students applying in some field of surgery and 20% applying specifically in CT surgery. This is a marked increase over National Residency Matching Program data from 2008 in which a total of 13.5% of US senior medical students applied in surgery or a surgical subspecialty [10]. Although we certainly do not believe that our program is the sole motivating factor for these students choosing surgical paths, we believe that their positive experiences augment their own internal motivations. We do, however, believe that some of these students would not have chosen surgical careers were it not for the experience they had working in our CT surgery summer program.

Attracting Students to Surgical Careers
The success of our program in stimulating students to pursue surgical careers has allowed us to reflect on those factors that may be important for motivating students to enter into surgical fields. Those of us who are surgeons know firsthand what a challenging, rewarding, intellectually stimulating, and genuinely fun field it is. The impact that surgeons have on their patients' lives is profound, and the earlier students learn this, the more motivated they will be to choose surgery. The influence that a dedicated mentor can have on the career decisions of a medical student is unparalleled. By receiving guidance from both CT surgical faculty as well as our laboratory general surgery residents, the students gain a broad perspective on surgery as a whole. This early immersion into surgery is an incredibly valuable experience, and we encourage other programs to seek out means to engage students during their early medical school experience.

Importance
Attracting the best medical students to CT surgery is more important than ever. Given the paradigm shift in CT training on the horizon and the ever-shrinking exposure of general surgery residents to cardiac surgery, it is critical to expose medical students to the possibility of CT surgery early in their preclinical years. The shortage of CT surgeons predicted by many in the next decade makes this issue of recruitment even more pressing.

Cardiothoracic surgery continues to evolve to encompass operations for more-complex patients and pathologic processes. The world of device-driven interventions for heart failure, minimally invasive valvular techniques, and transplants require a surgeon with not only excellent technical skills but a facile and scientific mind capable of objectively evaluating new techniques and disseminating knowledge to other medical professionals. As the field continues to evolve, we must have surgeons who can evolve with it. As William Stewart Halsted once wrote, we need "surgeons of the highest type, men who will stimulate the first youths of our country to study surgery and devote their energy and lives to raising the standard of surgical science" [11]. Programs such as this one, which capture the interest of medical students early in their education, can help to accomplish this goal.

Conclusions
In this report, we have presented the early results from a cohort of medical students who have participated in our program to expose them to academic CT surgery and clinical research. Programs aimed at encouraging medical students into CT surgery through active mentorship, operative skills training, and individual academic pursuits can be successful at inspiring medical students into surgical careers. We have had success in these pursuits, as demonstrated by the high academic productivity of our students and their 80% matriculation rate to surgical residencies.


   Acknowledgments
Top
 Abstract
 Introduction
 Material and Methods
 Results
 Comment
 Acknowledgments
References
 
Dr Allen is the Hugh R. Sharp Cardiac Surgery Research Fellow and Dr Weiss is the Irene Piccinini Investigator in Cardiac Surgery. This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C and the National Institutes of Health (NIH 2T32DK007713-12 ESW). The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government.


   References
Top
 Abstract
 Introduction
 Material and Methods
 Results
 Comment
 Acknowledgments
 References
 

  1. Salazar JD, Ermis P, Laudito A, et al. Cardiothoracic surgery resident education: update on resident recruitment and job placement Ann Thorac Surg 2006;82:1160-1165.[Abstract/Free Full Text]
  2. Salazar JD, Lee R, Wheatley 3rd GH, Doty JR. Are there enough jobs in cardiothoracic surgery?. The Thoracic Surgery Residents Association job placement survey for finishing residents. Ann Thorac Surg 2004;78:1523-1527.[Abstract/Free Full Text]
  3. National Residency Matching Program. Match results statistics: thoracic surgery fellowship. www.nrmp.org 2004Accessed Jan 14, 2009.
  4. Kron IL. How many lives did you save today? Ann Thoracic Surg 2006;81:1554-1556.[Free Full Text]
  5. Sonnad SS, Colletti LM. Issues in the recruitment and success of women in academic surgery Surgery 2002;132:415-419.[Medline]
  6. Dorsey ER, Jarjoura D, Rutecki GW. Influence of controllable lifestyle on recent trends in specialty choice by US medical students JAMA 2003;290:1173-1178.[Abstract/Free Full Text]
  7. Thornton J, Esposto F. How important are economic factors in choice of medical specialty? Health Econ 2003;12:67-73.[Medline]
  8. Shemin RJ, Dziuban SW, Kaiser LR, et al. Thoracic surgery workforce: snapshot at the end of the twentieth century and implications for the new millennium Ann Thorac Surg 2002;73:2014-2032.[Abstract/Free Full Text]
  9. Gott VL, Patel ND, Yang SC, Baumgartner WA. Attracting outstanding students (premedical and medical) to a career in cardiothoracic surgery Ann Thorac Surg 2006;82:1-3.[Free Full Text]
  10. National Residency Matching Program. Results and data: 2008 main residency match. www.nrmp.org 2006Accessed Jan 14, 2009.
  11. Halsted WS. The training of the surgeon Johns Hopkins Hosp Bull 1904;15:267-275.



This article has been cited by other articles:


Home page
 JAMAHome page
E. A. Kitsis
Shining a Light on Shadowing
JAMA, March 9, 2011; 305(10): 1029 - 1030.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
L. J. Tesche, R. H. Feins, M. M. Dedmon, K. N. Newton, T. M. Egan, B. E. Haithcock, N. K. Veeramachaneni, and M. E. Bowdish
Simulation Experience Enhances Medical Students' Interest in Cardiothoracic Surgery
Ann. Thorac. Surg., December 1, 2010; 90(6): 1967 - 1974.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
A. W. Kim, R. M. Reddy, R. S. D. Higgins, and Joint Council for Thoracic Surgical Education Subc
"Back to the future": Recruiting the best and brightest into cardiothoracic surgery
J. Thorac. Cardiovasc. Surg., September 1, 2010; 140(3): 503 - 504.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. Ouzounian, A. Hassan, C. J. Teng, G. H. Tang, S. A. Vanderby, T. B. Latham, and C. M. Feindel
The Cardiac Surgery Workforce: A Survey of Recent Graduates of Canadian Training Programs
Ann. Thorac. Surg., August 1, 2010; 90(2): 460 - 466.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Eric S. Weiss
Nishant D. Patel
Diane E. Alejo
Torin P. Fitton
Jason A. Williams
Christopher J. Barreiro
Lois U. Nwakanma
Stephen C. Yang
Duke E. Cameron
Vincent L. Gott
William A. Baumgartner
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Allen, J. G.
Right arrow Articles by Baumgartner, W. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Allen, J. G.
Right arrow Articles by Baumgartner, W. A.
Related Collections
Right arrow Education

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS