Incisions and Decisions: Impact of Operative Involvement on Medical Student Interest and Career Perceptions

Incisions and Decisions: Impact of Operative Involvement on Medical Student Interest and Career Perceptions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Incisions and Decisions: Impact of Operative Involvement on Medical Student Interest and Career Perceptions Alice Qian, Daniel Chen, AJ Haas, Angela Thelen, Kevin El-Hayek This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7473302/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Purpose : The impact of medical students’ third-year rotation operative exposure on career choice is unknown. We conducted a single-institution study to evaluate the effect of operative involvement on third-year medical students' interest in surgery. Methods : Six cohorts of third-year medical students who completed surgical rotations in 2023-2024 at a single academic medical center were given a survey to assess baseline perceptions and changes in interest in surgery as a career. Results : 35 out of 78 eligible students responded. Interest in surgery as a career increased from 2.06 pre-rotation to 2.91 post-rotation (p = 0.008). Students on the emergency general surgery (EGS) service showed an increase in interest from 2.18 pre-rotation to 3.45 post-rotation (p = 0.021). Students on an elective service reported a lesser increase from 2.00 to 2.67 (p = 0.100). Students who scrubbed-in < 8 times per week showed an increase in interest from 1.94 pre-rotation to 2.53 post-rotation (p = 0.214). Meanwhile, students who scrubbed in ≥ 8 times per week showed a significant increase in interest from 2.17 to 3.28 (p = 0.015). Key factors affecting interest included faculty engagement, resident engagement, perceptions of wellness/lifestyle, and types of operations involved. Conclusion : Actively engaging third-year medical students as members of the surgical team during their surgery rotation enhanced their interest in pursuing a career in surgery, underscoring the importance of hands-on experience in students' career aspirations. The number of cases students participated in during their rotation and surgical service was positively correlated with their interest in surgery. education medical student clinical rotations surgery Figures Figure 1 Figure 2 Background Third-year medical students often form impressions and make critical decisions regarding their specialty preferences during their clinical rotations. Given the projected shortage of 10,000 to 19,900 surgeons by 2036 in the United States [ 1 ], understanding the factors that influence medical students' interest in surgical careers is crucial for developing effective educational strategies to address the current and future needs of the surgical workforce. Negative perceptions of surgery, inadequate availability of role models, and lack of meaningful involvement can deter students from the field, whereas active involvement, such as scrubbing-in, suturing, assisting in the operating room (OR), and meaningful engagement with surgical procedures can significantly impact students' interest in pursuing surgical careers after their surgery rotation [ 2 , 3 ]. Previous studies have demonstrated that early and sustained exposure to surgical procedures, along with strong mentorship and role modeling from attending surgeons and residents, play significant roles in fostering students' interest in surgery. For instance, Dimou et al. highlighted that early exposure to surgery could mitigate misconceptions and dissatisfaction among preclinical students [ 4 ]. Similarly, Shelton et al. and Drolet et al. found that hands-on experiences such as laparoscopic training, suturing, and assisting in the OR significantly increased students' interest in surgical careers [ 5 , 6 ]. This study aimed to evaluate the impact of operative involvement on the interest and career perceptions of third-year medical students during their surgical rotations through a qualitative and quantitative survey methodology. By assessing changes in students' interests before and after their rotations, the correlation between hands-on surgical experience and students' career aspirations in surgery was predicted. We hypothesized that overall interest in pursuing a surgical field increases among third-year medical students following completion of the core surgery rotation but likely depends on the extent of involvement and the type of surgical services. Methods This single-institution study surveyed six cohorts of third-year medical students who completed their surgical rotations during the 2023–2024 academic year at the MetroHealth System in Cleveland, Ohio. The study was approved by the Case Western Reserve University Institutional Review Board (IRB No. STUDY20231036) and conducted in accordance with ethical standards outlined in the Declaration of Helsinki. The objective was to evaluate the effect of operative involvement on their interest in surgery as a career. Students were assigned to specific surgical services for two or four weeks based on personal preference and availability. These services included emergency general surgery (EGS) and various elective surgical services. Students were assigned to one attending physician preceptor per week by the program coordinator and expected to attend their preceptor’s cases throughout the week. Deviations to this schedule could be initiated by the residents on the team or students themselves. Surveys were administered at the end of surgery rotation to assess students' baseline perceptions and changes in their interest in surgery (see supplemental materials). Responding students gave informed consent to participate and have their survey responses recorded in this study. The survey included Likert scale questions to rate interest in surgery before and after the rotation (ranging from "0 – no interest" to "5 – exclusive interest"), as well as open-ended prompts for qualitative feedback. Additionally, students were asked about their operative exposure and satisfaction with the exposure. The average number of times students scrubbed in per week and their satisfaction with operative exposure based on a Likert Scale (ranging from “1 – extremely dissatisfied (not enough)” to “5 – too much”) were collected. Lastly, students were asked to identify other factors that either increased or decreased their interest in surgery from a provided checklist, which included the following options: faculty engagement, resident engagement, OR atmosphere, intraoperative assessments, work hours, patient population/pathology, feedback/performance in rotation, learning materials, didactics, hospital resource, wellness/lifestyle, types of operations viewed/involved in. Students could select multiple options, all of which carried equal weight. Descriptive statistics were used to summarize the data, including means, standard deviations, and 95% confidence intervals (CI). A paired two-sample t-test was performed to evaluate the statistical significance of changes in interest levels pre- and post-rotation. The change in interest was defined as the difference between the post-rotation and pre-rotation interest levels. Subgroup analyses were conducted based on the type of surgical service (EGS vs. elective services) and the frequency of scrubbing in (less than 8 times vs. 8 or more times per week). The scrubbing frequency threshold was determined using the median number of cases scrubbed per week as reported by respondents. Qualitative feedback was analyzed to identify key factors influencing students' interest in surgery. All open-ended responses were reviewed by the research team and categorized by thematic similarity into the factors that affected interest in surgery (listed above). Representative responses were selected to illustrate the five most frequently identified factors from student responses. The primary outcome was the change in students' interest in surgery pre- and post-rotation overall and stratified by surgical service. Secondary outcomes included the relationship between the frequency of scrubbing in and the change in interest levels. Results A total of 78 students were eligible for the study, and 35 responded, yielding a response rate of 45%. These students scrubbed in an average of 7.43 times per week (95% CI: 6.57–8.28), with 82.9% reporting satisfaction with scrub-in frequency based on a Likert Scale. 11.4% reported dissatisfaction with scrub-in frequency, citing insufficient scrub-in time, while 5.7% felt they had scrubbed in too frequently. Overall interest in pursuing a surgical career increased from a mean pre-rotation interest level of 2.06 (95% CI: 1.54–2.58) to a post-rotation interest level of 2.91 (95% CI: 2.35–3.48) (p = 0.008). However, interest in pursuing a surgical career varied by service (Fig. 1 ). Students assigned to the EGS service, who experienced higher operative exposure by scrubbing in on average 7.91 times per week (95% CI: 6.39–9.43), showed a significant increase in interest from a pre-rotation level of 2.18 (95% CI: 1.19–3.17) to a post-rotation level of 3.45 (95% CI: 2.28–4.63) (p = 0.021). In contrast, students on elective surgical services, who scrubbed in 7.21 times per week on average (95% CI: 6.11–8.31), exhibited an increase in interest from 2.00 (95% CI: 1.34–2.66) to 2.67 (95% CI: 2.00-3.33) (p = 0.100). Furthermore, interest in pursuing a surgical career varied by the frequency of scrubbing-in throughout the week (Fig. 2 ). Students who scrubbed in fewer than 8 times per week (n = 17) reported an increase in interest from 1.94 (95% CI: 1.12–2.76) to 2.53 (95% CI: 1.60–3.46) (p = 0.214) while students who scrubbed in 8 or more times per week (n = 18) demonstrated a more pronounced increase in interest from 2.17 (95% CI: 1.44–2.90) to 3.28 (95% CI: 2.56-4.00) (p = 0.015). Although only 4 out of 35 students expressed dissatisfaction in their frequency of scrubbing-in, 17 out of 35 (49%) students expressed feelings of limited or dissatisfactory involvement when scrubbing in, particularly when relegated to less significant tasks such as port site closure. Nevertheless, 28 out of 35 students (80%) reported scrubbing in almost daily, and 18 out of 35 (51%) reported scrubbing in 10 or more times per week at certain points. Additionally, 7 out of 35 students (20%) reported scrubbing in during weekends. When students were asked to identify factors that influenced their interest in surgery, more than 20 students included faculty and resident engagement, perceptions of wellness and lifestyle, types of operations, and the overall atmosphere in the operating room. Of these factors, resident engagement followed by faculty engagement were most frequently cited. Other less cited factors included work hours (57%) and feedback/performance in the rotation (43%). These themes were evident in qualitative open-ended responses (Table 1 ). Several students stated that overall level of student involvement depended heavily on the attending faculty and residents on the team. Some let students play an active role in participating in surgeries (scrubbing into open surgery, driving the camera in laparoscopic procedures, etc.), while others preferred students play a more passive role through observation. Ultimately, each student’s unique experience varied depending on their teams’ expectations of engagement. Table 1 Qualitative open-ended student survey responses illustrating the themes and factors identified as influential in shaping their interest in surgery Theme Qualitative student response Resident engagement “My interest in surgery did increase just by matter of working with residents who were friendly and thoughtful.” “Residents … treated each other and students poorly.” Faulty engagement “It was very hit or miss what type of involvement/experience we had based on which attendings/residents we were paired with. I feel that it would be most fair to have students rotate with multiple teams during the rotation, so that we get to work with a variety of surgeons.” “Some faculty don’t let students scrub into cases…” “I'm sure the faculty understand the importance of student participation. It's unnerving to have your patient be the first real patient a student helps operate on. But it's necessary…” Perceptions of wellness and lifestyle “Even if I loved surgery, you couldn't pay me enough to work the hours that the residents do.” “Residents are all burnt out…” Types of procedures “It was a bit demoralizing at times to see that my peers were getting several hours of engaged OR time per day, while I was watching multiple laparoscopic cases from the sidelines while not scrubbed in or engaged.” OR atmosphere “The environment is simply toxic…” “I spent a large amount of time helping out the scrub nurse/floating nurse because I wasn't able or allowed to participate a large amount of the time.” Discussion Especially considering the perceptions of surgery amongst preclinical medical students prior to beginning clinical rotations, early exposure to surgery plays an influential role in garnering interest and mitigating misconceptions and dissatisfaction [ 4 ]. Efforts to introduce students to surgery even prior to their surgical rotations have positive outcomes on overall interest in the field. For example, surgery-related activities such as laparoscopic training, suturing, surgical rounds, and assisting in the OR have been associated with increased interest amongst students to pursue surgery as a career compared to their baseline interest [ 3 , 4 ]. Given this early impact, there is no doubt that the third-year surgery rotation has a powerful impact on shaping students’ interest in pursuing a surgical career. During this time, students seek opportunities to develop technical skills and meaningful inclusion on the surgical team to decide if surgery is a potential career they envision for themselves [ 7 , 8 ]. This study provides compelling evidence that active involvement in the operating room during surgical rotations positively correlates with third-year medical students' interest in pursuing a career in surgery. Overall post-rotation interest in a surgical career increased significantly from pre-rotation interest. However, stratification by frequency of scrubbing-in and type of service demonstrated that these factors may influence student perceptions and interest. The higher frequency of scrubbing-in correlated with pre- and post-rotation interest. In this study, scrub-in frequency of eight or more times per week was associated with a significant increased interest, whereas lower scrub-in frequencies showed no such effect. Furthermore, students on EGS service demonstrated an increase in interest pre- and post-rotation, whereas those placed on elective surgical services did not show a significant increase in interest. One potential explanation for these findings is that students on EGS reportedly scrubbed-in more frequently than students on elective services, giving these students more direct and hands-on learning experiences in the OR. The EGS service may also experience higher daily caseloads and thus offer more opportunities for students to scrub into cases throughout the day [ 9 , 10 ]. However, operative time may also account for these differences as elective procedures such as cancer resection or hip replacements often exceed the duration of EGS procedures such as appendectomies and cholecystectomies [ 11 ]. Longer operative times among elective procedures potentially limits the number of cases students can scrub into and could deter them from considering a surgical career. Overall, these findings suggest that specific aspects of the third-year surgical rotation are more strongly associated with shaping student career aspirations. Although greater scrub-in frequency correlated with interest in surgery, the perceived quality of time spent scrubbing-in influenced student satisfaction with the experience. In this study, nearly half of the participating students expressed feeling of dissatisfactory involvement when delegated to less significant tasks in the OR such as port site closure, observing, and retracting. Tasks such as camera-driving during laparoscopic procedures were perceived as more engaging and provided a more meaningful OR experience. Our findings align with existing literature underscoring the critical role of direct involvement and hands-on experience in shaping career aspirations. The level of involvement in the OR is predictive of students viewing the OR as a positive learning experience and ultimately plays a major role in career choices [ 7 , 12 ]. In addition to the number of operations observed and cases participated/scrubbed, suturing in the operating room, assisting in dissection, and driving the camera in laparoscopic procedures directly affects students’ decision to pursue surgical careers, as these factors have been associated with a greater likelihood of promoting interest in surgery among students [ 2 , 13 , 14 ]. Opportunities to assist and perform minor parts of the procedures enhance the students’ exposure and overall experience. While the majority (83%) of students reported satisfaction with their frequency of involvement, a small subset (11%) of students felt limited or dissatisfied with their involvement. Some dissatisfaction arose from comparison of the level of involvement other students experienced in the OR. Literature suggests that this, in part, is a result of disparity between surgeons’ and medical students’ expectations for the rotation. Students often expect more active hands-on experiences to develop technical skills whereas surgeons believe their role entails teaching clinical applications of medicine and hence may not encourage active participation [ 15 ]. This highlights the need for communication between students and educators to align their expectations, ensuring that students have meaningful operative involvement while learning the clinical applications of medicine. These expectations are likely to vary depending on the specific team of surgeons and residents, emphasizing the importance of clear communication for each new team assignment. Students' perceptions of their roles in the OR significantly impact their career choices [ 4 ], suggesting that more active involvement in procedures could mitigate feelings of dissatisfaction with their surgical rotation and subsequent disinterest in surgery as a career. Other factors that can facilitate high-quality OR experiences not directly assessed in this study could include pre-rotation readiness, level of exposure to floor work, and working with junior versus senior residents versus fellows in the OR. The importance of mentorship and role models likewise play a role in students’ career choice. In this study, the most frequently cited factors influencing interest in surgery were resident and faculty engagement. Student perception of how residents and faculty engaged with them and each other shaped their sentiments about the surgery rotation. Studies have demonstrated a positive correlation between interest in surgery and students identifying attending and residents as role positive role models in their training [ 14 , 16 ]. Active involvement in medical education and encouragement can increase student confidence in OR etiquette, participation in rounds, and suturing skills, which ultimately mediates positive perceptions towards pursuing surgery as a career [ 17 , 18 ]. Operative exposure and quality of mentoring relationships with residents and attendings in increasing OR confidence represent key factors in the students’ career decisions. As evidenced, continuing these efforts longitudinally throughout the surgical rotation garners more interest in pursuing surgery as a career. This study has several limitations. First, it was conducted at a single hospital system in collaboration with one medical school, which limited the cohort size and the potential generalizability of the results. Increasing the size of sample and involving more institutions could establish even stronger associations between surgery rotation experiences and shaping students’ interest in the field. Additionally, the survey design could lend itself to nonresponse bias. Since the survey was optional for students with little incentive to for completing it, students that completed the survey were more likely those who felt strongly (either positively or negatively) regarding their experiences. In contrast, those who felt ambiguous or indifferent were likely less inclined to complete the survey. The retrospective design of the study limits our ability to determine causation despite the results suggesting that increased frequency of scrubbing-in and time on the EGS service correlated with increased interest in a surgical specialty after the rotation. Since both pre- and post-rotation interest were measured after the conclusion of the rotation, recall and social desirability biases could have contributed to the effects seen. Students may have inaccurately estimated the numbers of cases they scrubbed into and their pre-rotation interest levels. Shifts in students’ attitude towards surgery pre- and post-rotation could have been artifacts of memory or reflective of what students believed they should have gained from the rotation. Furthermore, pre-existing student interest could have influenced the frequency of scrubbing throughout. Especially given the action-based learning style of surgical residents and likely parallel of medical student that successfully match in surgery [ 19 ], students with more interest in surgery may have sought more opportunities to scrub-in and be more involved in the OR compared to their peers with less interest in surgery to begin with [ 20 ]. This can be supported by our finding that students that scrubbed in at least 8 times per week exhibited a higher pre-rotation interest level than students that scrubbed in less than 8 times per week. Despite these limitations, our results introduce valuable insights into medical student career path decision-making based on their experiences during third-year rotations. The practice of collecting both pre- and post-rotation feedback from students prospectively should be more widely integrated into medical school training to continue enhancing student experiences. The feedback provides insight for faculty and residents to identify areas and strength and improvement in mentoring the next generation of physicians. As demonstrated in this study, positive student experiences– whether through hands-on OR exposure or relationships with faculty and results–can foster interest in surgical careers and assist in addressing the current shortage of surgeons. Conclusion Our study underscores the critical importance of operative involvement and the broader learning environment in shaping medical students' interest in surgery. Active participation, combined with strong faculty and resident mentorship, correlate with greater student interest in pursuing surgical careers. These findings suggest that surgical education programs should prioritize hands-on experience and supportive mentorship to attract and retain future surgeons. Furthermore, concept of actively collecting both pre- and post-rotation feedback can assist in identifying areas to target for enhanced student engagement, which can ultimately serve the surgical fields well by garnering more interest in the field. Declarations Acknowledgements: The authors have no acknowledgements to declare. Competing Interests: The authors have no related conflicts of interest to declare. Funding/Financial support: The authors received no funding or financial support for this study. Authors' contributions: AQ collected survey data, performed statistical analysis, created figures 1-2 and table 1 based on survey responses, and was a major contributor in writing the manuscript. DC collected the survey data and was a major contributor in writing the manuscript. AH, AT, and KE made substantial revisions to the manuscript. All authors were involved in designing the study and creating the surveys. All authors read and approved the final manuscript. References The Complexities of Physician Supply and Demand: Projections From 2021 to 2036 [Internet]. American Association of Medical Colleges; 2024. Available from: https://www.aamc.org/media/75236/download?attachment Schmidt LE, Cooper CA, Guo WA. Factors influencing US medical students’ decision to pursue surgery. Journal of Surgical Research. 2016 Jun;203(1):64–74. Al-Heeti KNM, Nassar AK, DeCorby K, Winch J, Reid S. 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A Mentorship-Based Surgery Clerkship: A Prospective Study Investigating Student Satisfaction. Journal of Surgical Research. 2024 Mar;295:41–6. Kassam AF, Cortez AR, Winer LK, Kuethe JW, Athota KP, Quillin RC. The impact of medical student interest in surgery on clerkship performance and career choice. The American Journal of Surgery. 2020 Feb;219(2):359–65. McKinley SK, Cassidy DJ, Mansur A, Saillant N, Ghosh A, Evenson A, et al. Identification of Specific Educational Targets to Improve the Student Surgical Clerkship Experience. Journal of Surgical Research. 2020 Oct;254:49–57. Additional Declarations No competing interests reported. Supplementary Files QualtricsSurvey.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 04 Nov, 2025 Reviewers invited by journal 30 Sep, 2025 Editor assigned by journal 28 Aug, 2025 Submission checks completed at journal 28 Aug, 2025 First submitted to journal 27 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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02:39:36","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":67399,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7473302/v1/7b7362ed3a079d0e2d3d0006.html"},{"id":93543970,"identity":"2a01aedb-67f7-49c7-8a6c-16c85130f292","added_by":"auto","created_at":"2025-10-15 02:47:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":94079,"visible":true,"origin":"","legend":"\u003cp\u003eDifferences in surgical career interest pre-rotation versus post-rotation based on service\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7473302/v1/159e3c5dd45f6782760695e6.png"},{"id":93543971,"identity":"27ff76eb-61cc-4cb9-8896-3708a4ba394f","added_by":"auto","created_at":"2025-10-15 02:47:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":101061,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDifferences\u003c/strong\u003ein surgical career interest pre-rotation versus post-rotation based on frequency of scrubbing in\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7473302/v1/44d10f63bb6db414d0c42bb0.png"},{"id":93544732,"identity":"291e406d-465d-4133-9135-0d7346e8a0d8","added_by":"auto","created_at":"2025-10-15 02:55:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":546381,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7473302/v1/e4a4f8b6-3b70-4a5e-bc45-618a432d1c57.pdf"},{"id":93544725,"identity":"daeaf9e2-0524-4191-83c1-f1c9816a7c16","added_by":"auto","created_at":"2025-10-15 02:55:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":210167,"visible":true,"origin":"","legend":"","description":"","filename":"QualtricsSurvey.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7473302/v1/8ffd215cbbd4db048ada254d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eIncisions and Decisions: Impact of Operative Involvement on Medical Student Interest and Career Perceptions\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eThird-year medical students often form impressions and make critical decisions regarding their specialty preferences during their clinical rotations. Given the projected shortage of 10,000 to 19,900 surgeons by 2036 in the United States [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], understanding the factors that influence medical students' interest in surgical careers is crucial for developing effective educational strategies to address the current and future needs of the surgical workforce. Negative perceptions of surgery, inadequate availability of role models, and lack of meaningful involvement can deter students from the field, whereas active involvement, such as scrubbing-in, suturing, assisting in the operating room (OR), and meaningful engagement with surgical procedures can significantly impact students' interest in pursuing surgical careers after their surgery rotation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePrevious studies have demonstrated that early and sustained exposure to surgical procedures, along with strong mentorship and role modeling from attending surgeons and residents, play significant roles in fostering students' interest in surgery. For instance, Dimou et al. highlighted that early exposure to surgery could mitigate misconceptions and dissatisfaction among preclinical students [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Similarly, Shelton et al. and Drolet et al. found that hands-on experiences such as laparoscopic training, suturing, and assisting in the OR significantly increased students' interest in surgical careers [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study aimed to evaluate the impact of operative involvement on the interest and career perceptions of third-year medical students during their surgical rotations through a qualitative and quantitative survey methodology. By assessing changes in students' interests before and after their rotations, the correlation between hands-on surgical experience and students' career aspirations in surgery was predicted. We hypothesized that overall interest in pursuing a surgical field increases among third-year medical students following completion of the core surgery rotation but likely depends on the extent of involvement and the type of surgical services.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis single-institution study surveyed six cohorts of third-year medical students who completed their surgical rotations during the 2023\u0026ndash;2024 academic year at the MetroHealth System in Cleveland, Ohio. The study was approved by the Case Western Reserve University Institutional Review Board (IRB No. STUDY20231036) and conducted in accordance with ethical standards outlined in the Declaration of Helsinki. The objective was to evaluate the effect of operative involvement on their interest in surgery as a career. Students were assigned to specific surgical services for two or four weeks based on personal preference and availability. These services included emergency general surgery (EGS) and various elective surgical services. Students were assigned to one attending physician preceptor per week by the program coordinator and expected to attend their preceptor\u0026rsquo;s cases throughout the week. Deviations to this schedule could be initiated by the residents on the team or students themselves.\u003c/p\u003e\u003cp\u003eSurveys were administered at the end of surgery rotation to assess students' baseline perceptions and changes in their interest in surgery (see supplemental materials). Responding students gave informed consent to participate and have their survey responses recorded in this study. The survey included Likert scale questions to rate interest in surgery before and after the rotation (ranging from \"0 \u0026ndash; no interest\" to \"5 \u0026ndash; exclusive interest\"), as well as open-ended prompts for qualitative feedback. Additionally, students were asked about their operative exposure and satisfaction with the exposure. The average number of times students scrubbed in per week and their satisfaction with operative exposure based on a Likert Scale (ranging from \u0026ldquo;1 \u0026ndash; extremely dissatisfied (not enough)\u0026rdquo; to \u0026ldquo;5 \u0026ndash; too much\u0026rdquo;) were collected. Lastly, students were asked to identify other factors that either increased or decreased their interest in surgery from a provided checklist, which included the following options: faculty engagement, resident engagement, OR atmosphere, intraoperative assessments, work hours, patient population/pathology, feedback/performance in rotation, learning materials, didactics, hospital resource, wellness/lifestyle, types of operations viewed/involved in. Students could select multiple options, all of which carried equal weight.\u003c/p\u003e\u003cp\u003eDescriptive statistics were used to summarize the data, including means, standard deviations, and 95% confidence intervals (CI). A paired two-sample t-test was performed to evaluate the statistical significance of changes in interest levels pre- and post-rotation. The change in interest was defined as the difference between the post-rotation and pre-rotation interest levels. Subgroup analyses were conducted based on the type of surgical service (EGS vs. elective services) and the frequency of scrubbing in (less than 8 times vs. 8 or more times per week). The scrubbing frequency threshold was determined using the median number of cases scrubbed per week as reported by respondents. Qualitative feedback was analyzed to identify key factors influencing students' interest in surgery. All open-ended responses were reviewed by the research team and categorized by thematic similarity into the factors that affected interest in surgery (listed above). Representative responses were selected to illustrate the five most frequently identified factors from student responses. The primary outcome was the change in students' interest in surgery pre- and post-rotation overall and stratified by surgical service. Secondary outcomes included the relationship between the frequency of scrubbing in and the change in interest levels.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 78 students were eligible for the study, and 35 responded, yielding a response rate of 45%. These students scrubbed in an average of 7.43 times per week (95% CI: 6.57\u0026ndash;8.28), with 82.9% reporting satisfaction with scrub-in frequency based on a Likert Scale. 11.4% reported dissatisfaction with scrub-in frequency, citing insufficient scrub-in time, while 5.7% felt they had scrubbed in too frequently. Overall interest in pursuing a surgical career increased from a mean pre-rotation interest level of 2.06 (95% CI: 1.54\u0026ndash;2.58) to a post-rotation interest level of 2.91 (95% CI: 2.35\u0026ndash;3.48) (p\u0026thinsp;=\u0026thinsp;0.008).\u003c/p\u003e\u003cp\u003eHowever, interest in pursuing a surgical career varied by service (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Students assigned to the EGS service, who experienced higher operative exposure by scrubbing in on average 7.91 times per week (95% CI: 6.39\u0026ndash;9.43), showed a significant increase in interest from a pre-rotation level of 2.18 (95% CI: 1.19\u0026ndash;3.17) to a post-rotation level of 3.45 (95% CI: 2.28\u0026ndash;4.63) (p\u0026thinsp;=\u0026thinsp;0.021). In contrast, students on elective surgical services, who scrubbed in 7.21 times per week on average (95% CI: 6.11\u0026ndash;8.31), exhibited an increase in interest from 2.00 (95% CI: 1.34\u0026ndash;2.66) to 2.67 (95% CI: 2.00-3.33) (p\u0026thinsp;=\u0026thinsp;0.100).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFurthermore, interest in pursuing a surgical career varied by the frequency of scrubbing-in throughout the week (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Students who scrubbed in fewer than 8 times per week (n\u0026thinsp;=\u0026thinsp;17) reported an increase in interest from 1.94 (95% CI: 1.12\u0026ndash;2.76) to 2.53 (95% CI: 1.60\u0026ndash;3.46) (p\u0026thinsp;=\u0026thinsp;0.214) while students who scrubbed in 8 or more times per week (n\u0026thinsp;=\u0026thinsp;18) demonstrated a more pronounced increase in interest from 2.17 (95% CI: 1.44\u0026ndash;2.90) to 3.28 (95% CI: 2.56-4.00) (p\u0026thinsp;=\u0026thinsp;0.015).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAlthough only 4 out of 35 students expressed dissatisfaction in their frequency of scrubbing-in, 17 out of 35 (49%) students expressed feelings of limited or dissatisfactory involvement when scrubbing in, particularly when relegated to less significant tasks such as port site closure. Nevertheless, 28 out of 35 students (80%) reported scrubbing in almost daily, and 18 out of 35 (51%) reported scrubbing in 10 or more times per week at certain points. Additionally, 7 out of 35 students (20%) reported scrubbing in during weekends.\u003c/p\u003e\u003cp\u003eWhen students were asked to identify factors that influenced their interest in surgery, more than 20 students included faculty and resident engagement, perceptions of wellness and lifestyle, types of operations, and the overall atmosphere in the operating room. Of these factors, resident engagement followed by faculty engagement were most frequently cited. Other less cited factors included work hours (57%) and feedback/performance in the rotation (43%). These themes were evident in qualitative open-ended responses (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Several students stated that overall level of student involvement depended heavily on the attending faculty and residents on the team. Some let students play an active role in participating in surgeries (scrubbing into open surgery, driving the camera in laparoscopic procedures, etc.), while others preferred students play a more passive role through observation. Ultimately, each student\u0026rsquo;s unique experience varied depending on their teams\u0026rsquo; expectations of engagement.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eQualitative open-ended student survey responses illustrating the themes and factors identified as influential in shaping their interest in surgery\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQualitative student response\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eResident engagement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ldquo;My interest in surgery did increase just by matter of working with residents who were friendly and thoughtful.\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ldquo;Residents \u0026hellip; treated each other and students poorly.\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eFaulty engagement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ldquo;It was very hit or miss what type of involvement/experience we had based on which attendings/residents we were paired with. I feel that it would be most fair to have students rotate with multiple teams during the rotation, so that we get to work with a variety of surgeons.\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ldquo;Some faculty don\u0026rsquo;t let students scrub into cases\u0026hellip;\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ldquo;I'm sure the faculty understand the importance of student participation. It's unnerving to have your patient be the first real patient a student helps operate on. But it's necessary\u0026hellip;\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePerceptions of wellness and lifestyle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ldquo;Even if I loved surgery, you couldn't pay me enough to work the hours that the residents do.\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ldquo;Residents are all burnt out\u0026hellip;\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTypes of procedures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ldquo;It was a bit demoralizing at times to see that my peers were getting several hours of engaged OR time per day, while I was watching multiple laparoscopic cases from the sidelines while not scrubbed in or engaged.\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOR atmosphere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ldquo;The environment is simply toxic\u0026hellip;\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ldquo;I spent a large amount of time helping out the scrub nurse/floating nurse because I wasn't able or allowed to participate a large amount of the time.\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eEspecially considering the perceptions of surgery amongst preclinical medical students prior to beginning clinical rotations, early exposure to surgery plays an influential role in garnering interest and mitigating misconceptions and dissatisfaction [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Efforts to introduce students to surgery even prior to their surgical rotations have positive outcomes on overall interest in the field. For example, surgery-related activities such as laparoscopic training, suturing, surgical rounds, and assisting in the OR have been associated with increased interest amongst students to pursue surgery as a career compared to their baseline interest [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Given this early impact, there is no doubt that the third-year surgery rotation has a powerful impact on shaping students\u0026rsquo; interest in pursuing a surgical career. During this time, students seek opportunities to develop technical skills and meaningful inclusion on the surgical team to decide if surgery is a potential career they envision for themselves [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study provides compelling evidence that active involvement in the operating room during surgical rotations positively correlates with third-year medical students' interest in pursuing a career in surgery. Overall post-rotation interest in a surgical career increased significantly from pre-rotation interest. However, stratification by frequency of scrubbing-in and type of service demonstrated that these factors may influence student perceptions and interest.\u003c/p\u003e\u003cp\u003eThe higher frequency of scrubbing-in correlated with pre- and post-rotation interest. In this study, scrub-in frequency of eight or more times per week was associated with a significant increased interest, whereas lower scrub-in frequencies showed no such effect. Furthermore, students on EGS service demonstrated an increase in interest pre- and post-rotation, whereas those placed on elective surgical services did not show a significant increase in interest. One potential explanation for these findings is that students on EGS reportedly scrubbed-in more frequently than students on elective services, giving these students more direct and hands-on learning experiences in the OR. The EGS service may also experience higher daily caseloads and thus offer more opportunities for students to scrub into cases throughout the day [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, operative time may also account for these differences as elective procedures such as cancer resection or hip replacements often exceed the duration of EGS procedures such as appendectomies and cholecystectomies [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Longer operative times among elective procedures potentially limits the number of cases students can scrub into and could deter them from considering a surgical career. Overall, these findings suggest that specific aspects of the third-year surgical rotation are more strongly associated with shaping student career aspirations.\u003c/p\u003e\u003cp\u003eAlthough greater scrub-in frequency correlated with interest in surgery, the perceived quality of time spent scrubbing-in influenced student satisfaction with the experience. In this study, nearly half of the participating students expressed feeling of dissatisfactory involvement when delegated to less significant tasks in the OR such as port site closure, observing, and retracting. Tasks such as camera-driving during laparoscopic procedures were perceived as more engaging and provided a more meaningful OR experience. Our findings align with existing literature underscoring the critical role of direct involvement and hands-on experience in shaping career aspirations. The level of involvement in the OR is predictive of students viewing the OR as a positive learning experience and ultimately plays a major role in career choices [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In addition to the number of operations observed and cases participated/scrubbed, suturing in the operating room, assisting in dissection, and driving the camera in laparoscopic procedures directly affects students\u0026rsquo; decision to pursue surgical careers, as these factors have been associated with a greater likelihood of promoting interest in surgery among students [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Opportunities to assist and perform minor parts of the procedures enhance the students\u0026rsquo; exposure and overall experience.\u003c/p\u003e\u003cp\u003eWhile the majority (83%) of students reported satisfaction with their frequency of involvement, a small subset (11%) of students felt limited or dissatisfied with their involvement. Some dissatisfaction arose from comparison of the level of involvement other students experienced in the OR. Literature suggests that this, in part, is a result of disparity between surgeons\u0026rsquo; and medical students\u0026rsquo; expectations for the rotation. Students often expect more active hands-on experiences to develop technical skills whereas surgeons believe their role entails teaching clinical applications of medicine and hence may not encourage active participation [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This highlights the need for communication between students and educators to align their expectations, ensuring that students have meaningful operative involvement while learning the clinical applications of medicine. These expectations are likely to vary depending on the specific team of surgeons and residents, emphasizing the importance of clear communication for each new team assignment. Students' perceptions of their roles in the OR significantly impact their career choices [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], suggesting that more active involvement in procedures could mitigate feelings of dissatisfaction with their surgical rotation and subsequent disinterest in surgery as a career. Other factors that can facilitate high-quality OR experiences not directly assessed in this study could include pre-rotation readiness, level of exposure to floor work, and working with junior versus senior residents versus fellows in the OR.\u003c/p\u003e\u003cp\u003eThe importance of mentorship and role models likewise play a role in students\u0026rsquo; career choice. In this study, the most frequently cited factors influencing interest in surgery were resident and faculty engagement. Student perception of how residents and faculty engaged with them and each other shaped their sentiments about the surgery rotation. Studies have demonstrated a positive correlation between interest in surgery and students identifying attending and residents as role positive role models in their training [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Active involvement in medical education and encouragement can increase student confidence in OR etiquette, participation in rounds, and suturing skills, which ultimately mediates positive perceptions towards pursuing surgery as a career [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Operative exposure and quality of mentoring relationships with residents and attendings in increasing OR confidence represent key factors in the students\u0026rsquo; career decisions. As evidenced, continuing these efforts longitudinally throughout the surgical rotation garners more interest in pursuing surgery as a career.\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, it was conducted at a single hospital system in collaboration with one medical school, which limited the cohort size and the potential generalizability of the results. Increasing the size of sample and involving more institutions could establish even stronger associations between surgery rotation experiences and shaping students\u0026rsquo; interest in the field. Additionally, the survey design could lend itself to nonresponse bias. Since the survey was optional for students with little incentive to for completing it, students that completed the survey were more likely those who felt strongly (either positively or negatively) regarding their experiences. In contrast, those who felt ambiguous or indifferent were likely less inclined to complete the survey.\u003c/p\u003e\u003cp\u003eThe retrospective design of the study limits our ability to determine causation despite the results suggesting that increased frequency of scrubbing-in and time on the EGS service correlated with increased interest in a surgical specialty after the rotation. Since both pre- and post-rotation interest were measured after the conclusion of the rotation, recall and social desirability biases could have contributed to the effects seen. Students may have inaccurately estimated the numbers of cases they scrubbed into and their pre-rotation interest levels. Shifts in students\u0026rsquo; attitude towards surgery pre- and post-rotation could have been artifacts of memory or reflective of what students believed they should have gained from the rotation. Furthermore, pre-existing student interest could have influenced the frequency of scrubbing throughout. Especially given the action-based learning style of surgical residents and likely parallel of medical student that successfully match in surgery [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], students with more interest in surgery may have sought more opportunities to scrub-in and be more involved in the OR compared to their peers with less interest in surgery to begin with [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This can be supported by our finding that students that scrubbed in at least 8 times per week exhibited a higher pre-rotation interest level than students that scrubbed in less than 8 times per week. Despite these limitations, our results introduce valuable insights into medical student career path decision-making based on their experiences during third-year rotations.\u003c/p\u003e\u003cp\u003eThe practice of collecting both pre- and post-rotation feedback from students prospectively should be more widely integrated into medical school training to continue enhancing student experiences. The feedback provides insight for faculty and residents to identify areas and strength and improvement in mentoring the next generation of physicians. As demonstrated in this study, positive student experiences\u0026ndash; whether through hands-on OR exposure or relationships with faculty and results\u0026ndash;can foster interest in surgical careers and assist in addressing the current shortage of surgeons.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study underscores the critical importance of operative involvement and the broader learning environment in shaping medical students' interest in surgery. Active participation, combined with strong faculty and resident mentorship, correlate with greater student interest in pursuing surgical careers. These findings suggest that surgical education programs should prioritize hands-on experience and supportive mentorship to attract and retain future surgeons. Furthermore, concept of actively collecting both pre- and post-rotation feedback can assist in identifying areas to target for enhanced student engagement, which can ultimately serve the surgical fields well by garnering more interest in the field.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eThe authors have no acknowledgements to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e\u0026nbsp;The authors have no related conflicts of interest to declare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding/Financial support:\u003c/strong\u003e The authors received no funding or financial support for this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAQ collected survey data, performed statistical analysis, created figures 1-2 and table 1 based on survey responses, and was a major contributor in writing the manuscript. DC collected the survey data and was a major contributor in writing the manuscript. AH, AT, and KE made substantial revisions to the manuscript. All authors were involved in designing the study and creating the surveys. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eThe Complexities of Physician Supply and Demand: Projections From 2021 to 2036 [Internet]. American Association of Medical Colleges; 2024. Available from: https://www.aamc.org/media/75236/download?attachment\u003c/li\u003e\n\u003cli\u003eSchmidt LE, Cooper CA, Guo WA. Factors influencing US medical students\u0026rsquo; decision to pursue surgery. Journal of Surgical Research. 2016 Jun;203(1):64\u0026ndash;74. \u003c/li\u003e\n\u003cli\u003eAl-Heeti KNM, Nassar AK, DeCorby K, Winch J, Reid S. The Effect of General Surgery Clerkship Rotation on the Attitude of Medical Students Towards General Surgery as a Future Career. Journal of Surgical Education. 2012 Jul;69(4):544\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eDimou F, Koch A, Silva M, Donn N, Rosemurgy AS, Ross SB. Medical students\u0026rsquo; perception of a surgical career. Journal of the American College of Surgeons. 2011 Sep;213(3):S122\u0026ndash;3. \u003c/li\u003e\n\u003cli\u003eShelton J, Obregon M, Luo J, Feldman‐Schultz O, MacDowell M. Factors Influencing a Medical Student\u0026rsquo;s Decision to Pursue Surgery as a Career. World j surg. 2019 Dec;43(12):2986\u0026ndash;93. \u003c/li\u003e\n\u003cli\u003eDrolet BC, Sangisetty S, Mulvaney PM, Ryder BA, Cioffi WG. A mentorship-based preclinical elective increases exposure, confidence, and interest in surgery. The American Journal of Surgery. 2014 Feb;207(2):179\u0026ndash;86. \u003c/li\u003e\n\u003cli\u003eMcKinley SK, Witt EE, Acker RC, Cassidy DJ, Hamdi I, Mansur A, et al. A multisite study of medical student perspectives on the core surgical clerkship. Surgery. 2022 May;171(5):1215\u0026ndash;23. \u003c/li\u003e\n\u003cli\u003eSt. Hilaire C, Kopilova T, Gauvin JM. Attracting the Best Students to a Surgical Career. Surgical Clinics of North America. 2021 Aug;101(4):653\u0026ndash;65. \u003c/li\u003e\n\u003cli\u003eDeGirolamo K, D\u0026rsquo;Souza K, Apte S, Ball CG, Armstrong C, Reso A, et al. A day in the life of emergency general surgery in Canada: a multicentre observational study. Can J Surg. 2018 Aug;61(4):237\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003eGale SC, Shafi S, Dombrovskiy VY, Arumugam D, Crystal JS. The public health burden of emergency general surgery in the United States: A 10-year analysis of the Nationwide Inpatient Sample--2001 to 2010. J Trauma Acute Care Surg. 2014 Aug;77(2):202\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eMehta A, Efron DT, Canner JK, Manukyan MC, Dultz L, Burns C, et al. Surgeon variation in operating times and charges for emergency general surgery. J Surg Res. 2018 Jul;227:101\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eKo CY, Escarce JJ, Baker L, Klein D, Guarino C. Predictors for medical students entering a general surgery residency: national survey results. Surgery. 2004 Sep;136(3):567\u0026ndash;72. \u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Herrin JK, Lewis BJ, Rikkers LF, Chen H. Why do students choose careers in surgery? Journal of Surgical Research. 2004 Jun;119(2):124\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eBerman L, Rosenthal MS, Curry LA, Evans LV, Gusberg RJ. Attracting Surgical Clerks to Surgical Careers: Role Models, Mentoring, and Engagement in the Operating Room. Journal of the American College of Surgeons. 2008 Dec;207(6):793-800e2. \u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Neill R, Shapiro M, Merchant A. The Role of the Operating Room in Medical Student Education: Differing Perspectives of Learners and Educators. Journal of Surgical Education. 2018 Jan;75(1):14\u0026ndash;28. \u003c/li\u003e\n\u003cli\u003eMarshall DC, Salciccioli JD, Walton SJ, Pitkin J, Shalhoub J, Malietzis G. Medical Student Experience in Surgery Influences Their Career Choices: A Systematic Review of the Literature. Journal of Surgical Education. 2015 May;72(3):438\u0026ndash;45. \u003c/li\u003e\n\u003cli\u003eCochran A, Paukert JL, Neumayer LA. Does a general surgery clerkship influence student perceptions of surgeons and surgical careers? Surgery. 2003 Aug;134(2):153\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eJoel M, Iosif L, Grenda T, Tholey R. A Mentorship-Based Surgery Clerkship: A Prospective Study Investigating Student Satisfaction. Journal of Surgical Research. 2024 Mar;295:41\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eKassam AF, Cortez AR, Winer LK, Kuethe JW, Athota KP, Quillin RC. The impact of medical student interest in surgery on clerkship performance and career choice. The American Journal of Surgery. 2020 Feb;219(2):359\u0026ndash;65. \u003c/li\u003e\n\u003cli\u003eMcKinley SK, Cassidy DJ, Mansur A, Saillant N, Ghosh A, Evenson A, et al. Identification of Specific Educational Targets to Improve the Student Surgical Clerkship Experience. Journal of Surgical Research. 2020 Oct;254:49\u0026ndash;57. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"innovative-surgical-trends","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Innovative Surgical Trends](https://link.springer.com/journal/44414)","snPcode":"44414","submissionUrl":"https://submission.springernature.com/new-submission/44414/3?","title":"Innovative Surgical Trends","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"education, medical student, clinical rotations, surgery","lastPublishedDoi":"10.21203/rs.3.rs-7473302/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7473302/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: The impact of medical students’ third-year rotation operative exposure on career choice is unknown. We conducted a single-institution study to evaluate the effect of operative involvement on third-year medical students' interest in surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Six\u003cem\u003e \u003c/em\u003ecohorts of third-year medical students who completed surgical rotations in 2023-2024 at a single academic medical center were given a survey to assess baseline perceptions and changes in interest in surgery as a career.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: 35 out of 78 eligible students responded. Interest in surgery as a career increased from 2.06 pre-rotation to 2.91 post-rotation (p = 0.008). Students on the emergency general surgery (EGS) service showed an increase in interest from 2.18 pre-rotation to 3.45 post-rotation (p = 0.021). Students on an elective service reported a lesser increase from 2.00 to 2.67 (p = 0.100). Students who scrubbed-in \u0026lt; 8 times per week showed an increase in interest from 1.94 pre-rotation to 2.53 post-rotation (p = 0.214). Meanwhile, students who scrubbed in ≥ 8 times per week showed a significant increase in interest from 2.17 to 3.28 (p = 0.015). Key factors affecting interest included faculty engagement, resident engagement, perceptions of wellness/lifestyle, and types of operations involved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Actively engaging third-year medical students as members of the surgical team during their surgery rotation enhanced their interest in pursuing a career in surgery, underscoring the importance of hands-on experience in students' career aspirations. The number of cases students participated in during their rotation and surgical service was positively correlated with their interest in surgery.\u003c/p\u003e","manuscriptTitle":"Incisions and Decisions: Impact of Operative Involvement on Medical Student Interest and Career Perceptions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 02:39:31","doi":"10.21203/rs.3.rs-7473302/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"76268242971364365052235021884184868043","date":"2025-11-04T16:56:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-30T21:42:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-28T11:04:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-28T11:03:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"Innovative Surgical Trends","date":"2025-08-27T15:40:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"innovative-surgical-trends","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Innovative Surgical Trends](https://link.springer.com/journal/44414)","snPcode":"44414","submissionUrl":"https://submission.springernature.com/new-submission/44414/3?","title":"Innovative Surgical Trends","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5e7b9f59-66f0-425b-bb85-469e93315553","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-06T13:08:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-15 02:39:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7473302","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7473302","identity":"rs-7473302","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}