I vividly remember the first meeting of the Student Surgical Society in my first year of medical school. One of our trauma faculty gave a talk on “the surgeon lifestyle.” The room, at that time, contained over 50% of our incoming class. Over the next few months and years, the people in that room whittled down to the ten who would eventually apply and successfully match into General Surgery. As is common, initial enthusiasm and interest in surgery started at an incredible high and, for various reasons, waned throughout medical school. Some students cited concerns over lifestyle or training culture, while others found other specialties more compatible with their personalities and intellectual interests. The recruitment of exceptional individuals from diverse backgrounds is critical for our specialty’s continued growth and evolution. We know we have the best job in the world, so shouldn’t every medical student be convinced of the same?
The COVID-19 pandemic markedly exacerbates the challenges in transmitting our own enthusiasm to medical students. At present, and rightfully so, there is an increased focus on “front line” specialties like Emergency and Internal Medicine. These specialties tend to dominate modern conversations on social and traditional media regarding public healthcare. In the preclinical years, surgical interest group sessions are now converted to virtual format, often eliminating potential mentoring opportunities that arise organically in such in-person meetings and post-lecture conversations. Conversion of many office visits to telehealth decreases student opportunities to shadow surgeons. Suture workshops are often canceled or converted to zoom format, decreasing the crucial interaction of medical students with resident physicians who would later serve as near-peer mentors.
Similar recruitment challenges arise in the clinical years. Hospital systems are overwhelmed with COVID-positive patients, and many screening and diagnostic procedures are postponed. Elective procedures are delayed because of nursing and bed shortages, and academic medical centers have seen a decrease in surgical numbers as a whole. Therefore, students are exposed to fewer cases and are sometimes denied the opportunity to scrub in due to PPE shortages.
Residents and faculty are likewise affected by the COVID-19 pandemic. Increased provider burnout has been documented among trainees.1 Decreased opportunities to perform elective cases, near-constant exposure to the human cost of the pandemic, and the stress of exposure to infectious disease contribute to poor mental health among the most important role models to medical students.
Despite the overwhelming reach of this pandemic, surgeons clearly feel an obligation, a responsibility, and a desire to continue to move our field forward. While there is no analytic data to prove that interest in surgery has declined, we should not wait for a recruitment crisis to arise before taking action. Here we will outline some potential strategies that surgical departments can utilize to recruit exceptional and diverse applicants:
- Improve Accessibility: If you don’t have a social media account, get one. Encourage members of your department to start professional accounts on Twitter, Instagram, Facebook, or TikTok. Take potential applicants along for a day in the life of a surgeon through a “Live Twitter Takeover.” Help them understand that “the surgeon lifestyle” defies strict definition, especially amongst the diverse subspecialties within General Surgery.
- Expose Learners to Surgical Cases: Start an initiative within your department to record interesting surgical cases. Have a faculty member talk through the case in real-time. Though there is no substitute for hands-on interaction in the operating room, allowing students to engage in surgeon thought processes and experience human anatomy digitally can help increase engagement in the surgical discipline.
- Provide Informational Series: Offer online panel series and discussions with medical students, faculty, and residents. Highlight a culture of teamwork and camaraderie. Encourage asking frank questions and engaging in nuanced discussions. Have fun with it! Our institution has had recent success with a “Sautee and Suture” Zoom series, where student-suggested topics were discussed while cooking dinner recipes. Make medical students feel welcome by offering a diverse range of activities to match the diverse range of interests and passions of those within our field.
- Create a culture of compassion (and really mean it!): Brand us as exactly what we are, a field of service to a world in desperate need. Offer resources to residents, faculty, and medical students to discuss COVID-19 vaccination in your clinics and inpatient units. Involve your department in community outreach opportunities if and when they arise.
- Prioritize resident and faculty wellness: Consider the engagement of a wellness committee or appoint a Chief Wellness Officer if your institution lacks one. Ensure that it is not merely a performative role, but design a system of identifying and addressing department-specific needs.
We have the privilege and unique opportunity to recruit the next generation of outstanding medical students into the evolving field of surgery. For lack of a better phrase, these are unprecedented times. We have difficult and troubling years ahead, coping with the direct and indirect effects of the pandemic. We can anticipate large volumes of patients presenting with advanced cancer and other surgical crises due to delayed access to care. The landscape of surgery is changing, and so should our recruitment methods. We want to train the best and the brightest to provide surgical care to our communities. Our patients need and deserve them.
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References
- Cravero AL, Kim NJ, Feld LD, et al. Impact of exposure to patients with COVID-19 on residents and fellows: an international survey of 1420 trainees. Postgrad Med J 2020.
Polina Zmijewski
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