The impact of clerkships on students' specialty preferences: what do undergraduates learn for their profession?

Palliative care in a Graduate Entry Medical Curriculum: exploring students' attitudes on the importance of receiving teaching in palliative care

BACKGROUND

As people live longer with life-limiting illnesses, there is greater need for skills and knowledge in palliative care (PC). Medical students should acquire the knowledge, attitudes, and confidence during training for future decision-making. However, most graduates across Europe feel unprepared to provide PC. To develop PC training for medical students, we must gain perspective on their understanding of PC and their learning needs.

OBJECTIVES

The aim was to investigate graduate entry medical students' views on the importance of education in PC and how well PC topics were covered within their curriculum. The objective was to highlight areas that could be reviewed for future PC curricula.

METHODS

In this prospective quantitative study, penultimate and final-year students were recruited from a graduate entry medical school. Ethical approval was granted. Students completed an online questionnaire.

RESULTS

From 281 recruited students, 82 responded. Ninety-five percent of respondents felt everyone should have a PC rotation. The aspects of education perceived to be most important were knowledge of symptom control, communication, ethical issues, self-care, and grief. The only aspect considered well covered within the curriculum was ethical issues. Ninety-six percent of penultimate and 75% of final years wanted more teaching in PC.

CONCLUSION

Graduate entry medical students view PC as a vital subject within their medical school training. The study highlights challenges in providing education and sufficient placement in PC to correlate with the respondents' perceived needs. The findings contribute to the growing literature surrounding the importance of PC education within the medical school curriculum.

Negative Impact of Smaller Hometown Size on the Educational Experience of Medical Students: A Nationwide Study in Saudi Arabia

Background and objective Saudi Arabia's rapid medical education expansion has posed unique challenges for its students, particularly concerning specialty selection. Having broad exposure to medical specialties is crucial for making informed decisions. This study explores how the size of students' hometowns influences their exposure to their preferred specialty, thereby affecting their choice. Methods Our cross-sectional study collected data from medical students in their 4th and 5th years, interns, and graduates across Saudi Arabia. An electronic survey gathered information about medical specialty choice, interest levels, students' self-ranking compared to their peers, and level of exposure to the chosen specialty. Overall exposure to specialties was quantified by tallying participants' experiences in preclinical observerships, didactic lectures, research projects, core and elective rotations, and attended conferences. We divided the students into three city sizes: primary urban centers, intermediate urban cities, and small townships and compared the outcomes between these three groups. Results Responses were obtained from 1,072 participants, with 424 (39.6%) from primary urban centers, 367 (34.2%) from intermediate urban cities, and 281 (26.2%) from small townships. Student hometown size was an independent predictor of specialty exposure, with students from smaller cities reporting lower exposure scores (OR = 0.73, (0.63-0.84), p<0.01). The study also identified gender disparities in exposure, with female students found to be correlated with a lower exposure score (OR = 0.72, (0.58-0.89), p<0.01). Conclusion City size is a significant determinant of specialty exposure for Saudi medical students. These findings highlight the need for initiatives that promote equal educational experiences, ensuring comprehensive specialty exposure to all students.

Factors that influence medical students' decision to pursue a career in orthopaedics: a comprehensive analysis

PURPOSE

Selecting a postgraduate medical or surgical specialty is a significant decision for medical students, influenced by factors such as demographics, academic performance, satisfaction, work environments, personal aspirations, passion for a specific specialty, exposure to different fields during medical education, lifestyle considerations, financial factors, job market conditions, and prospects. Our research focused on orthopaedic surgery, a highly competitive specialty with many applicants and a low acceptance rate. We aimed to investigate the factors that contribute to the sustained interest in this specialty despite the challenges of securing a residency position. Hence, this study aims to examine the potential factors that influence students' decision to pursue a career as an orthopaedic surgeon.

METHODS

This cross-sectional study explores the perspectives and attitudes of 211 fifth-year medical students towards orthopaedic surgery after completing their clinical rotation at Mutah University's School of Medicine in 2022. The inclusion criteria for the study were limited to fifth-year medical students who successfully finished the orthopaedic rotation. A questionnaire was employed to evaluate students' firm commitment to orthopaedics as a prospective career and the degree of their current interest in the specialty.

RESULTS

The study involved 210 participants, with 99 selecting orthopaedics as their specialty and 111 pursuing alternatives. Furthermore, 41.4% expressed the intention to apply for orthopaedic residencies. Factors impacting orthopaedics selection included family/peer input (p = 0.002), prestige (p = 0.002), research prospects (p = 0.005), leadership potential (p = 0.011). Chi-square analysis showed associations between choosing orthopaedics and male gender (p = 0.028), parental occupation in musculoskeletal fields (p = 0.038), and elective rotations (p = 0.016).

CONCLUSION

This study examines the factors that influence medical students' career preferences in orthopaedic surgery, highlighting the significance of familial and peer influences, job prestige perceptions, gender considerations, parental involvement, elective rotations, research and teaching potential assessments, and aspirations for leadership roles. These findings reveal the complex array of factors that guide medical students toward orthopaedic surgery.

The power of rotation schedules on the career selection decisions of medical students

Choosing a career pathway in medicine is a high stakes decision for both medical students and the field of medicine as a whole. While past research has examined how characteristics of the medical student or specialties influence this decision, we introduce temporal elements as novel variables influencing career selection decisions in medicine. Specifically, we investigate how timing and duration of residency options, based on a rotation schedule that medical students have limited control over, influence their career selection decisions. An archival study investigating 5 years of medical student rotation schedules (N = 115) reveals that clinical rotation options appearing earlier and more often in the schedule were more likely to be selected. Moreover, timing and duration of exposure interacted such that residency options appearing later in the schedules were more likely to be selected if they also appeared more often. Conditional logistic regressions using student fixed-effects to control for idiosyncratic medical student differences (i.e., gender, & debt, etc.), and residency fixed-effects to control for idiosyncratic residency differences (income, and lifestyle, etc.), revealed the rotation schedule had a significant impact on residency selection decisions even when controlling for factors typically influencing this decision. Medical students' career decisions are influenced by when and how long different choice options appear in their rotation schedule, especially when they have limited influence over this schedule. The results have implications for healthcare policy by highlighting a tool for adjusting physician workforce composition by broadening exposure to a greater array of career options.

Student experiences of professionalism and role models in an oral and maxillofacial surgery internship: A qualitative study

INTRODUCTION

Dental students have a clear concept of professionalism and the importance of role models. Our aim was to determine how dental students experience their first oral and maxillofacial surgery internship in terms of their concept of professionalism and their perception of role models.

METHODS

From June to August 2020, semi-structured telephone interviews were conducted with 22 dental students in their eighth and ninth semesters at the Medical Faculty of the University of Ulm. The interviews were transcribed and evaluated by qualitative content analysis according to Mayring.

RESULTS

The students' concept of dental professionalism was shaped by the elements of a good approach to patients, professional competence, and manual skills. This perception was not changed by the internship. Having a role model was seen as an important learning strategy, and role models were perceived in both positive and negative ways. Role models were perceived as positive if they corresponded to the student's concept of professionalism and as negative if they did not correspond to this concept, especially with regard to social interaction or the approach to patients. Students' reactions to discrepancies between their own moral values and the role models' behaviour were characterised by passivity and withdrawal. With regard to potential future careers, positive internship experiences supported student goals, whereas negative experiences raised doubts about them.

CONCLUSION

Supervising dentists may still underestimate the considerable impact of internships, and their awareness of this impact needs to be increased. Students' reactions to conflicts between reality and their own values do not appear to be constructive. One approach to solving this problem may be to include discussions of professional development in curricula.

How often do medical students change career preferences over the course of medical school?

INTRODUCTION

During the preclinical years, students typically do not have extensive exposure to clinical medicine. When they begin their clinical rotations, usually in the third year, the majority of the time is spent on core rotations with limited experience in other fields of medicine. Students then must decide on their careers early in their fourth year. We aimed to analyze how often medical students change their career preferences between the end of their second and their fourth year.

METHODS

We conducted a retrospective, cohort study using the American Association of Medical Colleges Year 2 Questionnaire (Y2Q) and Graduating Questionnaire (GQ) from 2016 to 2020.

RESULTS

20,408 students answered both surveys, but 2,165 had missing values on the career choice question and were excluded. Of the remaining students, 10,233 (56%) changed their career choice between the Y2 and GQ surveys. Fields into which students preferentially switched by the GQ survey included anesthesia, dermatology, ENT, family medicine, OB/GYN, pathology, PM&R, psychiatry, radiology, urology, and vascular surgery. Many characteristics, including future salary, the competitiveness of the field, and the importance of work-life balance, were significantly associated with a higher likelihood of changing career choices. On the other hand, having a mentor and the specialty content were associated with a lower likelihood of change.

CONCLUSION

A majority of students switched their career preferences from the Y2Q to the GQ. Additional research should be focused on curricular design that optimizes student satisfaction with career decisions. This may include early integration of a variety of specialties.

Medical students' career decision-making stress during clinical clerkships

OBJECTIVES

Many medical students experience career decision-making stress in the final phase of training. Yet, the factors that induce or reduce career decision-making stress and how progression in their clerkships relates to these factors are unknown. This knowledge gap limits the possibilities for medical schools to develop and implement interventions targeting students' career decision-making stress. This study explores content, process, and context factors that may affect career decision-making stress.

METHODS

Using cross-sectional survey data from medical master students (n = 507), we assessed content (future work self), process (choice irreversibility, time pressure, career decision-making self-efficacy), and context (supervisory support, medical school support, study load, competition) factors and their relationships with career decision-making stress. The hypothesized relationships were tested with structural equation modelling.

RESULTS

A clearer future work self and higher career decision self-efficacy were associated with lower career decision-making stress, while experienced time pressure, competition, and study load were associated with higher career decision-making stress. Choice-irreversibility beliefs, supervisory support, and medical school support were unrelated to career decision-making stress. As students' clerkships progressed, they gained a clearer future work self, but also experienced more time pressure.

DISCUSSION

Clinical clerkships help students to form a clearer future work self, which can diminish career decision-making stress. Yet, students also experience more time pressure as the period of clerkships lengthens, which can increase career decision-making stress. A school climate of high competition and study load seems to foster career decision-making stress, while school support hardly seems effective in diminishing this stress.

How Do Clinical Electives during the Clerkship Year Influence Career Exploration? A Qualitative Study

Problem: Although many students begin medical school with some idea of their specialty interest, up to 80% of these students choose a different specialty by their final year. This pivot tends to happen in the clerkship year, when students are immersed in the clinical environment, gaining a practical understanding of the day-to-day work in different fields. Yet, in this year students have limited experiences with specialties. Clinical electives during the clerkship year may aid students in career development. The authors examined student career exploration through the lens of social cognitive career theory (SCCT). SCCT posits three variables that influence career development: personal goals, self-efficacy, and understanding outcome expectations. With this framework, the authors sought to understand how a program of clinical electives during the clerkship year influences students' perceptions of their career exploration. We aimed to: (1) describe an innovative clerkship elective program designed for career exploration, and (2) explore how this influenced students' career exploration using qualitative analysis. Intervention: Beginning in 2018, students at our institution were required to participate in three 2-week clinical electives during their clerkship year, called Clinical Immersive Experiences (CIExes). CIExes were categorized into four different types: apprenticeship, clinical skills building, integrative (multi-disciplinary), or subspecialty. Authors invited fourth year students to participate in interviews (January to March 2019) about how they selected electives and how these electives contributed to their career exploration. Interviews continued until reaching information sufficiency. Authors coded and analyzed transcripts using template analysis. Context: This curricular intervention took place in the context of large-scale curricular redesign. Students began clerkships partway into their second year of medical school. The family and community medicine clerkship, which was previously a 6-week core clerkship, was changed to a longitudinal format, thus freeing up 6 weeks for electives. Other core clerkships included anesthesia (2 weeks), medicine (8 weeks), neurology (4 weeks), obstetrics and gynecology (6 weeks), pediatrics (6 weeks), psychiatry (4 weeks), and surgery (8 weeks). Impact: From 15 student interviews, we identified three major themes. First, CIExes facilitated personalized career exploration. All students felt that at least one elective helped them solidify their decision about a specialty choice. Second, CIExes promoted focused learning and skills development that complemented core rotations. They noted the benefit of positive relationships with supervisors, particularly attendings, during these electives. Third, students highlighted how these electives fostered a positive learning environment and enhanced wellbeing. SCCT clarified how the CIEx program helped students advance their personal goals, self-efficacy, and outcome expectations during a pivotal time in medical school. Lessons Learned: We learned that from the student perspective, the inclusion of clinical electives in the clerkship year benefited students' career exploration by helping them develop and refine their career goals, increase self-efficacy, and test outcome expectations in a meaningful way as anticipated from SCCT. In addition, we found that CIExes created a positive learning environment that allowed deep relationships to develop in fields of interest and that supported a strong sense of wellbeing. Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1891545.

Impact of COVID-19 pandemic on Saudi medical students' career choices and perceptions of health specialties: findings from a national cross-sectional study

BACKGROUND

The COVID-19 pandemic has had a devastating effect on people across the globe. Its impact on medical students' education has also been profound. Here, we aimed to comprehensively determine the nature of this impact on their choice of specialty.

METHOD

A cross-sectional study was conducted among medical students in Saudi Arabia during the pandemic from May to June 2021. Data collected from 1984 medical students were analyzed.

RESULTS

Of the total sample, 810 (40.8%) respondents reported that the pandemic could affect their choice of specialty, with the majority being in the third year (n = 235). Across all class-years, the most common reason chosen was the inability to explore specialties of interest (n = 539, 66.5%). Another reason cited was the inability to support residency application (n = 175, 21.6%). A majority expressed concerns regarding enrollment in research activities. As high as 17.9% (n = 356) of the respondents admitted that they were trying to avoid specialty with frontline exposure to COVID-19, while 353 students (17.8%) were considering local training programs only. While examining certainty levels, of the 1174 (59.2%) students who reported not being affected by the pandemic, 924 (78.7%) had a weak certainty level. The majority were in the third (54.8%, n = 342) and fourth years (44.8%, n = 212).

CONCLUSIONS

This study is the first attempt to thoroughly examine the effect of COVID-19 on medical students' choice of specialty. This effect unfurled in 4 out of 10 surveyed students. Many students reported concerns regarding the inability to explore medical specialties and the inadequacy of obtained clinical knowledge. However, a subsidiary effect was observed among students who were assertive about their choice of specialty. These findings shed new light on the exigency of establishing a career counseling framework designed to meet individual learner needs, thereby galvanizing their morale. Further research could explore the long-term implications of the Saudi Commission for Health Specialties Matching System.

Students' intentions to practice primary care are associated with their motives to become doctors: a longitudinal study

BACKGROUND

Medical schools can contribute to the insufficient primary care physician workforce by influencing students' career preferences. Primary care career choice evolves between matriculation and graduation and is influenced by several individual and contextual factors. This study explored the longitudinal dynamics of primary care career intentions and the association of students' motives for becoming doctors with these intentions in a cohort of undergraduate medical students followed over a four-year period.

METHODS

The sample consisted of medical students from two classes recruited into a cohort study during their first academic year, and who completed a yearly survey over a four-year period from their third (end of pre-clinical curriculum) to their sixth (before graduation) academic year. Main outcome measures were students' motives for becoming doctors (ten motives rated on a 6-point scale) and career intentions (categorized into primary care, non-primary care, and undecided). Population-level flows of career intentions were investigated descriptively. Changes in the rating of motives over time were analyzed using Wilcoxon tests. Two generalized linear mixed models were used to estimate which motives were associated with primary care career intentions.

RESULTS

The sample included 217 students (60% females). Career intentions mainly evolved during clinical training, with smaller changes at the end of pre-clinical training. The proportion of students intending to practice primary care increased over time from 12.8% (year 3) to 24% (year 6). Caring for patients was the most highly rated motive for becoming a doctor. The importance of the motives cure diseases, saving lives, and vocation decreased over time. Primary care career intentions were positively associated with the motives altruism and private practice, and negatively associated with the motives prestige, academic interest and cure diseases.

CONCLUSION

Our study indicates that career intentions are not fixed and change mainly during clinical training, supporting the influence of clinical experiences on career-related choices. The impact of students' motives on primary care career choice suggests strategies to increase the attractivity of this career, such as reinforcing students' altruistic values and increasing the academic recognition of primary care.

Medical Student Career Choice: Who Is the Influencer?

BACKGROUND

While many factors influence medical student career choice, interactions with attending and resident physicians during clinical rotations are particularly important. To evaluate the influence of attending and resident physicians on medical students' career choices, particularly for those pursuing surgical careers, we quantified their respective influence in the context of other known influences.

METHODS

Rising fourth-year medical students and new graduates were given an IRB-exempt, 14-item online survey. Descriptive statistics were performed on the demographic information. Chi-square analysis was used, as were Kruskal-Wallis and Mann-Whitney analyses on the Likert responses (α = 0.05).

RESULTS

Survey response was 24%. Students pursuing general surgery rated residents greater than or equal to attendings on 7 of 8 key mentoring characteristics. Of students choosing a different specialty than the one they intended to pursue upon entering medical school, the influence of residents was cited by 100% of the students pursuing general surgery, compared to 59% of the entire cohort. Identification of a role model and perceived personality fit were significantly more important than other factors (P < 0.0001). Students pursuing general surgery rated the importance of identifying a role model and perceived personality fit greater than their peers.

CONCLUSIONS

Residents have greater influences on medical students' career choice compared to attendings. Students pursuing a surgical specialty, particularly general surgery, considered the influence of role models and perceived personality fit to be the most important factors in their specialty decision. These findings provide valuable insights to improve student experiences and career recruitment in surgical specialties, particularly general surgery.

Capturing the Perspective of Prospective Urology Applicants: Impacts of COVID-19 on Medical Education

OBJECTIVE

To capture the perspective of prospective urology applicants experiencing unique challenges in the context of COVID-19.

METHODS

A voluntary, anonymous survey was distributed online, assessing the impact of COVID-19 on a large sample of US medical students planning to apply to urology residencies. Themes of (1) specialty discernment, (2) alterations to medical education, and (3) the residency application process were explored.

RESULTS

A total of 238 medical students, 87% third and fourth years, responded to the survey. While 85% indicated that the pandemic had not deterred their specialty choice, they noted substantial impacts on education, including 82% reporting decreased exposure to urology. Nearly half of students reported changes to required rotations and 35% reported changes to urology-specific rotations at their home institutions. Students shared concerns about suspending in-person experiences, including the impact on letters of recommendation (68% "very concerned) and program choice (73% "very concerned"). Looking to the possibility of virtual interactions, students identified the importance of small group and one-on-one communication with residents (83% "very important") and opportunities to learn about hospital facilities (72% "very important").

CONCLUSION

Despite the impacts of COVID-19 on medical education, prospective urology applicants appear to remain confident in their specialty choice. Students' biggest concerns involve disruption of away rotations, including impacts on obtaining letters of recommendation and choosing a residency program.

Effect of the COVID-19 pandemic on medical student career perceptions: a national survey study

BACKGROUND & OBJECTIVE

The COVID-19 pandemic and resulting cancellation of medical student clinical rotations pose unique challenges to students' educations, the impact of which has not yet been explored.

DESIGN

This cross-sectional survey study collected responses from 13 April 2020 until 30 April 2020. Students at US allopathic medical schools completed the survey online.

RESULTS

1,668 responses were analyzed. A total of 337 (20.2%) respondents thought the pandemic would affect their choice of specialty, with differences across class years: 15.2% (53) of first-years (MS1s), 26.4% (92) of second-years (MS2s), 23.7% (162) of third-years (MS3s), and 9.7% (22) of fourth-years (MS4s) (p < 0.0001). Among all classes, the most common reason chosen was inability to explore specialties of interest (244, 72.4%), and the second was inability to bolster their residency application (162, 48.1%). Out of the MS3s who chose the latter, the majority were concerned about recommendation letters (68, 81.0%) and away rotations (62, 73.8%). As high as 17.4% (119) of MS3s said they were more likely to take an extra year during medical school as a result of the pandemic. Region of the US, number of local COVID cases, and number of local COVID deaths had no effect on whether respondents thought the pandemic would affect their specialty choice.

CONCLUSIONS

Our study found that about one-fifth of surveyed medical students currently believe that the COVID-19 pandemic will affect their choice of specialty, with many of these citing concerns that they cannot explore specialties or obtain recommendation letters. With prolonged suspension of clinical rotations, targeted efforts by medical schools to address these concerns through enhanced virtual curriculum development and advising strategies will become increasingly important. Further study is needed to explore whether these cross-sectional student perspectives will manifest as changes in upcoming National Residency Matching Program data.

Does initial postgraduate career intention and social demographics predict perceived career behaviour? A national cross-sectional survey of UK postgraduate doctors

OBJECTIVE

Studies indicate that initial career intentions and personal characteristics (eg, gender) can influence medical career decision-making. However, little is known about how personal characteristics and intention interact with career decision-making. To address this gap, we examined the link between career intention at the start of the 2-year UK Foundation Programme (FP) and career intentions on its completion.

METHODS

Data came from the 2017 UK National Career Destination Survey, a cross-sectional study completed by all second year foundation doctors. We included respondents' demographics (gender, graduate status on entry to medical school, career intention on starting the FP) and career intention as an outcome measure (eg, specialty (residency) training (UK), NHS non-training posts/further study, career break, working abroad). Multinomial regression was used to assess the independent relationship between background characteristics and career intention.

RESULTS

There were 6890 participants and 5570 usable responses. 55.9% of respondents were female and 43.1% were male, 77.1% were non-graduates and 22.9% were graduate entrants to medical school. Approximately two-thirds (62.3%, n=2170) of doctors who had an original intention to pursue specialty training after F2, still intended to do so on completion. Most of those who stated at the start of F2 that they did not want to pursue specialty indicated at the end of F2 they would be undertaking other employment opportunities outwith formal training. However, 37.7% of respondents who originally intended to pursue specialty training on FP completion did something different. Graduate entrants to medicine were more likely to immediately progress into specialty training compared with their peers who did medicine as a primary first degree.

CONCLUSION

Original intention is a strong predictor of career intentions at the end of the FP. However, a considerable proportion of doctors changed their mind during the FP. Further research is needed to understand this behaviour.

How do German medical students perceive role models during clinical placements ("Famulatur")? An empirical study

BACKGROUND

Studies have demonstrated the importance of role models in medical education. Medical students in Germany participate in clinical placements ("Famulatur") that last 4 months in total and represent the first real-world setting where students encounter possible role models in their clinical education. These placements are an extracurricular activity, however, and regarded as the "black box" of medical education. This study aimed to evaluate whether and how students experience role models during clinical placements, the qualities associated with potential role models and whether role model-related learning gains are relevant.

METHODS

We recruited 96 students (mean age: 23.83 years; 75% female) in their 5th to 9th semesters at the Faculty of Medicine at the University of Ulm, Germany, who were participating in a clinical placement between July and October 2015. Participants completed a questionnaire at the beginning of a 5-day working week to record sociodemographic and other information and another one at the end of the week to assess various aspects of their experiences. On each of the 5 days, they completed a structured questionnaire to record their perceived role models and self-assessed learning gains.

RESULTS

Role models and role modelling play an important role in clinical placements. The positive function of medical staff as role models predominated (88.4%) across all specialties. Junior doctors were the most frequently perceived role models (28.5%), followed by consultants (25.1%) and nursing staff (22.4%). The most commonly perceived positive quality was the interaction with students (16.5%), followed by team behaviour (13.6%), interaction with patients (13.6%) and professional expertise (13.4%). Students also had various kinds of learning gains such as knowledge or skills.

CONCLUSIONS

Although these clinical placements are extracurricular activities in Germany and their content is not regulated, they are home to a relevant amount of role modelling. Students experience the various medical professions in different roles and in a range of tasks and interactions. Defining basic learning objectives could help to increase the relevance of these placements for the medical curriculum in Germany and transfer the associated learning gains from the hidden to the open curriculum.

Working in preventive medicine or not? Flawed perceptions decrease chance of retaining students for the profession

BACKGROUND

Recruiting and retaining students in preventive medical (PM) specialties has never been easy; one main challenge is how to select appropriate students with proper motivation. Understanding how students perceive PM practice differently from practicing doctors is necessary to guide students, especially for those for whom PM is only a substitute for medicine as their first study preference, properly during their study and, later, the practice of PM.

METHODS

One thousand three hundred eighty-six PM students in four Vietnamese medical schools and 101 PM doctors filled out a questionnaire about the relevance of 44 characteristics of working in PM. ANOVAs were conducted to define the relationship between students' interest, year of study, willingness to work in PM, and the degree to which students had realistic perceptions of PM practice, compared to doctors' perceptions.

RESULTS

Overall, compared to doctors' perceptions, students overestimated the importance of most of the investigated PM practice's characteristics. Moreover, students' perception related to their preference and willing to pursue a career in PM after graduation. In particular, students for whom PM was their first choice had more realistic perceptions of community practice than those who chose PM as their second choice. And, second-choice students had more realistic perceptions than first-choice students in their final years of study, but expected higher work stress in PM practice. Students who were willing to pursue a career in PM rated the importance of community practice higher than those who were not. We also found that students' perception changed during training as senior students had more realistic perceptions of clinical aspects and working stress than junior students, even though they overemphasized the importance of the community aspects of PM practice.

CONCLUSIONS

To increase the number of students actually entering the PM field after graduation, the flawed perceptions of students about the real working environment of PM doctors should be addressed through vocation-oriented activities in the curriculum targeted on groups of students who are most likely to have unrealistic perceptions. Our findings also have implications for other less attractive primary health care specialties that experience problems with recruiting and retaining students.

Augmenting ENT surgery outside the medical school curriculum: the role of a 1-day otolaryngology course

Background

ENT is highly under-represented in the saturated UK medical school curriculum, comprising less than 1 per cent of the curriculum. A 1-day course was implemented in order to raise awareness of ENT among medical students, educate them in the specialty and teach a basic skill.

Methods

The skills day comprised lectures by consultants followed by a consultant-led workshop teaching tracheostomy. Pre- and post-course questionnaires assessed perceptions of ENT, confidence performing tracheostomy and interest in ENT as a career.

Results

Perceptions of ENT as a specialty were improved by up to 80 per cent (p < 0.01). There was improved understanding of and confidence in performing tracheostomies. Interest in a career in ENT was increased by 77 per cent (p < 0.01).

Conclusion

A 1-day course run by a student body can be a powerful adjunct to the medical school curriculum, in terms of educating undergraduates in ENT and inspiring the pursuit of ENT as a career.

The utility of virtual reality surgical simulation in the undergraduate otorhinolaryngology curriculum

OBJECTIVE

To examine the impact of temporal bone virtual reality surgical simulator use in the undergraduate otorhinolaryngology curriculum.

METHODS

Medical students attended a workshop involving the use of a temporal bone virtual reality surgical simulator. Students completed a pre-workshop questionnaire on career interests. A post-workshop questionnaire evaluated the perceived usefulness and enjoyment of the virtual reality surgical simulator experience, and assessed changes in their interest in ENT.

RESULTS

Thirty-two fifth-year University of Auckland medical students were recruited. The majority of students (53.1 per cent) had already chosen their career path. The simulator experience was useful for: stimulating thoughts around career plans (71.9 per cent), providing hands-on experience (93.8 per cent) and teaching disease processes (93.8 per cent). After the workshop, 53.1 per cent of students were more interested in a career in ENT.

CONCLUSION

Virtual reality may be a fun and engaging way of teaching ENT. Furthermore, it could help guide student career planning.

Is there an association between nurse, clinical teacher and peer feedback for trainee doctors' medical specialty choice? An observational study in Taiwan

OBJECTIVES

This study explored whether there is an association between medical trainees' future specialty choices and the 360-degree feedback they receive. We hypothesised that the higher the scores that teachers, trainees and/or nurses give to postgraduate year 1s (PGY1s) in any given specialty, the more likely that they will choose that specialty for their residency.

SETTING

The study was conducted in a large regional teaching hospital in Taiwan.

PARTICIPANTS

The participants of this study were n=66 PGY1s who had completed their medical studies domestically or internationally and had received their PGY1 training in a single teaching hospital in southern Taiwan. Data from 990 assessments were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

Logistic regression analyses for teachers', nursing staff and peers' authentic assessments of trainees were undertaken for (1) desired specialty, (2) applied specialty, (3) enrolled specialty, (4) consistency between desired and applied specialties, (5) consistency between applied and enrolled specialties and (6) consistency between desired and enrolled specialties. Alpha was set at p<0.05.

RESULTS

Nursing staff scores were significantly associated with all six dependent variables. Furthermore, teachers' scores were significantly associated with trainees' desired specialty and the consistency between desired and enrolled specialty. Peers' scores were not significantly associated with any dependent variable.

CONCLUSIONS

Trainees' specialty choices are associated with scores given by nursing staff and clinical teachers. We suggest that qualitative research methods should further explore this association to ascertain whether PGY1s are consciously influenced by these scores and if so, in what way.

How do workplaces, working practices and colleagues affect UK doctors' career decisions? A qualitative study of junior doctors' career decision making in the UK

OBJECTIVES

This study draws on an in-depth investigation of factors that influenced the career decisions of junior doctors.

SETTING

Junior doctors in the UK can choose to enter specialty training (ST) programmes within 2 years of becoming doctors. Their specialty choices contribute to shaping the balance of the future medical workforce, with views on general practice (GP) careers of particular interest because of current recruitment difficulties. This paper examines how experiences of medical work and perceptions about specialty training shape junior doctors' career decisions.

PARTICIPANTS

Twenty doctors in the second year of a Foundation Training Programme in England were recruited. Purposive sampling was used to achieve a diverse sample from respondents to an online survey.

RESULTS

Narrative interviewing techniques encouraged doctors to reflect on how experiences during medical school and in medical workplaces had influenced their preferences and perceptions of different specialties. They also spoke about personal aspirations, work priorities and their wider future.Junior doctors' decisions were informed by knowledge about the requirements of ST programmes and direct observation of the pressures under which ST doctors worked. When they encountered negative attitudes towards a specialty they had intended to choose, some became defensive while others kept silent. Achievement of an acceptable work-life balance was a central objective that could override other preferences.Events linked with specific specialties influenced doctors' attitudes towards them. For example, findings confirmed that while early, positive experiences of GP work could increase its attractiveness, negative experiences in GP settings had the opposite effect.

CONCLUSIONS

Junior doctors' preferences and perceptions about medical work are influenced by multiple intrinsic and extrinsic factors and experiences. This paper highlights the importance of understanding how perceptions are formed and preferences are developed, as a basis for generating learning and working environments that nurture students and motivate their professional careers.

Attitude toward learning of community medicine: A cross-sectional study among medical school students

BACKGROUND

Community medicine strives to protect and promote the health and well-being of the community through primary health care approach. However the preference of community medicine as career among medical school students and curriculum of community medicine is pivotal.

AIM

The study intended to find the attitude towards learning of community medicine and also to assess the preference of post graduation specialty among medical school students.

MATERIALS AND METHODS

A cross sectional study conducted at a teaching hospital located in Tamil Nadu, South India. The study questionnaire was administered to a total of 500 study participants and the data collected were analyzed using SPSS IBM version 21.0.

RESULTS

Almost 97% were of the opinion that community medicine subject is mandatory. Eighty three percent were interested in learning the principles. Only 21.8% students wanted to pursue post graduation in community medicine. Lack of attraction in terms of scientific technical interest, workplace conditions, and research potential has been reported for being not interested.

CONCLUSION

Majority enjoyed to learn principles of community medicine at undergraduate curriculum but only few preferred to opt community medicine as post graduate specialty. Therefore there is a room to influence the medical students positively towards learning community medicine in curriculum.

What do UK medical students value most in their careers? A discrete choice experiment

CONTEXT

Many individual- and job-related factors are known to influence medical careers decision making. Previous research has extensively studied medical trainees' (residents') and students' views of the factors that are important. However, how trainees and students trade off these factors at times of important careers-related decision making is under-researched. Information about trade-offs is crucial to the development of effective policies to enhance the recruitment and retention of junior doctors.

OBJECTIVES

Our aim was to investigate the strength of UK medical students' preferences for the characteristics of training posts in terms of monetary value.

METHODS

We distributed a paper questionnaire that included a discrete choice experiment (DCE) to final-year medical students in six diverse medical schools across the UK. The main outcome measure was the monetary value of training post characteristics, based on willingness to forgo and willingness to accept extra income for a change in each job characteristic calculated from regression coefficients.

RESULTS

A total of 810 medical students answered the questionnaire. The presence of good working conditions was by far the most influential characteristic of a training position. Medical students consider that, as newly graduated doctors, they will require compensation of an additional 43.68% above average earnings to move from a post with excellent working conditions to one with poor working conditions. Female students value excellent working conditions more highly than male students, whereas older medical students value them less highly than younger students.

CONCLUSIONS

Students on the point of completing medical school and starting postgraduate training value good working conditions significantly more than they value desirable geographical location, unit reputation, familiarity with the unit or opportunities for partners or spouses. This intelligence can be used to address the crisis in workforce staffing that has developed in the UK and opens up fruitful areas for future research across contexts and in terms of examining stated preferences versus actual career-related behaviour.

Plastic Surgery Inclusion in the Undergraduate Medical Curriculum: Perception, Challenges, and Career Choice-A Comparative Study

OBJECTIVE

The undergraduate medical curriculum has been overcrowded with core learning outcomes with no formal exposure to plastic surgery. The aim of this study was to compare medical students from two educational settings for the basic understanding, preferred learning method, and factors influencing a career choice in plastic surgery.

DESIGN AND SETTING

A prospective cohort study based on a web-based anonymous questionnaire sent to final year medical students at Birmingham University (United Kingdom), McGill University (Canada), and a control group (non-medical staff). The questions were about plastic surgery: (1) source of information and basic understanding; (2) undergraduate curriculum inclusion and preferred learning methods; (3) factors influencing a career choice. A similar questionnaire was sent to non-medical staff (control group). The data was analysed based on categorical outcomes (Chi-square χ2) and level of significance p ≤ 0.05.

RESULTS

Questionnaire was analysed for 243 students (Birmingham, n = 171/332, 52%) (McGill n = 72/132, 54%). Birmingham students (14%) considered the word "plastic" synonymous with "cosmetic" more than McGill students (4%, p < 0.025). Teaching was the main source of knowledge for McGill students (39%, p < 0.001) while Birmingham students and control group chose the media (70%, p < 0.001). McGill students (67%) more than Birmingham (49%, p < 0.010) considered curriculum inclusion. The preferred learning method was lectures for McGill students (61%, p < 0.01) but an optional module for Birmingham (61%). A similar proportion (18%) from both student groups considered a career in plastic surgery.

CONCLUSIONS

Medical students recognised the need for plastic surgery inclusion in the undergraduate curriculum. There was a difference for plastic surgery source of information, operations, and preferred method of learning for students. The study highlighted the urgent need to reform plastic surgery undergraduate teaching in collaboration with national educational bodies worldwide.

Relevance of clerkship characteristics in changing students' interest in family medicine: a questionnaire survey

OBJECTIVES

Exposure to family medicine (FM) can serve to promote students' interest in this field. This study aimed at identifying clerkship characteristics which decrease or increase students' interest in FM.

DESIGN

This cross-sectional questionnaire study analysed students' clerkship evaluations between the years 2004 and 2014. Descriptive statistics were used to compare four predefined groups: (1) high interest in FM before and after the clerkship (Remained high), (2) poor interest before and after the clerkship (Remained low), (3) poor interest before the clerkship which improved (Increased) and (4) high interest before the clerkship which decreased (Decreased).

SETTING

Students' evaluations of FM clerkships in the fourth of 6 years of medical school.

PARTICIPANTS

All questionnaires with complete answers on students' interest in FM and its change as a result of the clerkship (2382 of 3963; 60.1%). The students' mean age was 26 years (± 3.9), 62.7% (n=1505) were female.

OUTCOME MEASURE

The outcome was a change in students' interest in FM after completing the clerkship.

RESULTS

Interest in FM after the clerkship was as follows: 40.1% (n=954) Remained high, 5.5% (n=134) Remained low, 42.1% (n=1002) Increased and 12.3% (n=292) Decreased. Students with decreased interest had performed a below-average number of learning activities (4 vs 6 activities). A total of 45.9% (n=134 of 292) of the students with decreased interest reported that the difficulty of the challenge was inadequate for their educational level: 81.3% (n=109) felt underchallenged and 18.7% (n=25) overchallenged.

CONCLUSIONS

In more than 50% of cases, the clerkship changed the students' interest in FM. Those with decreased interest were more frequently underchallenged. We observed an increase in FM if at least six learning activities were trained. Our findings stress the importance of well-designed FM clerkships. There is a need for standardised educational strategies which enable teaching physicians to operationalise educational requirements.

A survey of how and why medical students and junior doctors choose a career in ENT surgery

Objective:

To ascertain determinants of an interest in a career in ENT surgery through a survey of medical students and junior doctors.

Methods:

A survey was administered, comprising Likert scales, forced response and single option questions, and free text responses, at five different courses or events for those interested in a career in ENT.

Results:

The survey had an 87 per cent response rate; respondents consisted of 43 applicants for national selection, 15 foundation doctors and 23 medical students. The most important factors that encourage ENT as a career included: the variety of operative procedures, work–life balance, inherent interest in this clinical area and inspirational senior role models. Exposure to ENT in undergraduate or post-graduate training is critical in deciding to pursue this specialty.

Conclusion:

It is important to promote those aspects of ENT surgery that attract people to it, and to argue for greater exposure to ENT during undergraduate and post-graduate training.

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.

Institution-Specific Factors Associated With Family Medicine Residency Match Rates

Phenomenon: Existing research provides little specific evidence regarding the association between public and private medical school curricular settings and the proportion of medical students matching into family medicine careers. Institutional differences have been inadequately investigated, as students who match into family medicine are often consolidated into the umbrella of primary care along with those matching in internal medicine and pediatrics. However, understanding medical school contexts in relation to career choice is critical toward designing targeted strategies to address the projected shortage of family physicians. This study examines factors associated with family medicine residency match rates and the extent to which such factors differ across medical school settings.

APPROACH

We combined data from a survey of 123 departments of family medicine with graduate placement rates reported to the American Academy of Family Physicians over a 2-year period. Chi-square/Fisher's Exact texts, t tests, and linear regression analyses were used to identify factors significantly associated with average match rate percentages.

FINDINGS

The resulting data set included 85% of the U.S. medical schools with Departments of Family Medicine that reported 2011 and 2012 residency match rates in family medicine. Match rates in family medicine were higher among graduates of public than private medical schools-11% versus 7%, respectively, t(92) = 4.00, p < .001. Using a linear regression model and controlling for institutional type, the results indicated 2% higher match rates among schools with smaller annual clerkship enrollments (p  = .03), 3% higher match rates among schools with clerkships lasting more than 3 to 4 weeks (p  = .003), 3% higher match rates at schools with at least 1 family medicine faculty member in a senior leadership role (p  = .04), and 8% lower match rates at private medical schools offering community medicine electives (p < .001, R(2) = .48), F(6, 64) = 9.95, p < .001. Three additional factors were less strongly related and varied by institutional type-informal mentoring, ambulatory primary care learning experiences, and institutional research focus. Insights: Educational opportunities associated with higher match rates in family medicine differ across private and public medical schools. Future research is needed to identify the qualitative aspects of educational programming that contribute to differences in match rates across institutional contexts. Results of this study should prove useful in mitigating physician shortages, particularly in primary care fields such as family medicine.

What predicts doctors' satisfaction with their chosen medical specialty? A Finnish national study

BACKGROUND

In Finland the number of medical specialists varies between specialties and regions. More regulation of the post-graduate medical training is planned. Therefore, it is important to clarify what predicts doctors' satisfaction with their chosen specialty.

METHODS

A random sample contained 50% of all Finnish doctors under 70 years of age. The respose rate was 50.5%. Working-age specialists were asked to value their motives when choosing a specialty. They were also asked if they would choose the same specialty again. The odds ratios for not choosing the same specialty again were tested.

RESULTS

Diversity of work was the most important motive (74% of respondents). Seventeen percent of GPs would not choose the same specialty again, compared to 2% of ophthalmologists and 4% of pediatricians. A major role of Diversity of work and Prestigious field correlated with satisfaction whereas Chance with dissatisfaction with the specialty.

DISCUSSION

Motives and issues related to the work and training best correlate with satisfaction with the specialty.

CONCLUSIONS

When the numbers of Finnish postgraduate medical training posts become regulated, a renewed focus should be given to finding the most suitable speciality for each doctor. Information about employment and career advice should play an important role in this.

What do UK doctors in training value in a post? A discrete choice experiment

CONTEXT

Many individual and job-related factors are known to influence medical careers decision making. Medical trainees' (residents) views of which characteristics of a training post are important to them have been extensively studied but how they trade-off these characteristics is under-researched. Such information is crucial for the development of effective policies to enhance recruitment and retention. Our aim was to investigate the strength of UK foundation doctors' and trainees' preferences for training post characteristics in terms of monetary value.

METHODS

We used an online questionnaire study incorporating a discrete choice experiment (DCE), distributed to foundation programme doctors and doctors in training across all specialty groups within three UK regions, in August-October 2013. The main outcome measures were monetary values for training-post characteristics, based on willingness to forgo and willingness to accept extra income for a change in each job characteristic, calculated from regression coefficients.

RESULTS

The questionnaire was answered by 1323 trainees. Good working conditions were the most influential characteristics of a training position. Trainee doctors would need to be compensated by an additional 49.8% above the average earnings within their specialty to move from a post with good working conditions to one with poor working conditions. A training post with limited rather than good opportunities for one's spouse or partner would require compensation of 38.4% above the average earnings within their specialty. Trainees would require compensation of 30.8% above the average earnings within their specialty to move from a desirable to a less desirable locality. These preferences varied only to a limited extent according to individual characteristics.

DISCUSSION

Trainees place most value on good working conditions, good opportunities for their partners and desirable geographical location when making career-related decisions. This intelligence can be used to develop alternative models of workforce planning or to develop information about job opportunities that address trainees' values.

'You become a man in a man's world': is there discursive space for women in surgery?

CONTEXT

The UK set a target of 20% of the surgical consultant workforce to be represented by women by 2009; in 2012, it remains 7%. Studies have attributed this shortfall to the nature of careers in surgery and differing career aspirations among women.

OBJECTIVES

Rather than exploring barriers to participation, this study aims to explore the self-narratives of those women who do undertake surgical careers and who do come to see themselves as surgeons.

METHODS

The study comprises 15 individual interviews with women in surgical careers, from those aspiring to be surgeons, to senior and retired surgeons. Data were explored using discourse analysis with a priori themes derived from the literature on women in surgery and Holland et al.'s theoretical framework of Figured Worlds.

RESULTS

Discourses of being a surgeon and discourses of being a woman, existed in competition. Female surgeons figured surgery as a career requiring 100% dedication, as they did motherhood, although the demands of the two roles differed and consequently the roles were not discursively compatible. Many related powerfully negative experiences in which their gender had marked them out as 'other' within surgery. Women described how they were expected to show masculine traits as surgeons and the ways to consequently become legitimate in the surgical world as a 'woman surgeon'. They found creative ways to articulate how women in general, and feminine qualities in particular, enhanced surgery. Finally, some women engaged in identity work, termed 'world making', - the creative orchestration of discourses of surgeonhood and motherhood to be mutually sustaining.

CONCLUSIONS

There is little discursive space in which to be both a successful woman and a successful surgeon. Those who combine these roles must either be innovative in refiguring what it means to be a woman or what it means to be a surgeon, or they must author a new space for themselves, a powerful discursive process termed 'world making'.

Impact of Interventions to Increase the Proportion of Medical Students Choosing a Primary Care Career: A Systematic Review

BACKGROUND

Increasing the attractiveness of primary care careers is a key step in addressing the growing shortage of primary care physicians. The purpose of this review was to (1) identify interventions aimed at increasing the proportion of undergraduate medical students choosing a primary care specialty, (2) describe the characteristics of these interventions, (3) assess the quality of the studies, and (4) compare the findings to those of a previous literature review within a global context.

METHODS

We searched MEDLINE, EMBASE, ERIC, CINAHL, PsycINFO, The Cochrane Library, and Dissertations & Theses A&I for articles published between 1993 and February 20, 2015. We included quantitative and qualitative studies reporting on primary care specialty choice outcomes of interventions in the undergraduate medical curriculum, without geographic restrictions. Data extracted included study characteristics, intervention details, and relevant outcomes. Studies were assessed for quality and strength of findings using a five-point scale.

RESULTS

The review included 72 articles reporting on 66 different interventions. Longitudinal programs were the only intervention consistently associated with an increased proportion of students choosing primary care. Successful interventions were characterized by diverse teaching formats, student selection, and good-quality teaching. Study quality had not improved since recommendations were published in 1995. Many studies used cross-sectional designs and non-validated surveys, did not include control groups, and were not based on a theory or conceptual framework.

DISCUSSION

Our review supports the value of longitudinal, multifaceted, primary care programs to increase the proportion of students choosing primary care specialties. Isolated modules or clerkships did not appear to be effective. Our results are in line with the conclusions from previous reviews and add an international perspective, but the evidence is limited by the overall low methodological quality of the included studies. Future research should use more rigorous evaluation methods and include long-term outcomes.

Impact of family medicine clerkships in undergraduate medical education: a systematic review

OBJECTIVE

Synthesise evidence about the impact of family medicine/general practice (FM) clerkships on undergraduate medical students, teaching general/family practitioners (FPs) and/or their patients.

DATA SOURCES

Medline, ERIC, PsycINFO, EMBASE and Web of Knowledge searched from 21 November to 17 December 2013. Primary, empirical, quantitative or qualitative studies, since 1990, with abstracts included. No country restrictions. Full text languages: English, French, Spanish, German, Dutch or Italian.

REVIEW METHODS

Independent selection and data extraction by two authors using predefined data extraction fields, including Kirkpatrick's levels for educational intervention outcomes, study quality indicators and Best Evidence Medical Education (BEME) strength of findings' grades. Descriptive narrative synthesis applied.

RESULTS

Sixty-four included articles: impact on students (48), teaching FPs (12) and patients (8). Sample sizes: 16-1095 students, 3-146 FPs and 94-2550 patients. Twenty-six studies evaluated at Kirkpatrick level 1, 26 at level 2 and 6 at level 3. Only one study achieved BEME's grade 5. The majority was assessed as grade 4 (27) and 3 (33). Students reported satisfaction with content and process of teaching as well as learning in FM clerkships. They enhanced previous learning, and provided unique learning on dealing with common acute and chronic conditions, health maintenance, disease prevention, communication and problem-solving skills. Students' attitudes towards FM were improved, but new or enhanced interest in FM careers did not persist without change after graduation. Teaching FPs reported increased job satisfaction and stimulation for professional development, but also increased workload and less productivity, depending on the setting. Overall, student's presence and participation did not have a negative impact on patients.

CONCLUSIONS

Research quality on the impact of FM clerkships is still limited, yet across different settings and countries, positive impact is reported on students, FPs and patients. Future studies should involve different stakeholders, medical schools and countries, and use standardised and validated evaluation tools.

Medical Specialty Choice and Related Factors of Brazilian Medical Students and Recent Doctors

BACKGROUND

Choosing a medical specialty is an important, complex, and not fully understood process. The present study investigated the factors that are related to choosing and rejecting medical specialties in a group of students and recent medical doctors.

METHODOLOGY AND FINDINGS

A cross-sectional survey of 1,223 medical students and doctors was performed in Brazil in 2012. A standardized literature-based questionnaire was applied that gathered preferable or rejected specialties, and asked questions about extracurricular experiences and the influence of 14 factors on a Likert-type scale from 0 to 4. Specialties were grouped according to lifestyle categories: controllable and uncontrollable, which were subdivided into primary care, internal medicine, and surgical specialties. Notably, the time period of rejection was usually earlier than the time period of intended choice (p < 0.0001, χ(2) = 107.2). The choice mainly occurred during the internship period in medical school (n = 466; 38.7%). An overall large frequency of participation in extracurricular activities was observed (n = 1,184; 95.8%), which were highly associated with the respective medical area. Orthopedic surgery had the highest correlation with participation in specialty-specific organized groups (OR = 59.9, 95% CI = 21.6-166.3) and psychiatry was correlated with participation in research groups (OR = 18.0, 95% CI = 9.0-36.2). With regard to influential factors in controllable lifestyle specialties, "financial reason" (mean score ± standard deviation: 2.8 ± 1.0; median = 3) and "personal time" (3.1 ± 1.3; median = 4) were important factors. In primary care, these factors were less important (1.7 ± 1.3 and 1.7 ± 1.5, respectively; median = 2 for both), and higher scores were observed for "curricular internship" (3.2 ± 1.1, median = 4) and "social commitment" (2.6 ± 1.3, median = 3).

CONCLUSION

The present findings provide important insights into developing strategies to stimulate interest in specialties based on the needs of the Brazilian healthcare system.

Speciality preferences in Dutch medical students influenced by their anticipation on family responsibilities

Physician gender is associated with differences in the male-to-female ratio between specialities and with preferred working hours. We explored how graduating students' sex or full-time or part-time preference influences their speciality choice, taking work-life issues into account. Graduating medical students at Radboud University Medical Centre, the Netherlands participated in a survey (2008-2012) on career considerations. Logistic regression tested the influence of sex or working hour preference on speciality choice and whether work-life issues mediate. Of the responding students (N = 1,050, response rate 83, 73.3 % women), men preferred full-time work, whereas women equally opted for part time. More men chose surgery, more women family medicine. A full-time preference was associated with a preference for surgery, internal medicine and neurology, a part-time preference with psychiatry and family medicine. Both male and female students anticipated that foremost the career of women will be negatively influenced by family life. A full-time preference was associated with an expectation of equality in career opportunities or with a less ambitious partner whose career would affect family life. This increased the likelihood of a choice for surgery and reduced the preference for family medicine among female students. Gender specifically plays an important role in female graduates' speciality choice making, through considerations on career prospects and family responsibilities.

Role models play the greatest role - a qualitative study on reasons for choosing postgraduate training at a university hospital

Objective: Why physicians choose a certain specialty at a university hospital for their postgraduate training is incompletely understood. Our aim was to identify factors that led physicians from different generations to opt for postgraduate training in a specialty with high or low patient contact at a university hospital.

Methods: We conducted 14 semi-structured interviews with residents and attending physicians from the departments of Internal Medicine (high patient contact) and Laboratory Medicine (low patient contact) at the University Hospital Hamburg-Eppendorf, Germany. We used template analysis to code the interview transcripts and iteratively reduced and displayed the data. Initial codes and concepts were shaped into categories until agreement on the final template was reached.

Results: We identified five main categories of factors that influenced postgraduate specialty selection. Role models with a civilized code of behavior and expertise in their specialty had had the greatest influence on participants’ choice of a specialty across generations. Electives and a doctoral thesis project had also influenced participants’ decisions, mainly because of meeting a role model in their supervisor. Patient contact and intellectual challenges were identified as contributing factors in the selection of a specialty with high patient contact. As reasons for selecting a university hospital for postgraduate education four categories were identified: the possibility to participate in scientific research, a broad spectrum of activities, personal contacts and future career opportunities.

Conclusions: The professional attitudes of teachers as role models were identified as having the greatest influence on postgraduate education choices. Besides other actions to attract students to certain specialties for their postgraduate education, the aspect of being perceived as a role model while teaching requires particular attention when preparing medical faculty for undergraduate medical teaching.

You've got to know the rules to play the game: how medical students negotiate the hidden curriculum of surgical careers

OBJECTIVES

The hidden curriculum may be framed as the culture, beliefs and behaviours of a community that are passed to students outside formal course offerings. Medical careers involve diverse specialties, each with a different culture, yet how medical students negotiate these cultures has not been fully explored. Using surgery as a case study, we aimed to establish, first, whether a specialty-specific hidden curriculum existed for students, and second, how students encountered and negotiated surgical career options.

METHODS

Using a constructivist grounded theory approach, we explored students' thoughts, beliefs and experiences regarding career decisions and surgery. An exploratory questionnaire informed the discussion schedule for semi-structured individual interviews. Medical students were purposively sampled by year group, gender and career intentions in surgery. Data collection and analysis were iterative: analysis followed each interview and guided the adaptation of our discussion schedule to further our evolving model.

RESULTS

Students held a clear sense of a hidden curriculum in surgery. To successfully negotiate a surgical career, students perceived that they must first build networks because careers information flows through relationships. They subsequently enacted what they learned by accruing the accolades ('ticking the boxes') and appropriating the dispositions ('walking the talk') of 'future surgeons'. This allowed them to identify themselves and to be identified by others as 'future surgeons' and to gain access to participation in the surgical world. Participation then enabled further network building and access to careers information in a positive feedback loop. For some, negotiating the hidden curriculum was more difficult, which, for them, rendered a surgical career unattractive or unattainable.

CONCLUSIONS

Students perceive a clear surgery-specific hidden curriculum. Using a constructivist grounded theory approach, we have developed a model of how students encounter, uncover and enact this hidden curriculum to succeed. Drawing on concepts of Bourdieu, we discuss unequal access to the hidden curriculum, which was found to exclude many from the possibility of a surgical career.

A survey of factors influencing career preference in new-entrant and exiting medical students from four UK medical schools

BACKGROUND

Workforce planning is a central issue for service provision and has consequences for medical education. Much work has been examined the career intentions, career preferences and career destinations of UK medical graduates but there is little published about medical students career intentions. How soon do medical students formulate careers intentions? How much do these intentions and preferences change during medical school? If they do change, what are the determining factors? Our aim was to compare medical students' career preferences upon entry into and exit from undergraduate medical degree programmes.

METHODS

This was a cross-sectional questionnaire survey. Two cohorts [2009-10, 2010-11] of first and final year medical students at the four Scottish graduating medical schools took part in career preference questionnaire surveys. Questions were asked about demographic factors, career preferences and influencing factors.

RESULTS

The response rate was 80.9% [2682/3285]. Significant differences were found across the four schools, most obviously in terms of student origin [Scotland, rest of UK or overseas], age group, and specialty preferences in Year 1 and Year 5. Year 1 and Year 5 students' specialty preferences also differed within each school and, while there were some common patterns, each medical school had a different profile of students' career preferences on exit. When the analysis was adjusted for demographic and job-related preferences, specialty preferences differed by gender, and wish for work-life balance and intellectual satisfaction.

CONCLUSIONS

This is the first multi-centre study exploring students' career preferences and preference influences upon entry into and exit from undergraduate medical degree programmes. We found various factors influenced career preference, confirming prior findings. What this study adds is that, while acknowledging student intake differs by medical school, medical school itself seems to influence career preference. Comparisons across medical school populations must therefore control for differences in input [the students] as well as context and process [the medical school] when looking at output [e.g., performance]. A robust, longitudinal study is required to explore how medical students' career preferences change as they progress through medical school and training to understand the influence of the learning environment on training choice and outcomes.

Career decisions and gender: the illusion of choice?

None

[Drawn towards a career in elderly care medicine, but not till after medical school. Elderly care medicine as a career choice]

In order to develop strategies for raising the interest of medical students in a career in elderly care medicine (a specialty in The Netherlands) we should start by gaining more insight into the process influencing career choices among medical students and graduates. In this qualitative study we conducted three focus group discussions with trainees in elderly care medicine and two focus group discussions with obstetrics and gynaecology trainees. We found that all trainees made their career choice after clinical exposure in the field. The elderly care medicine trainees did not make their choice until after graduation, working in temporary employment in a nursing home. The obstetrics and gynaecology trainees made their specialty choice during medical school after their clerkship. Almost all focus group participants had a very negative perception during medical school about geriatrics and elderly care medicine. Once they were employed in a nursing home they changed their minds. They came to realize the work was more interesting, more difficult, more intensive and more meaningful than they had initially thought.

What is different about medical students interested in non-clinical careers?

BACKGROUND

The proportion of medical school graduates who pursue careers other than full-time clinical practice has increased in some countries as the physician's role has evolved and diversified with the changing landscape of clinical practice and the advancement of biomedicine. Still, past studies of medical students' career choices have focused on clinical specialties and little is known about their choice of non-clinical careers. The present study examined backgrounds, motivation and perceptions of medical students who intended non-clinical careers.

METHODS

A questionnaire was administered to students at six Korean medical schools distributed across all provinces in the nation. The questionnaire comprised 40 items on respondents' backgrounds, their motivation for and interest in the study of medicine, their perceptions of medical professions, and their career intentions. Data was analyzed using various descriptive and inferential statistics.

RESULTS

In total, 1,388 students returned the questionnaire (60% response rate), 12.3% of whom intended non-clinical careers (i.e., basic sciences, non-clinical medical fields, and non-medical fields). Those who planned non-clinical careers were comparable with their peers in their motivation for studying medicine and in their views of medical professions, but they were less interested in the study of medicine (P < 0.01). The two groups also differed significantly on their perceptions of what was uninteresting about the study of medicine (P < 0.01). The two groups were comparable in gender and entry-level ratios but their distributions across ages and years of study differed significantly (P < 0.01). A majority of respondents agreed with the statements that "it is necessary for medical school graduates to pursue non-clinical careers" and that "medical schools need to offer programs that provide information on such careers." Still, our finding indicates that medical school curricula do not address such needs sufficiently.

CONCLUSIONS

Our study found some differences in backgrounds and perceptions of the study of medicine in medical students interested in non-clinical careers from their peers. Future studies are suggested to enhance our understanding of medical students" choice of non-clinical careers.

Associations between medical school and career preferences in Year 1 medical students in Scotland

OBJECTIVES

Little is known about the relationship between the career preferences of medical students and the medical schools at which they are enrolled. Our aim was to explore this relationship early in students' medical training.

METHODS

Year 1 (2009-2010) medical students at the five Scottish medical schools were invited to take part in a career preference questionnaire survey. Questions were asked about demographic factors, career preferences and influencing factors.

RESULTS

The response rate was 87.9% (883/1005). No significant differences were found among medical schools with regard to first-choice specialty. Surgery (22.5%), medicine (19.0%), general practice (17.6%) and paediatrics (16.1%) were the top career choices. Work-life balance, perceived aptitude and skills, intellectual satisfaction, and amount of patient contact were rated as the most important job-related factors by most respondents. Few differences were found among schools in terms of the impact of job-related factors on future career preferences. Students for whom the work-life balance was extremely important (odds ratio [OR]=0.6) were less likely to prefer surgery. Students for whom the work-life balance (OR=2.2) and continuity of care (OR=2.1) were extremely important were more likely to prefer general practice.

CONCLUSIONS

Students' early career preferences were similar across the five medical schools. These preferences result from the interplay among demographic factors and the perceived characteristics of the various specialties. Maintaining a satisfactory work-life balance is very important to tomorrow's doctors, and the data hint that this may be breaking down some of the traditional gender differences in specialty choice. Longitudinal work is required to explore whether students' career preferences change as they progress through medical school and training.

Specialty preferences of Iraqi medical students

BACKGROUND

  Medical students have a wide spectrum of specialty preferences.

OBJECTIVE

To study specialty preferences of Iraqi medical students and determine the factors controlling them.

METHODS

A questionnaire survey involved final-year medical students at Al-Kindy College of Medicine, Baghdad University, in April 2008. The questionnaire included data on gender, specialty preference and the reason behind choosing their most preferred single specialty. We statistically analysed the data using the chi-square test and an unpaired Student's t-test.

RESULTS

Clinical specialties were statistically rated higher than basic medical sciences specialties (73.1 vs. 26.9%) (unpaired Student's t-test, p < 0.05). Gender differences were found in clinical specialty preferences (chi-square test, p < 0.001). The most preferred clinical specialties chosen by both genders were internal medicine (29.4%), surgery (25%), paediatrics (25%), and obstetrics and gynaecology (20.6%). Gender differences were also found in basic medical sciences specialty preferences (chi-square, p < 0.05). The most preferred basic medical sciences specialties chosen by both genders were microbiology (32%), pharmacology (24%), pathology (16%), physiology (12%), biochemistry (8%) and anatomy (8%). Personal interest (33.3%) and anticipated higher income (29%) were ranked as the most influencing factors contributing to the choice of specialty in both genders. Other influential factors were ranked at lower rates, and included: prestige (14%), anticipated future mastering of skills and development (10.7%), charismatic role models (7.5%) and family or spousal influence (5.4%). However, no statistical gender differences were noted (chi-square, p > 0.05).

CONCLUSION

Clinical specialties outnumbered basic medical sciences specialties as specialty preferences. Personal interest and an anticipated higher income were the most influential factors contributing to specialty preference.

Attitudes of medical students towards general practice: Effects of gender, a general practice clerkship and a modern curriculum

Aims: Planning a career in general practice depends on positive attitudes towards primary care. The aim of this study was to compare attitudes of medical students of a Modern Curriculum at Hannover Medical School with those of the Traditional Curriculum before (pre) and after (post) a three-week clerkship in general practice. In parallel, we aimed to analyse several other variables such as age and gender, which could influence the attitudes.

Methods: Prospective survey of n=287 5th-year students. Attitudes (dependent variable, Likert-scale items) as well as socio-demographic characteristics (age, gender, rural/urban background), school leaving examination grades, former qualifications, experiences in general practice and career plans were requested. Attitudes were analysed separately according to these characteristics (e.g. career plans: general practitioner (GP)/specialist), curriculum type and pre/post the clerkship in general practice. Bi- and multivariate statistical analysis was used including a factor analysis for grouping of the attitude items.

Results: Most and remarkable differences of attitudes were seen after analysis according to gender. Women appreciated general practice more than men including a greater interest in chronic diseases, communication and psychosocial aspects. The clerkship (a total of n=165 students of the “post” survey could be matched) contributed to positive attitudes of students of both gender, whereas the different curricula did not show such effects.

Conclusions: Affective learning goals such as a positive attitude towards general practice have depended more on characteristics of students (gender) and effects of a clerkship in general practice than on the curriculum type (modern, traditional) so far. For the development of outcomes in medical education research as well as for the evolution of the Modern Curriculum such attitudes and other affective learning goals should be considered more frequently.

Determinants of choosing a career in surgery

INTRODUCTION

Student choice is an important determinant of the specialty mix of practicing physicians in Canada. Understanding student characteristics at medical school entry that are associated with a student choosing a residency in surgery can assist surgical educators in supporting medical students interested in surgery and in serving health human resources needs.

METHODS

From 2002 to 2004, data was collected from entering students in 15 classes at eight of 16 Canadian medical schools. Surveys included questions on career choice, attitudes to practice, and socio-demographics. Students were followed prospectively with survey data linked to their residency choice. Multiple logistic regression analysis was used to identify entry characteristics that predicted a student's ultimate choice of a surgical career.

RESULTS

Eight entry variables predicted whether a student named surgery (including obstetrics) as their top residency choice: having surgery as their top career choice, having a relative or friend in a surgical career, having undertaken volunteer work with sports teams, an interest in narrow scope of practice, greater interest in medical the social patient problems, an interest in urgent care, and younger age were identified as predictors of a surgical career choice.

DISCUSSION

Surgical educators may wish to attend to the factors that we found that predicted students selecting a surgical residency as their top career choice at medical school exit in order to foster and support students interested in the surgical disciplines during medical school. In addition, these factors could be used to identify students interested in a surgical career at medical school entry.

Choosing a medical specialty--study of Finnish doctors graduating in 1977-2006

BACKGROUND

Choosing a medical specialty is an important element predefining a physician's career and life. Although there has been some research in this area of interest, there has not been much research where the profession has been researched as a whole, or where trend data over different generations has been presented.

AIM

The aim of our study was to ascertain the motives affecting physicians' choice of a medical specialty.

METHODS

The study cohort comprised random sample of 7758 doctors who were registered in Finland during the years 1977-2006. Altogether 4167 questionnaires were returned, giving a response rate of 54%. An electronic questionnaire was used in data collection, supported by a traditional postal questionnaire.

RESULTS

Of the respondents, 76% thought the diversity of the field had affected their choices of specialty considerably or very much. For physicians under 35 years old, especially the good example set by colleagues (48%), and opportunities for career development (39%) were more important motives compared to those of older physicians.

CONCLUSIONS

According to this study, diversity of the work is the main motivating factor affecting physicians' choices of specialty. Especially, younger physicians follow the example set by more experienced colleagues.