Why medical students choose orthopedic surgery as a specialty?

Before the crisis announced the Moroccan surgery, the objectives of this study were to analyze the choice of specialties newly appointed to the internal review and the guidance of medical students and to determine the factors influencing this choice. Data on specialty choice students were analyzed and a questionnaire was offered to students of Morocco at the beginning of academic year 2013-20014 The form consisted of questions on the year of study. sex, professional guidelines and reasons for choice. candidates were male, the average age of our residents was 28 years. We also noted the importance of the passage as well as external service trauma. Care provided to patients, lifestyle and income reported by 85% of respondents to be the most important factors to pursue orthopedics as a career. The TR-Orth is now a specialty that responds to a positive choice. The choice of TR-Orth by students at the end of medical school curriculum is reinforced by teaching and practicing the specialty during the internship. The overall training is unsatisfactory overall. Students would deepen in some areas. This study confirms that there is currently a shift in trauma surgery, mostly induced by an a priori negative for particular workloads.


Introduction
Before any specialization, medical studies are organized in morocco in six years during which we separate a first cycle of medical studies of two years, of the second cycle of four years. In the term of these six years of formation ,some students appear at the test classifying of internship others prefer to take the competition of residency what allows them to choose , according to the ranking a specialty .this competition is very important as it determines the vocational guidance of the future students. The traumatology -orthopedics is a desirable profession for the graduats in medicine .the competition and the number of candidats were superior than posts offered by the ministry of health every year making access to the specialty increasing difficult. The different series of literature underlined the importance of the training orthopedic -traumatology with 45% of medicine students have not received courses of traumatology during their externship passage [1][2][3][4][5]. The objectives of this study were to analyse the choices of specialty of the internals recently appointed to the classifying examination as well as the orientations of the medical students and to determine the factors influencing this choice.

Methods
We led a medical investigation for the resident's exerting the traumatology as a specialty on the three CHU, Oujda, Fes and Rabat. The criteria of inclusions : the residents of traumatology ; foreign residents who cross their training here in Morocco; the internals spend theirs desiratats in traumatology-orthopedic service.
The criteria of exclusions : externat ; the specialists who spend their equivalence. Meanwhile, a questionnaire was sent by email or distributed personally to the students, all students received explanations on the purposes of the study, its confidential nature and they were free not to answer. The questionnaires were anonymous including 24 questions. The candidates left in two groups. (group1) resident on title and (group 2) resident on competes. The form was made of questions on: general information; the university curriculum; the impact of university training courses and medical exercise; the impact of teaching and the teacher; socio-economic factor. 45 people answered to questionnaires. 29 candidates for group 1 and 16 for the group 2.
The results are presented in the form of average medium of quantitative variables (more or less standard deviation) and percentage for the nominal variables.

Results
We led a medical investigation in 3 CHU on 45 residents exercing the specialty of traumatolgy -orthopedics. None of the respondents were excluded for a motive for an incomplete investigation as long as they have answered all the questions consequently a candidate Bernstein et al [6] showed that only 55% of medical graduates had a compulsory education in musculoskeletal discipline, including orthopedics and rheumatology. The other series in the literature have reported the importance of clinical training for the choice of orthopedics. Maintaining the course currently mandatory trauma also seems necessary and even desired by residents. Our data indicate that a significant proportion of group 1 were influenced by the passage as an intern serving traumatology-orthopedics, the same thing for that was more influenced by passing through a device placement as well as physician group 2 generalist. We sought to better understand the factors that motivated students to pursue an orthopedic career.
The Academy of Surgery recently observed that instead of surgical discipline should always be upgraded in our  [7]. The financial aspect is a fairly new data for the French doctors and remains well below the Anglo Saxon countries, in some studies, 40% of American students say they do not want to become general because of insufficient income [8]. Current developments reforms to reduce your self-employment earnings and potential future surgeons are potentially harmful on surgical vocations. It will be difficult to continue to expect motivate surgeons opting out of the utopia of one bonus linked to the vocation [9]. The feminization of the medical population is observed in developed countries [10,11] and the United States, the student rate increased from 13% in 1970 to 49% in 2007 [12]. This radical change in the medical population is obviously going to lead to changes in the choice of specialties. A study in the United States, found that among 292 women included Page number not for citation purposes 4 in the survey only 7% chose orthopedics as a specialty [13]. In our study, men were significantly more attracted to the specialty of orthopedics. The area has not had much success as much as other surgical specialties in recruiting residents' female sex despite the feminization of the medical school. The woman was able to get a position as a professor of orthopedic traumatology, this brings us, that in a strategy to increase the representation of women in orthopedics to Morocco, we will have a special care of women during their passage into orthopedic services which will encourage them to consider an orthopedic career. There are several limitations in this study, all first we were unable to assess the female candidates who are absent from this survey, we also interviewed and evaluated just too limited sample, it was necessary to carry out a similar study on a broader base of medical school and the need to develop a statistical analysis that could eventually provide a larger sample of women candidates. Because of this limitation on the number of CHU interviewed, we chose to focus on the description of the data obtained in our analysis instead of insisting on statistical significance, and more study was based on a survey asking residents to remember the reasons and factors influencing their career choices.

Conclusion
The answers to the disaffection of surgery are multiple and often expensive. However, some of them are obvious from reading this study. If Morocco wants to continue to develop trauma surgeons skilled, engaged and volunteers in this discipline, it will probably lead a real incentive policy and provide the means for surgery to be an upgraded profession whose hardship is finally recognized. The stakes are high because it is the price that young people return to surgery. Figure 1: Type of residency