title: Are self-identified "disadvantaged" students less likely to enter surgical residencies? A single-institution study.
abstract: Given more emphasis on training primary care physicians for underserved areas, we hypothesized that students self-identifying as "disadvantaged" would be less likely to pursue surgical training.
  
  
  
  We retrospectively reviewed medical school data on students graduating 2005-2014. Students were stratified into "disadvantaged" and "nondisadvantaged". Data were recorded on age, grade point average, Medical College Admission Test (MCAT), gender, surgery grade, United States Medical Licensing Examination step 1 score, and residency match into a surgical field. A comparison of the proportion of students matching into a surgical field was assessed with chi-square test. Multivariate logistic regression was performed to assess the factors that predict the choice of general surgery versus another surgical field.
  
  
  
  Of the 1140 students who graduated during the study period, 219 (19.2%) students self-identified as "disadvantaged". Of all students, 158 (13.9%) chose a surgical field. The disadvantaged group was older at entry and had lower grade point average and total MCAT scores. Twenty-seven (12.3%) disadvantaged students chose a surgical residency versus 130 (14.1%) nondisadvantaged students (P = 0.56). On multivariate logistic regression, female gender (odds ratio [OR] = 3.9; 95% confidence interval = [1.9-8.3], P < 0.01), disadvantaged status (OR = 2.8 [1.1-7.1], P = 0.03), and United States Medical Licensing Examination step 1 score ≥ 227 (OR = 0.43 [0.21-0.88], P = 0.02) were significantly associated with matching into general surgery versus another surgical specialty.
  
  
  
  Although the disadvantaged cohort was older and had lower undergraduate GPAs and MCAT scores, the proportion of disadvantaged students matching into a surgical residency was not statistically different. To address the future shortage of general surgeons in underserved areas, increasing enrollment of "disadvantaged" students may alleviate the "surgical desert".
authors.affiliation: Department of Surgery, UC San Diego Medical Center, San Diego, CA. Electronic address: junkart@ucsd.edu.
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Unkart
authors.affiliation: Division of Plastic Surgery, Department of Surgery, UC San Diego Medical Center, San Diego, CA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.affiliation: Department of Surgery, UC San Diego Medical Center, San Diego, CA.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Baumgartner
authors.affiliation: Department of Surgery, UC San Diego Medical Center, San Diego, CA; Division of Plastic Surgery, Department of Surgery, UC San Diego Medical Center, San Diego, CA.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Wallace
authors.affiliation: Division of Medical Education, UC San Diego School of Medicine, La Jolla, CA.
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Kelly
mesh_terms: D000328:Adult; D002140:California; D002321:Career Choice; D005260:Female; D013502:General Surgery / Q000193:education; D006801:Humans; D007396:Internship and Residency; D016015:Logistic Models; D008297:Male; D008507:Medically Underserved Area; D012189:Retrospective Studies; D012923:Social Class; D013043:Specialties, Surgical / Q000193:education*; D013337:Students, Medical; D035862:Vulnerable Populations
keywords: Disadvantaged; Education; Residency; Underserved surgery