Reducing barriers, hammering out myths, fixating interest and cementing a positive image of orthopaedic surgery in medical students

By Michael McLarnon
Fourth Year Medical Student, Queen’s University Belfast

Introduction

Orthopaedic operations typically have excellent outcomes^1-3 with immediate impact. Emphasis on reconstruction and functional restoration over resection sets the specialty apart and requires a personalised medical approach to patients. To attract the best possible candidates it is essential to engage and empower aspiring medical students early in their careers. This essay will outline encouraging factors with suggested initiatives, followed by identifying perceived career obstacles and how to address them.

Encouraging the Next Generation

Orthopaedic student societies improve career interest^4,5, bolster CVs⁵ and provide networking opportunities⁴. Electing university-based representatives is an effective method of increasing recruitment amongst medical students⁶. Therefore, supporting local university surgical societies by establishing a BOA medical student sub-committee, with regional representatives at each UK & Irish university, would further encourage students while promoting an orthopaedic career.

Student surgical conferences stimulate interest in surgery, particularly amongst pre-clinical students⁷. These conferences give students opportunities to explore a specialty in more depth, and specialty-specific workshops for orthopaedics may provide practical experience in a safe learning environment^8,9. 

Research experience is shown to encourage students towards their field of study⁶. National collaborative research projects such as STARSurg¹⁰ provide an opportunity for students to have small but impactful roles in large-scale studies¹¹. The BOA, or existing trainee research groups (CORNET, ORCA and SWORD), could similarly involve medical students in a large collaborative project.

Strong role models are an influential factor in pursuing surgery^12,13 at both trainee and consultant levels¹⁴. Although often developed organically, formal mentorship ensures each mentee receives guidance¹⁵. A BOA student mentorship scheme could help connect and inspire budding orthopaedic surgeons. These meetings could be held in or outside of the workplace environment, the latter of which may facilitate discussion regarding managing work-life balance¹⁵ (often deemed a significant career barrier). 

A student’s interactions with surgeons and the number of operations observed correlate with career intentions¹², as does a good teaching experience¹⁶. A recent UK study found that the average length of orthopaedic attachments has almost halved in recent decades¹⁷. Student selective components (SSCs), elective bursaries, and online educational webinars based on the BOA undergraduate syllabus could further supplement clinical placements. A six-week surgical SSC at an Irish medical school significantly strengthened surgical career aspirations and could be adapted specifically for orthopaedics¹⁸. Educational webinars facilitate interactive learning and improve accessibility to orthopaedics for interested students¹⁹; virtual reality integration, using tools such as Proximie, could facilitate practical sessions.

The opportunity to scrub is influential in encouraging medical students towards surgery²⁰. Evidence indicates that students are more likely to attend theatres with a welcoming environment where they can actively participate¹⁴. Access to simulation is also beneficial in boosting interest^20,21. High fidelity simulation such as an arthroscopic skills simulator could be made available to interested medical students²² and would help bridge the gap between textbook and operating theatre. Although less exciting, low fidelity simulations are typically cheaper and may be equally effective²³. 

Breaking down Barriers

Issues surrounding work-life balance are often raised, with the current generation more focussed on this than ever²⁴. Students and junior trainees hold perceptions that a surgical career is incompatible with family life²⁵. Consensus obtained at a recent ASiT conference concluded that better hours and more time allocated for training during working hours are the most influential factors relating to surgical recruitment and retention²⁰. A lack of flexible training opportunities in surgery is noteworthy, and only 10% of UK surgical trainees think the information provided on less than full time (LTFT) training is adequate²⁶.  

Despite this, it is worth reminding students that although generally reporting less leisure time, surgical trainees in the UK maintain equivocal life enjoyment to other trainees²⁷; orthopaedic surgeons also score highly in job satisfaction^28,29 and are among the happiest surgeons when balancing satisfaction with workload³⁰. 

With LTFT training negatively affecting career progression³¹, potential barriers also exist to parenting and motherhood. Possible solutions include providing hospital childcare, implementing cultural change encouraging more equally distributed maternity/paternity leave, and individualised initiatives to maintain skills during leave (e.g., taking call or theatre attendance one day a week, simulation training and out-of-training research). Hospital childcare support and day nurseries are other potential solutions. 

A lack of female mentorship is identified in surgery, and is perhaps consequential when considering the differing decisions and barriers women in surgery face¹⁵. An American study found that females were more likely to choose orthopaedics if they had a same-sex mentor³². Additionally, evidence indicates that minority groups are underrepresented in surgical leadership across all specialties in the UK³³, demonstrating a lack of role models for some students. Targeted mentorship schemes alongside appropriate equality and diversity monitoring may begin to challenge this.

A belief lingers that physical strength is a prerequisite for an orthopaedic career^34,35 and a stereotype persists that orthopaedic surgeons use blunt tools and lack academic ability. Regarding intelligence, evidence suggests this is not the case³⁶, nor is physical strength a precondition. Furthermore, as a specialty, orthopaedics has one of the best research outputs, especially in the UK^37,38.

Conclusion

Undergraduate conferences, practical skills sessions, mentorship schemes, and research opportunities all bolster student interest. This, in synergy with removing barriers such as lack of diversity and work-life balance issues through targeted interventions, will encourage a greater number of prospective medical students from a wider demographic towards considering this rewarding career.

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