In the evolving realm of medicine, anesthesiology remains a vital cornerstone, ensuring patient safety and comfort during and after surgical procedures. Despite this indispensable role, attracting medical students to pursue careers in anesthesiology is an ongoing challenge. Currently, medical school curricula are weighted toward preclinical sciences and often lack exposure to anesthesiology during preclinical clerkship years, contributing to a limited understanding of the specialty (asamonitor.pub/3J9GLA5).

A literature review revealed data that further shed light on medical students' perceptions of the specialty. A survey of medical students conducted at the Loyola Stritch School of Medicine indicated that a notable percentage of medical students failed to recognize the integral role of anesthesiologists in the OR (J Educ Perioper Med 2016;18:E402). Moreover, a 2020 Association of American Medical Colleges (AAMC) survey revealed that nearly 60% of graduating students matching in anesthesiology initially preferred different specialties during medical school (asamonitor.pub/3VODFZF). Among all the specialties, anesthesiology ranked among the lowest in “same specialty preference” at 9.3% (asamonitor.pub/3PP1M6X). This inclination toward other areas of medicine may stem from various factors, including exposure, societal perceptions, or personal interests, and it underscores the need to explore strategies for increasing medical student interest in anesthesiology.

Despite initial preferences, there has been a noticeable shift in the landscape of medical students' interest over the past decade. Data from the National Resident Matching Program illustrate a significant increase in applicants for anesthesiology residency programs (PGY-1 positions), from 1,836 in 2014 to 2,959 in 2023 (asamonitor.pub/3POsA7q; asamonitor.pub/3RreObY). The total number of applicants for all PGY-1 positions increased proportionally less, from 52,565 in 2014 to 64,381 in 2023. Also of note, the number of anesthesiology PGY-1 positions offered increased from 1,049 to 1,609 over the nine-year period.

Integrating dedicated anesthesiology rotations into the core clerkship curriculum is perhaps a logical approach to enhancing interest levels by providing students with firsthand exposure to the specialty. Studies evaluating required anesthesiology clerkships have demonstrated an improved understanding of perioperative medicine, added value to other rotations such as general surgery, and significantly improved procedural skills relevant to all future physicians (J Educ Perioper Med 2010;12:E057; J Educ Perioper Med 2016;18:E403). However, as of 2020, only 20% of medical schools in the United States have mandatory anesthesiology clerkships, likely due to implementation challenges and administrative hurdles (asamonitor.pub/3U6Kp41). As such, innovative educational initiatives remain pivotal to increasing medical student exposure.

These initiatives encompass various activities, including elective rotations, simulation sessions, mentorship programs, procedural skill sessions, and informal career discussions. Institutions such as Dalhousie University and Warren Alpert Medical School of Brown University have implemented successful programs to expose medical students to anesthesiology early in their training (Can J Anaesth 2019;66:1126-8; Adv Med Educ Pract 2023;14:1347-55). Brown University's elective titled “Anesthesia: Much More than Putting you to Sleep” demonstrated statistically significant improvements in the understanding of airway management, anesthetic pharmacology, ultrasound basics, vascular access, anesthesiology residency, and even anesthesiology subspecialties (Adv Med Educ Pract 2023;14:1347-55). Despite the small sample sizes, these initiatives lay the groundwork for future growth and implementation of similar programs across medical institutions.

Establishing formal mentorship networks that connect students with practicing anesthesiologists can offer invaluable insights and guidance. Watts et al. reported that positive role models, particularly anesthesiologists, play a significant role in shaping career choices (Anaesth Intensive Care 1998;26:201-3). Theoretically, by inserting themselves into the mentorship programs at their institutions, anesthesiologists can begin exposing a small group of students to the specialty early in their medical school curriculum. The impact of mentors is not limited to the U.S. Kuteesa et al. at Makerere University College of Health Sciences in Uganda found that a critical factor for medical students' specialty career preference was the presence of role models and mentors (BMC Med Educ 2021;21:215).

Near-peer mentoring strategies, in which residents and interns mentor students, have been developed to increase specialty exposure during medical school. Stanford University School of Medicine implemented this strategy across multiple departments, with residents actively mentoring medical and high school students. With these mentor relationships, expansion of the elective anesthesiology rotation and revision of the curriculum to follow Society for Education in Anesthesia guidelines demonstrated a nearly three-fold increase in interest and participation over five years (J Educ Perioper Med 1999;1:E009). This increased interest and participation occurred despite the rotation's status as an elective.

Nurturing an interest in anesthesiology among medical students requires a multifaceted approach encompassing curriculum reform, innovative educational initiatives, advocacy efforts, mentorship programs, and even informal career discussions. By providing students with early exposure, comprehensive education, and diverse learning opportunities, the field of anesthesiology can cultivate a new generation of physicians who are genuinely passionate about the specialty. As guardians of medical education, our collective responsibility is to ensure the continued growth and relevance of anesthesiology as a vital specialty in patient care.

Naveen Vanga, MD, Associate Professor of Anesthesiology, Critical Care, and Pain Medicine, Vice Chair for Education, and Director of Anesthesiology Simulation Education, UTHealth Houston-McGovern Medical School, Houston, Texas.

Naveen Vanga, MD, Associate Professor of Anesthesiology, Critical Care, and Pain Medicine, Vice Chair for Education, and Director of Anesthesiology Simulation Education, UTHealth Houston-McGovern Medical School, Houston, Texas.

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Ryan Rihani, MD, Assistant Professor of Anesthesiology, Critical Care and Pain Medicine, Director of Medical Student Education, and Associate Program Director for Anesthesiology Critical Care Medicine Fellowship, UTHealth Houston-McGovern Medical School, Houston, Texas.

Ryan Rihani, MD, Assistant Professor of Anesthesiology, Critical Care and Pain Medicine, Director of Medical Student Education, and Associate Program Director for Anesthesiology Critical Care Medicine Fellowship, UTHealth Houston-McGovern Medical School, Houston, Texas.

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