Increasing the appeal of neurosurgery to qualified medical students in Canada.

667 The education climate in Canadian medical schools has changed dramatically over the past ten years. A growing and aging population has demanded significant increases in medical school enrollment, with a focus on producing primary care physicians. Despite doubling the number of graduating medical students during this time (Figure 1), the number of candidates applying to Neurosurgery has remained relatively stable. These statistics are concerning when considering five of the past ten years have seen less students rank Neurosurgery as a first choice discipline than the number of Residency positions available, though the overall match rate has remained 1:1 (Figure 2)1. Based on current trends, it is possible that Neurosurgery is failing to appeal to and attract qualified applicants who may otherwise consider a career in this field. This may be inherently limiting the selection process for Neurosurgical programs across the country to only a small cohort of students. Inconsistencies between an increasing number of medical students but relatively stable number of Neurosurgery applicants could be due to both changing student priorities in medical and surgical careers as well as decreased exposure to Neurosurgery in the face of a changing medical curriculum. Both factors should be addressed in order to ensure students well suited for Neurosurgery continue to apply. As of 2010, balance between work and personal life and obtaining sufficient medical competence were cited as the two most important factors for Canadian medical students in determining a satisfying and successful career2. As student priorities continue to change, it is possible students have ruled out Neurosurgery on the basis of expected lifestyle and content difficulty prior to adequate exposure and knowledge of the specialty. Ironically, in the same National Physician Survey, Neurosurgeons report the highest percent of satisfaction compared to all surgical specialties when it comes to balance between personal and professional commitments. Of all respondents, 64.7% were somewhat or very satisfied with this component of their life. In addition, they had comparable results to other competitive surgical specialties when addressing satisfaction of their professional life. It may be beneficial to address student concerns early in training regarding lifestyle and content difficulty, as well as other factors considered important to medical students today, including length of training, job prospects, daily activity, financial remuneration, patient demographics, and the expectations of a Neurosurgical career. Students may also fail to experience adequate exposure to Neurosurgery during their training. In a recent survey of medical students, few agreed that they had a good understanding of the Neurosurgical specialty3. This is especially true for students undergoing their formative pre-clinical years where Increasing the Appeal of Neurosurgery to Qualified Medical Students in Canada