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“Attitudes and factors contributing to attrition in Canadian surgical specialty residency programs” by Adams and colleagues1 is of special interest to all final-year medical students, like myself, currently applying for surgical residencies in Canada.
The authors point out that most residents leaving general surgery programs pursue nonsurgical fields. This is consistent with my own anecdotal survey of colleagues in a variety of surgical specialties who left their residencies for family practice. The study suggests an underestimation by medical students who go on to pursue surgical residencies of the disparity between work life and personal life that is inherent to becoming a highly competent surgeon. Interestingly, the article also highlights that surgical residency attrition cannot be purely because of long hours and poor lifestyle. The questions posed, if reframed by medical students considering surgical specialties, queries, “Do we really know what we are getting ourselves into?”
Three main points come to mind. First, an important factor that is widely known and canvassed is the lack of meaningful exposure to most of the surgical residency choices during medical school, which may play a role in later regrets and attrition. The clerkship year introduces medical students to the ward, core areas of medicine, and some limited subspecialized areas. Students rotate through the various specialties as if throuhg a restaurant’s tasting menu, with each exposure spanning a mere few weeks. The Canadian Resident Matching Service (CaRMS) deadline in November of final year, just 6 months after clerkship ends, forces students to restrict the number and types of electives that can be accommodated in the small window before applications are due. Experiences encountered after the deadline may have limited influence on choice of career. One only hopes students do not discover their calling during a winter or spring elective during final year, when the ship for applying has already sailed. It cannot be surprising that young physicians find themselves in an area of medicine they are unhappy with or not particularly suited for, and that they ultimately feel unfulfilled.
Second, it is widely understood that medical students are expected to demonstrate “commitment” to their surgical specialty of choice.2,3 Thus, students often further prune their limited pre-CaRMS electives to be a competitive applicant. This is a great shame because, although the days of the rotating internship are long gone, many a satisfied and happy senior doctor have divulged that they have found themselves in an unintended area after rotating through a fortuitous elective.
Third, fear of underemployment is real and palpable among students, and why wouldn’t it be? This is a relatively recent concern for the medical profession and a phenomenon the previous generation didn’t face.
At the end of the day, I have always been told that your best track is the work you love to do — if indeed you are lucky enough to discover that early enough in your training.