title: Medical student experience in surgery influences their career choices: a systematic review of the literature.
abstract: OBJECTIVE
  Student experiences during surgical rotations may dictate interest in future surgical careers. The objective of this study was to systematically examine the effect of surgical experience (SE) on student attitudes toward surgical careers and also to identify variables influencing the educational value of SE.
  
  
  METHODS
  A systematic review of the available literature was conducted by 2 independent researchers searching Medline, EMBASE, Google Scholar, and Cochrane databases, in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses recommendations. Studies assessing SE during the students' surgical rotations were identified. The quality of the included studies was assessed using a validated quality index. Factors affecting student surgical rotation experience and perceptions of surgical careers were recorded.
  
  
  RESULTS
  Overall, 204 studies were identified; 20 unique studies met the inclusion criteria with a median cohort size of 169 (interquartile range: 107-262) respondents. Most were cross-sectional surveys (n = 16/20) and administered to clinical students (n = 16/20). All studies investigating the effect of SE on career choices (n = 8) found that positive experiences during the surgical placement were associated with an increased interest in surgical careers. The operating theater experience was identified as a defining feature of overall SE. Involvement in operative procedures, a welcoming environment, and avoidance of syncopal events positively influenced the SE, particularly in those who actively sought educational opportunities. Study limitations included single-center and single-year cohort designs (70%) with the use of nonvalidated research tools (95%).
  
  
  CONCLUSIONS
  A systematic review of the literature highlights a number of factors associated with a positive surgical rotation, which may lead to more students deciding to pursue a career in surgery. Understanding the factors that contribute to these decisions through multicenter studies using validated research tools may lead to more effective surgical rotations, ultimately improving the delivery of the surgical education.
authors.affiliation: Imperial College London, London, United Kingdom. Electronic address: dominic.marshall12@imperial.ac.uk.
authors.forename: Dominic C
authors.initials: DC
authors.lastname: Marshall
authors.affiliation: Imperial College London, London, United Kingdom.
authors.forename: Justin D
authors.initials: JD
authors.lastname: Salciccioli
authors.affiliation: Department of Undergraduate Medical Education, Northwick Park Hospital, London, United Kingdom; Department of Surgery, St Mark's Hospital, London, United Kingdom.
authors.forename: Sarah-Jane
authors.initials: SJ
authors.lastname: Walton
authors.affiliation: Department of Undergraduate Medical Education, Northwick Park Hospital, London, United Kingdom.
authors.forename: Joan
authors.initials: J
authors.lastname: Pitkin
authors.affiliation: Imperial College London, London, United Kingdom.
authors.forename: Joseph
authors.initials: J
authors.lastname: Shalhoub
authors.affiliation: Department of Undergraduate Medical Education, Northwick Park Hospital, London, United Kingdom; Department of Surgery, St Mark's Hospital, London, United Kingdom.
authors.forename: George
authors.initials: G
authors.lastname: Malietzis
mesh_terms: D002321:Career Choice; D004504:Education, Medical, Undergraduate; D013502:General Surgery / Q000193:education*; D006801:Humans; D013337:Students, Medical / Q000523:psychology*
keywords: Interpersonal and Communication Skills; Practice-Based Learning and Improvement; Professionalism; career choice; medical students; surgical experience