Problems with the fourth-year curriculum of students entering surgical residencies

Because of concerns about the relevance of the fourth-year curriculum of students entering surgical residencies, this study was undertaken to analyze the curriculum, electives, and grades and to compare the students' elective choices with previously documented preferences of surgical educators.

Computer profiles of all fourth-year students at New York Medical College who entered surgical residencies during a 3-year period were reviewed. The records of 115 students (92 male, 23 female), who were placed in 68 categorical and 47 preliminary positions, comprised the study. Four-week rotations in internal medicine, neurology, and ambulatory medicine were mandatory. An average of 5.1 electives per student, along with time for vacation and interviews, filled the remainder of the year.

Students were statistically significantly more likely to receive honors grades in electives. Students, especially those in preliminary positions, frequently selected electives in their eventual specialty choice.

Program directors interviewing prospective candidates for residency should view elective grades with care. Students often take electives that duplicate or do not enhance their career choices. Elective grades are inflated and may be based on subjective evaluations. This issue should be investigated further, and the major surgical education organizations should propose meaningful changes.