Intensive care as a specialty of choice for registered nurses: A descriptive phenomenological study

BACKGROUND

Shortage and retention of experienced nurses are crucial matters and internationally acknowledged, particularly in specialty areas such as Critical Care.

AIM

To explore the experiences of registered nurses in their first and fourth years of practice in an adult intensive care unit.

STUDY DESIGN

This descriptive phenomenological study was conducted over 4 years. Eligible participants were interviewed at two different points in their career. Ten registered nurses were interviewed after three to 6 months of employment in an adult intensive care unit (Phase One). Five of the same participants were interviewed in their fourth year of practice (Phase Two).

FINDINGS

Findings related to factors influencing the participants' choice of specialty and their retention are reported in this paper. Two themes emerged from Phase One: a unique environment, positive and negative emotions, unclear expectations, and the journey of a registered nurse. Two themes generated from data collected in Phase Two included a unique environment and being a proficient nurse. In both phases, nurses considered the Intensive Care Unit a stimulating learning environment.

CONCLUSIONS

This paper highlights that the registered nurse's perception of the Intensive Care Unit and Intensive Care Nursing influenced their choice of specialty, and learning opportunities influenced their decision to remain in the Intensive Care Unit.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study inform action areas for healthcare organizations and nursing managers. Challenges, learning opportunities and the nature of critical care nursing should be considered target areas for organizations to promote and develop as part of critical care nurses' retention strategies. Education not only for new graduate nurses but also for all registered nurses should be ongoing.

The association of a scholarly concentrations program with medical students' matched residencies

PURPOSE

Many medical school curricula include Scholarly Concentrations (SC) programs. While studies have examined how these programs affect students' future research involvement, the association of SC programs with students' specialty choices is uncertain. This study examines the SC program factors associated with congruence between the specialty focus of students' SC projects and the clinical specialty they matched into for residency.

METHODS

The authors conducted a retrospective cohort study of all students participating in the SC program at Johns Hopkins University School of Medicine for graduating classes 2013-2020. They used data from program questionnaires to categorize students' specialty interests (baseline) and SC program experiences (post-program). The authors categorized each student's project into specialties according to their faculty mentors' primary appointments, abstracted student publications from SCOPUS, and abstracted residency program rankings from Doximity Residency Navigator. The authors used multivariable logistic regression to calculate adjusted odds ratios (aOR) for specialty-congruent matching (same specialty as SC project) and for matching into a Doximity-ranked top 20 or top 10 program.

RESULTS

Overall, 35.3% of the 771 students matched into the same specialty as their SC projects. Increased odds of specialty-congruent matching occurred with 'definite' interest in the specialty at baseline [aOR (95% CI): 1.76 (0.98-3.15)] (P = 0.06) and with increasing publications with SC mentors [aOR (95% CI): 1.16 (1.03-1.30)] (P = 0.01). Congruence between SC specialty focus and matched specialty conferred no significant difference in odds of matching to a Doximity-ranked top 20 or top 10 program.

CONCLUSIONS

Baseline certainty of specialty interest and research productivity were associated with specialty congruence. However, as completing an SC project in a given specialty was not associated with increased odds of matching into that specialty nor into a higher Doximity-ranked program, SC program directors should advise students to pursue SC projects in any topic of personal interest.

The determining factors of medical students in considering a specialty as a future career path: A cross-sectional multinational study in the Middle East

Background and Aims

Throughout their years of study, undergraduate medical students are expected to gain broad comprehension of all medical specialties. After acquiring an undergraduate degree, the decision to choose a specialty is critical for every student's life as it determines the rest of their career path. This study aims to determine factors influencing medical students' choices between various specialties in different countries in the Middle East and North Africa.

Subjects and Methods

A cross-sectional study was conducted in March 2022 targeting medical students from the Middle East and North African countries. A questionnaire was used to collect data from the students, which consisted of four sections. Ethical approval was obtained from the Unit of Biomedical Ethics Research Committee at King Abdulaziz University. Participation was voluntary and anonymous. For statistical analysis, IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows (Version 21.0; IBM Corp., Armonk, NY, USA) was used. Categorical variables were presented using numbers, associated frequencies, and percentages (%). Categorical variables were correlated using the Chi-square test. One-way analysis of variance (ANOVA) test was used to compare the means of three or more independent groups. Logistic regression, odds ratio (OR), and 95% confidence interval (CI) were used to identify the factors associated with specialty selection. P < 0.05 was considered statistically significant.

Results

A total of 1109 students responded to the questionnaire. Participants' gender characteristics showed that there were 672 (60.6%) females and 437 (39.4%) males. Among them, 127 were in their second year, 180 in their third year, 362 in their fourth year, 85 in their fifth year, 37 in their sixth year, and 108 were interns. The median age of the participants was 22.0 years (mean = 22.09 ± 2.891). There were 473 (42.6%) students who were undecided about their future medical specialty. Income (759, 68.4%) and career prospects (723, 65.2%) were the most preferred factors in their decision to pursue a future medical specialization.

Conclusions

In conclusion, medical and surgical specialties have been identified as the preferred future career path. It was discovered that student's decision-making is influenced by income, career prospects, and the sense of competency needed to choose a future medical specialty. Future research would be more revealing.

Would You Consider Becoming a Rheumatologist? A Survey Regarding the Attractiveness of Rheumatology as a Career Among Moroccan Medical Students

Objective

To assess the attractiveness of a career in rheumatology among Moroccan medical students and to study factors that motivate or demotivate them to choose rheumatology as a future career.

Methods

An electronic survey was distributed among students in medical training, interns, and graduates from the Faculty of Medicine at the University Hospital of Tangier. The questionnaire evaluated the level of clinical exposure to rheumatology, the interest in rheumatology as a specialty, and the motivation or demotivation for choosing or not choosing rheumatology as a career.

Results

318 students responded to the survey. Of these, 57.5% reported that they had already completed a training period in a rheumatology department. Of Moroccan students, 35.6% would consider specialising in rheumatology and 8.5% of these stated that rheumatology was their first specialty choice. The uni- and multi-variate analysis determined that clinical exposure to rheumatology (OR=2.39 IC95% [1.46-3.91]) and female gender (OR=1.95 IC95% [1.2-3.2]) were the main statistically significant factors for the prediction of the choice of rheumatology. Intern status was statistically associated with not choosing rheumatology (OR=0.085 IC95% [0.03-0.24]. The main motivation factors for Moroccan medical students to choose rheumatology were the diversity of musculoskeletal diseases (54.5%) and the good balance work/life (46.6%). The main reasons for not choosing rheumatology were the limited therapeutic aspects of the discipline (30.3%) and an interest in surgical specialties (29.3%).

Conclusion

Rheumatology fascinates Moroccan medical students by the diversity of its pathologies and the good balance work/life. Greater clinical exposure to rheumatology is the strongest predictor of medical students choosing rheumatology as a future career.

Preferences, Career Aspects, and Factors Influencing the Choice of Specialty by Medical Students and Interns in Saudi Arabia: A Cross-Sectional Study

Background and objective Choosing a medical specialty is one of the most critical career decisions medical students and interns make. However, little is known about the factors these graduates consider when choosing their specialty. Our study assessed factors that medical students and interns consider when determining their specialty. Methods This is a cross-sectional survey-based study, conducted from November to December 2022. We utilized a previously published questionnaire for 1074 participants, including 837 medical students and 237 interns from Saudi Arabian universities. Results The majority of female participants (80.4%), compared with only 19.6% of male participants, considered interest in specific procedures and techniques typical of the specialty an important factor in choosing a specialty (p = 0.036). Dissertation research experience was an important factor for 83.5% of female participants and 16.5% of male participants (p = 0.024). Additionally, good quality teaching within the study program framework was important for 81.2% of female participants and 18.8% of male participants (p = 0.033), suggesting that male and female participants viewed the importance of good quality teaching differently. Female participants accounted for 80% of those who considered the overseas experience a factor in their specialty choice. Also, 74.4% of female and 25.6% of male participants considered friends, relatives, or other connections in the healthcare field a factor that affects their choice. Furthermore, 79.6% of female and 20.4% of male participants reported having good experiences with physician role models as an impactful factor in their specialty choice. Conclusion Female participants were most interested in obstetrics and gynecology (12.1%,), internal medicine (11.8%), and family medicine (10.8%). Male participants, on the other hand, showed more interest in family medicine (12.7%,), internal medicine (11.0%), and emergency medicine (10.1%). Medical schools and healthcare institutions must provide students and interns with enough information and resources to help them explore different specialties and make well-informed decisions about their careers.

How do foundation year and internship experience shape doctors' career intentions and decisions? A meta-ethnography

PURPOSE

Foundation years or internships are an important period for junior doctors to apply their knowledge and gain clinical competency. Experiences gained during the foundation years or internships are likely to inform newly qualified doctors' opinions about how they want to continue their career. We aimed to understand how medical doctors' internship experiences influence their career intention/decision.

METHODS

We conducted qualitative evidence synthesis using meta-ethnography. We searched six electronic bibliographic databases for papers published between 2000-2020 and included papers exploring how foundation years or internship experiences shape doctors' career intention/decisions, including in relation to migration, public/private/dual practice preference, rural/urban preference, and specialty choice. We used the GRADE-CERQual framework to rate confidence in review findings.

RESULTS

We examined 23 papers out of 6085 citations screened. We abstracted three high-level inter-related themes across 14 conceptual categories: (1) Deciding the personal best fit both clinically and in general (which option is 'more me'?) through hands-on and real-life experiences (2) Exploring, experiencing and witnessing workplace norms; and (3) Worrying about the future in terms of job market policies, future training and professional development opportunities. Confidence in findings varied but was rated high in 8 conceptual categories.

CONCLUSIONS

Our meta-ethnographic review revealed a range of ways in which internship experience shapes medical doctors' career intentions/decisions allowing us to produce a broad conceptual model of this phenomenon. The results highlight the importance of ensuring sufficient, positive and inspiring clinical exposure, improving workplace environment, relationship and culture, refraining from undermining specific specialities and communicating contractual and job market policies early on to young doctors, in order to attract doctors to less popular specialties or work locations where they are most needed. We propose our conceptual model should be further tested in new research across a range of contexts.

Effects of COVID-19 on career and specialty choices among Chinese medical students

Coronavirus disease 2019 (COVID-19) pandemic has brought unprecedented challenges to medical education systems and medical students. The aim of this study was to investigate the effects of COVID-19 pandemic on medical career and specialty choices among medical students. An online cross-sectional survey of Chinese medical students was conducted during the COVID-19 pandemic from February to April 2020. The students' willingness to be a doctor before and after the COVID-19 pandemic and changed willingness to specialize in respiratory medicine and infectious diseases were investigated. Multiple linear regression and binary logistic regression was used to explore factors that were associated with changes of willingness. A total of 1,837 medical students, including 1,227 females (66.8%), with a median age of 21.0 years, were recruited. Of the participants, 10.6% and 6.9% showed increased and decreased willingness to be a doctor after the COVID-19 outbreak, respectively. Moreover, 11.7% showed increased willingness and 9.5% showed decreased willingness to major in respiratory medicine and infectious diseases. Students with younger age, lower household income, fewer depressive symptoms, less exposure to negative pandemic information and more satisfaction with their own major after the pandemic were associated with increased willingness to be a doctor. Students who engaged in regular exercise, were males and undergraduate level, were interested in medicine, paid more attention to positive information, were satisfied with their majors, and had increased willingness to be a doctor after the pandemic were more likely to choose to specialize in respiratory medicine and infectious disease. However, the severity of anxiety symptoms was associated with decreased willingness to work in the specialties of respiratory medicine and infectious diseases. Psychological problems and professional satisfaction appear to be independent factors that affect medial career and specialty choices. The impacts of the COVID-19 pandemic on medical students require further research.

Quantifying the Financial Value of Clinical Specialty Choice and Its Association With Competitiveness of Admissions

Background The factors influencing medical student clinical specialty choice have important implications for the future composition of the US physician workforce. The objective of this study was to determine the career net present values (NPVs) of US medical students' clinical specialty choices and identify any relationships between a specialty's NPV and competitiveness of admissions as measured by the US Medical Licensing Examination (USMLE) Step 1 scores. Methodology NPVs were calculated using the results of the 2019 Doximity Physician Compensation report, a survey of 90,000 physicians. Mean USMLE Step 1 scores for matched US allopathic seniors in the 2018 National Resident Matching Program were used as a measure of clinical specialties' competitiveness of admissions. We calculated a composite measure of NPV and annual work-hours by dividing each specialty's NPV by the reported average number of hours worked per year. Results In our analysis, orthopedic surgery had the highest NPV ($10,308,868), whereas family medicine had the lowest NPV ($5,274,546). Dermatology and plastic surgery had the highest mean USMLE Step 1 scores (249 for both), whereas family medicine had the lowest (220). Clinical specialties' NPVs were positively associated with mean USMLE Step 1 scores (Pearson's r = 0.82; p < 0.001). Conclusions In this study, we describe associations suggesting that medical students respond to financial incentives in choosing clinical specialties and that these decisions are mediated by USMLE Step 1 scores. This underscores the importance of titrating and aligning incentives to improve the allocation of medical students into clinical specialties.

The Great Gamble? A Mixed-Methods Study of Factors In˜fluencing Medical Students in Specialty Choice

BACKGROUND

Career planning remains relatively unexplored as a domain of medical education. Our aim was to explore the career planning journey undertaken by medical students. Results Approximately one third of participants had decided their future specialty. Important factors in career choice were 'interest in specific [specialty] aspects,' 'work-life balance,' 'personality type' of others in the specialty, an enjoyable experience on rotation and role models. Negative influential factors included poor conduct of doctors encountered and negative portrayals of specialities by practicing doctors. Conclusion The undergraduate and early postgraduate periods are formative times in career planning for junior doctors. Students and interns/FY1s are strongly influenced by doctors in the clinical setting, and clinicians should be aware of this power to exert both positive and negative influence.

Inspiring Medical Students to Choose Primary Care Through Lifestyle Medicine Education

Despite a growing interest in lifestyle medicine, students at most medical schools in the United States are not receiving enough nutrition education and training in the principles of lifestyle modification to be effective at applying this knowledge to real-world clinical practice. Moreover, the rising prevalence of chronic lifestyle-related diseases and the increasing deficit of primary care providers is overwhelming the US health care system. The need for primary care physicians is being circumvented by medical students' diminishing interest in primary care partly due to concerns about salary, prestige, and being too broad in focus. Students may also recognize that the pharmaceutically based management of chronic conditions and supplemental lifestyle recommendations are often fraught with nonadherence, resulting in the progression of disease states. However, some medical schools have incorporated the concepts and practice of lifestyle medicine into their curriculums. This integration has the potential to inspire medical students to choose a primary care specialty, because students become more adept at addressing and treating the root causes of chronic disease. Lifestyle medicine education can empower students interested in primary care to fulfill their initial desires to treat and heal that may have inspired them to want to become doctors in the first place.

Factors Influencing US Allopathic Medical Students to Choose Pathology as a Specialty

The SARS-CoV-2 pandemic has highlighted the crucial role of pathologists in the health care system at a time of significant decline in the number of US medical students matching to pathology residency positions. To understand this decline, a national survey of fourth-year US allopathic medical students was conducted to assess experiences, knowledge, and attitudes of pathology and factors that impact specialty choice. Participating in a separate pathology course did not increase the probability of choosing pathology. Experiences significantly associated with choosing pathology included clinical or research opportunities in pathology during the last 2 years of medical school, autopsy observation/participation, and participation in pathology interest groups. Many respondents felt they were not sufficiently exposed to pathology to consider it as a specialty. Those who considered pathology but did not choose it were less likely to report understanding the activities of pathologists and being recruited by pathology faculty and more likely to express a preference for more direct patient contact as compared to those entering pathology. In general, respondents agreed that pathology has a good work-life balance and a satisfying degree of intellectual challenge. On the other hand, respondents generally agreed that information on social media and perception of the pathology job market do not seem to be positive and few agreed that pathology is a highly regarded specialty. We identify steps to address these issues and increase the number of US medical students choosing pathology as a specialty crucial to the future of medicine and public health.

The Association Between Personality Traits and Specialty Preference Among Medical Students in Jordan

Aim

To assess the association between personality traits by the five-factor model and specialty choice preference among medical students and immediate medical graduates in Jordan and to identify if there were any significant differences in personality profiles between those planning to pursue different career pathways.

Methods

This is a cross-sectional study including fifth- and sixth-year medical students and post-graduate internship doctors at five universities in Jordan. An online survey was used to collect data from participants, which included their general characteristics, their personality profile using the Big Five Inventory–2, and questions about their most preferred specialty choice.

Results

One thousand and twelve participants were enrolled in this study. Only 4.9% were interested in pursuing a specialty in basic medical sciences, and about 12% wanted to be non-practicing medical doctors. Almost half of all participants wanted to pursue a career in surgery-oriented specialties. Those were more extraverted, more conscientious, and had less negative emotions than students who chose medicine-oriented specialties. Students who decided to pursue clinical specialties and students who wanted to be practicing doctors were more extraverted and more conscientious.

Conclusion

Medical students and fresh medical graduates from Jordan who exhibited higher extraversion and conscientiousness and lower negative emotions preferred to be practicing clinicians. They were more inclined to pursue a career in surgery-oriented specialties. These findings might be helpful in understanding the preferences of young doctors and in counseling them about their career paths. Medical educators may wish to incorporate personality trait evaluation in planning post-graduate programs.

Junior doctors' aspirations for careers in ophthalmology: 40 years of surveys of UK medical graduates

Objective

Using data from 40 years of national surveys of UK medical graduates, we report on ophthalmology as a career choice.

Design, setting, and participants

Self-administered questionnaire surveys of all graduates from all UK medical schools in selected years of qualification between 1974 and 2015.

Main outcome measures

Career specialty preferences of doctors one, three, and five years after graduation; career specialty destinations 10 years after graduation.

Results

One year after graduation, ophthalmology was the first career preference of 1.6% of the qualifiers of 1974–83, 2.2% of 1993–2002, and 1.8% of 2005–15. The corresponding percentages three years after graduation were 1.5, 1.8, and 1.2%. Men were more likely than women to choose ophthalmology: among graduates of 2005–15, 2.4% of men and 1.4% of women did so at one year, as did 1.7% of men and 0.7% of women at five years. Seventy per cent of doctors practising as ophthalmologists 10 years after qualification had told us in their first post-qualification year that ophthalmology was their first choice of career.

Conclusions

There has been no systematic change in recent years in the proportion of recent medical graduates intending to have a career in ophthalmology when surveyed one year after graduation. However, the proportion at three and five years after graduation was lower than that at year 1. Suggestions for maintaining interest in the specialty include improved career advice, greater early clinical exposure to ophthalmology, and improved access to flexible training. Most practising ophthalmologists had made early decisions that this was their intended career.

The Influence of Gender on the Choice of Radiology as a Specialty Among Medical Students in Saudi Arabia: Cross-Sectional Study

Background

Medical undergraduates are the future doctors of the country. Therefore, determining how medical students choose their areas of specialty is essential to obtain a balanced distribution of physicians among all specialties. Although gender is a significant factor that affects specialty choice, the factors underlying gender differences in radiology are not fully elucidated.

Objective

This study examined the factors that attracted medical students to and discouraged them from selecting diagnostic radiology and analyzed whether these factors differed between female and male medical students.

Methods

This cross-sectional study conducted at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, used an electronic questionnaire sent to medical students from all medical years during February 2018. Subgroup analyses for gender and radiology interest were performed using the chi-square test and Cramér’s V test.

Results

In total, 539 students (276 women; 263 men) responded. The most common factor preventing students from choosing radiology as a career was the lack of direct patient contact, which deterred approximately 47% who decided against considering this specialty. Negative perceptions by other physicians (P<.001), lack of acknowledgment by patients (P=.004), and lack of structured radiology rotations (P=.007) dissuaded significantly more male students than female students. Among those interested in radiology, more female students were attracted by job flexibility (P=.01), while more male students were attracted by focused patient interactions with minimal paperwork (P<.001).

Conclusions

No significant difference was found between the genders in terms of considering radiology as a specialty. Misconception plays a central role in students’ judgment regarding radiology. Hence, early exposure to radiology, assuming a new teaching method, and using a curriculum that supports the active participation of students in a radiology rotation are needed to overcome this misconception.

Pediatric Career Choice: Insights From a Novel, Medical School Pathway Program

OBJECTIVE

Research on how medical students choose a career in pediatrics is either dated or conflated with primary care career choice. Capitalizing on student participation in an innovative, time-variable, competency based pathway program, Education in Pediatrics Across the Continuum (EPAC), the authors explored the process of career decision-making in students at 5 medical schools (including 4 EPAC sites) who begin medical school with an interest in pediatrics.

METHODS

Individual, semistructured interviews were conducted with students in 5 groups: Group 1: accepted into EPAC, n = 8; Group 2: accepted into EPAC, opted-out, n = 4; Group 3 applied to EPAC, not accepted, pursued pediatrics, n = 4; Group 4: applied to EPAC, not accepted, did not pursue pediatrics, n = 3; Group 5: pursued pediatrics at a non-EPAC site, n = 6. Data collection and analysis occurred iteratively, with inductive coding of data revealing patterns in data explored in subsequent interviews and refined in the final analysis.

RESULTS

All students described intrinsic guiding principles, that is, "doing what you love," that attracted them to pediatrics. They described extrinsic, phase-specific experiences before medical school, before clerkship, and in clerkship that shaped their perceptions of a career in pediatrics and shed light on collective values of different specialties. Student's assessment of how their guiding principles aligned with the collective values of pediatrics, which students encountered in the clerkship phase, was a key to making career decisions.

CONCLUSIONS

Intrinsic and extrinsic factors do not act alone but interact in clerkships, and influence career choice of students who enter medical school with an interest in pediatrics.

[Where did all the men in child and adolescent psychiatry and psychotherapy go? The influence of gender on the choice of specialization]

Where did all the men in child and adolescent psychiatry and psychotherapy go? The influence of gender on the choice of specialization Abstract. Objective: To examine the factors influencing graduates to choose child and adolescent psychiatry (CAP) or orthopaedic surgery (OR) as a career specialty. Method: We distributed a web-based survey to residents in child and adolescent psychiatry and orthopedic surgery in Germany. The survey included questions related to the factors contributing to their career choice, particularly sociodemographic, workplace, and education-related matters. Results: 101 participants completed the questionnaires (CAP: 49 women, 10 men; OR 21 women and 21 men). CAP residents were significantly older and more often married with children. Exposure to the subject during medical school was significantly more common among OR residents. CAP residents rated the factors "time for breaks," "regular work hours," "structured workday," "reconciliation of work and family life," "overall work load," and "sufficient time for each individual patient" as significantly more important than did OR residents. OR residents in turn considered "spectacular cases," "fast decision-making," "high technical requirements," and "positive experiences during medical school" as significantly more important. A family-friendly workplace was especially more important to woman in CAP. Conclusions: There is a need to rebrand the perception of psychiatry and to expose medical students early on to the subject if we are to attract more (male) psychiatrists in the future.

Why do Danish junior doctors choose general practice as their future specialty? Results of a mixed-methods survey

Background: A well-staffed and an efficient primary healthcare sector is beneficial for a healthcare system but some countries experience problems in recruitment to general practice.

Objectives: This study explored factors influencing Danish junior doctors’ choice of general practice as their specialty.

Methods: This study is based on an online questionnaire collecting quantitative and qualitative data. Two focus-group interviews were conducted to inform the construction of the questionnaire to ensure high content validity. All Danish junior doctors participating in general practice specialist training in 2015 were invited to participate in the survey, from which both qualitative and quantitative data were collected. The data was analysed using systematic text condensation and descriptive statistics.

Results: Of 1099 invited, 670 (61%) junior doctors completed the questionnaire. Qualitative data: junior doctors found educational environments and a feasible work–life balance were important. They valued patient-centred healthcare, doctor–patient relationships based on continuity, and the possibility of organizing their work in smaller, manageable units. Quantitative data: 90.8% stated that the set-up of Danish specialist-training programme positively influenced their choice of general practice as their specialty. Junior doctors (80.4%) found that their university curriculum had too little emphasis on general practice, 64.5% agreed that early basic postgraduate training in general practice had a high impact on their choice of general practice as their specialty.

Conclusion: Several factors that might positively affect the choice of general practice were identified. These factors may hold the potential to guide recruitment strategies for general practice.

Effect of medical student debt on mental health, academic performance and specialty choice: a systematic review

OBJECTIVES

With the high and rising total cost of medical school, medical student debt is an increasing concern for medical students and graduates, with significant potential to impact the well-being of physicians and their patients. We hypothesised that medical student debt levels would be negatively correlated with mental health and academic performance, and would influence career direction (ie, medical specialty choice).

DESIGN

We performed a systematic literature review to identify articles that assessed associations between medical student mental health, academic performance, specialty choice and debt. The databases PubMed, Medline, Embase, Scopus and PsycINFO were searched on 12 April 2017, for combinations of the medical subject headings Medical Student and Debt as search terms. Updates were incorporated on 24 April 2019.

RESULTS

678 articles were identified, of which 52 met the inclusion criteria after being reviewed in full text. The majority of studies were conducted in the USA with some from Canada, New Zealand, Scotland and Australia. The most heavily researched aspect was the association between medical student debt and specialty choice, with the majority of studies finding that medical student debt was associated with pursuit of higher paying specialties. In addition, reported levels of financial stress were high among medical students, and correlated with debt. Finally, debt was also shown to be associated with poorer academic performance.

CONCLUSIONS

Medical student debt levels are negatively associated with mental well-being and academic outcomes, and high debt is likely to drive students towards choosing higher paying specialties. Additional prospective studies may be warranted, to better understand how educational debt loads are affecting the well-being, career preparation and career choices of physicians-in-training, which may in turn impact the quality of care provided to their current and future patients.

Selection or education? Medical school ranking and medical students' speciality choice preferences in the United States

Limited research exists on the influence of top-ranked medical schools on students' speciality choice. We surveyed medical students (n = 468) at eight medical schools in the United States including two ranked in the top 10. Significance tests and logistic regressions were used to determine the relationship between school ranking and preferences for various speciality attributes. An analysis was conducted separately for students in lower (1st and 2nd) years versus higher (3rd and 4th) years of medical school. Among students in lower years, speciality preferences by students in top-ranked schools were less likely to be influenced by the length of training or work-life balance compared to students in non-top-ranked schools. Among higher year students, speciality preference of students in top-ranked schools was more likely to be influenced by prestige than their peers, with no difference in the influence of other factors. We also found evidence that students in top-ranked schools were less likely to be interested in primary care specialities, and this was more pronounced among those in higher years. Our findings suggest that top-ranked schools may influence speciality choice through both selection and education, and initiatives aimed at changing the emphasis on speciality prestige at top-ranked schools could increase primary care physician output.

Swedish doctors' experiences and personality regarding medical specialty choice: a qualitative study

OBJECTIVES

To explore an understanding of medical doctors' entire process of specialty choice with a focus on the influence of personal experiences and personality traits on choices made.

METHODS

A qualitative study was performed. Semi-structured individual interviews were conducted with medical doctors undergoing their specialty training in Sweden about their experiences and personalities. The transcribed interviews were analyzed with an inductive content analysis approach.

RESULTS

A total of 15 medical doctors participated. Three themes were identified using content analysis: To be invited or not, to fit in or not and to contribute or not. Furthermore, the results refute that specialty choice is a long-term, complex process.

CONCLUSIONS

First, the importance of being invited to the specialty choice was stressed by the doctors, especially in their early years when they needed to feel valued and trusted. Secondly, the need to fit in was essential to make a sustainable career choice. Finally, the doctors' expressed a will to contribute to the medical field of their chosen specialty. The interviews showed that specialty choice is a long-term, complex process; therefore, one implication for the healthcare sector would be to target the entire chain of medical education to improve recruitment strategies for those specialties with recruitment difficulties. More studies are needed to understand better how positive and negative encounters within the healthcare sector can influence young doctors' specialty choice.

Factors affecting senior medical students' career choice

OBJECTIVES

To gain insight into factors affecting career preference and career choice during the final phase of medical school, above and beyond a model that was presented by Bland and colleagues in 1995 (the "Bland model").

METHODS

A qualitative study was conducted. One-hour semi-structured interviews were conducted with final-year medical students about career preference and the factors influencing preference and choice. The interviews were transcribed and a thematic analysis was applied, to identify patterns and interrelationships in the data and to compare and contrast these with the Bland model.

RESULTS

Twenty-four students participated. Three critical sets of factors, not present in the Bland model, emerged from the interviews: (a) factors arising from student-initiated information collection, (b) patient population characteristics of a specialty domain, and (c) the characteristics of teams and colleagues within a specialty.

CONCLUSIONS

Students appear to actively match and calibrate perceptions of different specialty characteristics with their current personal needs and expected future needs, and to include cues from self-initiated information collection about a speciality. This agency aligns with Billett's workplace learning theory. Next, specialty patient population features appear to be taken into account; this was not unexpected but not included in the Bland model. Finally, the characteristics of teams and colleagues of a specialty were stressed in the interviews. These three components broaden the applicability of the Bland model--originally created for primary-care careers--to medical specialties in general.

#ChoosePsychiatry #the60secondchallenge - a thematic analysis of videos published on Twitter about reasons for choosing psychiatry

This article was migrated. The article was marked as recommended. Aims and Method #ChoosePsychiatry is the Royal College of Psychiatrist's social media campaign aimed at medical students and foundation doctors to encourage recruitment into psychiatry.  This study explored the reasons given for choosing psychiatry in videos uploaded by psychiatrists to Twitter alongside the campaign, through the use of thematic analysis.  Results Each psychiatrist gave different reasons for choosing psychiatry but four main themes were identified: prior experience of psychiatry, career factors, patient factors and knowledge factors.  Both undergraduate and postgraduate experiences were influential in choosing psychiatry.  In particular, perceived job satisfaction, an opportunity to deliver holistic care and a sense of making a difference were also influential in choosing psychiatry. Clinical Implications Findings here support efforts to improve the undergraduate experience and to increase foundation posts, as well as maintaining some of the current key messages of the campaign.  However, whilst engagement with the videos on Twitter was observed, further consideration of the most appropriate social media platform to ensure engagement with the target audience is needed.

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.

Examining Medical Student Specialty Choice Through a Gender Lens: An Orientational Qualitative Study

Phenomenon: A growing number of women are entering the medical workforce, yet their distribution across medical specialties remains nonuniform. We sought to describe how culture, bias, and socialization shape gendered thinking regarding specialty choice at a Canadian undergraduate medical institution.

APPROACH

We analyzed transcripts from the Career Choices Project: 16 semistructured focus group discussions with 70 students graduating from Memorial University of Newfoundland in 2003, 2006, 2007, and 2008. The questions and prompts were designed to explore factors influencing specialty choice and did not specifically probe gender-based experiences. Focus groups were audio-recorded, transcribed, and deidentified before analysis. Analysis was inductive and guided by principles of orientational qualitative inquiry using a gender-specific lens.

FINDINGS

The pursuits of personal and professional goals, as well as contextual factors, were the major themes that influenced decision-making for women and men. Composition of these major themes varied between genders. Influence of a partner, consideration of familial commitments (both present and future), feeling a sense of connectedness with the field in question, and social accountability were described by women as important. Both genders hoped to pursue careers that would afford "flexibility" in order to balance work with their personal lives, though the construct of work-life balance differed between genders. Women did not explicitly identify gender bias or sexism as influencing factors, but their narratives suggest that these elements were at play. Insights: Our findings suggest that unlike men, women's decision-making is informed by tension between personal and professional goals, likely related to the context of gendered personal and societal expectations.

Medical Students' Perspectives on Careers in Hospital Medicine: A National Study

This article was migrated. The article was marked as recommended. Purpose: Concerns over burnout and other factors may influence whether students pursue hospital medicine as a career. We investigate whether there are certain predictive factors that ultimately play a role in medical students' career interest in hospital medicine. Methods: In January 2011, 960 third-year medical students from 24 U.S. allopathic medical schools were surveyed at baseline, and six to nine months later when they became fourth-years at follow-up. Hospitalist-oriented students were categorized as those students who indicated interest in the specialties of family medicine, internal medicine, or pediatrics, and who indicated that they were "very likely" or "somewhat likely" to become a hospitalist. Respondents were also asked to respond to a list of seven factors that potentially influenced their specialty choice. Results: Adjusted response rate for the fourth-year survey was 50% (n=463/919). Medical students considering hospitalist careers were more likely to report that perceived burnout between various specialties played an important influential role in their specialty decision-making (49.7% [42.2-57.2%], vs. non-hospitalists 39.9% [32.8-47.0%], P=0.03). Conclusions: Given that students are reporting burnout as a factor in their decision-making in favor of hospitalist careers, further studies are needed to explore what aspects of a hospitalist career are appealing to students.

The Effect of Medical Student Volunteering in a Student-Run Clinic on Specialty Choice for Residency

Introduction: Student-run free clinics (SRFCs) are a recent popular addition to medical school education, and a subset of studies has looked at the influence of SRFC volunteering on the medical student’s career development. The majority of the research done in this area has focused on understanding if these SRFCs produce physicians who are more likely to practice medicine in underserved communities, caring for the uninsured. The remainder of the research has investigated if volunteering in an SRFC influences the specialty choice of medical school students. The results of these specialty choice studies give no definitive answer as to whether medical students chose primary or specialty care residencies as a result of their SRFC experience.

Keeping Neighbors in Good Health through Service (KNIGHTS) is the SRFC of the University of Central Florida College of Medicine (UCF COM). Both primary and specialty care is offered at the clinic. It is the goal of this study to determine if volunteering in the KNIGHTS SRFC influences UCF COM medical students to choose primary care, thereby helping to meet the rising need for primary care physicians in the United States.

Methods: A survey was distributed to first, second, and third-year medical students at the UCF COM to collect data on demographics, prior volunteering experience, and specialty choice for residency. Responses were then combined with records of volunteer hours from the KNIGHTS Clinic and analyzed for correlations. We analyzed the frequency and Pearson’s chi-squared values. A p value of less than 0.05 was considered statistically significant.

Results: Our survey had a total response rate of 39.8%. We found that neither the act of becoming a KNIGHTS Clinic volunteer nor the hours volunteered at the KNIGHTS Clinic influenced the UCF COM student’s choice to enter a primary care specialty (p = NS). Additionally, prior volunteering/clinical experience or the gender of the medical school student did not influence a student’s choice to volunteer at the KNIGHTS Clinic.

Discussion: Volunteering at KNIGHTS Clinic did not increase student choice to enter primary care, with students choosing other specialties at equal rates, probably due to the variety of specialties present at the KNIGHTS Clinic. This suggests that the volunteer attending physicians present at an SRFC may influence the choice of residency for students. It also suggests that SFRCs are not a viable tool to increase the number of primary care doctors in the United States.

Educational Debt in the Context of Career Planning: A Qualitative Exploration of Medical Student Perceptions

Phenomenon: Medical students in the United States face increasing educational debt because medical education costs have risen while public investment in higher education has declined. Contemporary students borrow more money and accumulate debt far surpassing that of previous generations of physicians, and both interest rates and terms of loan repayment have changed significantly in the last decade. As a result, the experiences of medical students differ from the experiences of physician educators. Little is known about how contemporary medical students view their debt in the context of career planning. Understanding contemporary U.S. medical students' lived experiences of educational debt is important, because high debt levels may affect medical students' well-being and professional development.

APPROACH

The study's purpose was to explore contemporary students' views of their debt in the context of career planning. In 2012, 2nd-year medical students enrolled in a health policy course at one medical school were invited to write an essay about how debt influences their career choices. The authors analyzed 132 essays using immersion and crystallization and iterative, team-based coding. Code-recode strategies, member checking, and reflexivity ensured validity and rigor.

FINDINGS

Three themes emerged about the meaning of debt: debt symbolizes lack of social investment, debt reinforces a sense of entitlement, and debt is a collective experience. Four approaches to debt management emerged: anticipation, avoidance, acceptance, and disempowerment. Insights: Medical students' views of debt are more complex than previously reported. Medical educators should recognize that many students experience debt as a stressor, acknowledge students' emotions about debt, and invite discussion about the culture of entitlement in medical education and how this culture affects students' professionalism. At the same time, educators should emphasize that students have many repayment options and that regardless of specialty choice, most physicians repay their debts without significant difficulty. Further exploration is needed of the relationships between the amount of debt owed, students' attitudes toward their debt, and other student characteristics. Because students experience debt in a range of ways, more nuanced approaches to understanding and reframing student perceptions of debt are necessary.

Predictors of full-time faculty appointment among MD-PhD program graduates: a national cohort study

PURPOSE

The authors sought to identify variables associated with MD-PhD program graduates' academic medicine careers.

METHODS

We analyzed data for a national cohort of MD-PhD program graduates from 2000 to 2005, using multivariable logistic regression to identify independent predictors of full-time academic medicine faculty appointment through 2013.

RESULTS

Of 1,860 MD-PhD program graduates in 2000-2005, we included 1,846 (99.2%) who had completed residency training before 2014. Of these 1,846 graduates, 968 (52.4%) held full-time faculty appointments. Graduates who attended schools with Medical Scientist Training Program (MSTP) funding (vs. no MSTP funding; adjusted odds ratio [aOR], 1.41; 95% confidence interval [CI], 1.14-1.74) and participated in ≥1 year of research during residency (vs. no documented research year; aOR, 1.85; 95% CI, 1.50-2.28) were more likely to have held full-time faculty appointments. Asian/Pacific Islander (aOR, 0.74; 95% CI, 0.60-0.93) and under-represented minority (URM; aOR, 0.68; 95% CI, 0.48-0.98) graduates (each vs. white graduates), graduates who reported total debt of ≥$100,000 (vs. no debt) at graduation (aOR, 0.58; 95% CI, 0.39-0.88), and graduates in surgical practice (aOR, 0.64; 95% CI, 0.48-0.84) and other practice (aOR, 0.66, 95% CI, 0.54-0.81) specialties (each vs. 'medicine, pediatrics, pathology, or neurology') were less likely to have held full-time faculty appointments. Gender was not independently associated with likelihood of full-time faculty appointment.

CONCLUSIONS

Over half of all MD-PhD program graduates in our study had full-time faculty appointments. Our findings regarding variables independently associated with full-time faculty appointments can inform the design of strategies to promote academic medicine career choice among MD-PhD program graduates. Further research is warranted to identify other factors amenable to intervention, in addition to those included in our study, which will foster the further development of a diverse academic medicine physician-scientist workforce nationally.

Surveying Fourth-Year Medical Students Regarding the Choice of Diagnostic Radiology as a Specialty

PURPOSE

The aim of this study was to survey fourth-year medical students, both those choosing and those not choosing diagnostic radiology as their specialty, regarding factors influencing their choice of specialty and their perceptions of radiology.

METHODS

A voluntary anonymous online survey hyperlink was sent to 141 US medical schools for distribution to fourth-year students. Topics included demographics, radiology education, specialty choice and influencing factors, and opinions of radiology.

RESULTS

A representative sampling (7%) of 2015 fourth-year medical students (n = 1,219; 51% men, 49% women) participated: 7% were applying in radiology and 93% were not. For respondents applying in radiology, the most important factor was intellectual challenge. For respondents applying in nonradiology specialties, degree of patient contact was the most important factor in the decision not to choose radiology; job market was not listed as a top-three factor. Women were less likely than men to apply in radiology (P < .001), with radiology selected by 11.8% of men (56 of 476) and only 2.8% of women (13 of 459). Respondents self-identifying as Asian had a significantly higher (P = .015) likelihood of selecting radiology (19 of 156 [12.2%]) than all other races combined (44 of 723 [6.1%]). Respondents at medical schools with required dedicated medical imaging rotations were more likely to choose radiology as a specialty, but most schools still do not require the clerkship (82%).

CONCLUSIONS

The reasons fourth-year medical students choose, or do not choose, diagnostic radiology as a specialty are multifactorial, but noncontrollable factors, such as the job market, proved less compelling than controllable factors, such as taking a radiology rotation.

The specialty choices of graduates from Brighton and Sussex Medical School: a longitudinal cohort study

BACKGROUND

Since 2007 junior doctors in the UK have had to make major career decisions at a point when previously many had not yet chosen a specialty. This study examined when doctors in this new system make specialty choices, which factors influence choices, and whether doctors who choose a specialty they were interested in at medical school are more confident in their choice than those doctors whose interests change post-graduation.

METHODS

Two cohorts of students in their penultimate year at one medical school (n = 227/239) were asked which specialty interested them as a career. Two years later, 210/227 were sent a questionnaire measuring actual specialty chosen, confidence, influence of perceptions of the specialty and experiences on choice, satisfaction with medicine, personality, self-efficacy, and demographics. Medical school and post-graduation choices in the same category were deemed 'stable'. Predictors of stability, and of not having chosen a specialty, were calculated using bootstrapped logistic regression. Differences between specialties on questionnaire factors were analysed.

RESULTS

50% responded (n = 105/277; 44% of the 239 Year 4 students). 65% specialty choices were 'stable'. Factors univariately associated with stability were specialty chosen, having enjoyed the specialty at medical school or since starting work, having first considered the specialty earlier. A regression found doctors who chose psychiatry were more likely to have changed choice than those who chose general practice. Confidence in the choice was not associated with stability. Those who chose general practice valued lifestyle factors. A psychiatry choice was associated with needing a job and using one's intellect to help others. The decision to choose surgical training tended to be made early. Not having applied for specialty training was associated with being lower on agreeableness and conscientiousness.

CONCLUSION

Medical school experiences are important in specialty choice but experiences post-graduation remain significant, particularly in some specialties (psychiatry in our sample). Career guidance is important at medical school and should be continued post-graduation, with senior clinicians supported in advising juniors. Careers advice in the first year post-graduation may be particularly important, especially for specialties which have difficulty recruiting or are poorly represented at medical school.

Factors considered by undergraduate medical students when selecting specialty of their future careers

Introduction

Medical students are the source of a country's physicians. Determining how medical students select their areas of specialization is the key to achieve a balanced distribution of doctors among all specialties. The objective is to identify the number of medical students who have decided their postgraduate specialty career, their career specialties preference, and factors that may influence their decision to select a particular specialty.

Methods

A facility based cross-sectional study was conducted in September 2013 at Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan. A self-administered semi-structured questionnaire comprising demographic data and questions about future specialties preferences and factors influencing those preferences was distributed to 887 male and female students, (from first to fifth academic years) recruited in the study.

Results

Response rate was 73% with 647 questionnaires collected, out of 887 eligible medical students. Of the returned questionnaires, 604 were valid. The majority of students (541, 89.6%) have chosen a specialty. Surgery, medicine, paediatrics and obstetrics and gynecology were the most selected specialties. The least selected specialty was anaesthesiology. A significant association was found between gender and specialty choice using Chi-square test (p = 0.00). There was no association between undergraduate level and specialty choice (p = 0.633). The most common reason for choosing a specific specialty was “Personal Interest” (215, 39.7%) followed by being “Helpful to the community” (144, 26.6%).

Conclusion

Surgery, medicine, paediatrics and obstetrics and gynecology were the most selected specialties.

Medical student debt and major life choices other than specialty

BACKGROUND

Median indebtedness at graduation is now more than $170,000 for graduates of US Medical Schools. Debate still exists as to whether higher debt levels influence students to choose high paying non-primary care specialties. Notably, no previous research on the topic has taken into account cost of attendance when constructing a debt model, nor has any research examined the non-career major life decisions that medical students face.

METHODS

Medical students were surveyed using an anonymous electronic instrument developed for this study. The survey was delivered through a link included in a study email and students were recruited from school wide listservs and through snowball sampling (students were encouraged to share a link to the survey with other medical students). No incentives were offered for survey completion.

RESULTS

Responses were recorded from 102 US Allopathic medical schools (n=3,032), with 22 institutions (11 public, 11 private) meeting inclusion criteria of 10% student body response proportion (n=1,846). Students with higher debt relative to their peers at their home institution reported higher frequencies of feeling callous towards others, were more likely to choose a specialty with a higher average annual income, were less likely to plan to practice in underserved locations, and were less likely to choose primary care specialties. Students with higher aggregate amounts of medical student loan debt were more likely to report high levels of stress from their educational debt, to delay getting married and to report disagreement that they would choose to become a physician again, if given the opportunity to revisit that choice. Increases in both aggregate and relative debt were associated with delaying having children, delaying buying a house, concerns about managing and paying back educational debt, and worrying that educational debt will influence one's specialty choice.

CONCLUSIONS

Medical student debt and particularly debt relative to peers at the same institution appears to influence the way that students approach major life choices like when to start a family, when to buy a home, and what specialty to choose. Future research should take into account cost of attendance when looking for the impact of medical student debt on major life choices.

Factors affecting future specialty choice among medical students in Kuwait

BACKGROUND

Choosing a medical specialty can be either a daunting and confusing experience for some medical students and junior doctors or a foregone conclusion to others. The aim of this study is to evaluate factors affecting future specialty choice among medical students in Kuwait University.

METHODS

A self-administered questionnaire was used to collect data from medical students registered in Kuwait University during the academic year 2011/2012. Chi-square test and logistic regression were used to test the association between deciding a future specialty and students' sociodemographic and academic factors.

RESULTS

Of the 422 students approached, 387 (91.7%) decided to participate. A total of 144 (37.2%) students made a decision regarding their choice of future medical specialty. Pediatrics, general surgery, and cardiology were the most desired specialties - 18 (12.5%), 17 (11.8%), and 16 (11.1%) students requested these specialties, respectively. Only 61 (42.4%) of those who selected a future specialty received advice regarding their choice. Looking for a good treatment outcome for patients (66; 45.8%) and a challenging specialty (58; 40.3%) were the most influencing incentives when selecting a future specialty. Students in the clinical phase of their study were 3.014 (95% CI: 1.498-6.065) more likely to report on their decision regarding a future specialty compared to students in the basic medical sciences phase (p=0.002).

CONCLUSION

A variety of factors appeared to inspire medical students in Kuwait to choose a future medical specialty. When identified, these factors can be used by mentors of medical students and directors of residency training programs to motivate students to choose specialties that are limited in Kuwait.

Who's choosing whom? A sociological study of the specialty choices in a Danish context

Objectives: The purpose of this study was to investigate if habitus, the unconscious and embodied mental structures founded early in life, can contribute to our understanding of how individuals choose a medical specialty.