Changes in the patterns of specialties selected by high and low academic performers before and after 1980

Impact of AOA status and perceived lifestyle on career choices of medical school graduates

BACKGROUND

Based upon student ratings of such factors as predictable work hours and personal time, medical specialties have been identified as lifestyle friendly, intermediate, or unfriendly. Lifestyle friendly programs may be more desirable, more competitive, and for students elected to the Alpha Omega Alpha (AOA) Honor Medical Society, more attainable.

OBJECTIVE

The objective of this study was to evaluate whether AOA students increasingly entered lifestyle friendly residency programs and whether trends in program selection differed between AOA and non-AOA graduates.

DESIGN

This retrospective cohort study examined PGY-2 data from the Association of American Medical Colleges and the 12 allopathic schools in the Associated Medical Schools of New York.

PARTICIPANTS

Data on 1987-2006 graduates from participating schools were evaluated.

MAIN MEASURES

Residency program selection over the 20-year period served as the main outcome measure.

KEY RESULTS

AOA graduates increasingly entered lifestyle-friendly residencies--from 12.9% in 1987 to 32.6% in 2006 (p < 0.01). There was also a significant decrease in AOA graduates entering lifestyle unfriendly residencies, from 31.6% in 1987 to 12.6% in 2006 (p < 0.01). Selection of lifestyle intermediate residencies among AOA graduates remained fairly stable at an average of 53%. Similar trends were found among non-AOA students. However, within these categories, AOA graduates increasingly selected radiology, dermatology, plastic surgery and orthopedics while non-AOA graduates increasingly selected anesthesiology and neurology.

CONCLUSIONS

While lifestyle factors appear to influence residency program selection, AOA graduates differentially were more likely to either choose or attain certain competitive, lifestyle-friendly specialties. Health care reform should be targeted to improve lifestyle and decrease income disparities for specialties needed to meet health manpower needs.

Free choice and career choice: Clerkship electives in medical education

INTRODUCTION

Medical education experiences, particularly in clinical years, are reported determinants of career choice. Less is known about features of clinical education experiences including length, discipline, setting and choice, which may serve as landmarks in career choice decisions. This study's purpose was to explore the benefits of a free choice clerkship elective, and more specifically, its role in clarifying career choice.

METHODS

Using framework and content analysis methodology, we analysed University of British Columbia, third-year medical student anonymised assignments regarding free choice and 2-week clerkship elective experiences. This clerkship was designed to provide students with clerkship experiences outside the conventional curricular model, while encouraging student choice of ambulatory and community settings. Assignment questions included: reasons for choosing elective; whether learning objectives were met; influence of elective on career choice; and unique elective experiences. Iterative review, coding, analysis and indexing of assignments were carried out to identify themes and corroborate findings.

RESULTS

Emergent themes included: positive views of experience; transferable knowledge and skills; and influencer of future education and career choices. Although students were encouraged to choose clerkship experiences outside the conventional curricular model, most students chose the elective to clarify future career decisions.

DISCUSSION

This qualitative descriptive study highlights the influence of highly regarded, free choice clerkship elective experiences in the career decision making process in medical education. Further examination of the details of clerkship elective experiences which influence career choice is recommended.

The relationship between specialty choice and gender of U.S. medical students, 1990-2003

PURPOSE

Women have been postulated to be more responsible than men for the recent trend of lifestyle factors influencing the specialty choices of graduating U.S. medical students. The authors looked at the specialty choices of U.S. medical students between 1990 and 2003 to determine whether and to what degree women were responsible for the trends toward controllable lifestyle specialties.

METHOD

Specialty preference was based on analysis of results from the American Association of Medical Colleges' Medical School Graduation Questionnaire. Specialty lifestyle (controllable vs. uncontrollable) was classified using a standard definition from prior research. A random effects regression model was used to assess differences between men and women in specialty choice over time and the proportion of variability in specialty preference from 1990 to 2003 explained by women.

RESULTS

Overall, a greater proportion of women planned to pursue uncontrollable specialties compared with men in every year analyzed. Both women and men demonstrated a decreasing interest in uncontrollable lifestyle specialties by almost 20%. However, regression analysis found that women were more slightly more likely to choose an uncontrollable lifestyle specialty compared to men over time (p < .01).

CONCLUSION

Among U.S. medical graduates, women were not more responsible than were men for the trend away from uncontrollable lifestyle specialties over the time period studied. Men and women expressed similar and significant rates of declining interest in specialties with uncontrollable lifestyles.

Impact of Generalist Physician Initiatives on Residency Selection

OBJECTIVE

To compare the residency selection choices of students who experienced courses resulting from generalist physician initiatives to choices made by students prior to the implementation of those courses and to describe the characteristics of students selecting primary care residencies.

BACKGROUND

In the fall of 1994 a first year Community Continuity Experience course was initiated and in the summer of 1995 a third year Multidisciplinary Ambulatory Clerkship was begun at the University of Texas Medical Branch in Galveston. These courses were inserted into the curriculum to enhance and promote primary care education.

DESIGN/METHODS

We examined the residency selections of cohorts of graduating medical students before (1992-1996) and after (1997-1999) the implementation of the primary care courses. Survey information on career preferences at matriculation and in the fourth year of medical school were available for students graduating after the programs began. We compared the career preferences and characteristics of those students who selected a primary care residency to those who did not.

RESULTS

Prior to the implementation of the programs, 45%(425/950) of students graduating selected primary care residencies compared to 45% (210/465) of students participating in the programs (p=0.88). At matriculation, 45% of students had listed a primary care discipline as their first career choice. Among the students who had indicated this degree of primary care interest 61% ended up matching in a primary care discipline. At year 4, 31% of students indicated a primary care discipline as their first career choice and 92% of these students matched to a primary care residency. By univariate analysis, minority students (53%) were more likely to select a primary care residency than non-minority students (40%); students in the two lowest grade point average quartiles (55% and 50%) selected primary care residencies compared to 37% and 38% of students in the top 2 quartiles; and students who stated that income potential had little or no impact on their choice were more likely to select a primary care residency (48%) than those who said income potential was important (37%).

CONCLUSIONS

We observed no significant trend towards higher proportions of graduating students selecting primary care discipline residencies as a result of implementing courses that emphasized primary care. Those students expressing an interest in a primary care discipline at their entrance into medical school were more likely to select a primary care residency. A more significant impact on graduating students interested in primary care may be made through the medical student selection process than by altering the curriculum.

Understanding and improving medical student specialty choice: a synthesis of the literature using decision theory as a referent

BACKGROUND

As emphasis in medicine has shifted to increasing the number of physicians who choose primary care specialties, many studies of medical specialty choice have been conducted. Although researchers have approached the topic in a number of ways, most approaches have tended to focus on narrow elements of the choice, such as the effect of programs or curricula. A more comprehensive approach is possible by fitting the process to a preexisting broad theoretical framework.

SUMMARY

This synthesis of the literature examines specialty choice from the perspective of decision theory--with its aims of understanding how decisions are made, providing information about the quality of decisions, and improving the decision-making process.

CONCLUSION

This approach has the potential to not only help deconstruct the process of decision making regarding specialty choice but also uncover information about the best ways to help medical students learn to make wise decisions.

The changing health care system. A research agenda for medical education

The volatility in the U.S. health care system due to unprecedented changes in its organization, financing, and delivery, coupled with a growing physician surplus in certain areas, suggests the need for a research agenda to investigate the impact of these forces on the educational programs of medical schools. This article discusses the potential impact of trends in the health care environment on the following key aspects of undergraduate medical education: admissions, faculty, curriculum, and educational outcomes. A representative set of research questions intended to stimulate inquiry and guide empirical studies in each of the four domains is proposed.