Graduate surgical education has changed significantly in recent decades, according to background information in the article. "Specialization is a growing trend that might jeopardize the future of general surgery," the authors write. "Research has demonstrated that it likely results from multiple factors, including the changing demographics of medical schools and surgery residency programs, residency type (academic vs. community setting) and early exposure through research performed during residency."

Kate V. Viola, M.D., of the Yale School of Medicine, New Haven, Conn., and colleagues conducted a national survey of general surgery residents in January 2008. A total of 4,586 responded (75 percent). Participants were asked about their reasons for pursuing surgery as a career, their views on specialization, self-assessments of their performance and perceptions of the current and future status of general surgery.

Residents who responded were an average of 30.6 years old, and 31.7 percent were female. The researchers found that:

• Of participants who reported their family status, 51.3 percent were married, 23.6 percent were in a relationship, 22.6 percent were single and about one-fourth (25.4 percent) had children
• 28.7 percent of residents expressed concern that general surgery as a discipline was becoming obsolete; women were less likely than men to agree with this statement (25.9 percent vs. 30.1 percent)
• 55.1 percent believed that the modern general surgeon must be specialty trained to be successful; this sentiment was more common among men than women (56.4 percent vs. 52.7 percent of women), single residents than married residents (59.1 percent vs. 51.9 percent) and residents without children vs. those with children (57 percent vs. 50.1 percent)
• 78.1 percent associated specialty training with a better income and 62.3 percent associated it with a better lifestyle
• Single residents and those without children were more likely to plan for a fellowship (59.1 percent single vs. 51.9 percent married, and 57 percent of those without children vs. 50.1 percent of those with children)
• Male gender was an independent predictor of worry that general surgery was becoming obsolete, whereas women who were single or had no children were more likely to identify lifestyle rather than income as a motivator for specialty training

"This study raises interesting questions regarding trainees' beliefs and intent to seek specialty training," the authors conclude. "Each fellowship experience is unique and provides varying potential for income and lifestyle flexibility. More research is needed to stratify resident characteristics associated with considering postresidency training and the impact of marriage and children on the rigors of residency and fellowship."

Note: If no author is given, the source is cited instead.

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