Do Student Perceptions of Surgeons Change during Medical School? A Longitudinal Analysis during a 4-Year Curriculum

Background: Student recruiting is a top priority for surgical educators. Efforts have focused on improving the junior clerkship, but earlier interventions might prove to be more effective. This study was performed to determine students' perceptions of surgeons across all 4 years, with special emphasis on the effect of the 3^rd-year clerkship. Study Design: During 2004 to 2007, medical students at all levels were surveyed with 21 statements about surgeons' behavior, lifestyle issues, and potential as role models. Subjects responded anonymously using a 5-point Likert scale (1 = strongly agree). Surveys were administered annually to medical student year 1 (MS1), MS2, and MS4, and before and after the clerkship to MS3. Data were analyzed using chi-square contingency table analyses. Results: Three-thousand and sixty surveys were analyzed (MS1, n = 833; MS2, n = 670; MS3, n = 1,193; and MS4, n = 364). Responses among MS1 and MS2 confirm that students enter medical school with negative impressions of surgeons. The surgical clerkship had a positive impact, but this effect was lost by senior year. Changes in perceptions were statistically significant for 20 of 21 statements. This is underscored by the fact that the proportion of students applying to general surgery from our medical school remains essentially unchanged (2004, 5.3%; 2005, 7.4%; 2006, 10%; 2007, 7.4%; and 2008, 6%). Conclusions: These data suggest that the junior surgery clerkship has a favorable but transient impact on the negative perceptions that medical students have about surgeons. Perceptions return to negative values within 1 year of the clerkship. Recruiting efforts should be focused on earlier interaction with students rather than concentrating on a 2- to 3-month rotation in the junior year.