740 Subspecialty Career Choices in Orthopaedics – What Factors Affect the Decision-Making Process?

Aim Orthopaedics has become increasingly subspecialised, nevertheless, reduced diversity in the profession persists. There is limited data on the importance of factors affecting subspecialty career choice among orthopaedic trainees. Aims of this study were to evaluate the importance of factors informing subspecialty career choices of trainees and assess whether these differed between the respondents’ gender and seniority. Method An anonymised online survey was designed and distributed to collect demographic information, stage of training and subspecialty career plans of orthopaedic trainees in the four Scottish training regions. Participants ranked the importance of 15 factors covering clinical, academic and lifestyle domains which may influence subspecialty choice on a Likert scale. Results From 37 responders, there were 27% junior trainees (ST1-3), 65% senior trainees (ST4-8) and 8% in research posts. Only 30% of junior trainees had selected their subspecialty in contrast to 75% of senior trainees (p=0.02). No significant difference in subspecialty choice was found between men and women (p=0.41) or junior and senior trainees (p=0.21). Most popular subspecialties overall for both genders were arthroplasty (35%), hand & wrist (19%), and trauma (19%). No difference in the importance of each factor was observed between genders or junior and senior trainees. The most important factors on subspecialty choice were interest in field, clinical opportunities, and influential mentor(s). Conclusions Most trainees approach completion of orthopaedic training with clear subspecialty preferences. A variety of factors affect this decision. Focus should be on wider subspecialty exposure at earlier stages in orthopaedic training programmes with concurrent mentor provision.