Reducing barriers, hammering out myths, fixating interest and cementing a positive image of orthopaedic surgery in medical students

By Michael McLarnon
Fourth Year Medical Student, Queen’s University Belfast

This essay was runner-up in the 2021 BOA Medical Student Essay Prize

As a medical student, what would encourage you to consider a career in T&O and what are the perceived barriers to such a career?


Orthopaedic operations typically have excellent outcomes1-3 with immediate impact. Emphasis on reconstruction and functional restoration over resection sets the specialty apart and requires a personalised medical approach to patients. To attract the best possible candidates it is essential to engage and empower aspiring medical students early in their careers. This essay will outline encouraging factors with suggested initiatives, followed by identifying perceived career obstacles and how to address them.

Encouraging the Next Generation

Orthopaedic student societies improve career interest4,5, bolster CVs5 and provide networking opportunities4. Electing university-based representatives is an effective method of increasing recruitment amongst medical students6. Therefore, supporting local university surgical societies by establishing a BOA medical student sub-committee, with regional representatives at each UK & Irish university, would further encourage students while promoting an orthopaedic career.

Student surgical conferences stimulate interest in surgery, particularly amongst pre-clinical students7. These conferences give students opportunities to explore a specialty in more depth, and specialty-specific workshops for orthopaedics may provide practical experience in a safe learning environment8,9

Research experience is shown to encourage students towards their field of study6. National collaborative research projects such as STARSurg10 provide an opportunity for students to have small but impactful roles in large-scale studies11. The BOA, or existing trainee research groups (CORNET, ORCA and SWORD), could similarly involve medical students in a large collaborative project.

Strong role models are an influential factor in pursuing surgery12,13 at both trainee and consultant levels14. Although often developed organically, formal mentorship ensures each mentee receives guidance15. A BOA student mentorship scheme could help connect and inspire budding orthopaedic surgeons. These meetings could be held in or outside of the workplace environment, the latter of which may facilitate discussion regarding managing work-life balance15 (often deemed a significant career barrier). 

A student’s interactions with surgeons and the number of operations observed correlate with career intentions12, as does a good teaching experience16. A recent UK study found that the average length of orthopaedic attachments has almost halved in recent decades17. Student selective components (SSCs), elective bursaries, and online educational webinars based on the BOA undergraduate syllabus could further supplement clinical placements. A six-week surgical SSC at an Irish medical school significantly strengthened surgical career aspirations and could be adapted specifically for orthopaedics18. Educational webinars facilitate interactive learning and improve accessibility to orthopaedics for interested students19; virtual reality integration, using tools such as Proximie, could facilitate practical sessions.

The opportunity to scrub is influential in encouraging medical students towards surgery20. Evidence indicates that students are more likely to attend theatres with a welcoming environment where they can actively participate14. Access to simulation is also beneficial in boosting interest20,21. High fidelity simulation such as an arthroscopic skills simulator could be made available to interested medical students22 and would help bridge the gap between textbook and operating theatre. Although less exciting, low fidelity simulations are typically cheaper and may be equally effective23

Table 1: Improving medical student interest in orthopaedics

Encouraging factors

Current initiatives

Further suggestions

Student groups and societies; locally run events

  • Local surgical/orthopaedic societies
  • BOA medical student section
  • BOTA medical student representative


  • BOA medical student sub-committee, with regional representatives at each UK University
  • BOA outreach to student societies
  • BOA medical student events

Student surgical and orthopaedic conferences

  • National conferences by trainee organisations with medical student tickets & sessions
  • University surgical society conferences
  • A virtual/in-person national undergraduate orthopaedic conference
  • BOA Careers day

Practical Workshops

  • BOA annual congress
  • Local student-run workshops
  • Section on website: “How to organise an orthopaedic workshop”
  • Sponsoring local society events

National Research Collaboratives

  • UK-wide surgical research collaboratives (e.g., STARSurg)


  • A national orthopaedic research collaborative with undergraduate opportunities


  • ASiT surgical mentorship scheme
  • Local university society mentorship schemes
  • BOA orthopaedic mentorship scheme for students
  • Encouraging informal mentorship

University placement

  • Elective orthopaedics +/- trauma placements
  • SSCs in orthopaedics
  • BOA elective bursary
  • Student webinars in orthopaedics
  • Examples on website of orthopaedic electives/reviews

Theatre exposure

  • Students may attend theatres/scrub during their placements/electives in orthopaedics
  • Undergraduate access to simulation tools
  • Culture of student involvement/ scrubbing in (timetabled)
  • Local workshops for students

Breaking down Barriers

Issues surrounding work-life balance are often raised, with the current generation more focussed on this than ever24. Students and junior trainees hold perceptions that a surgical career is incompatible with family life25. Consensus obtained at a recent ASiT conference concluded that better hours and more time allocated for training during working hours are the most influential factors relating to surgical recruitment and retention20. A lack of flexible training opportunities in surgery is noteworthy, and only 10% of UK surgical trainees think the information provided on less than full time (LTFT) training is adequate26.  

Despite this, it is worth reminding students that although generally reporting less leisure time, surgical trainees in the UK maintain equivocal life enjoyment to other trainees27; orthopaedic surgeons also score highly in job satisfaction28,29 and are among the happiest surgeons when balancing satisfaction with workload30

With LTFT training negatively affecting career progression31, potential barriers also exist to parenting and motherhood. Possible solutions include providing hospital childcare, implementing cultural change encouraging more equally distributed maternity/paternity leave, and individualised initiatives to maintain skills during leave (e.g., taking call or theatre attendance one day a week, simulation training and out-of-training research). Hospital childcare support and day nurseries are other potential solutions. 

A lack of female mentorship is identified in surgery, and is perhaps consequential when considering the differing decisions and barriers women in surgery face15. An American study found that females were more likely to choose orthopaedics if they had a same-sex mentor32. Additionally, evidence indicates that minority groups are underrepresented in surgical leadership across all specialties in the UK33, demonstrating a lack of role models for some students. Targeted mentorship schemes alongside appropriate equality and diversity monitoring may begin to challenge this.

A belief lingers that physical strength is a prerequisite for an orthopaedic career34,35 and a stereotype persists that orthopaedic surgeons use blunt tools and lack academic ability. Regarding intelligence, evidence suggests this is not the case36, nor is physical strength a precondition. Furthermore, as a specialty, orthopaedics has one of the best research outputs, especially in the UK37,38.

Table 2: Perceived barriers and potential solutions

Perceived barrier

Potential solutions in orthopaedics

Work-life balance

  • Providing information: realistic work schedule; trainee versus consultant; examples of consultants maintaining multiple commitments
  • LTFT training opportunities in orthopaedics
  • Challenging burnout and improving trainee support network

Parenting and motherhood

  • LTFT training adaptations and individualised programmes
  • Greater provision of hospital childcare
  • Female surgical role-models
  • Female surgical mentors/advisors


  • Fair representation of minority groups
  • Mentorship opportunities for specific groups
  • Equality and diversity monitoring
  • Female role-models in orthopaedics


  • Dispel the myth that this is an absolute barrier (or a barrier at all)


Undergraduate conferences, practical skills sessions, mentorship schemes, and research opportunities all bolster student interest. This, in synergy with removing barriers such as lack of diversity and work-life balance issues through targeted interventions, will encourage a greater number of prospective medical students from a wider demographic towards considering this rewarding career.


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