Factors considered by medical students when formulating their specialty preferences in Japan: findings from a qualitative study

Medical students' choices of specialty in The Gambia: the need for career counseling

BACKGROUND

Understanding preferences for specialties by medical students and the factors driving choices assists policy makers in ensuring optimal spread of personnel across disciplines.

METHODS

This cross-sectional survey using self-administered structured questionnaires was conducted on consenting students of the first medical school in The Gambia, established in 1999. Data collection was in June/July 2011. Questions were on sociodemographic characteristics of students, their parents, factors related to career preferences and opinions about counseling services. Data were analysed using JMP 8.0 software.

RESULTS

Respondents were 52.4% of 202 eligible students. Mean age was 24.1 ± 5.0 years. Females constituted 54.7%. Muslims were 72.7% while Gambians formed 77.0%. Commonest specialties chosen by females were Obstetrics/Gynaecology, Paediatrics and Surgery in that order, while males preferred Internal Medicine, Surgery and Obstetrics/Gynaecology. Commonest factors influencing choices by females were 'focus on urgent care' (65.5%) and 'intellectual content of specialty' (56.9%). For males, these were 'intellectual content of specialty' (60.4%) and 'focus on urgent care' / 'individual's competence' (50.0% each). More females (30.0%) than males (23.0%) had ever received career counseling, but all students desired it.

CONCLUSIONS

Significant gender differences exist in specialty choices and factors influencing these choices amongst these students. All want career counseling.

What Undergraduate Factors Influence Medical Students When Making Their Choice of Post Graduate Career?

Objectives:

To determine what factors final year medical students consider when deciding upon their future post graduate career and to what extent each factor influences their decision.

Methods:

150 final year medical students were asked to complete an anonymous questionnaire relating to factors relating to their future career choice. Students were asked to rate each factor according to the level of importance or influence it exerted when choosing a post graduate career. A simple visual analogue scale from 1 to 10 was utilised with 10 being most influential.

Results:

The most significant factors influencing final year medical students in their career choice were clinical mentors and specialty themed PBL cases with scores of 6.8 and 6.5 out of a maximum of 10. Clinical exposure exerted the weakest influence with a mean score of 2.5.

Conclusion:

Various factors influence the future career choice of final year medical students to a differing extent. In order to promote Urology as a favourable career choice in this cohort, a concerted and coherent effort should be made at national level to engage medical students and promote the specialty.

Medical students' choice of specialty and factors determining their choice: a cross-sectional questionnaire survey in Melaka-Manipal Medical College, Malaysia

Information about medical students' choice of specialty can be helpful for planning health manpower. However, such information from medical students in Malaysian medical schools is lacking. We carried out a cross-sectional questionnaire survey among fourth- and fifth-year medical undergraduate students at Melaka-Manipal Medical College. A total of 425 students responded to the survey questionnaire. Nearly a quarter of the students indicated internal medicine as their choice of specialty. Other choices were general surgery (13.2%), pediatrics (11.3%), orthopedics (12.7%) and obstetrics & gynecology (Ob/Gyn) (12.1%). Female students (OR 1.91; 95% CI 1.18-3.08), fourth-year students (OR 1.9; 95% CI 1.15-3.12), and students who reported a higher self-rated knowledge of their subject of choice were more likely to choose internal medicine and allied specialties (OR 1.53; 95% CI 1.07-2.19). The influence of teaching faculty and consultants at the teaching hospitals (74.4%) and inspiration obtained during clinical postings (71.9%) were the factors which were rated by the most students as 'important' for choosing a specialty. About half of the students intended to pursue their postgraduate studies in Malaysia, most of the rest in the United Kingdom or Australia. While internal medicine and surgical subspecialties were preferred, students were not inclined towards primary care or diagnostic subspecialties. Incentives should be provided and other measures should be taken to make these branches more attractive.

Truth or fallacy? Three hour wait for three minutes with the doctor: Findings from a private clinic in rural Japan

INTRODUCTION

While previous reports examine various aspects of Family Medicine in Japan, there is sparse research on consultation lengths. A common phrase permeates throughout Japan, sanjikan machi, sanpun shinsatsu that means, "Three hour wait, three minute visit." The purpose of this study is to examine consultation length in Japan, and how it is affected by patient variables.

CASE DESCRIPTION

We conducted a case study of consultation length and how it varies in relation to the demographics, presenting illness, and diagnoses at a rural clinic in central Japan. Data were coded according to the standards of the International Classification of Primary Care. Descriptive statistics were obtained to identify features of the data. Further, regression analysis was performed to characterize and to quantify the association between length of consultation and various subject level characteristics.

DISCUSSION AND EVALUATION

A total of 263 patients aged 0 - 93 years old had consultations during the 8-day study period. The mean consultation duration was 6.12 minutes. Of all consultations, 11.8% lasted 3 minutes or less. The mean (median) consultation time among males was 6.29 (5.2) minutes and among females was 6.03 (5.4) minutes. The duration of visits increased with age. Among different International Classification of Primary Care categories, psychological issues required the most time (mean = 10.75 min, median = 10.9 min) while urological issues required the least (mean = 5.08 min, median = 4.9 min). The majority of cases seen in the clinic were stable, chronic conditions and required shorter consultation times.

CONCLUSIONS

While the mean and median consultation length in this study extends beyond the anecdotal three minutes, the average length of consultation is still remarkably short. Trends affecting consultation length were similar to other international studies. These data present only one aspect of primary care delivery in Japan. To better understand the significance of consultation length relative to the delivery of primary care, future research should examine issues such as continuity, frequency of consultations over time and comprehensiveness of care.

Hypertensive patients' perceptions of their physicians' knowledge about them: a cross-sectional study in Japan

Background

In order to evaluate the difference in quality of primary care provided by physicians between the types of medical institutions in Japan, we examined whether the physicians' comprehensive knowledge of their patients is perceived differently by the patients seen at clinics and hospitals.

Methods

Patients with prescriptions for hypertensive drugs were approached sequentially at 13 pharmacies, and were administered a questionnaire on their perception of their physician's knowledge about them. Data were obtained for 687 patients (362 from clinics and 325 from hospitals). A physician's knowledge of his or her patients was assessed according to six aspects: their medical history, their current medications, history of allergy, what worries patients most about their health, patients' values and beliefs on their health, and patients' roles and responsibilities at work, home, or school. Responses were scored from 1 through 6 (1: knows very well; 6: doesn't know at all).

Results

Patients treated in clinics were seen more frequently, for a longer period, and had fewer complications than the patients who were treated in hospitals. Among the six aspects of physicians' knowledge assessed, 79.3% of the patients reported that their physicians knew their complete list of medications "very well or well," while 28.3% reported the same about their roles and responsibilities at work, home, or school. Physicians in clinics were considered to know their patients' worries about their health (p = 0.004) and the roles and responsibilities of the patients at work, home, or school (p = 0.028) well. Multiple regression analysis showed that the type of medical institutions remained as a significant variable only for the aspect of patients' worries about their health. The factor that consistently affected the patients' perception of physicians' knowledge about them was the patients' age.

Conclusions

Hypertensive patients' perceptions of their physicians' knowledge about them did not differ significantly between clinics and hospitals in Japan for most of the aspects. In order to differentiate the roles of physicians in hospitals and clinics better and ensure the quality of primary care, the establishment of a standardized educational system to train primary care physicians better is recommended.

The perception of the hidden curriculum on medical education: an exploratory study

BACKGROUND

Major curriculum reform of undergraduate medical education occurred during the past decades in the United Kingdom (UK); however, the effects of the hidden curriculum, which influence the choice of primary care as a career, have not been sufficiently recognized. While Japan, where traditionally few institutions systematically foster primary care physicians and very few have truly embraced family medicine as their guiding discipline, has also experienced meaningful curriculum reform, the effect of the hidden curriculum is not well known. The aim of this study is to identify themes pertaining to the students' perceptions of the hidden curriculum affecting undergraduate medical education in bedside learning in Japan.

METHODS

Semi-structured interviews with thematic content analysis were implemented. Undergraduate year-5 students from a Japanese medical school at a Japanese teaching hospital were recruited. Interview were planned to last between 30 to 60 minutes each, over an 8-month period in 2007. The interviewees' perceptions concerning the quality of teaching in their bedside learning and related experiences were collected and analysed thematically.

RESULTS

Twenty five medical students (18 males and 7 females, mean age 25 years old) consented to participate in the interviews, and seven main themes emerged: "the perception of education as having a low priority," "the prevalence of positive/negative role models," "the persistence of hierarchy and exclusivity," "the existence of gender issues," "an overburdened medical knowledge," "human relationships with colleagues and medical team members," and "first experience from the practical wards and their patients."

CONCLUSIONS

Both similarities and differences were found when comparing the results to those of previous studies in the UK. Some effects of the hidden curriculum in medical education likely exist in common between the UK and Japan, despite the differences in their demographic backgrounds, cultures and philosophies.

Shortage in general practice despite the feminisation of the medical workforce: a seeming paradox? A cohort study

Background

Female medical students often prefer primary care specialties, while male students appear to be attracted to hospital specialties. Notwithstanding the steady feminisation of medicine, in many countries there are still difficulties in recruiting trainees for general practice. This seeming paradox raises the question on what specific role gender plays in a specialty choice. The authors looked at the (a) the role of gender in general practice specialty choice of Dutch medical students, (b) the decisive factors in career choice and relation of gender to these, and (c) differences in how male and female students are influenced by the GP clerkship.

Methods

A cohort of 206 final year medical students at the Maastricht University, the Netherlands were asked to complete a questionnaire focusing on career preferences before and after a 12-week general practice clerkship and at graduation, a couple of months later.

Results

Gender was significantly related to willingness to become a GP in bivariate analysis. Adding variables in multivariate analysis made this effect disappear. While females expressed overall higher preference for general practice than males, after the GP clerkship likelihood of choosing general practice increased with 38% among male and 22% among female students. After graduation, interest in general practice had dropped, mainly among females. Attitudes predicting a GP career choice were: extrinsic career motivation before the clerkship, and the content of GP work (patient contacts, treatments) and motivation to work with chronic and palliative patients after the clerkship.

Conclusion

Gender 'as such' appeared not to be a distinctive predictor of specialty choice. It is students' attitudes towards GP work and preferred patient category that determine the career choice in general practice. However, more male students were positively influenced by the GP clerkship than female students. The motivating effect of the clerkship is not long lasting. Especially female graduates change their interest in favour of other specialties, which may explain why eventually few students choose general practice. It might be worthwhile to reinforce an initial preference for general practice by motivational guidance throughout the whole period of clerkships.

Factors affecting medical students in formulating their specialty preferences in Jordan

BACKGROUND

In recent years there has been a growing appreciation of the issues of career preference in medicine as it may affect student learning and academic performance. However, no such studies have been undertaken in medical schools in Jordan. Therefore, we carried out this study to investigate the career preferences of medical students at Jordan University of Science and Technology and determine factors that might influence their career decisions.

METHODS

A cross-sectional questionnaire-based survey was carried out among second, fourth and sixth year medical students at the Jordan University of Science and Technology, Irbid, Jordan during the academic year 2006/2007. A total of 440 students answered the questionnaire which covered demographic characteristics, specialty preferences, and the factors that influenced these career preferences. Possible influences were selected on the basis of a literature review and discussions with groups of medical students and physicians. Students were asked to consider 14 specialty options and select the most preferred career preference.

RESULTS

The most preferred specialty expressed by male students was surgery, followed by internal medicine and orthopaedics, while the specialty most preferred by female students was obstetrics and gynaecology, followed by pediatrics and surgery. Students showed little interest in orthopedics, ophthalmology, and dermatology. While 3.1% of females expressed interest in anesthesiology, no male students did. Other specialties were less attractive to most students. Intellectual content of the specialty and the individual's competencies were the most influential on their preference of specialty. Other influential factors were the "reputation of the specialty", "anticipated income", and "focus on urgent care".

CONCLUSION

Surgery, internal medicine, pediatrics, and obstetrics and gynaecology were the most preferred specialty preferences of medical students at Jordan University of Science and Technology.