The Sorting Hat of Medicine: Individual Choice or Institutional Culture

In a recent article by Baimas-George and Vrochides,¹ the authors argue that self- sorted Hogwarts houses may be a useful tool for medical students struggling to decide what training and career path to pursue. While the authors’ creative application of J.K. Rowling’s Hogwarts houses certainly makes for an enjoyable read, their interpretation of their research findings may enforce stereotypes regarding medical specialty selection rather than serve as a helpful tool for students selecting their future training plans. At a time when the Journal of Surgical Education is publishing important work regarding recruitment and retention of underrepresented minority students,² gender-based discrimination experienced by female surgical trainees,^3,4 and ongoing efforts to increase the diversity of national surgical leadership,⁵ I am wary of the potential for Baimas-George and Vrochides’ publication to undermine the Journal’s efforts.

The authors conducted a cross-sectional survey of residents in surgical (general surgery, orthopedics, urology, etc.) and nonsurgical (internal medicine, emergency medicine, pediatrics, etc.) programs, collecting information on each participant’s gender, residency/specialty selection and year, knowledge of the Harry Potter world, and self- sorted Hogwarts house. Upon finding differences in the proportion of self-sorted Gryffindors, Hufflepuffs, Ravenclaws, and Slytherins in various surgical and non-surgical specialties, the authors conclude that particular Hogwarts house-related characteristics may be predictive of success in surgical and nonsurgical specialties and encourage students to use this information to inform their specialty choices.

For example, upon finding that surgical specialties had a higher proportion of self- reported Slytherins and a lower proportion of self-reported Hufflepuffs than nonsurgical specialties, the authors conclude that students with the “ambition, cunning, leadership, talent, resourcefulness, and power” of the house of Slytherin should seriously consider surgical training and students with the “acceptance, inclusivity, patience, and fairness” of the house of Hufflepuff should consider looking elsewhere. While it is true that individual- level character traits make particular specialty-specific skills more or less difficult to master for particular students, we disagree with the authors’ focus on individual-level decisions at the exclusion of institutionalized culture.

The authors indicate that self-reported Slytherins purportedly self-select into surgery, while self-reported Hufflepuffs self-select out. This interpretation is the logical equivalent to, upon finding that men dominate the field of orthopedic surgery,⁶ concluding that traits associated with “maleness” are predictive of success in orthopedics and that individuals lacking in those traits should be encouraged to apply elsewhere. This interpretation completely ignores the impacts of specialty culture, the collection of choices made by Departments of Surgery and other medical training institutions that make particular students feel more or less welcome in a given specialty. We would argue that a better interpretation of the data would yield several questions, instead of advice: What about different surgical fields makes students with particular personality traits and characteristics feel more or less valued, and thus more or less likely to consider pursuing further surgical training? Is the purported selection process beneficial for the field of surgery, and for medical training in general? Surely the field of surgery would receive just as much benefit from fostering and welcoming students with the characteristics of Hufflepuff as it does by prizing students with the characteristics of Slytherin.

In light of Salles et al’s recent publication in the Journal regarding resident sense of social belonging as a predictor of well-being and attrition,⁷ we encourage Baimas- George, Vrochides, and all readers to consider the ways in which we can foster institutions and environments that make all students feel welcome, regardless of supposed differences in personality (or magical ability). Concluding that differences in specialty selection must be due to individual factors is a dangerous logical leap; we should instead ask how the various environments and cultures of medicine can be improved such that all students feel encouraged to pursue what they truly love.