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Association of Demographic Factors and Medical School Experiences With Students’ Intention to Pursue a Surgical Specialty and Practice in Underserved Areas

Educational Objective
To identify which demographic and experiential factors are associated with medical students' intention to pursue surgery and practice in medically underserved areas.
1 Credit CME
Key Points

Question  What demographic and experiential factors are associated with medical students’ intention to pursue surgery and practice in medically underserved areas?

Findings  In this cross-sectional study of 48 096 graduating medical students interested in pursuing surgery, students who were female, Black, Hispanic, Indian/Pakistani, multiracial Black and White, or had global health or health disparity experiences were more likely to report an intention to practice in underserved areas.

Meaning  These findings highlight the importance of medical schools’ and residency training programs’ social and clinical mission to diversify the surgical workforce and improve the supply of surgeons who are motivated to practice in underserved areas.


Importance  The surgical workforce shortage is a threat to promoting health equity in medically underserved areas. Although the Health Resources and Services Administration and the American College of Surgeons have called to increase the surgical pipeline for trainees to mitigate this shortage, the demographic factors associated with students’ intention to practice in underserved areas is unknown.

Objective  To evaluate the association between students’ demographics and medical school experiences with intention to pursue surgery and practice in underserved areas.

Design, Setting, and Participants  This cross-sectional study surveyed graduating US allopathic medical students who matriculated between 2007-2008 and 2011-2012. Analysis began June 2020 and ended December 2020.

Main Outcomes and Measures  Intention to pursue surgery and practice in underserved areas were retrieved from the Association of American Medical Colleges graduation questionnaire. Logistic regression models were constructed to evaluate (1) the association between demographic factors and medical students’ intention to pursue surgical specialties vs medical specialties and (2) the association between demographic factors and medical school electives with intention to practice in underserved areas.

Results  Among 57 307 students who completed the graduation questionnaire, 48 096 (83.9%) had complete demographic data and were included in the study cohort. The mean (SD) age at matriculation was 23.4 (2.5) years. Compared with students who reported intent to pursue nonsurgical careers, a lower proportion of students who reported intent to pursue a surgical specialty identified as female (3264 [32.4%] vs 19 731 [51.9%]; χ2 P < .001). Multiracial Black and White students (adjusted odds ratio [aOR], 1.72; 95% CI, 1.11-2.65) were more likely to report an intent for surgery compared with White students. Among students who reported an intention to pursue surgery, Black/African American students (aOR, 3.24; 95% CI, 2.49-4.22), Hispanic students (aOR, 2.00; 95% CI, 1.61-2.47), multiracial Black and White students (aOR, 2.27; 95% CI, 1.03-5.01), and Indian/Pakistani students (aOR, 1.31; 95% CI, 1.02-1.69) were more likely than White students to report an intent to practice in underserved areas. Students who reported participating in community health (aOR, 1.61; 95% CI, 1.42-1.83) or global health (aOR, 1.83; 95% CI, 1.61-2.07) experiences were more likely to report an intention to practice in underserved areas.

Conclusions and Relevance  This study suggests that diversifying the surgical training pipeline and incorporating health disparity and community health in undergraduate or graduate medical education may promote students’ motivation to practice in underserved areas.

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Article Information

Corresponding Author: Mytien Nguyen, MS, 333 Cedar St, New Haven, CT 06510 (mytien.nguyen@yale.edu).

Accepted for Publication: July 31, 2021.

Published Online: October 6, 2021. doi:10.1001/jamasurg.2021.4898

Author Contributions: Dr Mason and Ms Nguyen had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Nguyen, Mason.

Acquisition, analysis, or interpretation of data: Nguyen, Cerasani, Dinka, Rodriguez, Omoruan, Acosta, Alder, Brutus, Termuhlen, Dardik, Stain.

Drafting of the manuscript: Nguyen, Cerasani, Dinka, Rodriguez, Omoruan, Acosta, Alder, Brutus, Dardik.

Critical revision of the manuscript for important intellectual content: Nguyen, Cerasani, Dinka, Rodriguez, Omoruan, Acosta, Alder, Brutus, Termuhlen, Dardik, Mason, Stain.

Statistical analysis: Nguyen.

Obtained funding: Mason.

Administrative, technical, or material support: Nguyen, Cerasani, Dinka, Rodriguez, Omoruan, Acosta, Alder, Brutus, Mason.

Supervision: Dardik, Mason, Stain.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study is based on data provided by the Association of American Medical Colleges (AAMC) and is supported by a Medical Education Scholarship Research and Evaluation grant from the AAMC Northeast Group on Educational Affairs (NEGEA) to Dr Mason and Albany Medical College Dean’s Discretionary Grant program. Ms Nguyen is supported by the National Institutes of Health Medical Scientist Training Program Training Grant (T32GM136651).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Meeting Presentation: This work was presented at the 2021 annual meeting of the Association of Veterans Affairs Surgeons; April 25, 2021; virtual.

Disclaimer: This manuscript reflects the work and views of the authors and may not reflect the official views of the funding agencies (the Association of American Medical Colleges Northeast Group on Educational Affairs, the National Institutes of Health National Institute of General Medical Sciences, and Albany Medical College).

Additional Contributions: We thank Ashar Ata, MD (Albany Medical College), Sherry Wren, MD (Stanford University), Miguel Paniagua, MD (National Board of Medical Examiners), and Donna Jeffe, PhD (Washington University at St Louis), for their thoughtful perspectives and input. Additional critical review of the manuscript was performed by members of the Ad-Hoc Publication Committee, Association of VA Surgeons in Lynnwood, Washington. No compensation was received.

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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

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