Aspirations to become an anaesthetist: longitudinal study of historical trends and trajectories of UK-qualified doctors' early career choices and of factors that have influenced their choices

Background

It is important to inform medical educators and workforce planners in Anaesthesia about early career choices for the specialty, factors that influence them and to elucidate how recent choices of men and women doctors relate to the overall historical trends in the specialty’s popularity.

Methods

We analysed longitudinal data on career choice, based on self-completed questionnaires, from national year-of-qualification cohorts of UK-trained doctors from 1974 to 2012 surveyed one, three and 5 years post-qualification. Career destination data 10 years post-qualification were used for qualifiers between 1993 and 2002, to investigate the association between early choice and later destinations.

Results

In years 1, 3 and 5 post-qualification, respectively, 59.9% (37,385), 64.6% (31,473), and 67.2% (24,971) of contactable doctors responded. There was an overall increase, from the early to the later cohorts, in the percentage of medical graduates who wished to enter anaesthesia: for instance year 1 choices rose from 4.6 to 9.4%, comparing the 1974 and 2012 cohorts. Men were more likely than women to express an early preference for a career in anaesthesia: for example, at year 3 after qualification anaesthesia was the choice of 10.1% of men and 7.9% of women. There was a striking increase in the certainty with which women chose anaesthesia as their future career specialty in recent compared to earlier cohorts, not reflected in any trends observed in men choosing anaesthesia.

Sixty percent of doctors who were anaesthetists, 10 years after qualifying, had specified anaesthesia as their preferred specialty when surveyed in year 1, 80% in year 3, and 92% in year 5.

Doctors working as anaesthetists were less likely than those working in other hospital specialties to have specified, as strong influences on specialty choice, ‘experience of the subject’ as students, ‘inclinations before medical school’, and ‘what I really want to do’. Men anaesthetists were more influenced in their specialty choice than men in other hospital specialties by ‘wanting a career with acceptable hours’; the corresponding difference among women was not significant.

Conclusions

We suggest a focus on inspirational teaching of anaesthesia in medical school and on greater exposure to the specialty in the foundation programme. Factors which may discourage women from entering anaesthesia should be explored and addressed.

Electronic supplementary material

The online version of this article (doi:10.1186/s12871-017-0392-5) contains supplementary material, which is available to authorized users.

Short-term career perspectives of young cardiologists in the Netherlands

Background

Since it was anticipated that the need for doctors would increase due to demographic changes, the number of positions for medical specialty training programs has increased from the year 2000 onwards. However, the number of permanent positions for young cardiologists did not follow that trend leading to concerns about future employment. Therefore, the aim of the current study was to assess short-term career perspectives of young cardiologists in the Netherlands.

Methods

All cardiologists who ended their training between 1 January 2011 and 31 December 2014 were invited to fill in a questionnaire about their first employment status and were followed yearly until the participant had a permanent position. The timespan between the end of training and the moment of permanent employment was assessed. Furthermore, the association between professional profile and short-term career perspectives was investigated.

Results

The observed unemployment was 1.6% and lasted less than a year in all cases. Of the participants, 77% started their career with a temporary contract; within four years this was 7%. Of young cardiologists, 46% started their career as a fellow and 24% as an attending physician. A total of 29% of male cardiologists started their career with a permanent contract as compared with 12% of females (p = 0.01). Within two years this difference was no longer observed.

Conclusions

Unemployment is low among young cardiologists. Most cardiologists start their career with a temporary contract. The time to a permanent contract is slightly longer for female cardiologists as compared with males.

Dreams and disappointments regarding nursing: Student nurses' reasons for attrition and retention. A qualitative study design

BACKGROUND

In the Netherlands, hundreds of students register annually for a nursing programme, but not all of these students manage to complete their training.

OBJECTIVE

The main aim of this study was to examine which factors affect student nurses' decision to leave or complete their programme.

THEORETICAL FRAMEWORK

The study used an exploratory descriptive design, employing a qualitative phenomenological approach.

SAMPLE

Student nurses (n=17) at the beginning of their third year of the four-year Bachelor's programme.

DATA COLLECTION

Data were collected at four Universities of Applied Sciences in the Netherlands, from December 2013 to January 2014. Semi-structured interviews were used to collect the data, using an interview guide.

RESULTS

The main reasons for students to become nurses were the caring aspect, personal experiences with healthcare, role models in their immediate environment, and job opportunities. They had both altruistic and professional perceptions of their profession. Reasons for attrition were strongly related to the training programme and to their clinical placements, in particular the perceived lack of support from mentors and team. Feelings of being welcomed and working in a nice team proved to be more important reasons for completing the programme than the specific clinical field.

CONCLUSIONS

Student nurses started their studies with many dreams, such as caring for people and having the opportunity to deliver excellent nursing care. When their expectations were not met, their dreams became disappointments which caused them to consider stopping and even to leave (attrition). The role of lecturers and mentors seems invaluable in protecting and guiding students through their programme and placements. Optimal cooperation between lecturers and mentors is of paramount importance to retain student nurses in their training programmes.

Medical students' career choices, preference for placement, and attitudes towards the role of medical instruction in Ethiopia

BACKGROUND

In Ethiopia, the health care delivery and the system of medical education have been expanding rapidly. However, in spite of the expansion, no studies have been carried out among medical students to identify their career choices and attitudes towards the medical instruction. Therefore, this study aimed to fill the gap in evidence in these specific areas.

METHODS

Pretested questionnaire was self-administered among fifth and sixth year medical students in six government owned medical schools in Ethiopia. A total of 959 students were involved in the study with a response rate of 82.2%. Career choices, intention where to work just after graduation, and attitudes towards medical instruction were descriptively presented. Binary logistic regression model was fitted to identify factors associated with the intention of medical students to work in rural and remote areas.

RESULTS

Majority, (70.1%) of the medical students wanted to practice in clinical care settings. However, only a small proportion of them showed interest to work in rural and remote areas (21% in zonal and 8.7% in district/small towns). For most, internal medicine was the first specialty of choice followed by surgery. However, students showed little interest in obstetrics and gynecology, as well as in pediatrics and child health as their first specialty of choice. Medical students' attitudes towards their school in preparing them to work in rural and remote areas, to pursue their career within the country and to specialize in medical disciplines in which there are shortages in the country were low. The binary logistic regression model revealed that a significantly increased odds of preference to work in rural and remote areas was observed among males, those who were born in rural areas, the medical students of Addis Ababa University and those who had the desire to serve within the country.

CONCLUSION

This study showed that Ethiopian medical schools are training medical workforce with preferences not to work in rural and remote places, and not to specialize in disciplines where there are shortages in the country. Thus, attention should be given to influence medical students' attitude to work in rural and remote locations and to specialize in diverse clinical specialties.

Professional values and career choice of nursing students

BACKGROUND AND AIM

Professional values are abstract and general behavioral principles that provide basic standards to judge aims and actions, and these principles are formed by strong emotional loyalty of members of the profession. Research was conducted to compare the career choice and professional values of nursing students at two universities in the upper Midwest of the United States and in the middle of Turkey.

MATERIALS AND METHODS

A descriptive and comparative design was used. The participants of the study were comprised nursing students from a university in the upper Midwest of United States and a university in the middle of Turkey. The sample consisted of 728 students in all grades. Data were collected by a questionnaire, The Nurses Professional Values Scale-Revised and Vocational Choices in Entering Nursing Scale. Number, percentage distribution, mean, standard deviation, t test, and one-way variance analysis were used in the analysis of data. Ethical considerations: Ethical approval was obtained from the Ethics Commission. Informed consent was received from the students.

RESULTS

The students' mean age for American students was 24.3 ± 5.6 years, while the mean age for Turkish students was 19.8 ± 1.7 years. Mean score of American students on The Vocational Congruency (a subgroup of the Vocational Choices in Entering Nursing Scale) was 38.5 ± 5.9 and Turkish students was 29.6 ± 8.9 (p < 0.05). Mean score of American students on The Nurses Professional Values Scale-Revised was 109.2 ± 12.3 and that of Turkish students was 101.6 ± 17.0.

CONCLUSION

This study concluded that the majority of nursing students had high professional values, and when students' scores were compared, American students had higher professional values, and in career choice, they considered primarily fitness of the profession to themselves and their goals, while Turkish students primarily thought of their living conditions.

Career choice and perceptions of nursing among healthcare students in higher educational institutions

BACKGROUND

Due to the ageing population and competition from other healthcare courses, a greater demand in the healthcare workforce has made it challenging for educational institutions to attract school leavers to enter nursing courses. Understanding the considerations of students who have chosen non-nursing healthcare courses and their perceptions of nursing can help identify specific strategies to enhance the attractiveness of nursing course. This study aims to examine the differences between healthcare career choices and perceptions of nursing as a career choice among first-year non-nursing healthcare students.

METHOD

A descriptive survey design was conducted at the beginning of the healthcare courses of seven healthcare groups and from four higher educational institutions in Singapore. A total of 451 students responded, yielding an overall response rate of 52.7%. The online survey was administered using a valid and reliable 35-item parallel scale, known as the Healthcare Career Choice and Nursing Career Choice.

RESULTS

The participants perceived prior healthcare exposure as the most influential factor and self-efficacy as the least influential factor when choosing nursing as a career. In comparison to their own healthcare career choices, nursing was perceived to have greater gender stigma and, as nurses, they would be less likely to achieve higher qualifications and career advancements, and they would be less likely to enjoy fulfilling careers. They also perceived that they would be less likely to gain their parents' support to pursue nursing and to make their parents proud.

CONCLUSIONS

This study provides educators and policy-makers with vital information to develop key strategies to improve nursing enrolment in educational institutions. These strategies include early exposure to nursing as a rewarding career during school years, addressing the issue of gender stigma, and promoting information on the career and educational advancement of a registered nurse to parents of school leavers.

Development and psychometric testing of an instrument to compare career choice influences and perceptions of nursing among healthcare students

BACKGROUND

With the availability of more healthcare courses and an increased intake of nursing students, education institutions are facing challenges to attract school leavers to enter nursing courses. The comparison of career choice influences and perception of nursing among healthcare students can provide information for recruitment strategies. An instrument to compare the influences of healthcare career choice is lacking. The purpose of this study is to develop and evaluate the psychometric properties of an instrument to compare the influences of healthcare career choice with perceptions of nursing as a career choice.

METHODS

The study was conducted in two phases. In phase one, two sets of scales with parallel items that measure the influences of healthcare career choice and perceptions of nursing as a career choice were developed through an earlier qualitative study, literature review, and expert validation. Phase two involved testing the construct validity, concurrent validity and reliability with a convenience sample of 283 first year healthcare students who were recruited at two education institutions in Singapore.

RESULTS

An exploratory factor analysis revealed 35-parallel items in a six-factor solution (personal interest, prior healthcare exposure, self-efficacy, perceived nature of work, job prospects, and social influences) that explained 59 and 64% of the variance for healthcare career choice and nursing as a career choice respectively. A high correlation (r = 0.76, p < 0.001) was obtained with an existing tool, confirming the concurrent validity. The internal consistency was sufficient with Cronbach's alpha of 0.93 for healthcare career choice and 0.94 for nursing as a career choice. The test-retest reliability was acceptable with an Intraclass Correlation Coefficient of 0.63 for healthcare career choice and 0.60 for nursing as a career choice.

CONCLUSIONS

The instrument provides opportunities for understanding the differences between influences of healthcare career choice and perceptions of nursing as a career choice. This comparative understanding of career choice influences can guide educator and policy-makers on nursing recruitment.

Undergraduate Neuroscience Majors: A Missed Opportunity for Psychiatry Workforce Development

OBJECTIVE

This study sought to determine whether and to what extent medical students with an undergraduate college major in neuroscience, relative to other college majors, pursue psychiatry relative to other brain-based specialties (neurology and neurosurgery) and internal medicine.

METHODS

The authors analyzed data from AAMC matriculation and graduation surveys for all students who graduated from US medical schools in 2013 and 2014 (n = 29,714). Students who majored in neuroscience, psychology, and biology were compared to all other students in terms of their specialty choice at both time points. For each major, the authors determined rates of specialty choice of psychiatry, neurology, neurosurgery, and, for comparison, internal medicine. This study employed Chi-square statistic to compare odds of various specialty choices among different majors.

RESULTS

Among medical students with an undergraduate neuroscience major (3.5% of all medical students), only 2.3% preferred psychiatry at matriculation, compared to 21.5% who chose neurology, 13.1% neurosurgery, and 11% internal medicine. By graduation, psychiatry specialty choice increased to 5.1% among neuroscience majors while choice of neurology and neurosurgery declined. Psychology majors (OR = 3.16, 95% CI 2.60-4.47) but not neuroscience majors (OR 1.28, 0.92-1.77) were more likely than their peers to choose psychiatry.

CONCLUSIONS

Psychiatry struggles to attract neuroscience majors to the specialty. This missed opportunity is an obstacle to developing the neuroscience literacy of the workforce and jeopardizes the neuroscientific future of our field. Several potential strategies to address the recruitment challenges exist.

Factors associated with physicians' choice of a career in research: a retrospective report 15 years after medical school graduation

Relatively little is known regarding factors associated with the choice of a research career among practicing physicians, and most investigations of this issue have been conducted in the absence of a theoretical/conceptual model. Therefore we designed a survey to identify the determinants of decisions to pursue a biomedical research career based upon the Theory of Planned Behavior and the concept of stereotype threat. From October 2012 through January 2014 electronic surveys were sent to four consecutive Harvard Medical School graduating classes, 1996-1999. Respondents provided demographic information, indicated their current research involvement, and provided retrospective reports of their experiences and attitudes when they were making career choices as they completed medical school. Multivariable ordinal regression was used to identify factors independently associated with current research involvement. Completed questionnaires were received from 358 respondents (response rate 65 %). In unadjusted analyses, variables associated with more extensive research involvement included non-minority status, male gender, lower debt at graduation, strong attitudes toward research at time of graduation, and greater social pressures to pursue research (all P < .001). These associations remained significant in multivariable regression analysis (all P < 0.01). However, an interaction between sex and prior research publications was also detected, indicating that more extensive research involvement during medical school doubled the likelihood of a research career for women (OR 2.53, 95 % CI 1.00-6.40; P = 0.05). Most of the factors predicting research career choice involve factors that are potentially modifiable, suggesting that appropriately designed behavioral interventions may help to expand the size and diversity of the biomedical research community.

Stick or twist? Career decision-making during contractual uncertainty for NHS junior doctors

OBJECTIVES

To examine the extent, and nature, of impact on junior doctors' career decisions, of a proposed new contract and the uncertainty surrounding it.

DESIGN

Mixed methods. Online survey exploring: doctors' future training intentions; their preferred specialty training (ST) programmes; whether they intended to proceed immediately to ST; and other plans. Linked qualitative interviews to explore more fully how and why decisions were affected.

SETTING

Doctors (F2s) in second year of Foundation School (FS) Programmes in England.

PARTICIPANTS

Invitations sent by FSs. Open to all F2s November 2015-February 2016. All FSs represented. Survey completed by 816 F2s. Sample characteristics broadly similar to national F2 cohort.

MAIN OUTCOME MEASURES

Proportions of doctors intending to proceed to ST posts in the UK, to defer or to exit UK medicine. Proportion of doctors indicating changes in training and career plans as a result of the contract and/or resulting uncertainty. Distribution of changes across training programmes. Explanations of these intentions from interviews and free text comments.

RESULTS

Among the responding junior doctors, 20% indicated that issues related to the contract had prompted them to switch specialty and a further 20% had become uncertain about switching specialty. Switching specialty choice was more prevalent among those now choosing a community-based, rather than hospital-based specialty. 30% selecting general practice had switched choice because of the new contract. Interview data suggests that doctors felt they had become less valued or appreciated in the National Health Service and in society more broadly.

CONCLUSIONS

Doctors reported that contract-related issues have affected their career plans. The most notable effect is a move away from acute to community-based specialities, with the former perceived as more negatively affected by the proposed changes. It is concerning that young doctors feel undervalued, and this requires further investigation.

Using medical specialty and selection criteria clusters to study specialty selection by Israeli medical students

BACKGROUND

During their final year of medical school, Israeli students must consider which specialty to choose for residency. Based on the vocational counseling literature we presumed that choices are made by selecting from a cluster of related specialties while considering professional and socio-economic issues.

METHODS

Questionnaires distributed to final-year medical students at two Israeli medical schools ascertained inclinations toward various medical specialties and the importance of various selection criteria. Analysis focused on seven specialties where >20% of students reported they had positive inclinations. For each such specialty, the specialty and selection criteria query were compared using unpaired two-tailed Student's t-tests to determine differences between students with positive inclinations toward the specialty with those not so inclined. These data were placed in tables, with the significant differences highlighted to facilitate visual recognition of cluster patterns.

RESULTS

Completed questionnaires were obtained from 317 of 455 students. Students often had positive inclinations toward more than one specialty (specialty clusters) associated with a group of selection criteria (selection criteria clusters). For example, interest in internal medicine was clustered with interest in internal medicine subspecialties, cardiology and research. Furthermore, there was a "reciprocal" aspect to some specialty cluster patterns. For example, those interested in internal medicine had little interest in surgical specialties. Selection criteria clusters revealed occupational interests and socio-environmental factors associated with the specialty clusters. For example, family medicine, which clustered with pediatrics and psychiatry, had a sub-cluster of: Bedside specialty with family orientation affording long-term patient care. Another sub-cluster was time for childrearing and family, only daytime work and outpatient care. Clusters also revealed students' perceptions that differed from expected: Cardiology is changing from a cognitive to a procedure-oriented subspecialty, clustering not only with internal medicine and its subspecialties but also with emergency medicine, surgical subspecialties and anesthesiology.

CONCLUSIONS

The concept that career choice involves selecting from a cluster of related specialties provides information about the specialties students might be considering. Moreover, students are not only looking for individual aspects of a specialty, but for a package including clusters of socio-economic and occupational features. Practically, examining clusters can help in career counseling of medical students and assist residency program directors in marketing their specialties.

Why neurology? Factors which influence career choice in neurology

OBJECTIVE

To evaluate the factors which influence the decision to pursue a career in neurology.

METHODS

An anonymous survey was developed using a Likert scale to rate responses. The survey was sent to adult and child neurology faculty, residents and fellows, as well as medical students applying for neurology. Descriptive statistics were used to analyse the factors of influence. Respondents were subsequently categorized into pre-neurology trainees, neurology trainees, child neurologists and adult neurologists, and differences between the groups were analysed using Pearson's chi-square test.

RESULTS

One hundred and thirty-three anonymous responses were received. The respondents were neurologists across all levels of training and practice. Across all respondents, the most common factor of high importance was intellectual content of specialty, challenging diagnostic problems, type of patient encountered and interest in helping people. Responses were similar across the groups; however, the earliest trainees cited interest in helping people as most important, while those in neurology training and beyond cite intellectual content of the specialty as most important.

DISCUSSION

As trainees transition from their earliest levels of clinical experience into working as residents and faculty, there is a shift in the cited important factors. Lifestyle and financial factors seem to be the least motivating across all groups. Encouragement from peers, mentors, faculty and practicing physicians is considered high influences in a smaller number of neurologists. This may present an opportunity for practicing neurologists to make connections with medical students early in their education in an effort to encourage and mentor candidates.

Does a PBL-based medical curriculum predispose training in specific career paths? A systematic review of the literature

BACKGROUND

North American medical schools have used problem-based learning (PBL) structured medical education for more than 60 years. However, it has only recently been introduced in other medical schools outside of North America. Since its inception, there has been the debate on whether the PBL learning process predisposes students to select certain career paths.

OBJECTIVES

To review available evidence to determine the predisposition of specific career paths when undertaking a PBL-based medical curriculum. The career path trajectory was determined as measured by official Matching Programs, self-reported questionnaires and surveys, and formally defined career development milestones.

METHODS

A systematic literature review was performed. PubMed, Medline, Cochrane and ERIC databases were analysed in addition to reference lists for appropriate inclusion.

RESULTS

Eleven studies fitting the inclusion criteria were identified. The majority of studies showed that PBL did not predispose a student to a career in a specific speciality (n = 7 out of 11 studies, 64%). However, three studies reported a significantly increased number of PBL graduates working in primary care compared to those from a non-PBL curriculum.

CONCLUSIONS

PBL has been shown not to predispose medical students to a career in General Practice or any other speciality. Furthermore, a greater number of similar studies are required before a definitive conclusion can be made in the future.

Career Satisfaction Among Dental Public Health Specialists in India - A Cross-sectional Survey

INTRODUCTION

The satisfaction in career is an important indicator for the growth of the discipline and the profession. An empirical investigation of satisfaction in career and amendments needed in course and profession may help in growth of discipline.

AIM

To assess career satisfaction among Dental Public Health (DPH) specialists working in India and analyze their perspective on changes required in the profession.

MATERIALS AND METHODS

Questionnaire for this cross-sectional survey was adapted from Minnesota Job Satisfaction Survey which included 40 enquiries to understand the reasons for choosing public health dentistry as career, competencies of public health dentists, satisfaction as a public health dentist and changes required in the profession. The questions were both open and closed end type. Updated electronic mail details of all registered public health dentists were collected from the head office of Indian Association of Public Health Dentistry. Each participant was contacted by electronic mail and consent to participate were sought. Reminders were e-mailed thrice during three months. A total of 580 participants were contacted. A total of 183 responses were received, among which 179 consented.

RESULTS

Nearly half of the respondents felt they are yet to achieve the accomplishment from the present career as public health dentist. Only 46.9% felt that there is advancement in the profession as career. Nearly three-fourth of respondents could not attain recognition as a public health dentist. A 45.8% of respondents were of the opinion that career in public health dentistry would provide them a steady employment and 53.1% of public health dentists would envision as satisfied in their career in next 10 years. Nearly 85% felt public health dentistry training needs a major course correction.

CONCLUSION

There has been some reservation or skepticism about the future of the specialty as the jobs are in declining stage. This information provides insight about success and failures of public health dentistry as profession which would be needed for planning the dental manpower.

Influencing Factors on Choosing Psychiatry as a Career: An Exploration in Chinese University Students

There is a consistent need of psychiatric professionals in the world including China, and a consistent challenge to recruit more medical students into the psychiatric careers. We aimed to look for factors which have an impact on career-choosing of psychiatry in Chinese university students. We invited 508 non-medical students (NM), 304 medical students without (MO) and 123 medical students with clinical internship experience (MW), to answer a matrix of 43 questions regarding factors influencing career-choosing of psychiatry. Answers to these questions were analyzed through exploratory and confirmatory factor analyses, once the latent factors were identified and structurally-validated, their mean scores in three groups of students were calculated. Five factors with five items each were identified, namely social status inferiority, career importance, practice reward, career preference, and practice stress. NM scored lower than MO and MW did on Social Status Inferiority; NM group scored higher than MO and MW groups did on Career Importance; MW scored lower than NM and MO did on Practice Reward and on Career Preference; Regarding Practice Stress, NM scored higher than MO did, who then in turn, scored higher than MW did. In addition, Practice Stress was positively correlated with advice of the medical educators; and Social Status Inferiority and Career Preference were positively correlated with the psychiatry teaching of the medical educators. Raising career rewards, improving social status, and reinforcing psychiatric education might help to recruit more medical students to specialize in psychiatry practicing.

Views on Careers in Clinical Neurosciences Among Neurosurgeons and Neurologists in China

BACKGROUND

China has a large and aging population. The need for physicians with training in clinical neurosciences will grow. There is little known regarding the factors that lead physicians in China to pursue careers in clinical neurosciences. The objective of this study was to garner a clearer understanding of factors that influence physicians to pursue careers in neurosurgery and neurology in China.

METHODS

We surveyed attendees at a national neuroscience conference on the factors that influence their pursuit of careers in clinical neurosciences. Responses were quantified on a Likert scale. One-way analysis of variance was used to compare different groups of respondents.

RESULTS

Factors associated with the intellectual elements of the specialties were rated most highly. Differences were noted between respondents, with trainees rating lifestyle-related factors more highly compared with attending physicians.

CONCLUSIONS

The intellectual challenges are important factors for physicians in China influencing the pursuit of careers in the clinical neurosciences. This finding echoes results found elsewhere in the world. However, differences with trainees elsewhere in the world emerge when evaluating additional factors influencing trainees pursuing careers in the clinical neurosciences. Trainees in China rate educational experiences and mentorship more highly, whereas U.S. trainees rate altruistic goals more highly. This study provides a clearer understanding of factors influencing career choice among clinical neuroscientists in China.

Gender difference in preference of specialty as a career choice among Japanese medical students

BACKGROUND

In Japan, the absolute deficiency of doctors and maldistribution of doctors by specialty is a significant problem in the Japanese health care system. The purpose of this study was to investigate the factors contributing to specialty preference in career choice among Japanese medical students.

METHODS

A total of 368 medical students completed the survey giving an 88.2 % response rate. The subjects comprised 141 women aged 21 ± 3 (range, 18-34) years and 227 men aged 22 ± 4 (range, 18-44) years. Binary Logistic regression analysis was performed using specialty preferences as the criterion variable and the factors in brackets as six motivational variables (e.g., Factor 1: educational experience; Factor 2: job security; Factor 3: advice from others; Factor 4: work-life balance; Factor 5: technical and research specialty; and Factor 6: personal reasons).

RESULTS

Women significantly preferred pediatrics, obstetrics & gynecology, and psychology than the men. Men significantly preferred surgery and orthopedics than the women. For both genders, a high odds ratio (OR) of "technical & research specialty" and a low OR for "personal reasons" were associated with preference for surgery. "Technical & research specialty" was positively associated with preference for special internal medicine and negatively for pediatrics. "Work-life balance" was positively associated with preference for psychology and negatively for emergency medicine. Among the women only, "technical & research specialty" was negatively associated with preference for general medicine/family medicine and obstetrics & gynecology, and "job security" was positively associated for general medicine/family medicine and negatively for psychology. Among men only, "educational experience" and "personal reasons" were positively, and "job security" was negatively associated with preference for pediatrics. For both genders, "work-life balance" was positively associated with preference for controllable lifestyle specialties.

CONCLUSION

We must acknowledge that Japanese medical students have dichotomized some motivations for their specialty preference based on gender. Systematic improvements in the working environment are necessary to solve these issues.

Hospital preferences of nursing students in Korea: a discrete choice experiment approach

BACKGROUND

DCE was applied to investigate nursing students' preferred hospital choice criteria and to investigate the trends in the trade-offs by calculating the marginal rate of substitution between these criteria. This study identified the properties of the hospitals primarily selected by nursing students, and aims to estimate the monetary value of each attribute.

METHODS

Based on discussions and in-depth interviews with nursing students' focus groups and a literature review, we created a discrete choice experiment (DCE) that assessed how students' stated preference for a certain hospital choice was influenced by various job attributes: higher salary, location, hospital type, salary per year, provision of a dormitory, etc. We applied this DCE to nursing students in South Korea using a brief structured questionnaire, and we used conditional logit models to estimate the utility of each job's attributes. Willingness to pay (WTP) was estimated as the ratio of the value of the coefficient of interest to the negative of the cost attribute.

RESULTS

Complete data for the DCE analysis were available for 702 nursing students. In the main effect mixed logit model, the welfare system and organizational culture were most strongly associated with job preference. Location, hospital type, and opportunity to upgrade qualifications had a negative influence on hospital choice. The WTP threshold was 7,043,000 KRW for the welfare system and 9,928,000 KRW for the organizational culture (relation-oriented).

CONCLUSIONS

Better nursing working conditions, such as a positive organizational culture and the provision of a welfare system, can improve the motivation and applications for hospitals in rural areas.

Impact of the primary care curriculum and its teaching formats on medical students' perception of primary care: a cross-sectional study

Background

Switzerland is facing an impending primary care workforce crisis since almost half of all primary care physicians are expected to retire in the next decade. Only a minority of medical students choose a primary care specialty, further deepening the workforce shortage. It is therefore essential to identify ways to promote the choice of a primary care career. The aim of the present study was to explore students’ views about the undergraduate primary care teaching curriculum and different teaching formats, and to evaluate the possible impact of these views on students’ perceptions of primary care.

Methods

We surveyed fifth year medical students from the Medical Faculties in Geneva and Lausanne, Switzerland (n = 285) with a four sections electronic questionnaire. We carried out descriptive analyses presented as frequencies for categorical data, and means and/or medians for continuous data.

Results

The response rate was 43 %. Overall, primary care teaching had a positive impact on students’ image of primary care. In Lausanne, primary care curricular components were rated more positively than in Geneva. Curricular components that were not part of the primary care teaching, but were nevertheless cited by some students, were frequently perceived as having a negative impact.

Conclusions

The primary care curriculum at Lausanne and Geneva Universities positively influences students’ perceptions of this discipline. However, there are shortcomings in both the structure and the content of both the primary care and hidden curriculum that may contribute to perpetuating a negative image of this specialization.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-016-0532-x) contains supplementary material, which is available to authorized users.

Which positive factors determine the GP satisfaction in clinical practice? A systematic literature review

Background

Looking at what makes General Practitioners (GPs) happy in their profession, may be important in increasing the GP workforce in the future. The European General Practice Research Network (EGPRN) created a research team (eight national groups) in order to clarify the factors involved in GP job satisfaction throughout Europe. The first step of this study was a literature review to explore how the satisfaction of GPs had been studied before. The research question was “Which factors are related to GP satisfaction in Clinical Practice?”

Methods

Systematic literature review according to the PRISMA statement. The databases searched were Pubmed, Embase and Cochrane. All articles were identified, screened and included by two separate research teams, according to inclusion or exclusion criteria. Then, a qualitative appraisal was undertaken. Next, a thematic analysis process was undertaken to capture any issue relevant to the research question.

Results

The number of records screened was 458. One hundred four were eligible. Finally, 17 articles were included. The data revealed 13 subthemes, which were grouped into three major themes for GP satisfaction. First there were general profession-related themes, applicable to many professions. A second group of issues related specifically to a GP setting. Finally, a third group was related to professional life and personal issues.

Conclusions

A number of factors leading to GP job satisfaction, exist in literature They should be used by policy makers within Europe to increase the GP workforce. The research team needs to undertake qualitative studies to confirm or enhance those results.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-016-0524-x) contains supplementary material, which is available to authorized users.

The influence of temperament and character profiles on specialty choice and well-being in medical residents

BACKGROUND

Multiple factors influence the decision to enter a career in medicine and choose a specialty. Previous studies have looked at personality differences in medicine but often were unable to describe the heterogeneity that exists within each specialty. Our study used a person-centered approach to characterize the complex relations between the personality profiles of resident physicians and their choice of specialty.

METHODS

169 resident physicians at a large Midwestern US training hospital completed the Temperament and Character Inventory (TCI) and the Satisfaction with Life Scale (SWLS). Clusters of personality profiles were identified without regard to medical specialty, and then the personality clusters were tested for association with their choice of specialty by co-clustering analysis. Life satisfaction was tested for association with personality traits and medical specialty by linear regression and analysis of variance.

RESULTS

We identified five clusters of people with distinct personality profiles, and found that these were associated with particular medical specialties Physicians with an "investigative" personality profile often chose pathology or internal medicine, those with a "commanding" personality often chose general surgery, "rescuers" often chose emergency medicine, the "dependable" often chose pediatrics, and the "compassionate" often chose psychiatry. Life satisfaction scores were not enhanced by personality-specialty congruence, but were related strongly to self-directedness regardless of specialty.

CONCLUSIONS

The personality profiles of physicians were strongly associated with their medical specialty choices. Nevertheless, the relationships were complex: physicians with each personality profile went into a variety of medical specialties, and physicians in each medical specialty had variable personality profiles. The plasticity and resilience of physicians were more important for their life satisfaction than was matching personality to the prototype of a particular specialty.

Private or salaried practice: how do young general practitioners make their career choice? A qualitative study

BACKGROUND

Young French postgraduates in general practice increasingly prefer salaried practice to private practice in spite of the financial incentives offered by the French government or local communities to encourage the latter. This study aimed to explore the determinants of choice between private or salaried practice among young general practitioners.

METHODS

A qualitative study was conducted in the South West of France. Semi-structured interviews of young general practitioners were audio-recorded until data saturation. Recordings were transcribed and then analyzed according to Grounded Theory by three researchers working independently.

RESULTS

Sixteen general practitioners participated in this study. For salaried and private doctors, the main factors governing their choice were occupational factors: working conditions, need of varied scope of practice, quality of the doctor-patient relationship or career flexibility. Other factors such as postgraduate training, having worked as a locum or self-interest were also determining. Young general practitioners all expected a work-life balance. The fee-for-service scheme or home visits may have discouraged young general practitioners from choosing private practice.

CONCLUSIONS

National health policies should increase the attractiveness of ambulatory general practice by promoting the diversification of modes of remuneration and encouraging the organization of group exercises in multidisciplinary medical homes and community health centers.

Career anchors of dentist leaders

OBJECTIVE

The work of a health care leader is demanding; in order to cope, leaders need motivation and support. The occurrence of intrinsic factors called career anchors (combination of one's competence, motives and values) could be a contributing factor in dentist leaders' career decisions. The aim of our study was to identify dentist leaders' career anchors and their association to dentist leaders' retention or turnover of the leadership position.

MATERIAL AND METHODS

Materials were gathered in 2014 via an electronic questionnaire from 156 current (Leaders) or former (Leavers) Finnish dentist leaders. Career anchor evaluation was conducted by the questionnaire and scoring-table taken from Edgar Schein's Career Anchors Self-Assessment. Both the most and the least important career anchors were detected by the highest and lowest scores and their occurrence reported as percentages. Associations between career anchor scores and tendency to stay were analyzed with logistic regression.

RESULTS

'Technical/Functional Competence' and 'Lifestyle' were most frequently reported as the most important and 'Entrepreneurial Creativity' and 'General Managerial Competence' as the least important career anchors. However, a higher level of 'General Managerial Competence' anchor was most significantly associated with staying in a leadership position. Instead, 'Pure Challenge' and 'Lifestyle' decreased the odds to stay.

CONCLUSIONS

The knowledge of the important and essential career anchors of dentist leaders' and individuals' could perform crucial part in career choices and also in planning education, work opportunities and human resource policies promoting retention of dentist leaders and probably also other health care leaders.

Choosing to become a general practitioner - What attracts and what deters? An analysis of German medical graduates' motives

BACKGROUND

To be able to counter the increasing shortage of general practitioners (GPs) in many countries, it is crucial to remain up-to-date with the decisive reasons why young physicians choose or reject a career in this field.

MATERIALS AND METHODS

Qualitative content analysis was performed using data from a cross-sectional survey among German medical graduates (n = 659, response rate = 64.2%). Subsequently, descriptive statistics was calculated.

RESULTS

The most frequent motives to have opted for a GP career were (n = 74/81): Desire for variety and change (62.2%), interest in a long-term bio-psycho-social treatment of patients (52.7%), desire for independence and self-determination (44.6%), positively perceived work-life balance (27.0%), interest in contents of the field (12.2%), and reluctance to work in a hospital (12.2%). The most frequent motives to have dismissed the seriously considered idea of becoming a GP were (n = 207/578): Reluctance to establish a practice or perceived associated risks and impairments (33.8%), stronger preference for another field (19.3%), perception of workload being too heavy or an unfavorable work-life balance (15.0%), perception of too low or inadequate earning opportunities (14.0%), perception of the GP as a distributor station with limited diagnostic and therapeutic facilities (11.6%), perception of too limited specialization or limited options for further sub-specialization (10.6%), rejection of (psycho-) social aspects and demands in general practice (9.7%), and perceived monotony (9.7%).

CONCLUSION

While some motives appear to be hard to influence, others reveal starting points to counter the GP shortage, in particular, with regard to working conditions, the further academic establishment, and the external presentation of the specialty.

Attitudes towards primary care career in community health centers among medical students in China

BACKGROUND

Very few of the primary care doctors currently working in China's community health centers have a college degree (issued by 5-year medical schools). How to attract college graduates to community services in the future, therefore, has major policy relevance in the government's ongoing efforts to reform community health care and fill in the long-absent role of general physicians in China. This paper examined medical school students' attitudes towards working in communities and the factors that may affect their career choices in primary care to inform policy on this subject.

METHODS

A cross-sectional survey was designed upon the issuance of community health reform policy in 2006 by the Chinese government. The survey was conducted among 2714 medical students from three medical schools in representative regions in China. Binomial and multinomial regression analyses were carried out using a collection of plausible predictors such as place of rearing, income, etc. to assess their willingness to work in communities.

RESULTS

Of the 2402 valid responses, besides 5.7 % objection to working in communities, 19.1 % expressed definite willingness. However, the majority (41.5 %) of students only consider community job as a temporary transition, in addition to 33.7 % using it as their backup option. The survey analyses found that medical students who are more likely to be willing to work in communities tend to come from rural backgrounds, have more exposure to community health reform, and possess certain personally held value and fit.

CONCLUSION

To attract more graduates from 5-year medical schools to work in communities, a targeted recruiting approach or admission policy stands a better chance of success. The findings on the influencing factors of medical students' career choice can help inform policymakers, medical educators, and community health managers to improve the willingness of swing students to enter primary care to strengthen basic health services.

Application of career related research in Pakistan: The case of apples vs mangoes

Career choice of medical graduates is dependent on a number of factors as identified in literature across the globe. This article presents an overview of contemporary research on career choices of medical graduates and the generalisation of findings in Pakistan. A number of issues are highlighted which include lack of standardised instruments, classification of specialties and mixed evidence regarding variables and socio cultural differences..

Impact Of Socio-Economic Status On Determinants Of Medical Career

BACKGROUND

Research on determinants of Medical profession has established some constant factors with universal impact and appeal. However, the dramatic changes in the dynamics of medical profession and medical education over the past years have necessitated a revisiting of the established conclusions. The knowledge of impact of economic status on these determinants would pave way to greater interest and research on the subject, especially in Hazara Division where it is practically nonexistent.

METHODS

This exploratory research followed deductive-inductive approach and was conducted upon 550 respondents from four public and private colleges in Hazara Division. Extensive study of related literature yielded 20 broad determinants of medical career. Pre-research pilot testing verified the reliability of a self-designed instrument. The data collection method adopted was a single shot survey. Personal data of respondents was collected during administration of the instrument. The sample was extracted through systematic random sampling technique giving due weight to proportional representation of each college as well as to the gender distribution.

RESULTS

The results revealed a significant difference in the impact of reassuring social perceptions and social status and prestige of medical profession between upper middle class and lower middle class. The results also showed that the students of upper middle class faced significantly greater domestic and familial pressure to enter the medical profession than those from lower middle class.

CONCLUSIONS

The findings showed that the upper middle class is under greater influence of societal forces and wider impressions about the medical profession. The students hailing from upper middle class enter the Medical career motivated by urge for social status and prestige and are most compelled by domestic and familial pressures to enter medicine.

[Job stress of nursing aides in Swiss nursing homes : Nonlinear canonical analysis]

BACKGROUND

Due to demographic changes, the demand for care in nursing homes for the elderly and infirmed is growing. At the same time nursing staff shortages are also increasing. Nursing aides are the primary care providers and comprise the largest staff group in Swiss nursing homes. They are exposed to various forms of job stress, which threaten job retention.

OBJECTIVE

The aim of this study was to discover which features of the work situation and which personal characteristics of the nursing aides were related to the workload.

MATERIAL AND METHODS

Data from nursing aides in Swiss nursing homes were investigated through a secondary analysis of a national quantitative cross-sectional study, using descriptive statistics and a nonlinear canonical correlation analysis.

RESULTS

A total of 1054 nursing aides were included in the secondary analysis, 94.6 % of whom were women between the ages of 42 and 61 years. The job stress most frequently mentioned in the descriptive analysis, almost 60 % of the participants referred to it, was staff shortage. The nonlinear canonical correlation analysis revealed that many job strains are caused by social and organizational issues. In particular, a lack of support from supervisors was associated with staff not feeling appreciated. These job strains correlated with a high level of responsibility, the feeling of being unable to work independently and a feeling of being exploited. These strains were predominant in the nursing aides between 32 and 51 years old who had part time jobs but workloads of 80-90 %.

CONCLUSION

Middle-aged nursing aides who worked to 80-90 % are particularly at risk to resign from the position prematurely. Measures need to be mainly implemented in the social and organizational areas. It can be assumed that a targeted individual support, recognition and promotion of nursing aides may decrease the level of job strain.

The perceived usefulness of community based education and service (COBES) regarding students' rural workplace choices

BACKGROUND

Community Based Education and Service (COBES) are those learning activities that make use of the community as a learning environment. COBES exposes students to the public and primary health care needs of rural communities. The purpose of this study was to investigate students' perceived usefulness of COBES and its potential effect on their choice of career specialty and willingness to work in rural areas.

METHOD

A mixed method cross sectional study design using semi-structured interviews, questionnaires, and focus group discussions were used for health facility staff, faculty and students and community members.

RESULTS

One hundred and seventy questionnaires were administered to students and 134 were returned (78.8% response rate). The majority (59.7%) of students were male. Almost 45% of the students indicated that COBES will have an influence on their choice of career specialty. An almost equal number (44%) said COBES will not have an influence on their choice of career specialty. However, 60.3% of the students perceived that COBES could influence their practice location. More males (64.7%, n = 44) than females (57.8%, n = 26) were likely to indicate that COBES will influence their practice location but the differences were statistically insignificant (p = 0.553). The majority of students, who stated that COBES could influence their practice location, said that COBES may influence them to choose to practice in the rural area and that exposure to different disease conditions among different population groups may influence them in their career choice. Other stakeholders held similar views. Qualitative data supported the finding that COBES could influence medical students' choice of specialty and their practice location.

CONCLUSION

Medical students' 'perceptions of the influence of COBES on their choice of career specialty were varied. However, most of the students felt that COBES could influence them to practice in rural locations.

The training paths and practice patterns of Canadian paediatric residency graduates, 2004-2010

BACKGROUND

The Paediatric Chairs of Canada have been proactive in workforce planning, anticipating paediatric job opportunities in academic centres. To complement this, it is important to characterize the practice profiles of paediatricians exiting training, including those working outside of tertiary care centres.

OBJECTIVE

To describe the training paths and the practice patterns of Canadian paediatric residency graduates.

METHODS

A survey was completed in 2010 to 2011 by Canadian program directors regarding residents completing core paediatrics training between 2004 and 2010. Data collection included training path after completing core paediatrics training and practice type after graduation.

RESULTS

Of 699 residents completing their core training in paediatrics, training path data were available for 685 (98%). Overall, 430 (63%) residents completed subspecialty training while 255 (37%) completed general paediatrics training only. There was a significant increase in subspecialty training, from 59% in earlier graduates (2004 to 2007) to 67% in later graduates (2008 to 2010) (P=0.037). Practice pattern data after completion of training were available for 245 general paediatricians and 205 subspecialists. Sixty-nine percent of general paediatricians were community based while 85% of subspecialists were hospital based in tertiary or quaternary centres. Of all residents currently in practice, only 36 (8%) were working in rural, remote or underserviced areas.

CONCLUSIONS

Almost two-thirds of recent Canadian paediatric graduates pursued subspecialty training. There was a significant increase in the frequency of subspecialty training among later-year graduates. Few graduates are practicing in rural or underserviced areas. Further studies are needed to determine whether these trends continue and their impact on the future paediatric workforce in Canada.

The effect of a career activity on the students' perception of the nursing profession and their career plan: A single-group experimental study

BACKGROUND

Students' conceptualizations of nursing and their reasons for choosing the profession motivate them and affect their education, work performance and career plans. Nursing educators should support them to plan their careers consciously during their education.

OBJECTIVES

The study aimed to investigate the effect of career-planning event for nursing students on their conceptualizations of the nursing profession and their career plans.

DESIGN

The study was as single-group experimental study using a pre-test and post-test.

SETTINGS

The career-planning event was held in the conference hall of the university involved in the current study, and was open to the all students of the nursing school.

PARTICIPANTS

The sample of the study consisted of 105 students who participated in the "Nursing Career Symposium" held on 27 March 2015. Methods At the event, the importance of career planning and the opportunities of the nursing profession was presented. The data were collected using a questionnaire consisted of two sections including descriptive characteristics and the opinions of the students regarding their career plans and Perception of Nursing Profession Scale. The students completed the first section of the questionnaire before the career event began and the second section of the questionnaire and scale both before and after the event.

RESULTS

The participants had positive conceptualizations of the profession. Following a career event, the participants' opinions of professional qualities and professional status as measured through the Perception of Nursing Profession Scale showed a significant increase, and that the event had made an important contribution to their career plans.

CONCLUSIONS

In the light of these results, it is possible to suggest that such events have an important place during education in that they introduce the nursing profession, and they develop the students' positive thoughts regarding the profession in terms of both course content and teaching methodology.

Factors influencing US medical students' decision to pursue surgery

BACKGROUND

Interest and applications to surgery have steadily decreased over recent years in the United States. The goal of this review is to collect the current literature regarding US medical students' experience in surgery and factors influencing their intention to pursue surgery as a career. We hypothesize that multiple factors influence US medical students' career choice in surgery.

METHODS

Six electronic databases (PubMed, SCOPUS, Web of Science, Education Resources Information Center, Embase, and PsycINFO) were searched. The inclusion criteria were studies published after the new century related to factors influencing surgical career choice among US medical students. Factors influencing US medical student surgical career decision-making were recorded. A quality index score was given to each article selected to minimize risk of bias.

RESULTS

We identified 38 relevant articles of more than 1000 nonduplicated titles. The factors influencing medical student decision for a surgical career were categorized into five domains: mentorship and role model (n = 12), experience (clerkship n = 9, stereotype n = 4), timing of exposure (n = 9), personal (lifestyle n = 8, gender n = 6, finance n = 3), and others (n = 2).

CONCLUSIONS

This comprehensive systemic review identifies mentorship, experience in surgery, stereotypes, timing of exposure, and personal factors to be major determinants in medical students' decisions to pursue surgery. These represent areas that can be improved to attract applicants to general surgery residencies. Surgical faculty and residents can have a positive influence on medical students' decisions to pursue surgery as a career. Early introduction to the field of surgery, as well as recruitment strategies during the preclinical and clinical years of medical school can increase students' interest in a surgical career.

Enhancing Nephrology Career Interest through the ASN Kidney TREKS Program

The Kidney Tutored Research and Education for Kidney Students (TREKS) Program is a product of the American Society of Nephrology (ASN) Workforce Committee that seeks to connect medical and graduate students to nephrology. This program starts with a weeklong camp-like course introducing participants to renal physiology through classic and modern experiments. Next, each student is matched with a nephrology mentor at his or her home institution to foster a better understanding of a nephrology career. Lastly, the students are encouraged to participate in scholarly activities and attend the ASN Kidney Week. Now in its third year, with a total of 84 participants, survey data suggest early success of the program, with a self-reported 40% increased interest in nephrology fellowship and/or research careers. In addition, students give high ratings to the course components and mentorship pairings. Continued student tracking will be necessary to determine the long-term program effect.

Social dominance theory and medical specialty choice

Understanding how medical students select their specialty is a fundamental issue for public health and educational policy makers. One of the factors that students take into account is a specialty's prestige which hinges partly on its focus on technique rather than whole person. We examine the potential of a psychological framework, social dominance theory, to explain why some students, and not others, are drawn to more prestigious, technique-oriented specialties, based on their desire for hierarchy. We conducted a cross-sectional study among medical students at Institution X (N = 359). We examined the link between medical students' characteristics i.e. social dominance orientation (SDO), gender, age, and their career intention. We also examined level of medical students' SDO at different stages of the curriculum. SDO scores were significantly associated with technique-oriented career intentions (OR 1.56; 95 % CI [1.18, 2.06]; p = 0.001). The effect was independent of gender. Medical students' SDO scores were significantly higher in later stages of the medical curriculum (F = 6.79; p = 0. 001). SDO is a significant predictor of medical students' career intention. SDO scores are higher in students during the clinical phase of the curriculum. Medical socialization, involving the internalization of implicit and explicit norms, particularly in hospital settings, is likely to underpin our findings. This theory illuminates consistent findings in the literature on specialty prestige and the influence of medical school on career choice.

Interest in nursing among academic degree holders in Israel: A cross-sectional quantitative study

BACKGROUND

The shortage of nurses is a global problem. One strategy for producing more registered nurses worldwide and in Israel in particular is to offer graduate entry nursing programs for individuals with non-nursing academic degrees. In order to recruit academic degree holders into the nursing profession, it is important to identify factors that might attract them.

OBJECTIVES

The purpose of this study was to explore whether the perception of nurse characteristics by academic degree holders is associated with their interest in enrolling in a graduate entry nursing program or in recommending this program to a family member, and whether ethnic background, gender and interaction with a nurse have an effect on this interest.

DESIGN

A cross-sectional quantitative study.

SETTINGS

The setting of the study was on the campus of Tel Aviv University.

PARTICIPANTS

A convenience sample of 522 individuals with an academic education, men and women, aged 18-60 and equally distributed between Jewish and Arab Israelis, took part in the study.

METHODS

Participants completed a questionnaire based on the Porter Nursing Image Scale.

RESULTS

A moderate positive correlation was found between perception of nurses and interest in nursing (r=0.32, p<0.01). Arab Israelis, women, and individuals who have or have had interactions with nurses, viewed nurses in a more positive light and had a higher interest in nursing than their counterparts.

CONCLUSIONS

Efforts should be made to foster a positive public image of nursing among the population of people with an academic education. Recruitment strategies should be tailored to each of this population's subgroups.

Factors influencing the career interest of medical graduates in obstetrics and gynaecology in Hong Kong: a cross-sectional questionnaire survey

INTRODUCTION

The trend of declining interest of medical graduates in pursuing obstetrics and gynaecology as a career has been observed in many overseas studies. This study aimed to evaluate the career interest of the most recent medical graduates in Hong Kong, especially their level of interest in obstetrics and gynaecology, and to identify key influential factors for career choice and career interest in obstetrics and gynaecology.

METHODS

All medical graduates from the Chinese University of Hong Kong and the University of Hong Kong who attended the pre-internship lectures in June 2015 were invited to participate in this cross-sectional questionnaire survey. The main outcome measures were the level of career interest in obstetrics and gynaecology, the first three choices of specialty as a career, key influential factors for career choice, and key influential factors for career interest in obstetrics and gynaecology.

RESULTS

Overall, 73.7% of 323 new medical graduates participated in the study and 233 questionnaires were analysed. The median score (out of 10) for the level of career interest in obstetrics and gynaecology was 3. There were 37 (16.2%) participants in whom obstetrics and gynaecology was among their first three choices, of whom 29 (78.4%) were female. Obstetrics and gynaecology ranked as the eighth most popular career choice. By factor analysis, the strongest key influential factor for career interest in obstetrics and gynaecology was clerkship experience (variance explained 28.9%) and the strongest key influential factor for career choice was working style (variance explained 26.4%).

CONCLUSIONS

The study confirmed a low level of career interest in obstetrics and gynaecology among medical graduates and a decreasing popularity of the specialty as a career choice. The three key influential factors for career interest in obstetrics and gynaecology and career choice were working style, clerkship experience, and career prospects.

participants in the Indiana University-Moi University elective

BACKGROUND

Global health experiences evoke a profound awareness of cultural differences, inspire learners to prioritize professional values, and provide a lens for addressing global health care challenges. This study compares the long-term career and practice choices of participants in a 2-month Indiana University-Moi University, Kenya elective from 1989-2013 with those of a control group.

METHODS

Global health elective (GHE) participants and a random sample of alumni without GHE experience were surveyed on their clinical practice, public health and global health activities.

RESULTS

Responses from 176 former participants were compared with a control group of 177 alumni. GHE participants were more likely than similar controls to provide care to underserved U.S. populations (p=0.037), spend time in global health, public health, and public policy activities (p=0.005) and be involved in global health advocacy (p=0.001). Using multivariable analysis, GHE participants were more likely to be generalists (p<0.05), report that healthcare costs influenced medical decision-making (p<0.05), and provide healthcare outside the U.S. for ≥1 week/year (p<0.001).

CONCLUSIONS

Many years out of training, GHE participants were more likely to be generalists working with underserved populations, to be cost-conscious in their healthcare decision-making, and to be involved in global health, public health or public policy.

IMPLICATIONS

With the primary care provider shortage and need for greater awareness among providers of healthcare costs, our study shows that that global health experiences may yield broader benefits to the U.S. medical system.

Factors that influence the choice to work in rural township health centers among 4,669 clinical medical students from five medical universities in Guangxi, China

PURPOSE

To produce competent undergraduate-level medical doctors for rural township health centers (THCs), the Chinese government mandated that medical colleges in Central and Western China recruit rural-oriented, tuition-waived medical students (RTMSs) starting in 2010. This study aimed to identify and assess factors that influence the choice to work in rural township health centers among both RTMSs and other students from five medical universities in Guangxi, China.

METHODS

An internet-based self-administered questionnaire survey was conducted with medical students in Guangxi province. Multinomial logistic regression was used to identify factors related to the attitudes toward work in a rural township health center.

RESULTS

Among 4,669 medical students, 1,523 (33%) had a positive attitude and 2,574 (55%) had a neutral attitude toward working in THCs. Demographic characteristics, personal job concerns, and knowledge of THCs were associated with the choice of a career in THCs. The factors related to a positive attitude included the following: three-year program, a rural-oriented medical program, being male, an expectation of working in a county or township, a focus on medical career development, some perceived difficulty of getting a job, having family support, sufficient knowledge of THCs, optimism toward THC development, seeking lower working pressure, and a lower expected monthly salary.

CONCLUSION

Male students in a three-year program or a rural-oriented tuition-waived medical education program were more likely to work in THCs. Selecting medical students through interviews to identify their family support and intentions to work in THCs would increase recruitment and retention. Establishing favorable policies and financial incentives to improve living conditions and the social status of rural physicians is necessary.

Assessing the Academic Productivity of Foundation for Anesthesia Education and Research (FAER) Resident Scholars

BACKGROUND

The Foundation for Anesthesia Education and Research Resident Scholar Program (RSP) supports academically promising anesthesiology residents to attend mentoring seminars at the American Society of Anesthesiologists annual meeting. The objective of this study was to describe the career paths of RSP participants.

METHODS

Prior RSP participants were surveyed regarding their academic productivity and their evaluation of the RSP experience. Univariate statistics were used to characterize the survey results.

RESULTS

A total of 882 RSP participants were surveyed. The response rate was 26%. Seventy-two percent of respondents had worked in an academic institution, and 45% (95% CI: 38%-51%) were currently at an academic institution, which is higher than the national average of 18% (P<0.001).

CONCLUSIONS

This program may be a model for supporting the development of future academic anesthesiologists.

Why medical students do not like to join rural health service? An exploratory study in India

Introduction:

Inadequate, inequitable distribution of the medical workforce remains a challenge across the globe, and India is no exception. Odisha, a state in India faces a major shortage of doctors particularly in rural and remote areas. In order to address this challenge, it is essential to understand medical students’ career plans, specialization preferences, choices of job location and sector, and views on working in rural and remote areas. This study explored the immediate and long-term career plans of final year medical students, their intended practice locations and underlying reasons for the choices.

Methodology:

A cross-sectional survey was conducted in all the medical colleges (three government and three private) in the state of Odisha. Through the systematic sampling method, data were gathered from 390 final year students. A semi-structured questionnaire was administered to the students and data were analyzed using SPSS version 20.

Results:

Of the 390 students, 290 (74.35%) were from a government college. The most preferred immediate career goal was postgraduation studies (45.9% of students in government medical schools and 54% in private). About 17% of government students and 9% of private students showed willingness to work in rural areas, in the long run. Nearly 44.5% mentioned opportunities for career growth, followed by the possibilities for higher education (26.8%) as major the factors for preferring an urban posting. Similarly, higher pay scales, better working conditions were major factors for preferring the private sector. Most of the students maintained that good housing, better salaries, and adequate facilities at the workplace would attract more students toward rural service.

Conclusion:

Since public funded medical students are not motivated to serve in rural settings, increasing the number of places or establishing new medical institutions may not be an effective solution to the issue. Approaches such as extended clinical apprenticeship in rural health facilities, long-term community engagement during medical studentship could be considered.

Who wants to become a general practitioner? Student and curriculum factors associated with choosing a GP career--a multivariable analysis with particular consideration of practice-orientated GP courses

OBJECTIVE

Because of the increasing shortage of general practitioners (GPs) in many countries, this study aimed to explore factors related to GP career choice in recent medical graduates. Particular focus was placed on the impact of specific practice-orientated GP courses at different stages of the medical undergraduate curriculum.

DESIGN

Observational study. Multivariable binary logistic regression was used to reveal independent associations with career choice.

SETTING

Leipzig Medical School, Germany.

SUBJECTS

659 graduates (response rate = 64.2%).

MAIN OUTCOME MEASURE

Choice of general practice as a career.

RESULTS

Six student-associated variables were found to be independently related to choice of general practice as a career: age, having family or friends in general practice, consideration of a GP career at matriculation, preference for subsequent work in a rural or small-town area, valuing the ability to see a broad spectrum of patients, and valuing long-term doctor-patient relationships. Regarding the curriculum, after adjustment independent associations were found with a specific pre-clinical GP elective (OR = 2.6, 95% CI 1.3-5.3), a four-week GP clerkship during the clinical study section (OR = 2.6, 95% CI 1.3-5.0), and a four-month GP clinical rotation during the final year (OR = 10.7, 95% CI 4.3-26.7). It was also found that the work-related values of the female participants were more compatible with those of physicians who opt for a GP career than was the case for their male colleagues.

CONCLUSION

These results support the suggestion that a practice-orientated GP curriculum in both the earlier and later stages of undergraduate medical education raises medical schools' output of future GPs. The findings are of interest for medical schools (curriculum design, admission criteria), policy-makers, and GPs involved in undergraduate medical education. More research is needed on the effectiveness of specific educational interventions in promoting interest in general practice as a career.

Career interest, self-efficacy, and perception in undecided and nursing undergraduate students: a quantitative study

Career choice variables of career interest, self-efficacy, and perception were chosen based upon Social Cognitive Career Theory concepts for study between nursing and undecided undergraduate student groups. Components of the Career Search Questionnaire and Perceptions of Professional Nursing instruments were combined and adapted to form the Career Choice Survey for use in this research. This web-based survey totaling 40 questions was sent to 577 undergraduate students with a 12% response rate (N=68). Due to the need to increase nursing recruitment and retention, hypotheses were developed that distinguish if any relationship existed between groups. Findings of this quantitative study resulted in statistically significant results on two of the three variable hypotheses (p=.006 for career interest, p=.002 for self-efficacy, p=.395 for perception), aligning with previous research and provide insight into the change in nursing perception. Overall, scores for each subscale were encouraging to current nurses and expected from undecided students. Implications for practice include increases in accurate nursing portrayal in the media and early career counseling to younger populations. Nurse educators can further research in career choice with focus on continuing education for current nurses and recruitment of young nursing hopefuls.

Do medical students prefer a career in community medicine?

BACKGROUND

Inadequate attention to management and institutional reforms is an important barrier to achieving universal health coverage. Skilled and motivated public health managers in adequate numbers are an important requirement to overcome this hurdle. However, what are the career choices of medical students? Are they interested in Community Medicine and Public Health? To document the career choices of MBBS students and their perceptions toward Community Medicine as a career option.

METHODS

A cross sectional survey was carried out among 226 MBBS students (III, V and VII semesters) studying in a tertiary care teaching hospital of South India during July-October 2011. A pre-tested semi-structured questionnaire was used, and information was collected on socio-demographic variables, choice of specialty and reasons for preference. Qualitative content analysis of student feedback was done by categorization and interpretation of data in terms of common themes.

RESULTS

Of the 226 available students, 204 (90.3%) students returned the completely filled questionnaires. Of them, 101 (49.5%) were girls. The mean (standard deviation) age of the participants was 20.13 (±1.3) years. Almost all (92.1%) wanted to pursue post-graduation in India and Internal medicine was the most preferred career choice (30.9%). The qualitative responses for opinion about Community Medicine as a career choice were interpreted under two themes; those that were favorable and those not so favorable.

CONCLUSIONS

There is limited preference for Community Medicine as a career choice. curriculum modification and explanation of career path after post-graduation in Community Medicine will help to generate interest in the subject.

Becoming a nurse - A study of career choice and professional adaptation among Israeli Jewish and Arab nursing students: A quantitative research study

BACKGROUND

The growing shortage of nurses is a global issue, with nursing recruitment and retention recognized as priorities worldwide. Israeli Jews and Israeli Arabs share residency and citizenship. However, language, religion, values, customs, symbols and lifestyle differ between the groups. This research covers only Arab citizens of Israel and not those in the occupied territories, the West Bank and Gaza. The future of the profession lies in the ability to recruit and retain the next generation of nurses.

OBJECTIVE

To examine career choice and professional adaptation among Israeli Jews and Israeli Arab nursing students by addressing motivation, materialistic factors and professional adaptation.

PARTICIPANTS & SETTINGS

395 students, which comprised the total number of students in the first five years of the nursing program's existence, in the nursing faculty at an academic college in Israel.

METHOD

A questionnaire was created and administered to the students in the first week of their first year in the nursing program.

RESULTS

Altruistic motivation, such as the opportunity to help others, was the primary factor that influenced students to choose nursing as a profession followed by professional interest. Materialistic factors, such as social status and good salary, had less influence. A significant positive correlation was found between professional adaptation and all three dimensions of role perception - teamwork, professional knowledge, and treatment skills. The female students perceived those components as more important than the male students and the Jewish students perceived themselves as more suitable for nursing than the Arab students.

CONCLUSIONS

Career choice and professional adaptation are influenced by multiple factors. Future recruitment and retention strategies used to address the critical nursing shortage should consider these factors, as well as the role of mentors, peers, and role models in the formulation of career expectations and career choice decisions.

Career motivations, perceptions of the future of dentistry and preferred dental specialties among saudi dental students

AIM

The purpose of this study was to determine the career motivations, perceptions of the future of dentistry and preferred postgraduate specialties of Saudi dental students.

METHODS

A pretested, self-administered, 16-item questionnaire was distributed to first- through fifth-year dental students at King Saud University in Saudi Arabia. Descriptive statistics were calculated, and the level of significance was set at 5%.

RESULTS

Of the 530 potential participants, 329 students (198 male and 131 female respondents) completed the questionnaire. High professional status (71.4%), a secure career (67.8%), a high income (78.1%), flexible working hours (54.4%), a wide range of career options after graduation (59.3%), opportunities for self-employment (69.3%) and good job opportunities abroad (65.3%) were endorsed to a great/considerable extent by the respondents. "It takes time to establish a practice" (62.3%), "Postgraduate education is a necessity" (72.4%) and "The increasing number of dental institutions is a threat to the profession" (59.3%) were endorsed to a great or considerable extent by the respondents. The most popular specialty among the male students was oral maxillofacial surgery (20.1%) and among female students was operative dentistry (23.4%).

CONCLUSION

The career motivations of this group of dental students seemed to relate to socioeconomic aspects of dentistry and perceptions of the future of dentistry seemed to relate to the need for postgraduate education.

Work values and intention to become a registered nurse among healthcare assistants

PURPOSE

To examine the work values of Swiss healthcare assistant students, who, at the end of their vocational education in hospitals and nursing homes, choose to pursue a registered nurse degree.

DESIGN

A prospective, cross-sectional survey was administered to a full cohort of healthcare assistant students in their last year of study in the canton of Bern (n=272).

METHOD

Multivariate methods (logistic regression) were applied to estimate the joint effect of work experience and work values in choosing to pursue a registered nurse education.

FINDINGS

Among work values, extrinsic values (regarding wage, career und educational perspectives) had a strong effect on the decisions of healthcare assistant students to pursue further education as registered nurses. Grades, socio-economic background and satisfaction during education also had an effect.

CONCLUSIONS

Higher valuation of income, career and further education affect the career intentions of nursing assistants who have already obtained a recognized healthcare education and nursing experience. Teachers and trainers should actively identify the work values and expectations of these students. Provision of adequate advice and suggestions for the career development of these students may be an important route by which to address the nursing shortage and recruitment problems.

The effect of a change in selection procedures on students' motivation to study dentistry

BACKGROUND

The aim of this study was to determine whether changes in student selection criteria at The University of Adelaide effected a change in motivation and influencing factors to study dentistry by comparing cohorts.

METHODS

Online questionnaire completed by first-year dentistry students at The University of Adelaide between 1993-1996 and 1997-2005.

RESULTS

All 666 students completed the questionnaire with 647 suitable for analysis. The likelihood of students being motivated for a career in dentistry because it 'fits with family' was greater for the 1997-2005 cohort (OR = 1.68, 95% CI = 1.14-2.49, p < 0.01) than it was for 1993-1996 enrollees, whereas 'status' became less important (OR = 0.47, 95% CI = 0.30-0.73, p < 0.01). Being influenced by a dentist (OR = 2.41, 95% CI = 1.63-3.55, p < 0.001) or a dental employee (OR = 3.19, 95% CI = 0.90-4.85, p < 0.001) was much greater for the 1997-2005 group than it was for the 1993-1996 cohort. Where students came from, parents' level of education and gender were not significant in the multivariate analysis of factors associated with motivation and influences of students' career choice.

CONCLUSIONS

Changes to the selection procedure were associated with increased emphasis on lifestyle factors and the dental profession, but not with the desire to help people or the importance of the work itself in students' decision to study dentistry.

Surgery as a career choice among medical students at University of Medical Sciences and Technology

BACKGROUND

Medical students are the source of a country's surgeons. There are concerns regarding a possible decline in the proportion of students choosing surgery as a career in some developing countries.

OBJECTIVE

To identify the level of interest in surgical careers and the factors influence a student's interest in pursuing a surgical career in Sudan.

METHODS

A cross-sectional descriptive study was conducted in September 2013 at the Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan. A self administered questionnaire was distributed to 887 male and female students, (from first to fifth academic years) recruited in the study.

RESULTS

Response rate was 73% with 647 questionnaires were collected, out of 887 medical students. Of the returned questionnaires, 604 were valid. Most of the students have decided upon a specialty 541 (89.6%) while 63 (10.4%) did not. Two hundred (36.9%) out of the 541 respondents stated that surgery is their choice for specialty. General Surgery was the popular surgical specialty (48%), followed by Cardiothoracic Surgery (16.5%), Neurosurgery (11%) and Orthopedics (10.5%). Compared with students interested in a career in other medical specialties, those interested in surgery were younger (Pre-clerkship students).

CONCLUSION

Surgery is the most popular choice of postgraduate training by medical students. Fewer than half of the medical students who choose surgery were willing to consider general surgery as a future career choice. Financial reasons and advice from of others were considered by many students as important factors to select surgery.