Israeli medical students' perceptions of six key medical specialties

Why choose paediatrics? A scoping review of factors affecting the choice of paediatrics as a career

Despite being a popular speciality at the undergraduate level, paediatrics lags behind most other medical and surgical specialities for postgraduate recruitment. As many individuals decide on their future career choice while still in medical school, it is essential to identify the factors that attract individuals to a career in paediatrics. To determine the positive influencing factors determining paediatrics as a career choice. A scoping review of primary research articles was conducted using a comprehensive electronic search strategy and reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews recommendations. Studies exploring medical students, junior doctors, and current paediatricians' perceptions of paediatrics were included. Factors affecting career choice were identified. Thirty-six studies out of a possible 3106 met the inclusion criteria and were included in this review. Six key influencing themes were identified. These were early undergraduate and clinical exposure to paediatrics; an attractive work-life balance; the presence of role models and mentors; an enjoyable working atmosphere and varied clinical work; a personal commitment to paediatrics; and working with children.

CONCLUSION

 Medical students are drawn by the wide clinical variety in paediatrics, enjoyable working atmosphere, and enthusiastic colleagues. Given the importance of early clinical exposure in determining student motivation, paediatrics needs to do more to advertise the wide variety of clinical and research work available, starting early in medical school. In addition, medical students need to be offered more opportunities to experience the speciality through student selected components, summer schools, or workshops, requiring coordination between medical schools and regional paediatric departments.

WHAT IS KNOWN

• Research suggests that many medical students make choices on their future career based on medical school experiences. • Paediatrics is a popular subject among medical students, however applications for the specialilty are in decline.

WHAT IS NEW

• Six key factors influencing paediatrics as a career choice have been identified, the most common being early exposure to paediatrics at medical school and lifestyle factors. • Interventions aimed at increasing student involvement in paediatrics at the undergraduate level have been shown to be associated with an increase in the number of individuals applying for the speciality following graduation.

Uzmanlık öğrencilerinin branş tercihlerini etkileyen faktörler arasında şiddetin yeri

Amaç: Bu çalışmanın amacı, Ege Üniversitesi Tıp Fakültesi'nde tıpta uzmanlık eğitimi alan hekimlerin sağlık alanında yaşadıkları şiddet deneyimlerinin uzmanlık tercihlerine etkisini belirlemektir. Gereç ve Yöntem: ege Üniversitesi Tıp Fakültesi Hastanesi’nde görevli 704 tıpta uzmanlık öğrencisi olduğu belirlendi. 25.05.2020-25.03.2021 tarihleri arasında tıpta uzmanlık öğrencilerinin 394’üne ulaşılarak yüz yüze anket uygulandı. 389 anket değerlendirmeye alındı. Verilerin analizi IBM SPSS Statistics 25.0 programı ile yapıldı. İstatistiksel çözümlemelerde Pearson Ki-kare testi uygulandı. İkiden fazla grubu olan karşılaştırmalarda Bonferroni düzeltmesi yapıldı. İstatistiksel anlamlılık düzeyi p<0,05 olarak kabul edildi. Bulgular: Katılımcıların %51,7’si erkek, %48,1’i kadındı. Tıpta uzmanlık eğitimi öncesinde, hekimlerin %54,5'inin şiddete maruz kaldığı ve %76,9'unun şiddete tanık olduğu belirlendi. Sağlıkta şiddete tanık olmanın branş seçiminde anlamlı derecede etkili olduğu bulundu (p=0,005). Temel bilimler katılımcıları tarafından branş seçiminde şiddetle ilgili faktörlere anlamlı derecede daha fazla öncelik verildiği belirlendi (p<0,001). Çalıştığı kurumda, şiddete maruz kalanların (p=0,002) ve tanık olanların (p=0,014) anlamlı olarak yüksek oranda branş değiştirmeyi düşündüğü saptandı. Ayrıca katılımcıların %22,9'unun tıp mesleği dışında bir iş yapmak istediği belirlendi. Sonuç: Sağlık sistemindeki sorunların giderilmesi, toplumun eğitilmesi, medyanın etkin kullanımı ve yargı kurumlarının aldığı kararların caydırıcı olması sağlıkta şiddetin önlenmesinde oldukça önemlidir.

A Research on the Factors Affecting the Preference of Medical Specialization Branches

Aim. The aim of this study is to determine the factors affecting the preferences of specialization in the field of medicine. Materials and Methods. Mixed research and exploratory sequential research design were used. In the exploratory phase, data were collected from specialist physicians (n=14) and findings were analyzed by descriptive and content analysis. In the light of qualitative findings, a measurement tool was developed and applied to medical school students and the physicians who prepared specialty exams (n = 502). Results. Qualitative findings were structured under 3 themes: individual, occupational and systemic factors. The measurement tool, which was named “Physicians' Preference Tendencies of Specialty Branch” was structured as 42 items and 7 dimensions: risk, comfort, health problems, status, emotional interest, gender, and marital status emerged. Conclusions. Although there are many factors that affect preferences of the medical field, it is concluded that personality traits and idealism of individuals and mortality rates associated with branch or field of medicine are the most significant professional factors, while the risks and the exposure to violence and the application of the additional payment based on the performance of candidates are the systemic factors that affect selections and preferences. Also, it was concluded that qualitative data obtained in the research were supported with quantitative data.

Final-year medical students' competence profiles according to the modified requirement tracking questionnaire

BACKGROUND

Undergraduate medical education is supposed to equip medical students with basic competences to select any specialty of their choice for postgraduate training. Medical specialties are characterized by a great diversity of their daily work routines and require different sets of competence facets. This study examines the self-assessed competence profiles of final-year undergraduate medical students and their specialty choice for postgraduate training. Students' profiles, who wish to choose anaesthesiology, internal medicine, or paediatrics, are compared with the physicians' competence profiles from these three disciplines.

METHODS

In this study, 148 volunteer final-year undergraduate medical students completed the modified requirement-tracking (R-Track) questionnaire for self-assessment of their competence profiles. The R-Track questionnaire contains 63 competence facets assigned to six areas of competence: "Mental abilities", "Sensory abilities", "Psychomotor & multitasking abilities", "Social interactive competences", "Motivation", and "Personality traits". The expression of the different competence facets had to be assessed on a 5-point Likert scale (1: "very low" to 5: "very high"). Additionally, socio-demographic data and the participants' first choice of a medical speciality for postgraduate education were collected. We used analysis of variance (ANOVA) for mean score comparison of subgroups and least significant difference (LSD) tests for post hoc analysis.

RESULTS

The competence area with the highest rating was "Motivation" (3.70 ± 0.47) while "Psychomotor & multitasking abilities" received the lowest rating (3.34 ± 0.68). Individual facets of competence ranked from "In need of harmony" (4.36 ± 0.72), followed by "Tactfulness" (4.26 ± 0.64), and "Cooperation/Agreeableness" (4.24 ± 0.53) to "Risk orientation" (2.90 ± 0.92), "Mathematical reasoning" (2.87 ± 1.25), and "Sanctioning" (2.26 ± 0.93). The students' competence profiles showed 100 % congruence with physicians' competence profiles of the postgraduate specialty of their choice for internal medicine, 33.3 % for paediatrics, and 0 % for anaesthesiology.

CONCLUSIONS

Undergraduate medical students could define their competence profiles with the modified R-Track questionnaire and compare them with the profile of their desired specialty for postgraduate training to discover possible learning gaps or to detect good specialty matches. A combination of students' competence self-assessment with an external assessment of students' facets of competence could provide curricular planners with useful information how to design learning opportunities for specific facets of competence.

Defining competence profiles of different medical specialties with the requirement-tracking questionnaire - a pilot study to provide a framework for medial students' choice of postgraduate training

BACKGROUND

The medical specialties are characterised by a great diversity in their daily work which requires different sets of competences. A requirement analysis would help to establish competence profiles of the different medical specialities. The aim of this pilot study was to define competence profiles for individual medical specialties. This could provide a framework as support for medical graduates who wish to choose a medical specialty for their postgraduate training.

METHODS

In February 2020, physicians were invited via the State Chamber of Physicians' monthly journal to electronically fill out the requirement tracking (R-Track) questionnaire. It contains 63 aspects assigned to six areas of competence: "Mental abilities", "Sensory abilities", "Psychomotor and multitasking abilities", "Social interactive competences", "Motivation", and "Personality traits". The expression of the different aspects was assessed on a 5-point Likert scale (1: "very low" to 5: "very high"). Sociodemographic data and information about the current workplace (hospital or practice) were also collected.

RESULTS

In total, 195 practicing physicians from 19 different specialities followed the invitation by the State Chamber of Physicians to participate in this survey. For almost all medical specialties, the competence area "Motivation" reached rank 1. "Psychomotor and multitasking abilities" received high ranks among specialties performing surgical activities, while "Social interactive competences" and "Personality traits" were highly rated by specialties with an intense level of patient-physician-interaction. "Mental abilities" were only rated highly by radiologists (rank 2) and physiologists (rank 3) while "Sensory abilities" were generally rated very low with the expression (rank 4) for anaesthesiology and ENT.

CONCLUSIONS

In this pilot study, a first outline of competences profiles for 17 medical specialties were defined. The specific "Motivation" for a medical specialty seemed to play the greatest role for most specialties. This first specialty specific competence framework could provide a first insight into specific competences required by medical specialties and could serve medical graduate as a decision aid when looking for a medical specialty for their postgraduate training.

Consensual qualitative research on the internship experience and development of career identity of Korean doctors

BACKGROUND

Career identity is defined as the ability to substantialise career goals and results from the social learning process achieved through interactions with others. This study aimed to understand how the internship experience in Korea affects career identity, which provides a foundation for developing professional values while promoting personal goals and aspirations.

METHODS

We conducted eleven semi-structured interviews with interns at a university hospital in Korea who had completed internships and chosen a speciality. The interview transcripts underwent inductive thematic analysis using consensual qualitative research approaches. Themes identified were categorised from three domains for the year-long internship experience: personal cognitive, social interaction, and system domains.

RESULTS

Researchers derived seven categories and 20 subcategories from the transcripts: (1) self-reflection throughout internship training, (2) practical awareness of the internship programme's operation, (3) perception of individual competence, (4) recognition of mentor importance, (5) situational awareness in the clinical department, (6) relationship experience, and (7) experience of institutional limitations. The internship experience, during which the individual is in charge and core values drive career decisions, is important for the formation of career identity and career orientation. The internship programme provides information about the clinical department to applicants seeking residency and serves a mediating role, providing information about applicants to the clinical departments. Internship is an important period during which career identity is formed.

CONCLUSION

The internship programme provides information about clinical departments to applicants seeking residency; it is an important period during which career identity is formed. This study helps provide an in-depth understanding of interns and a base for developing institutional and policy support for students during an uncertain time when specialties should be selected.

PERCEPTION OF FIRST-YEAR VERSUS SIXTH-YEAR MEDICAL STUDENTS IN SERBIA ON STUDYING MEDICINE AND POSTGRADUATE CAREER

Self-perceived stress during undergraduate medical training could influence forthcoming career choices. The aim of this study was to explore the attitudes and potential differences between 1^st and 6^th year students regarding aspects of medical training and career plans. As many as 570 students in 1^st and 400 in 6^th year of studies at the Faculty of Medicine, University of Belgrade, were recruited on December 2-9, 2013. Data were acquired through a self-administered questionnaire. Students in both years rated “Helping other people” as the most important reason to study medicine. Freshmen rated statistically significantly higher ‘good incomes’ and ‘social status’ as reasons to study medicine (p=0.003 and p=0.037, respectively). The most desirable fields of specialization were surgery and internal medicine (36.4% and 18.7% for 1^st year, and 26.3% and 36.6% for 6^th year, respectively). Significantly more freshmen would prefer working abroad (χ²=3.891, p=0.029). In terms of careers abroad, students in both years expressed the highest interest in working in western and northern Europe. Desires for specialty training among medical students follow the pattern of the most frequent disciplines in the Serbian physician population, with gender differences comparable to other populations. A certain percentage of students would likely emigrate.

Motives influencing students' preferences for obstetrics and gynaecology speciality: A cross-sectional multi-site Swiss study

OBJECTIVES

Knowing and understanding the reasons why medical students choose postgraduate medical specialities are essential to help influence the workforce for a balanced national healthcare system. The objective of this study was to determine motivating factors for choosing a speciality career in general and, more specifically, for the choice of obstetrics and gynaecology (OBGYN) over surgery or general practice.

STUDY DESIGN

This study was based on prospectively collected data from a large research multi-site cross-sectional study. We sent a survey to medical students in the sixth year, which contained questions about demographics, choice of speciality and motives for choosing. We grouped the specialities into families of specialities and motives into motivating factors clustered by principal component analysis. We used a multivariate analysis of variance (MANOVA) test to identify differences between motivating factors in speciality categories and gender. We performed logistic regression analyse to compare the choice of OBGYN to choices of surgery and general practice as well as undecided.

RESULTS

A total of 1749 students responded with an average return rate of 56%. Our study revealed four motivating factors: "experiential", "relational", "occupational" and "scientific". Logistic regression analysis showed that the choice of OBGYN was particularly influenced by "experiential factor" (OR 1.5; 95%CI [1.2; 1.9]) and by gender (OR 4.5; 95%CI [2.2; 9.2]). When we compared the motivational profile of OBGYN to other speciality categories, OBGYN appeared to stand between surgery and general practice for the "experiential" and "relational" factors, more like surgery for the "occupational factor" and more like general practice for the "scientific factor".

CONCLUSION

This study highlighted the importance of "experiential factor" and gender for choosing OBGYN as a career. OBGYN seemed to stand between surgery and general practice from a Swiss students' point of view. These findings provide useful information for targeted interventions to promote OBGYN at the undergraduate level. Such interventions could include providing more hands-on experiences, improving integration of male students and encouraging student involvement in patient care.

Challenges to the Israeli healthcare system: attracting medical students to primary care and to the periphery

Background

The greatest challenges facing healthcare systems include ensuring a sufficient supply of primary care physicians and physicians willing to work in rural or peripheral areas. Especially challenging is enticing young physicians to practice primary care in rural/peripheral areas. Identifying medical students interested in primary care and in residencies in Israel’s periphery should aid the healthcare leadership. It may be particularly important to do so during the clinical years, as this is the stage at which many future physicians begin to crystallize their specialty and location preferences.

Methods

Questionnaires, distributed to 6 consecutive 5th-year classes of the Hebrew University – Hadassah School of Medicine, from 2010 to 2016, elicited information on criteria for choosing a career specialty, criteria for choosing a residency program and whether one-time monetary grants authorized in the 2011 physicians’ union contract would attract students to residencies in the periphery.

Results

Completed questionnaires were returned by 511 of 740 (69%) students. Ninety-eight (19%) were interested in a primary care residency, 184 (36%) were unsure and 229 (45%) were not interested. Students interested in primary care were significantly less interested in specialties that perform procedures/surgeries and in joining a medical school faculty, while being more inclined towards specialties dealing with social problems, controllable lifestyles and working limited hours. The percentage of students interested in primary care was stable during the study period.

Forty-eight of the students indicated interest in residencies in the country’s periphery, and 42% of them were also interested in primary care residencies. Overall, only 3.7% of students were interested in both a primary care residency and a residency in the periphery.

Thirty percent of the students indicated that the monetary incentives tempted them to consider a residency in the periphery. Fifty-three percent of these students reported that they did not yet know the geographic area where they wished to do their residency, as compared to only 22% among those not interested in incentives.

Conclusions

This study provides the healthcare leadership with information on the characteristics of the students at a centrally-located medical school who tend to be more interested in primary care and in working in the periphery. Specifically, the study found that students interested in primary care desire a positive life/work balance, something that Israeli non-hospital primary care practice provides. Students considering residencies in the periphery were similarly inclined. Moreover, about a third of students had positive thoughts about monetary incentives for residencies in peripheral hospitals. These students should be identified early during their clinical experience so that attempts to recruit them to the periphery can commence before their specialty and location preferences have fully crystallized. Parallel studies should be performed at additional Israeli medical schools.

Medical specialty selection criteria of Israeli medical students early in their clinical experience: subgroups

BACKGROUND

Israeli medical school classes include a number of student subgroups. Therefore, interventions aimed at recruiting medical students to the various specialties should to be tailored to each subgroup.

METHODS

Questionnaires, distributed to 6 consecutive 5th-year classes of the Hebrew University - Hadassah School of Medicine, elicited information on criteria for choosing a career specialty, criteria for choosing a residency program and the importance of finding a specialty interesting and challenging when choosing a residency.

RESULTS

Completed questionnaires were returned by 540 of 769 (70%) students. The decision processes for choosing a medical specialty and choosing a residency program were different. Family and colleagues had minimal influence on choosing a specialty, while family and their residential locality had much influence on choosing a residency, especially among women. Older age, marriage, and spousal influence were positively associated with choice of a specialty. Two-thirds of the students had completed military service, 20% were attending medical school prior to military service, 5% had completed national service and 9% had entered medical school without serving. Despite the pre-military subgroup being younger and having another 7 years of medical school, internship and military service before residency, they had begun thinking about which specialty to choose, just like the post-military students. When choosing a residency program, post-military women were more influenced by their families and family residential locality than their pre-military counterparts; differences ascribed to the older and often married post-military women having or wanting to begin families. This difference was reinforced by fewer post- than pre-military women willing to wait 2-3 years for a residency in the specialty that interested them most and were willing to begin residency immediately after internship in a specialty that interested them less.

CONCLUSIONS

Medical school classes are composed of various subgroups, each with its own characteristics. It is important to differentiate between choosing a specialty and a residency program. Choosing a specialty is a uniquely personal decision with some spousal influence among married students. It is of central importance even among pre-military students not slated to begin residency for many years. In contrast, choosing a residency program is influenced by family, where one grew up and other family-related considerations.

Medical students' perceptions of a career in family medicine

Background

In Israel, there is a shortage of family medicine (FM) specialists that is occasioned by a shortage of students pursuing a FM career.

Methods

A questionnaire, based on methods adapted from marketing research, was used to provide insight into the medical specialty selection process. It was distributed to 6^th-year medical students from two Israeli medical schools.

Results

A response rate of 66% resulted in collecting 218 completed questionnaires. Nineteen of the students reported that they were interested in FM, 68% of them were women. When compared to students not interested in FM, the selection criteria of students interested in FM reflected greater interest in a bedside specialty which provides direct long-term patient care. These latter students were also more interested in a controllable lifestyle that allowed time to be with family and children and working outside the hospital especially during the daytime. These selection criteria aligned with their perceptions of FM, which they perceived as providing them with a controllable lifestyle, allowing them to work limited hours with time for family and having a reasonable income to lifestyle ratio. The students not interested in FM, agreed with those interested in FM, that the specialty affords a controllable lifestyle and the ability to work limited hours Yet, students not interested in FM more often perceived FM as being a boring specialty and less often perceived it as providing a reasonable income to lifestyle ratio. Additionally, students not interested in FM rated the selection criteria, academic opportunities and a prestigious specialty, more highly than did students interested in FM. However, they perceived FM as neither being prestigious nor as affording academic opportunities

Conclusion

This study enriches our understanding of the younger generation's attitudes towards FM and thus provides administrators, department chairs and residency program directors with objective information regarding selection criteria and the students’ perceptions of FM. We identified the disconnect between the selection criteria profiles and the perceptions of FM of students not inclined to pursue a residency in FM. This allowed for recommendations on how to possibly make FM more attractive to some of these students.

Medical Students' Perceptions of Emergency Medicine Careers

Introduction

Previous studies on specialty choice have investigated specialty characteristics that are appealing to undergraduate students. Little is known about how students’ attitudes towards Emergency Medicine (EM) careers evolve over their schooling.

Methods

An open-ended survey of medical students’ career interests was distributed five times over the four-year undergraduate curriculum from 1999 to 2008 at Memorial University. We tested specialty choices across genders, and looked at how likely a student’s choice in their first year influenced their final year choice, a metric we termed “endurance”. The qualitative data was coded to identify key themes and sentinel quotes. Lastly, we conducted semi-structured interviews with academic emergency physicians at Dalhousie University to assess the relevance of these findings to postgraduate training.

Results

Males expressed more interest in EM than females. EM had more endurance than internal medicine, but less than family medicine, over the four-year curriculum. The biggest drawbacks for EM included lack of patient follow-up and lack of EM experience; positive perspectives focused on clinical variety and elective experiences. Lifestyle was prominent, seen as both positive and negative. Emergency physicians considered EM lifestyle attractive, and characterized medical students’ perceptions as “skewed,” highlighting lack of insight into system flaws.

Conclusions

Medical students’ opinions towards EM tended to shift over time, particularly the perception of the work. Medical students’ perceptions differ from that of experienced emergency physicians. Medical schools may be able to improve clinical exposure and provide more informed counselling or mentoring with respect to EM.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Medical student career choice: a qualitative study of fourth-year medical students at Memorial University, Newfoundland

BACKGROUND

Specialty career choice is a critical decision for medical students, and research has examined factors influencing particular specialties or assessed it from a demographic perspective. The purpose of this study was to explore and describe influential factors in students' decision-making, irrespective of their particular specialty in a Canadian medical school.

METHODS

Study participants were recruited from fourth-year medical classes at the Memorial University of Newfoundland in 2003, 2006, 2007 and 2008. Sixteen focus groups (n = 70) were led by a nonfaculty facilitator to uncover factors affecting medical student career choice. The analysis was guided by principles of grounded theory methodology. The focus group transcripts were sequentially coded based on recurring topics and themes that arose in the students' discussions. A set of key themes emerged and representative quotations for each theme were tracked.

RESULTS

Twenty themes were identified from the focus group discussions: 7 major, 3 intermediate and 10 minor themes. The major themes were undergraduate experience, exposure, public perception and recruitment, teacher influence, family/outside influences, residency issues and personal philosophy. Intermediate themes included lifestyle, bad-mouthing/negative perceptions and context. Minor themes included critical incidents/experiences, information gaps, uncertainty, nature of the work, extracurricular programs, timing of decision-making, financial issues, prestige, fit with colleagues and gender issues.

INTERPRETATION

Exposure to specialties and the timing of this exposure appears to be crucial to career choice, as does the context (who, what, when, where) of any particular rotation. Given the influence of personal philosophy, future research examining students' level of self-assessment and self-reflection in their decision-making processes and level of certainty about their selected specialty would be useful.

Undergraduate medical education in the U.S. and Israel: contrasts and common challenges

In 2014, the Israeli Council for Higher Education (CHE) commissioned an international panel of outstanding educators to prepare an ad hoc report reviewing the four established medical schools in Israel. The report described the strengths, weaknesses and challenges facing medical education in Israel with a focus on three specific areas: workforce planning, the structure of the curriculum and the financing of medical education. There are interesting parallels between the challenges facing medical education in the U.S. and in Israel: a lack of clarity regarding the optimal size for the workforce and the optimal method for enhancing the number of primary care physicians; an absence of methodologies for evaluating innovations in medical education and a lack of transparency in funds flow. However, there are also important differences, one of the most important being an absence in Israel of students' hands-on responsibility for their patients until year six of their undergraduate medical education. The presence of a small number of medical schools with common funding and geographic proximity, in a relative sense, provides the Israeli medical schools with a unique opportunity to evaluate innovations in medical education and to set a high bar for inter-school collaboration and cooperation.

Policy issues related to educating the future Israeli medical workforce: an international perspective

A 2014 external review of medical schools in Israel identified several issues of importance to the nation's health. This paper focuses on three inter-related policy-relevant topics: planning the physician and healthcare workforce to meet the needs of Israel's population in the 21(st) century; enhancing the coordination and efficiency of medical education across the continuum of education and training; and the financing of medical education. All three involve both education and health care delivery. The physician workforce is aging and will need to be replenished. Several physician specialties have been in short supply, and some are being addressed through incentive programs. Israel's needs for primary care clinicians are increasing due to growth and aging of the population and to the increasing prevalence of chronic conditions at all ages. Attention to the structure and content of both undergraduate and graduate medical education and to aligning incentives will be required to address current and projected workforce shortage areas. Effective workforce planning depends upon data that can inform the development of appropriate policies and on recognition of the time lag between developing such policies and seeing the results of their implementation. The preclinical and clinical phases of Israeli undergraduate medical education (medical school), the mandatory rotating internship (stáge), and graduate medical education (residency) are conducted as separate "silos" and not well coordinated. The content of basic science education should be relevant to clinical medicine and research. It should stimulate inquiry, scholarship, and lifelong learning. Clinical exposures should begin early and be as hands-on as possible. Medical students and residents should acquire specific competencies. With an increasing shift of medical care from hospitals to ambulatory settings, development of ambulatory teachers and learning environments is increasingly important. Objectives such as these will require development of new policies. Undergraduate medical education (UME) in Israel is financed primarily through universities, and they receive funds through VATAT, an education-related entity. The integration of basic science and clinical education, development of earlier, more hands-on clinical experiences, and increased ambulatory and community-based medical education will demand new funding and operating partnerships between the universities and the health care delivery system. Additional financing policies will be needed to ensure the appropriate infrastructure and support for both educators and learners. If Israel develops collaborations between various government agencies such as the Ministries of Education, Health, and Finance, the universities, hospitals, and the sick funds (HMOs), it should be able to address successfully the challenges of the 21st century for the health professions and meet its population's needs.

Smart marketing may improve public understanding of the anesthesia profession

Background

A 2005 survey led by the Israeli Society of Anesthesiologists (ISA) found that large parts of the Israeli public are not familiar with the profession of anesthesia. The ISA has subsequently been conducting a public campaign for several years with the aim to enhance community knowledge regarding the anesthesiologists’ training and their critical role in the perioperative period.

Objective

The present study sought to evaluate the value of a campaign aiming to enhance public understanding of the importance of a medical profession; more specifically, a campaign to promote awareness of the community regarding the anesthesia profession. If proved to be successful, public campaigns may be considered in other countries and for other medical professions with similar difficulties.

Methods

In 2013, five hundred participants from the general community were asked to answer a questionnaire focusing on the profession of anesthesia.

Results

Public knowledge has improved following the campaign. Specifically, improvement was demonstrated regarding the qualification of the anesthesiologist as an MD (92% vs. 64% in 2013 and 2005, respectively), and enhanced awareness of the anesthesia team’s critical role in the operating room (OR) (48% vs. 30% in 2013 and 2005, respectively).

Conclusions

The Israeli community is attentive to public campaigns that address the roles of a medical profession. Enhanced public knowledge regarding the importance of the anesthesia profession may have a significant impact on both the payment policy for anesthesiologists and on the recruitment of more physicians to the field of anesthesia. Public campaigns may be considered for other medical professions with similar difficulties.

Medical students' and interns' interest in orthopedic surgery: the gender factor

OBJECTIVE

There is an extremely small proportion of female medical students choosing to specialize in orthopedic surgery. The aim of the study was to assess medical students' and interns' interests and perceptions of orthopedic surgery and explore why women are not interested in orthopedic surgery.

SETTING

Questionnaires were distributed to final-year medical students and interns assessing their interests and perception of orthopedic surgery.

PARTICIPANTS

Final-year medical students and interns.

RESULTS

Responses were obtained from 317 students and 199 interns. Among the medical students, 15% were interested in orthopedic surgery, but only 2% were women. Both male and female students perceived orthopedics as an "action"-packed, procedure-based profession, providing instant gratification, time in the operating room, high income, and the option for private practice. Female medical students considered it boring. Among interns, 11% were interested in orthopedic surgery; however, only 2% were women. When compared with the interns who were not interested in orthopedic surgery, a greater number of the interns interested in orthopedic surgery rated time with family and a procedure-intensive profession as important. Female students and interns were also interested in other surgical fields.

CONCLUSIONS

The increasing majority of women among medical students will reshape the future of physician workforce by dictating changes in workforce participation, working conditions, and intercollegial relationships. Orthopedic surgery will need to adapt to these realities.

Choosing a medical specialty: the difference between what students want and what society needs

The choice of a specialty by medical students is a complex one that has significant implications for the future supply of physician manpower. The study by Weissman et al. portrays this choice as reflecting the degree of congruence between a student’s needs and values and his or her perception of the characteristics of the various specialties. The existing shortages in the supply of various specialists in Israel may be interpreted as signifying a lack of alignment of student needs and perceptions. This commentary will extend the implications of this work to include the connection between students’ choices and the physician manpower needs of society, and will focus on primary care physician shortages in the United States as but one example of the implications of these relationships.