# “Hold the retractor, that’s it?” – A retrospective longitudinal evaluation-study of the surgical and the elective tertial in the practical year

## TL;DR

This study found that medical students rate compulsory surgical training worse than elective options, which could affect future surgical workforce recruitment.

## Contribution

The study provides new evidence that elective surgical training is preferred over mandatory surgical training among medical students.

## Key findings

- Mandatory surgical training received significantly lower ratings than other elective terms (69.3 vs 76.7 and 84.6).
- Elective conservative subjects were rated better than elective operative subjects (81.8 vs 85.9).
- Deficiencies in autonomy and supervision in compulsory surgery may contribute to declining student interest in surgical careers.

## Abstract

In the context of the shortage of physicians, the practical year is an important component in the acquisition of future medical talent. Previous studies suggest that PJ students rate several satisfaction parameters significantly lower in the surgical term than in other terms. Poor perceptions of surgical topics may lead to a health care problem. The aim of the current study was to analyse in detail the specific comparison between compulsory surgical and other elective surgical terms.

7762 anonymous online PJ evaluations at the Medical Faculty of Münster from 2007-2020 (RR 60.6%) were retrospectively analysed. The elective subjects were divided into operative and conservative subjects. In particular, evaluations and subjective learning gains were compared.

On the one hand, this study confirmed that the mandatory subject surgery was rated significantly worse than the other tertials (Msurg=69,3, MInt=76,7, Melec=84,6; p<0,001). Among the elective subjects, the conservative subjects were also preferred and rated better than the operative subjects (30,7% vs. 69,3%; Mop=85,9, Mkons=81,8; p<0,001). A final comparison of the elective operative subjects and the compulsory surgical terms showed that the elective operative subjects were also rated sig. better than the compulsory surgical term (Msurg=69,3, Mop=85,9; p<0,001).

The compulsory surgical specialty was found to be deficient in student autonomy and supervision, which may explain the worsening recruitment problem. In order to improve the attractiveness of surgical training, a compulsory surgical elective could be introduced, where students could learn the core competencies in smaller units. This enhancement could increase the interest of future medical professionals in surgical training.