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World J Surg (2018) 42:1655–1665

significant competitive disadvantage compared to profes sional administrators with advanced management skills. As the US healthcare system undergoes rapid reforms, the physician executive (PE) will be responsible for shaping the practice of medicine in this country. In response to systemic challenges facing the US healthcare system, many medical students, residents and practicing physicians have embarked on the pursuit of a business degree. One of the most popular options among US trainees is the Master of Business Administration (MBA) or equivalent diploma. There were only six formal MD–MBA programs nationwide in 1993, which expanded quickly to 33 in 2001 and 51 in 2009 [2]. Among over 130 allopathic medical schools in the USA, more than 50 cur rently offer a combined MD–MBA option to their gradu ates [3]. However, the added value of such proposition remains poorly defined. Although this trend appears to be generally positive, many potential PEs are often ‘‘lost to medicine’’ even before their residency training begins. The end of medical school is a critical branch point for MBA educated students to decide to invest in clinical training or to forgo clinical care for the myriad other opportunities available to them [2, 4]. Therefore, better understanding of factors that play the most influential role in the development process of PEs will allow medical programs working to recruit interested stu dents to best support their interest. In addition, more medical students, physicians in training and even physi cians in practice may become attracted to this opportunity as a result of observed tangible benefits [5]. Given this understanding, we seek to identify the value added in receiving an MBA dual degree. The goal of this literature review was to assess which particular skill sets are most likely to be gained from such exposure. We hypothesize that multiple assets are acquired by those physicians who supplement their clinical expertise with business education. Search Strategy and Inclusion Criteria. We conducted literature search from the following four large electronic databases. 1. Biomedical: 1. PubMed; 2. SCOPUS; and 3. Embase (Excerpta Medica dataBASE). 2. Educational: ERIC (Education Resources Information Center). The key words/phrases used for conducting electronic database search were: medical education, physician healthcare executives, MD/MBA dual degree, clinician administrators, physician leadership and finance. The Methods

search was initiated on July 9, 2016, and was last updated on July 9, 2017. We included all articles from the above-mentioned database from January 2000 to July 2017. Articles pub lished in non-English languages were excluded. We then conducted full text review to assess for relevance. Several studies were not included because they were considered to be outside of the scope of this study. To guarantee the reporting quality and provide substantial transparency for the articles selected for this review, we followed the recommendation of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [6]. We adopted a protocol that has been recommended as part of the reporting guidelines for conducting a survey with questionnaires [7, 8]. Briefly, articles were assigned a validated index score to assess the quality of studies selected for this review. The following factors were used to calculate a score for every article: (a) size of the study, (b) justification of research method, (c) explicit objective, (d) replicability of the study, (e) representativeness and (f) response rate. Article quality assessment

Data analysis

We were unable to conduct a meta-analysis due to the following limitations within our source manuscripts: (a) large variations in survey; (b) diverse participant pop ulations; and (c) varying levels of career advancement before achieving the MBA (i.e., medical student, resident physician and attending physician).

Results

A total of 492 articles were found on PubMed, 696 were identified on Embase, 366 on SCOPUS and 26 on ERIC. Most studies were deemed irrelevant for this review and outside the scope of this topic. Forty-one articles were selected for further full text review upon reaching criteria for relevance, full-access and date of publication. Ulti mately, 23 articles met our predetermined inclusion crite ria. A schematic diagram of our article inclusion procedure can be visualized in Fig. 1. Shown in Table 1 is a summary of each article’s quality assessment score. Additionally, Table 2 provides a quick glance of characteristics of the study type, number of participants and study findings of these 23 articles.

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