Perceptions and attitudes toward neurosurgery as a career choice among medical students and interns in Hong Kong

Abstract

Background: Medical students and Interns have specialty preferences as they progress toward the next stage of their career. Neurosurgery has seen decline in interest in recent years, and a survey was designed to investigate perceptions and influencing factors. Method: An anonymous cross-sectional electronic survey was administered to Interns and medical students from Year 4 to Year 6 in two local medical schools using Likert rankings (agree strongly, agree moderately, agree somewhat, and disagree). Questions pertained to perceptions toward and influencing factors regarding a career in Neurosurgery. Results: The study involved 86 participants, 44 male and 42 female, involving Year 4 (22.1%), Year 5 (26.7%), Year 6 (34.9%) medical students, and Interns (16.3%). The overwhelming majority agreed that Neurosurgery is intellectually interesting and innovative (97.7%), and has potential for technological advancement (98.8%). Most were either interested (34.7%) in Neurosurgery or still uncertain (42.7%), but all participants unanimously perceive that it is difficult to obtain a training post. Discussion: Significantly, most participants (43%) were undecided about Neurosurgery as their future specialty choice, and among those uncertain or not interested, the majority felt that more exposure during medical school (91.4%), mentoring or programmes to provide guidance (97.3%), and positive role models (89.7%) would be encouraging factors to promote interest. Furthermore, despite admiration toward Neurosurgery as an interesting specialty, 100% of participants unanimously perceived that it is difficult to obtain a Neurosurgery training post in Hong Kong, with one participant commenting that they believe programmes “only accept the cream of the crop, [and a training post is] unattainable for most”. The majority (69.1%) do not perceive that Neurosurgery has fixed work hours that would enable work-life balance, and 55.2% strongly agree that fixed hours would be an encouraging factor. Only a small minority (15.5%) would find a higher income as an encouraging factor. For participants already interested in Neurosurgery, all perceived that positive role models had an influence to some degree, and 89.3% perceive they had exposure during medical school that influenced their interest. Conclusion: The findings show potential areas for encouragement of medical students and interns toward further exploring Neurosurgery. Many are discouraged by perceived difficulty of obtaining a residency post and would find more exposure in medical school and mentoring programmes beneficial. Confidence in availability of training posts and fixed hours were also considered more important than greater prestige or income. Introducing the specialty early in medical school may help clarify misconceptions and attract new talent into the field.