Vol. 4, Issue 7 (2018)
Australian medical student’s perceptions of orthopaedic surgery: Factors influencing the pursuit of orthopaedic training
Author(s): M Wilson, F Rusli, J Nguyen, S Fletcher
Abstract: Introduction: Previous research has shown that myriad factors determine medical students' choice of career path. Exposure to surgical specialties is beneficial to medical students, no matter their eventual area of specialisation. Orthopaedic Surgery is the second largest surgical subspecialty and has an important role in the musculoskeletal health of Australians. Undergraduate musculoskeletal education is often delivered in combination with other clinical placements and has to compete with other specialties in the curriculum. Methods: This study determined the understanding of Orthopaedics in a medical student cohort and explored factors influencing its choice as a specialty in an Australian context. Senior medical students from the University of Tasmania were examined on 20 different surgical scenarios and chose the appropriate subspecialty for the condition. Clinical scenarios included a host of Orthopaedic and non-Orthopaedic cases. The online platform used was Survey Monkey. Results: As far as we are aware, this study was the first of its kind in Australia. It was determined that direct clinical exposure to Orthopaedics enhanced both understanding and desirability of the specialty. Over 80% of respondents reported favorable benefits that were statistically significant. Lack of clinical experience in Orthopaedics was associated with a poor understanding of the specialty in all cohorts. Conclusion: Knowledge of medical students' perception of the educational opportunities provided in Orthopaedics has national significance at a workforce level and has relevance to the Australian Orthopaedic Association (AOA) and the Royal Australasian College of Surgeons (RACS). Indeed, medical students are more likely to consider an Orthopaedic career if their early experience of it was enjoyable, rewarding and educational. Background and aims: The field of Orthopaedic Surgery, despite being the second largest surgical subspecialty in Australia, is a poorly understood field amongst medical students. Indeed, there is a level of misunderstanding about the nature and scope of Orthopaedic Surgery amongst both medical professionals and the general public. The reasons for this lack of understanding are not clear and have not been previously examined in the Australian context. Medical schools have an essential role in equipping junior doctors with the clinical skills and acumen that they need to function as medical professionals, however the time dedicated to formal Orthopaedic teaching is generally very limited and often ad hoc in nature. Increasing medical students’ understanding of the scope and importance of Orthopaedics is of vital importance to not only key stakeholders such as the Australian Orthopaedic Association (AOA) and the Royal Australasian College of Surgeons (RACS), but also to the Australian community at large. Fourth and Fifth Year Medical students at the University of Tasmania, in the clinical training part of their program, were invited to participate in an electronic survey to analyze their understanding of Orthopaedics and other surgical subspecialties in an Australian context. The students were asked to identify which surgical subspecialty would be most likely to treat the presented clinical case. The cases varied in their level of complexity, but were all deemed to be common enough issues to warrant focus in the medical school curriculum. The entire spectrum of Orthopaedics was included to delineate the depth and breadth of understanding of the medical student body. The electronic survey utilized the Survey Monkey platform and involved 55 medical students in their final two clinical years; this cohort was chosen because they had the maximum Orthopaedic exposure in the medical program, usually in the form of four or five week rotations. There were approximately 200 students in total of Year 4 and 5 medical students and only 36 had completed an Orthopaedic rotation at the time of the survey. According to previous research, the likelihood of students selecting Orthopaedics as the managing craft group significantly improved if they had Orthopaedic Surgical experience (2) Overall, there was a gap in knowledge in students selecting the appropriate managing craft group in relation to Orthopaedic scenarios. Students were likely to associate Orthopaedic Surgeons with non-operative conditions such as gout, but a significant minority recognized the chief role of Rheumatology in this medical condition. This study has highlighted the gap between medical students’ perceptions and the reality of the scope of Orthopaedic Surgery. Moreover, it has emphasized the need for greater exposure and education in Orthopaedic Surgery if future medical practitioners are to successfully enter Orthopaedic Surgical Education and Training (SET). For those doctors who do not pursue Orthopaedics as a future vocation, exposure to the specialty in medical school enhances the appreciation of the field in terms of referral patterns and clinical scope, as well as facilitates improved understanding and communication between various craft groups, all of which benefit patients.