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Background: The concept of social belonging has been shown to be important for retention and student success in collegiate environments and general surgery training. However, this concept has never been explored in relation to medical students' impressions of orthopaedic surgery careers., Question/purpose: To investigate medical students' sense of belonging in orthopaedic surgery and how it affects their interest in pursuing orthopaedic surgery careers., Methods: Medical students from four medical schools were invited to participate in telephone interviews aimed to investigate medical students' reasons for considering (or not considering) orthopaedic surgery as a future career. Students were selected using random sampling and theoretical sampling methods (selecting participants based on specific characteristics) to obtain a diversity of student perspectives across medical school year, gender, race, age, and interest in orthopaedics. Semistructured interviews with open-ended questions and face validity were used to minimize bias in the interview process. Analysis was performed using grounded theory methodology, a rigorous and well-established method for creating conceptual models based on qualitative data. The result seeks to be a data-driven (as opposed to hypothesis-driven) theory that provides perspective on human behavior. Interviews were conducted until the point of thematic saturation, defined as the point when no new ideas occur in subsequent interviews; this was achieved at 23 students (16 self-identified as women, 12 self-identified as underrepresented minorities)., Results: Medical students articulated stereotypes about orthopaedic surgeons, in particular, that they were white, male, and athletic. Students derived their sense of belonging in orthopaedic surgery from how closely their identities aligned with these stereotypes about the field. Students who felt a sense of belonging described themselves as being part of a cultural "in-group," and students who did not feel a sense of belonging felt that they were in a cultural "out-group." Members of the in-group often reported that orthopaedic experiences further reinforced their positive identity alignment, which typically led to increased interest and continued engagement with the field. Conversely, students in the out-group reported that their exposures to orthopaedics further reinforced their lack of identity alignment, and this typically led to decreased interest and engagement. Many students in the out-group reported pursuing other specialties due to a lack of belonging within orthopaedics., Conclusion: Students derive their sense of belonging in orthopaedics based on how closely their identity aligns with stereotypes about the field. Importantly, there were gender and racial factors associated with orthopaedic stereotypes, and thus with belonging (self-identifying as the in-group). Moreover, out-group students tended not to choose orthopaedic surgery careers because of a lack of belonging in the specialty., Clinical Relevance: With knowledge of the factors that influence students' sense of belonging, academic orthopaedic departments can focus on interventions that may lead to a more diverse pool of medical students interested in orthopaedic surgery. These might include explicitly addressing stereotypes about orthopaedics and cultivating positive identity alignment for students from diverse backgrounds through targeted mentorship fostering partnerships with affinity organizations, and creating space to talk about barriers. Targeted interventions such as these are needed to interrupt the cycle of in-group and out-group formation that, in this small multicenter study, appeared to deter students with underrepresented identities from pursuing orthopaedic surgery careers., Competing Interests: All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2021 by the Association of Bone and Joint Surgeons.)

Research apprenticeships offer opportunities for deep understanding of scientific practice, transparency about research careers, and possible transformational effects on precollege youth. We examined two consecutive field-based environmental biology apprenticeship programs designed to deliver realistic career exploration and connections to research scientists. The Shaw Institute for Field Training (SIFT) program combines introductory field-skills training with research assistance opportunities, and the subsequent Tyson Environmental Research Fellowships (TERF) program provides immersive internships on university field station-based research teams. In a longitudinal mixed-methods study grounded in social cognitive career theory, changes in youth perspectives were measured during program progression from 10th grade through college, evaluating the efficacy of encouraging career path entry. Results indicate SIFT provided self-knowledge and career perspectives more aligned with reality. During SIFT, differences were found between SIFT-only participants compared with those who progressed to TERF. Transition from educational activities to fieldwork with scientists was a pivotal moment at which data showed decreased or increased interest and confidence. Continuation to TERF provided deeper relationships with role models who gave essential early-career support. Our study indicates the two-stage apprenticeship structure influenced persistence in pursuit of an environmental research career pathway. Recommendations for other precollege environmental career-exploration programs are presented., (© 2016 S. K. Flowers et al. CBE—Life Sciences Education © 2016 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).)

Purpose: The authors sought to identify variables associated with MD-PhD program graduates' academic medicine careers., Methods: We analyzed data for a national cohort of MD-PhD program graduates from 2000 to 2005, using multivariable logistic regression to identify independent predictors of full-time academic medicine faculty appointment through 2013., Results: Of 1,860 MD-PhD program graduates in 2000-2005, we included 1,846 (99.2%) who had completed residency training before 2014. Of these 1,846 graduates, 968 (52.4%) held full-time faculty appointments. Graduates who attended schools with Medical Scientist Training Program (MSTP) funding (vs. no MSTP funding; adjusted odds ratio [aOR], 1.41; 95% confidence interval [CI], 1.14-1.74) and participated in ≥1 year of research during residency (vs. no documented research year; aOR, 1.85; 95% CI, 1.50-2.28) were more likely to have held full-time faculty appointments. Asian/Pacific Islander (aOR, 0.74; 95% CI, 0.60-0.93) and under-represented minority (URM; aOR, 0.68; 95% CI, 0.48-0.98) graduates (each vs. white graduates), graduates who reported total debt of ≥$100,000 (vs. no debt) at graduation (aOR, 0.58; 95% CI, 0.39-0.88), and graduates in surgical practice (aOR, 0.64; 95% CI, 0.48-0.84) and other practice (aOR, 0.66, 95% CI, 0.54-0.81) specialties (each vs. 'medicine, pediatrics, pathology, or neurology') were less likely to have held full-time faculty appointments. Gender was not independently associated with likelihood of full-time faculty appointment., Conclusions: Over half of all MD-PhD program graduates in our study had full-time faculty appointments. Our findings regarding variables independently associated with full-time faculty appointments can inform the design of strategies to promote academic medicine career choice among MD-PhD program graduates. Further research is warranted to identify other factors amenable to intervention, in addition to those included in our study, which will foster the further development of a diverse academic medicine physician-scientist workforce nationally.

Objective: We sought to determine the prevalence of college laboratory research apprenticeship (CLRA) participation among students considering medical careers and to examine the relationship between CLRA participation and medical-school acceptance among students who applied to medical school., Methods: We used multivariate logistic regression to identify predictors of: 1) CLRA participation in a national cohort of 2001-2006 Pre-Medical College Admission Test (MCAT) Questionnaire (PMQ) respondents and 2) among those PMQ respondents who subsequently applied to medical school, medical-school acceptance by June 2013, reporting adjusted odds ratios (aOR) and 95% confidence intervals (95% CI)., Results: Of 213,497 PMQ respondents in the study sample (81.2% of all 262,813 PMQ respondents in 2001-2006), 72,797 (34.1%) reported CLRA participation. Each of under-represented minorities in medicine (URM) race/ethnicity (vs. white, aOR: 1.04; 95% CI: 1.01-1.06), Asian/Pacific Islander race/ethnicity (vs. white, aOR: 1.20; 95% CI: 1.17-1.22), and high school summer laboratory research apprenticeship (HSLRA) participation (aOR: 3.95; 95% CI: 3.84-4.07) predicted a greater likelihood of CLRA participation. Of the 213,497 PMQ respondents in the study sample, 144,473 (67.7%) had applied to medical school and 87,368 (60.5% of 144,473 medical-school applicants) had been accepted to medical school. Each of female gender (vs. male, aOR: 1.19; 95% CI: 1.16-1.22), URM race/ethnicity (vs. white, aOR: 3.91; 95% CI: 3.75-4.08), HSLRA participation (aOR: 1.11; 95% CI: 1.03-1.19), CLRA participation (aOR: 1.12; 95% CI: 1.09-1.15), college summer academic enrichment program participation (aOR: 1.26; 95% CI: 1.21-1.31), and higher MCAT score (per point increase, aOR: 1.31; 95% CI: 1.30-1.31) predicted a greater likelihood of medical-school acceptance., Conclusions: About one-third of all PMQ respondents had participated in CLRAs prior to taking the MCAT, and such participation was one of the several variables identified that were independently associated with medical-school acceptance.

Purpose: MD-PhD scientists are a successful, but small and fairly homogenous group of biomedical researchers. The authors conducted a retrospective cohort study to identify predictors of MD-PhD program enrollment to inform evidence-based strategies to increase the size and diversity of the biomedical research workforce., Method: Using deidentified data from all 2001-2006 Pre-Medical College Admission Test Questionnaire (PMQ) respondents, they developed multivariate logistic regression models to identify demographic, experiential, and attitudinal variables associated with MD-PhD program enrollment at matriculation compared with all other MD program enrollment at matriculation and with not enrolling in medical school by August 2012., Results: Of 207,436 PMQ respondents with complete data for all variables of interest, 2,575 (1.2%) were MD-PhD program enrollees, 80,856 (39.0%) were other MD program enrollees, and 124,005 (59.8%) were non-medical-school matriculants. Respondents who were black (versus white), were high school and college laboratory research apprenticeship participants, and highly endorsed the importance of research/finding cures as reasons to study medicine were more likely to be MD-PhD program enrollees, whereas respondents who highly endorsed the status of medicine as a reason to study medicine were less likely to be MD-PhD program enrollees than either other MD program enrollees or non-medical-school matriculants., Conclusions: MD-PhD program directors succeed in enrolling students whose attitudes and interests align with MD-PhD program goals. Continued efforts are needed to promote MD-PhD workforce diversity and the value of high school and college research apprenticeships for students considering careers as physician-scientists.

Purpose: To explore the relationship between gender and full-time faculty appointment in a national cohort of contemporary U.S. medical school graduates., Method: The authors analyzed deidentified, individual records for the 1998-2004 national cohort of U.S. medical graduates using multivariate logistic regression to identify predictors of full-time faculty appointment through July 2009. They reported adjusted odds ratios (aOR) significant at P < .05., Results: Of 66,889 graduates, 12,038 (18.0%) had held full-time faculty appointments. Among all graduates, women (aOR = 1.21) were more likely than men to have held faculty appointments. Among only male graduates, those who participated in research during college (aOR = 1.08), who entered medical school with greater planned career involvement in research (aOR = 1.08), and who authored/coauthored a research paper during medical school (aOR = 1.12) were more likely, and those with higher debt were less likely (aOR = 0.96), to have held faculty appointments. Among only faculty appointees, higher proportions of men than women had participated in medical school research electives (63.5% [3,899/6,138] versus 54.2% [3,197/5,900]; P < .001) and authored/coauthored research papers during medical school (44.1% [2,707/6,138] versus 33.6% [1,981/5,900]; P < .001); female faculty had reported higher debt at medical school graduation than had male faculty (P = .014)., Conclusions: In this national cohort of U.S. medical graduates, women were more likely than men to have held full-time faculty appointments. However, male and female faculty appointees entered academic medicine with different research experiences and debt, possibly impacting their academic medicine career trajectories.

Purpose: To describe trends in specialty choice and to identify predictors of primary care specialty choices among graduates of U.S. MD-granting medical schools., Method: A longitudinal study evaluated 1997-2006 medical school graduates who completed the Association of American Medical Colleges' Matriculating Student Questionnaire and Graduation Questionnaire. Multivariate logistic regression identified significant predictors of graduates' choice of primary care specialty (general internal medicine, general pediatrics, internal medicine subspecialties, pediatrics subspecialties, family medicine, and obstetrics-gynecology) or "no-board-certification specialty," compared with all other specialties (reference)., Results: The sample included 102,673 graduates (64.9% of all 1997-2006 graduates). General internal medicine, family medicine, general pediatrics, and obstetrics-gynecology choice decreased, whereas internal medicine subspecialties, pediatrics subspecialties, and no-board-certification specialty choice increased over time (each: P < .001). Female graduates and those who planned to practice in underserved communities, espoused more-altruistic beliefs about health care, and ascribed greater importance to social responsibility in their choice of medicine at matriculation were more likely to choose general internal medicine, general pediatrics, family medicine, or obstetrics-gynecology, whereas graduates who had a physician parent and who planned full-time academic medicine careers were less likely to do so (each: P < .01). Graduates with higher debt were less likely to choose internal medicine and pediatrics specialties (each: P < .001) and more likely to choose obstetrics-gynecology (P = .001)., Conclusions: Generalist-primary care specialty choices declined since 1997, whereas primary care subspecialty and no-board-certification specialty choices increased. Associations between primary care specialty choices and demographic, attitudinal, and career intention variables can inform the design of interventions to address expected primary care workforce shortages.

Objective: To identify predictors of attrition during graduate medical education (GME) in a single medical school cohort of contemporary US medical school graduates., Design: Retrospective cohort study., Setting: Single medical institution., Participants: Recent US allopathic medical school graduates., Main Outcome Measure: Attrition from initial GME program., Results: Forty-seven of 795 graduates (6%) did not complete the GME in their initial specialty of choice. At bivariate analysis, attrition was associated with election to the Alpha Omega Alpha Honor Medical Society, being an MD-PhD degree holder, and specialty choice (all P < .05). Attrition was not associated with graduation year (P = .91), sex (P = .67), or age (P = .12). In a multivariate logistic regression model, MD-PhD degree holder (odds ratio, 3.43; 95% confidence interval, 1.27-9.26; P = .02), election to Alpha Omega Alpha (2.19; 1.04-4.66; P = .04), choice of general surgery for GME (5.32; 1.98-14.27; P < .001), and choice of 5-year surgical specialty including those surgical specialties with a GME training requirement of 5 years or longer (2.74; 1.16-6.44; P = .02) each independently predicted greater likelihood of attrition., Conclusion: Academically highly qualified graduates and graduates who chose training in general surgery or in a 5-year surgical specialty were at increased risk of attrition during GME.

Context: MD/PhD program participants represent only a small proportion of all US medical students, yet they are expected to play a major role in the future physician-scientist workforce. The characteristics and career intentions of recent MD/PhD program and other MD program graduates have not been compared., Objective: To identify factors associated with MD/PhD program graduation among recent medical graduates., Design, Setting, and Participants: Deidentified data were obtained from a nationally representative sample of 88,575 US medical graduates who completed the national Association of American Medical Colleges Graduation Questionnaire from 2000-2006. Multivariate logistic regression was used to test responses to items regarding graduates' characteristics and career plans in association with program graduation, reporting adjusted odds ratios (ORs)., Main Outcome Measure: MD/PhD program graduation., Results: Of the 79,104 respondents with complete data (71.7% of all 2000-2006 graduates), 1833 (2.3%) were MD/PhD program graduates. Variables associated with greater likelihood of MD/PhD program graduation included planned substantial career involvement in research (OR, 10.30; 95% confidence interval [CI], 8.89-11.93); lower educational debt (compared with > or = $150,000: $100,000-$149,999, OR, 1.85; 95% CI, 1.35-2.52; $50,000-$99,999, OR, 5.50; 95% CI, 4.14-7.29; $1-$49,999, OR, 17.50; 95% CI, 13.30-23.03; no debt, OR, 17.41; 95% CI, 13.22-22.92); and receipt of medical school scholarships or grants (OR, 3.22; 95% CI, 2.82-3.69). Compared with planned training in internal medicine, MD/PhD graduation was positively associated with planned training in dermatology, neurology, ophthalmology, pathology, pediatrics, or radiology. Variables associated with lower likelihood of MD/PhD graduation included female sex (OR, 0.68; 95% CI, 0.60-0.77); race/ethnicity underrepresented in medicine (OR, 0.64; 95% CI, 0.52-0.80); and, compared with internal medicine, planned training in emergency medicine (OR, 0.58; 95% CI, 0.40-0.84) or surgery (OR, 0.70; 95% CI, 0.57-0.85)., Conclusion: Compared with graduates of other MD degree programs, MD/PhD graduates tend to be less demographically diverse, have a lower debt burden, favor different medical specialties, and have greater planned career involvement in research.

National efforts to increase diversity of academic medicine faculty led us to study the evolution of medical graduates' academic medicine career intentions. We conducted a retrospective cohort study of 1997-2004 U.S. allopathic medical graduates who completed both the Association of American Medical Colleges' Matriculating Student Questionnaire and Graduation Questionnaire, categorizing the evolution of academic medicine career intentions (sustained, emerging, diminished and no intent) by similarities/differences in graduates' responses to the career choice question on both questionnaires. Multivariable logistic regression models identified independent predictors of sustained and emerging intent (compared with no intent) and diminished intent (compared with sustained intent). Of 87,763 graduates, 67% indicated no intent, 20% emerging intent, 8% sustained intent and 5% diminished intent to pursue an academic medicine career. Asians were more likely and underrepresented minorities less likely to have sustained and emerging intent. Women were more likely to have emerging intent. Graduates planning more extensive career involvement in research at matriculation and reporting greater satisfaction with the quality of their medical education, higher clinical clerkship ratings, and lower debt were more likely to have sustained and emerging intent and less likely to have diminished intent. Graduates planning to practice in underserved areas and choosing family medicine were less likely to have sustained and emerging intent and more likely to have diminished intent (all p < 0.05). Findings can inform efforts to develop an academic medicine workforce that can meet our nation's healthcare needs and more equitably reflect the diversity of our society and medical student population.

Purpose: During the last 15 years, the proportion of U.S. allopathic medical graduates planning to pursue alternative careers (other than full-time clinical practice) has been increasing. The authors sought to identify factors associated with contemporary medical graduates' career-setting plans., Method: The authors obtained anonymous data from the 108,408 U.S. allopathic medical graduates who completed the 1997-2004 national Association of American Medical Colleges Graduation Questionnaire (GQ). Using multinomial logistic regression, responses to eight GQ items regarding graduates' demographics, medical school characteristics, and specialty choice were tested in association with three career-setting plans (full-time university faculty; other, including government agencies, non-university-based research, or medical or health care administration; or undecided) compared with full-time (nonacademic) clinical practice., Results: The sample included 94,101 (86.8% of 108,408) GQ respondents with complete data. From 1997 to 2004, the proportions of graduates planning full-time clinical practice careers decreased from 51.3% to 46.5%; the proportions selecting primary care and obstetrics-gynecology specialties also decreased. Graduates reporting Hispanic race/ethnicity or no response to race/ethnicity, lower debt, dual advanced degrees at graduation, and psychiatric-specialty choice were consistently more likely to plan to pursue alternative careers. Graduates selecting an obstetrics-gynecology specialty/ subspecialty were consistently less likely to plan to pursue alternative careers. Being female, Asian/Pacific Islander, Black or Native American/Alaskan, and selecting non-primary-care specialties were variably associated with alternative career plans., Conclusions: As the medical student population becomes more demographically diverse, as graduates increasingly select non-primary-care specialties, and as dual-degree-program graduates and alternative career opportunities for physicians expand, the proportion of U.S. graduates planning full-time clinical practice careers likely will continue to decline.

Objective: We sought to identify predictors of obstetrics and gynecology (OBGYN) specialty choice among US medical graduates over time., Study Design: We examined OBGYN specialty choice for its association with 16 items on the 1997, 2000, and 2004 AAMC Graduation Questionnaire (GQ). Multivariate logistic regression identified independent predictors of OBGYN specialty choice for each year., Results: Eighty-three percent of US graduates completed the GQ in the 3 years studied. Fewer responders chose OBGYN over time (1997, 8.2%; 2000, 6.5%; 2004, 6.2%). Women, blacks, and graduates with more positive ratings of the OBGYN clerkship were more likely to choose OBGYN in each year (each P < .001). Graduates reporting more positive beliefs about the practice of medicine and preferring academic careers were less likely to choose OBGYN (each P < .05)., Conclusion: Predictors of OBGYN specialty choice from among the GQ variables tested have remained stable over time, but with a smaller pool of likely applicants.

Background: Predictors of U.S. allopathic medical-school graduates' board-certification plans have not been characterized., Method: Using multivariable logistic regression, graduates' responses to 11 questions on the 1997-2004 Association of American Medical Colleges Graduation Questionnaire were analyzed to identify independent predictors of plans for specialty-board certification., Results: The proportion of 108,408 graduates planning specialty-board certification decreased from 97.3% in 1997 to 88.4% in 2004. Among 101,805 (93.9%) graduates with complete data, graduates who were Hispanic, rated their clinical clerkships, quality of medical education, and confidence in clinical skills more highly, had any debt, and planned "University-faculty" careers were more likely to plan becoming board certified. Females, Asians/Pacific Islanders, and graduates who planned to practice in underserved areas, planned "other" nonclinical-practice careers, and graduated with MD/other (non-PhD) degrees were less likely to plan becoming board certified., Conclusion: Specialty-board certification does not appear to be among the professional goals for a growing proportion of U.S. medical graduates.

Background: Identification of correlates of contemporary US medical graduates' surgical career plans can provide insights about the emerging surgical workforce composition and inform future recruitment efforts., Study Design: We analyzed individualized records of 95,176 graduates who completed the 1997 to 2004 Association of American Medical Colleges Graduation Questionnaire for associations between planning a general-surgery or a surgical-specialty (orthopaedic surgery, neurologic surgery, plastic surgery, urology, or otolaryngology) career and a set of medical-school experience, professional-setting preference, and demographic variables., Results: Graduates who reported better quality of their surgery clerkship experience and career-setting preference of "university faculty" compared with "nonuniversity clinical practice" were more likely to plan general-surgery or surgical-specialty careers compared with nonsurgical careers (each p < 0.001). Women and graduates from combined MD/PhD programs and those who planned to practice in underserved areas were less likely to plan general-surgery or surgical-specialty careers compared with nonsurgical careers (each p < 0.001). Graduates of nonwhite race or ethnicity and from combined MD/other-degree (non-PhD) programs were more likely to plan general-surgery careers (p < 0.001). Compared with 1997 graduates, 1998 to 2004 graduates were less likely to plan general-surgery careers than surgical-specialty careers (each p < or = 0.001), and 1999 to 2004 graduates were more likely to plan surgical-specialty careers than nonsurgical careers (each p < or = 0.006)., Conclusions: Contemporary graduates planning surgical careers represent a relatively narrow spectrum of US medical graduates, and those planning general-surgery careers differ in numerous ways from those planning surgical-specialty careers. Targeted efforts are warranted to recruit US medical graduates qualified to meet the nation's future health-care needs and advance the profession of surgery.

Objective: The authors sought to compare categorical general surgery applicants with applicants in other specialties regarding their final specialty-choice ranking for residency positions., Method: The authors analyzed the 2004-match year applicant-pool data from the Electronic Residency Application Service and Common Application Service as well as rank-list data from the National Resident Matching Program (NRMP), the Urology Match Program, and the San Francisco Matching Program for 20 different specialties. Two-tailed chi-square tests measured differences between the proportions of applicants who ultimately ranked programs in categorical general surgery and each of 19 other specialties and between the proportions of U.S. students who ranked categorical general surgery and each of 19 other specialties as a non-preferred choice. A Bonferroni-adjusted alpha was set at 0.0013 to reduce the likelihood of a type I error., Results: The proportion of applicants ranking each specialty ranged from 42% (786/1859) in pathology to 91% (282/31l) in neurological surgery. The proportion of categorical general surgery applicants ranking categorical general surgery programs was 51% (2004/3900), which was significantly lower than the proportions ranking 12 of 19 other specialties (each p < 0.001). Of the 2004 categorical general surgery applicants ranking categorical general surgery programs, 278 (278/2004, 14%) ranked categorical general surgery as a non-preferred specialty. Among 1230 U.S. students ranking categorical general surgery programs, 144 (12%) did so as a non-preferred specialty-a proportion significantly higher compared with U.S. students ranking 15 of 19 other specialties as non-preferred (each p < 0.001)., Conclusions: In 2004, the categorical general surgery applicant pool was relatively uncommitted to the specialty of general surgery. The number of applicants ranking categorical general surgery as a non-preferred specialty was likely even higher than these data indicate, as unmatched applicants in non-NRMP matches who then ranked categorical general surgery programs in the NRMP were tabulated by the NRMP as having ranked categorical general surgery as their preferred specialty.