Stitching the Story: Third-Year Clerkship Impact on Applicants to General Surgery Residency

Medical students' clerkship experiences play a crucial role in shaping specialty interests. Factors such as mentorship, autonomy, and meaningful patient care contribute to clerkship quality and career decisions. Previous studies suggest that positive interactions with residents and attendings significantly influence students' likelihood of pursuing a specialty. This study evaluates key clerkship factors associated with students' interest in general surgery, focusing on mentorship, clinical exposure, and academic performance.

This retrospective study was conducted at a single medical school, analyzing data from students who completed their third-year surgical clerkship between May 2023 and December 2024. A deidentified survey assessed students' specialty preferences, clerkship timing, service assignments, team structures, and subjective factors influencing specialty choice. Performance data from the surgery shelf exam and clerkship grades were analyzed for associations.

Among 144 respondents (27.6% response rate), 23.7% applied to general surgery. At the start of the third y, 18.0% were not interested in surgery, 39.6% were open-minded, 36.8% were interested, and 4.9% were committed. Notably, students exposed to postgraduate year-1 residents had a significantly higher likelihood of applying (odds ratio 1.887, P = 0.046). Direct participation in cases (60.6%), interactions with residents (56.7%), and faculty mentorship (52.0%) were key factors, whereas long work hours negatively impacted the interest.

This study highlights that direct clinical exposure, mentorship from junior residents, and active case participation strongly influence medical students' interest in general surgery. Although academic performance did not significantly impact specialty selection, subjective experiences and the quality of interactions played a pivotal role.