[Development, factor-analytical control and psychometric evaluation of a questionnaire on specialty choices among medical students]

Attitudes towards career choice and general practice: a cross-sectional survey of medical students and residents in Tyrol, Austria

BACKGROUND

The global primary healthcare workforce is declining, leading to a shortage of general practitioners. Although various educational models aim to increase interest in general practice, effective interventions are limited. The reasons for this low appeal among medical graduates remain unclear.

METHODS

This cross-sectional study surveyed medical students' and residents' attitudes towards general practice in Tyrol, Austria. The online questionnaire addressed professional values, general practice-related issues, personal professional intentions, and demographics. Data analysis employed chi-square tests and multivariate logistic regression to explore predictors of interest in general practice.

RESULTS

The study included 528 students and 103 residents. Key values identified were stable positions, assured income, and work-family reconciliation. General practice was recognised for long-term patient relationships and patient contact, with students attributing more positive work-environmental characteristics and higher reputation to it than residents. Few participants (students: 3.2%, residents: 11.7%) had opted for general practice; about half were considering it as career option. Reasons not to choose general practice were preferences for other specialties, intrinsic characteristics of general practice, workload, insufficient time for the patients, financial pressures, low reputation, and perceived mediocre training quality. Predictors of interest in general practice included perception of independent decision-making, importance of work-family balance (students), better practical experiences in general practice during medical school (students and residents), younger age, and perceiving general practice as offering a promising future (residents). Both groups felt underprepared by medical school and/or general practice training for general practice roles. The attractiveness of specialist medicine over general practice was related to clearer content boundaries, better career opportunities, and higher incomes.

CONCLUSIONS

According to these results, measures to improve attractiveness of general practice should focus on (i) high-quality undergraduate education including practical experiences, and (ii) on ensuring professional autonomy, work-family reconciliation, and job stability. Efforts to encourage more graduates to pursue this essential healthcare sector are crucial for strengthening primary healthcare and public health services.

TRIAL REGISTRATION

The study has not been registered as it did not include a direct medical intervention on human participants.

Pilot phase evaluation of the elective general practice class: results of student surveys of the first two years

Background: Primary health care in rural regions is currently undergoing a global crisis in respect of the next generation of practitioners. National and international recommendations advise placing greater emphasis upon practical skills and competences in medical studies. It is also in the interest of training the next generation to include mentoring and longitudinal integration of contact to teaching practices for general medicine in an early stage. Consequently, the General Practice Class (KAM) was introduced in Halle in 2011 as an elective with 20 individually mentored students per year, beginning with the first subject-related semester. We are now reporting on the results of the evaluation for the first two years. Method: A standardised online survey was carried out with all students who took part in the KAM in the two years 2011 and 2012 (N=38). For both years the survey was made at the end of the first summer semester on the basis of an adapted version of the Heidelberger Inventar zur Lehrevaluation (Heidelberg Inventory for the Evaluation of Teaching, HILVE-II) and the Berliner Evaluationsinstrument für selbsteingeschätzte, studentische Kompetenzen (Berlin Evaluation Instrument for the self-assessment of student competences, BEvaKomp). Furthermore, each year the preference for the choice of specialty and location of a medical practice was queried. Predictors for the preference of the chosen specialty and the location of a medical practice were estimated by binary logistic regression analysis. Via univariate evaluations the number of students who reported an increase in knowledge in different areas of competence as a result of the KAM was counted. Correlations between the intention to remain in the KAM and the quality of teaching were evaluated on the basis of bivariate correlations. Results: 48% of the students agreed partly or fully that the KAM seminars enhanced their specialist competence. This individual acquiring of competence in the model project represented a significant predictor for the preferred choice of the area (OR 7.98; 95% CI [1.27-50.27], p=0.027). Students who assessed the commitment (r=0.504), support (r=0.526) and interaction management (r=0.529) of the mentors positively were more likely inclined to continue their participation in the KAM. Conclusion: The successful conveyance of care-relevant competences to students proved to be an important predictor in our project for the preference of the specialty general practice. This requires that the medical mentors are suitably trained and that the students are specifically prepared for practical experience.

Physicians' working conditions in hospitals from the students' perspective (iCEPT-Study)-results of a web-based survey

Background

Medical students undergo numerous clinical clerkships. On these occasions they are confronted with current working conditions in hospitals. Because of the many implications of the students’ perceptions of these working conditions, it is important to assess those. Hereby the focus was put on the students’ perception of their supervising physician.

Methods

This study is a part of a prospective anonymized web-based survey (iCEPT-Study). The study was conducted in Germany among medical students after their clinical rotations. 1587 medical students took part in this study (63,0 % female and 37,0 % male). 11259 were invited to take part (response rate of 14,1 %). In this study a questionnaire was used which was based on the Effort-Reward-Imbalance (ERI) model and the Job-Demand-Control (JDC) model. A mathematical calculated ratio (ER- and JDC-Ratio; combined as ‘ER/JDC-Ratio’) was used to measure the students’ perceptions of working conditions, namely distress (primary outcome). As a secondary outcome perceived job satisfaction was measured.

Results

Distress was perceived by 67.4 % (95 %-CI: 65.1|69.7) of the students. 54.1 % (95 %-CI: 51.7|56.6) of polled students stated that their supervising physician seemed to be very satisfied with his job. Analysis of age distribution revealed that the proportion of students’ who perceived their supervising physician as very satisfied with his job dropped from 72.5 % among under 20-year olds to 63.0 % among 20–24-year olds and was at 44.5 % among the over 30-year olds. Looking at the specialty, the specialty of surgery was rated with the highest distress prevalence (ER/JDC-Ratio > 1): 81.3 % of students stated that their supervising surgeon encountered unfavorable working conditions.

Conclusion

Two out of three medical students rated the physicians working conditions as stressful. This implicates that already in this early phase of their career the majority of medical students get to know the hospital as an unfavorable workplace concerning working conditions. To facilitate the transition from medical schools to hospitals working conditions of physicians must be improved.

Dynamics of career choice among students in undergraduate medical courses. A BEME systematic review: BEME Guide No. 33

INTRODUCTION

Due to the lack of a theoretically embedded overview of the recent literature on medical career decision-making, this study provides an outline of these dynamics. Since differences in educational routes to the medical degree likely affect career choice dynamics, this study focuses on medical career decision-making in educational systems with a Western European curriculum structure.

METHODS

A systematic search of electronic databases (Medline, Embase) was conducted from January 2008 to November 2014. A panel of seven independent reviewers performed the data extraction, quality assessment and data synthesis using the Bland-Meurer model of medical specialty choice as a reference.

RESULTS

Fifty-seven studies met the inclusion criteria for the review. Factors associated with specialty preference or career choice can be classified in five main categories: (1) medical school characteristics (e.g., curriculum structure), (2) student characteristics (e.g., age, personality), (3) student values (e.g., personal preference), (4) career needs to be satisfied (e.g., expected income, status, and work-life balance), and (5) perception of specialty characteristics (e.g., extracurricular or curricular experiences). Especially career needs and perceptions of specialty characteristics are often associated with medical career decision-making.

CONCLUSION

Our results support that medical career decisions are formed by a matching of perceptions of specialty characteristics with personal needs. However, the process of medical career decision-making is not yet fully understood. Besides identifying possible predictors, future research should focus on detecting interrelations between hypothesized predictors and identify the determinants and interrelations at the various stages of the medical career decision-making process.

Clerkship in primary care: a cross-sectional study about expectations and experiences of undergraduates in medicine

Introduction: With the amendment of the medical licensure act (Approbationsordnung) in 2012, a four-week clerkship in primary care (FHV) became mandatory. We investigated the expectations with which students begin the FHV, which criteria are relevant in selecting the location for the FHV, and the experiences the students had during the FHV.

Method: In a cross-sectional study, all third-year students at both medical schools in Saxony-Anhalt were surveyed in 2013 about their expectations and experiences regarding the FHV. This is the last cohort for which the FHV is optional. Questions were asked about 29 items addressing six topics (personal information, selection of FHV location, selection of FHV medical practice, expectations, experiences, and specialty selection).

Results: Out of a student body of 446, responses were received from N=424 (response rate 95.1%; of which 61.8% female). Of these students, 71 (16.7%) had completed the FHV and 70 (16.5%) were planning to; another 267 students (63%) had not (yet) planned to participate in an FHV. Where a student’s parents lived, personal recommendations of a particular medical practice and the attractiveness of the region were the most important criteria for selecting the clerkship site. After completing the FHV, the learning objectives reflected themselves in the experiences of the students in a similar order and significance as in the expectations of students who planned or had not (as of yet) planned to complete the FHV. A relevant influence of the FHV confirming the choice to specialize in general practice or outpatient care was not indicated by those who had completed the FHV.

Conclusion: After location and practice, the FHV is selected according to personal criteria and in connection with prioritized learning objectives. From the students’ perspective, the most frequently named learning objectives are also identified as acquired experience after completing the FHV. However, the FHV does not have a reinforcing effect on the selection of general practice as a specialty.

Motives of former interns in general practice for speciality-choice--results of a cross-sectional study among graduates 2007 to 2012

BACKGROUND

The influence of a final-year elective internship in general practice (IGP) on motives affecting graduates' choice of specialty is the object of great public interest, yet still insufficiently evaluated. Longitudinal studies show the influence of numerous motives (e.g., work-life balance), but not following the IGP experience itself. Thus, we performed a cross-sectional questionnaire study of all graduates who completed the IGP in Saxony-Anhalt during 2007-2012 regarding their motives for choosing a speciality.

METHOD

A standardized questionnaire was sent to 109 former interns in general practice. The questionnaire contained 29 items addressing three topics (personal attitudes, concept of personal and professional life, motives for speciality choice) and used single-choice and multiple-choice answers, as well as Likert scales. Correlation analysis was carried out by means of Kendall's tau.

RESULTS

The questionnaire reached 97 former interns, of which 45 (46%) responded. In the overall ranking of motives for speciality choice, family (71%), leisure time (66%) and job opportunities (48%) rated as more important than income (36%), mentoring (20%), status or scientific work (20%). Only 29% of the respondents stated that their speciality choice was changed by the IGP. If the speciality choice was already established before the IGP, the influence of the IGP on speciality choice was significantly low (r = -.5; p < .01). However, if the IGP had an influence on speciality choice, it was correlated with a new perception of general practice (r = .36; p<.01). This new perception was associated with a positive influence of the medical teacher during the IGP.

CONCLUSION

The final-year IGP is an opportunity to change the perception of general practice in students who are still undecided. This can lead to different speciality choices in a subgroup. Personal attitudes and concepts of personal life and career were also important factors affecting speciality choice. The aspects of the positive influence exerted by medical teachers on those students who are still undecided during the IGP should be carefully evaluated.