Factors associated with physicians' choice of a career in research: a retrospective report 15 years after medical school graduation

Millennials Medical Students Generation at the Crosswalks: Motivations and Attitudes Towards Study and Future Career - A Mixed-Method Study

BACKGROUND AND OBJECTIVES

The aim of this study was to investigate in the millennium medical student generation the influence of the curriculum (problem-based curriculum [PBC] vs science-based curriculum [SBC]), gender and semester level on medical students' motives to study medicine, their attitudes toward their career and in this regard their view about their study condition in university.

METHODS

Semi-structured qualitative interviews with 28 medical students were performed and analyzed using Mayring's content analysis. Based on these results, a quantitative questionnaire for a nationwide survey was developed using a mixed-method-approach and send to most medical faculties in Germany. Data from n=1053 students entered statistical analysis.

RESULTS

Humanistic ideals prevailed in the choice to enter medical school and to become a physician. PBC students were found to be significantly (p<0.001) more idealistic and patient oriented, and they regard their curriculum more competitive than SBC-students (p<0.001). A balanced work and family life is essential for all students but particularly important for the PBC - group, male and undergraduate students. The majority of students wanted to work with patients and omitted patient-distant line of work. Undergraduate SBC-students saw their studies as old-fashioned citing lack of patient contact (p<0.001 compared to PBC), which eased in the graduate study part.

CONCLUSION

This study found major differences in student's perceptions depending on curriculum type. PBC-students were more idealistic, and humanistic ideals prevailed in comparison to SBC. For both, close patient contact is essential in their training. Particularly for female students, lifestyle factors and a balanced work-life-integration outweigh career ambitiousness. This study offers an important insight to policy makers and educators to understand the motivation and perceptions of the millennial student generation regarding their studies and future career plans, which should be considered in educational policies.

Diversity, equity and inclusion: a survey of pediatric radiology fellowship graduates from 1996 to 2020

BACKGROUND

Understanding the sociodemographic diversity and the experiences of trainees is imperative for developing an inclusive pediatric radiology workforce and improving patient outcomes.

OBJECTIVE

To describe the sociodemographics of a pediatric radiology fellowship program over 25 years and examine potential associations with (a) a trainee's sense of inclusion and belonging during training and (b) graduates' ultimate choice/type of practice, progression to positions of leadership and mentorship of others.

MATERIALS AND METHODS

We designed and administered an online survey of sociodemographic diversity to graduates of one of the largest pediatric radiology fellowship programs in North America who graduated over the last 25 years. Respondents answered questions regarding (a) racial/ethnic identity, gender identity, sexual orientation, disability and other sociodemographics; (b) their sense of inclusion and belonging during fellowship training; and (c) their current type of practice, leadership and mentorship of others. Univariate analysis of variance (ANOVA) tests determined whether sociodemographic background was associated with inclusion/belonging during training, and with current type of radiology practice, leadership and mentorship. We assessed associations with covariates of interest and current leadership and mentorship roles using chi-square or Fisher exact tests. A heat map assessed individual and overall Likert scores across covariates.

RESULTS

Seventy-six graduates completed the survey (46% response rate). Three percent of respondents identified as Black/African American, 7% as Latino/a/x, 45% as female, 4% as LGBTQ (lesbian, gay, bisexual, transgender, queer/questioning) and 5% as living with a disability at the time of fellowship. Graduates of international medical schools (P = 0.09) and osteopathic medical (DO) schools (P = 0.09), first-generation college graduates (P = 0.023), those with a first language other than English (P = 0.02) and U.S. military veterans (P = 0.048) reported significantly lower feelings of inclusion and belonging during training. Gender identity and sexual orientation did not correlate with feelings of exclusion or inequity. Graduates between 1996 and 2010 were significantly more likely to have filled a leadership role than those graduating after 2011 (P = 0.004) and were also significantly more likely to have mentored individuals underrepresented in medicine/pediatric radiology than those who graduated after 2011 (P = 0.04). None of the other sociodemographic variables demonstrated an association with leadership or mentorship, although 92.3% of those with a first language other than English served as a mentor compared to 68.2% of native English speakers (P = 0.097).

CONCLUSION

Efforts to promote a more diverse and inclusive workforce in pediatric radiology should be directed toward increasing numbers of fellows who are underrepresented in medicine (Black/African American, Hispanic/Latino/a/x) and providing a more inclusive training environment for first-generation college graduates, graduates of international and DO medical schools, fellows whose first language is not English, and veterans of the U.S. Armed Forces.

Disparities in Gender and Race Among Physician-Scientists: A Call to Action and Strategic Recommendations

The size of the physician-scientist workforce has declined for the past 3 decades, which raises significant concerns for the future of biomedical research. There is also a considerable gender disparity among physician-scientists. This disparity is exacerbated by race, resulting in a compounding effect for women of color. Proposed reasons for this disparity include the time and expense physicians must devote to obtaining specialized research training after residency while at the same time burdened with mounting medical school debt and domestic and caretaking responsibilities, which are disproportionately shouldered by women. These circumstances may contribute to the overall gender disparity in research funded by the National Institutes of Health (NIH). Women apply for NIH grants less often than men and are therefore less likely to receive an NIH grant. However, when women do apply for NIH grants, their funding success is comparable with that of men. Increasing representation of women and groups underrepresented in medicine (UIM) requires not only improving the pipeline (e.g., through training) but also assisting early- and midcareer women-and especially women who are UIM-to advance. In this article, the authors propose the following solutions to address the challenges women and other UIM individuals face at each of these career stages: developing specific NIH research training programs targeted to women and UIM individuals in medical school and residency; creating institutional and individual grant initiatives; increasing student loan forgiveness; setting up robust institutional mentorship programs for individuals seeking to obtain independent funding; providing childcare stipends as part of NIH grants; and instituting an NIH requirement that funded investigators participate in efforts to increase diversity in the physician-scientist workforce. Enabling more women and UIM individuals to enter and thrive in the physician-scientist workforce will increase the size and diversity of this critical component of biomedical research.

Health Professions Educational Debt: Personal, Professional, and Psychological Impacts 5 Years Post-graduation

INTRODUCTION

Cost burden in health professions education is rising. To bridge the gap between growing tuition and stagnating wages, student loans are increasingly obtained to cover educational costs. The spiraling after-effects are a source of acute concern, raising alarms across institutions and occupations. There is little dissemination to date of feasible data collection strategies and outcomes beyond 1 year post-graduation. Research is needed in evaluating the impacts of healthcare educational debt on career and personal choices following transition to practice.

MATERIALS AND METHODS

This study utilized a cross-sectional, mixed methods design. Doctor of Physical Therapy (DPT) Program graduates 5 years following degree completion completed a quantitative online survey, with topics including debt-to-income ratio, educational debt repayment strategies, impact on personal factors, non-education debt, and perceived value of their health professions education. Subsequent phone interviews were conducted by student researchers to gain insights into alumni perceptions of the impacts of educational debt on personal and professional decision-making. Data analysis involved descriptive and correlational quantitative statistics and open and axial coding of interview constructs.

RESULTS

The mixed methods format was successful in obtaining desired depth of response data. Quantitative findings demonstrated primary factors impacted by educational debt as savings, housing, leisure, discretionary spending, and family planning. Qualitative findings revealed impacts on themes of "personal factors" (81%), "professional factors" (62.5%), and "psychological factors" (56%) 5 years after graduation. Most negatively impacted were housing decisions, hours worked, initial job selection, and ability to save for the future, contributing to decreased mental health wellbeing with anxiety, frustration, and guilt. The majority (75%) of respondents perceived a high degree of value during and following their DPT education, though many expressed discordance between expectations and realities of practice.

DISCUSSION

Findings demonstrate that impacts of health professional educational debt in professional, personal, and psychological factors continue 5 years following degree completion, regardless of debt load. Successful implementation of this pilot methodology indicates potential for use of such extended data collection strategies. Further research is needed at the programs, profession, and/or interprofessional level to garner depth of understanding to guide interventions designed to mitigate or prevent these long-term repercussions.

Diversity of the physician workforce: Specialty choice decisions during medical school

Background

Despite efforts to increase the overall diversity of the medical student body, some medical specialties have a less diverse applicant pool based on both gender and race than would be expected based on medical graduate demographics.

Objectives

To identify whether women and Underrepresented in Medicine (URiM) medical students have baseline differences in their career interests or if their career plans change more during medical school when compared to men and non-URIM students.

Methods

Secondary data analyses of all medical students who applied through ERAS from 2005–2010 was conducted. Binary logistic regression models with the response being a planned career in one of four medical specialties (internal medicine, pediatrics, OB/GYN, and general surgery/surgical specialties) at medical school entry and graduation. Regression models included demographics, student attitudes, debt, academic metrics, and medical school experiences.

Results

Comparatively, women were less likely to be interested in internal medicine and surgery and more interested in pediatrics and OB/GYN at matriculation. URiM students expressed more interest in OB/GYN and surgery when starting medical school. At graduation, women were less likely to plan for internal medicine and surgery and were more interested in pursuing OB/GYN and pediatrics. URiM students were more likely to plan for a career in internal medicine and less likely to choose pediatrics.

Conclusions

From matriculation to graduation, women have relatively stable preferences regarding planned medical specialties. In contrast, URiM students’ specialty plans shifted over time among the four specialties, with variation in preferences occurring between matriculation and graduation.

Increasing evidence-based substance use interventions globally: The National Institute on Drug Abuse postdoctoral fellowships

As of April 2020, 121 individuals from 47 nations had completed 124 NIDA International Program INVEST Drug Abuse Research Fellowships. This is the first comprehensive effort to assess the fellowships from the combined perspectives of career outcomes, migration patterns, publications, cost per publication, and funding. We searched electronic sources such as university websites, ResearchGate, LinkedIn, PubMed, and NIH databases to find current curriculum vitae, journal articles published in 2018 and 2019, and funding records. We found electronic records for 94.2% of former NIDA INVEST fellows (n = 114); 55.5% were male (n = 67). The majority are at least partially involved in addiction research, prevention, or treatment (85.9%; n = 98), primarily at academic institutions (73.7%, n = 84) as faculty members (65.8%, n = 75) conducting research (86%, n = 98). Nearly three-fourths (74.6%, n = 85) are still working in their home countries; and 74.6% (n = 85) coauthored at least one research article indexed in PubMed during 2018 or 2019. Of the 656 unique research articles, 52.4% (n = 344) were published by multinational groups. The average cost to NIDA for each peer-reviewed publication was $19,677. More than half (53.5%, n = 61) of the fellows received funding through 431 unique grants-led by NIDA (55), other NIH Institutes and Centers (57) and other U.S. funders (55). Using the measures of career outcomes, migration patterns, publications, cost per publication, and funding INVEST fellowships are cost-effective mechanisms to advance scientific knowledge, build addiction research capacity, foster international cooperation, and promote adoption of evidence-based addiction policies and interventions around the world.

Six ways to get a grip on your first health education leadership role

Entering into health education leadership with clear intentions can help guide a new career. While being asked, or simply considering, an educational leadership position is exciting, it is important to consider your motivation for this position and how this position will mesh with your life and what you want to achieve in this position. In addition, it is important to look to mentors for advice and consider other avenues of professional development. Our six tips provide insight into the consideration, negotiation and selection of a health education leadership career that can yield numerous rewards both personally and professionally.

Breaking Tradition to Bridge Bench and Bedside: Accelerating the MD-PhD-Residency Pathway

PROBLEM

Physician-scientists are individuals trained in both clinical practice and scientific research. Often, the goal of physician-scientist training is to address pressing questions in biomedical research. The established pathways to formally train such individuals are mainly MD-PhD programs and physician-scientist track residencies. Although graduates of these pathways are well equipped to be physician-scientists, numerous factors, including funding and length of training, discourage application to such programs and impede success rates.

APPROACH

To address some of the pressing challenges in training and retaining burgeoning physician-scientists, New York University Grossman School of Medicine formed the Accelerated MD-PhD-Residency Pathway in 2016. This pathway builds on the previously established accelerated 3-year MD pathway to residency at the same institution. The Accelerated MD-PhD-Residency Pathway conditionally accepts MD-PhD trainees to a residency position at the same institution through the National Resident Matching Program.

OUTCOMES

Since its inception, 2 students have joined the Accelerated MD-PhD-Residency Pathway, which provides protected research time in their chosen residency. The pathway reduces the time to earn an MD and PhD by 1 year and reduces the MD training phase to 3 years, reducing the cost and lowering socioeconomic barriers. Remaining at the same institution for residency allows for the growth of strong research collaborations and mentoring opportunities, which foster success.

NEXT STEPS

The authors and institutional leaders plan to increase the number of trainees who are accepted into the Accelerated MD-PhD-Residency Pathway and track the success of these students through residency and into practice to determine if the pathway is meeting its goal of increasing the number of practicing physician-scientists. The authors hope this model can serve as an example to leaders at other institutions who may wish to adopt this pathway for the training of their MD-PhD students.

Is Australia's clinician scientist capacity appropriate for addressing the next pandemic?

Australia's clinical research communities responded quickly to COVID-19. Similarly, research funding to address the pandemic was appropriately fast-tracked and knowledge promptly disseminated. This swift and purposeful research response is encouraging and reflects thorough and meticulous training of the academic workforce; in particular the clinician scientist. Clinician scientists have formal clinical and research qualifications (primarily PhD), and are at the forefront of translating knowledge into health care. Yet in reality, advances in medical research are not rapid. Scientific discovery results from the long-term accumulation of knowledge. The drivers of this knowledge are often PhD students who provide new lines of clinical inquiry coupled with the advanced training of early- and mid-career researchers who sustain discovery through a clinician scientist workforce. A crucial point during these COVID-19 times is that this initial investment in training must be nurtured and maintained. Without this investment, the loss of a future generation of potential discoveries and a vibrant scientific workforce to safeguard us from future global health threats is at risk. This risk includes the modest gains achieved by increasing female and minority representation in STEM and the clinician scientist workforce. COVID-19 has presented serious concerns to Australia's health and economy. This perspective is central to these concerns and urges investment in the continuity of training and maintaining a sustainable clinician scientist workforce sufficient to address current and future pandemics, alongside continuing discoveries to improve the health of Australians.

A medical student scholarly concentrations program: scholarly self-efficacy and impact on future research activities

BACKGROUND

The Scholarly Concentrations program was established at Johns Hopkins University School of Medicine in 2009 with the aim of instilling passion for scholarship.

OBJECTIVE

Our study aimed to determine whether the Scholarly Concentrations program achieves positive changes in medical student self-efficacy in conducting research and, if so, whether this results in future career aspirations toward scholarship.

DESIGN

We used the Clinical Research Appraisal Inventory-Short Form (CRAI-SF) to assess changes in self-efficacy among students completing the Scholarly Concentrations program between 2014 and 2017. We calculated composite mean scores of six domains. We included outcomes on whether students published a manuscript, overall program perceptions, and likelihood of future research careers. We analyzed relationships between CRAI-SF scores and outcomes using paired t-tests and multivariable-adjusted logistic regression.

RESULTS

A total of 419 students completed the Scholarly Concentrations program. All 6 CRAI domain scores showed significant improvements in self-efficacy between the pre-Scholarly Concentrations and post-Scholarly Concentrations ratings (range of changes 0.76-1.39, p < 0.05 for all). We found significant associations between post-Scholarly Concentrations self-efficacy ratings and course satisfaction (adjusted OR 1.57 [95% CI 1.20, 2.07]) and mentor satisfaction (OR 1.46 [1.15, 1.86]), as well as students' intent to conduct future research (OR 1.46 [1.15, 1.86]). These results were robust to sensitivity analyses, and pronounced in the group of students without prior research experience.

CONCLUSIONS

Our findings suggest that a Scholarly Concentrations program is associated with an increased self-efficacy for research, and these changes in self-efficacy are associated with higher satisfaction in the scholarly experience and increased likelihood of pursuing scholarly work. Other medical schools could use such a tool of self-efficacy to both investigate the overall Scholarly Concentrations experience and understand factors that may increase interest in future physician-scientist pathways.

A snapshot of underrepresented physicians 15 years after medical school

We conducted a study to compare medical school experiences, values, career paths, and career satisfaction of under-represented in medicine (URiM) and non-URiM physicians approximately 15 years after medical school, guided by the Theory of Planned Behavior and the concept of stereotype threat. The sample consisted of four graduating classes, 1996-1999, of Harvard Medical School, 20% of whom were URiM. URiM respondents came from families of lower educational attainment and graduated with more debt. As students, they reported a greater experience of stereotype threat and, and at graduation they showed a tendency to place a higher value on avoiding a career that places them under constant pressure. Concerning their current status, URiM respondents expressed a lower level of satisfaction with their career progress. Multivariable analyses indicated that across the entire sample, URiM status was not a significant predictor of employment in academic medicine, but that being in academic medicine was predicted by mentors' encouragement for a research career, greater intention to pursue research, and a lower value on having a financially rewarding career. Lower career satisfaction was predicted by one's status as URiM, employment in academic medicine, greater involvement in research, and a greater value on avoiding constant pressure. The data suggest that negative student experiences in medical school, combined with the lack of mentor encouragement and financial pressures may discourage URiM medical students from pursuing academic careers, and that pressures for productivity and working in academic medicine may degrade the satisfaction derived by physicians in general.

Evaluation of a Spanish Health Topics Course for Undergraduate Pre-health Latino Students

Introduction: Language concordance between doctors and patients and increased matriculation of underrepresented minorities in medical school are commonly cited goals of medical centers and medical schools in addressing health disparities for individuals with limited English proficiency. Pre-medical education may represent a high-yield untapped opportunity to address both through a Spanish Health Topics, or Temas de Salud, course for Latino pre-health students. 

Methods: The authors implemented a longitudinal course for pre-health, Latino, undergraduate students to prepare them for success in bilingual health careers. The course included educational components of health knowledge, Spanish terminology, Hispanic/Latino sociocultural context, and exposure to medical learning formats presented during monthly sessions spread out over two years. A post-course survey with comfort and knowledge assessments was administered after each one-year cycle of the program. 

Results: One hundred and sixteen students (57%) out of 203 course-participants responded to the Spanish Health Topics course survey. The student comfort level and self-perceived knowledge about specific health issues increased for both students of native-level Spanish and less advanced fluency, though a larger improvement was noted in several health topics for native speakers. Eighty-five percent of students reported perceiving the class to be useful for their future careers, and 92% of respondents indicated having applied learned concepts in social and/or academic settings outside of class.

Discussion: Most students reported benefits of the course. Future studies should focus on a more detailed evaluation of enrolled students’ knowledge, attitudes, confidence, and long-term retention compared to students in a standard premedical path. Temas de Salud may enhance the bilingual, bicultural skillset of Latino underrepresented minorities in medicine, and can be replicated at other institutions.

Review article: A primer for clinical researchers in the emergency department: Part VII. Considering a research higher degree in emergency medicine: How does it work, where to start, what to consider

In this series we address important topics for clinicians who participate in research or are considering research as part of their career path in emergency medicine. While much emergency research is successfully done by clinicians without a research higher degree (RHD), undertaking a master's degree or doctorate allows a research topic to be pursued in greater depth. It also provides a solid basis for a future research career in terms of research quality, advanced skills, academic progression and track record, as well as eligibility for grants and RHD supervision. The decision to undertake a RHD is not an easy one, and requires consideration of the time and cost involved, as well as the impact on a clinician's life plans. However, the expertise provided through a RHD often ultimately complements clinical training and establishes an excellent foundation for future research and career. This article provides an overview of RHDs and what to consider before embarking on one.

What will it take? Pathways, time and funding: Australian medical students' perspective on clinician-scientist training

BACKGROUND

Clinician-scientists are in decline worldwide. They represent a unique niche in medicine by bridging the gap between scientific discovery and patient care. A national, integrated approach to training clinician-scientists, typically programs that comprise a comprehensive MD-PhD pathway, are customary. Such a pathway is lacking in Australia. The objective was to gather perceptions from Australian medical students on factors they perceive would influence their decision to pursue clinician-scientist training.

METHODS

A cross-sectional mixed methods design used quantitative and qualitative questions in an online self-report survey with medical students from a four-year MD program. Quantitative measures comprised scaled response questions regarding prior experience and current involvement in research, and short- and long-term opinions about factors that influence their decisions to undertake a research higher degree (RHD) during medical school. Qualitative questions gathered broader perceptions of what a career pathway as a clinician-scientist would include and what factors are most conducive to a medical student's commitment to MD-PhD training.

RESULTS

Respondents (N = 418; 51% female) indicated Time, Funding and Pathway as the major themes arising from the qualitative data, highlighting negative perceptions rather than possible benefits to RHD training. The lack of an evident Pathway was inter-related to Time and Funding. Themes were supported by the quantitative data. Sixty percent of students have previous research experience of varying forms, and 90% report a current interest, mainly to improve their career prospects.

CONCLUSIONS

The data emphasise the need for an MD-PhD pathway in Australia. A model that provides an early, integrated, and exclusive approach to research training pathways across all stages of medical education is suggested as the best way to rejuvenate the clinician-scientist. A national pathway that addresses factors influencing career decision making throughout the medical education continuum should include an appropriate funding structure, and provide early and continuing advice and mentoring. It should be flexible, gender equitable, and include post-graduate training. The implications of implementing MD-PhD programs represent a substantial investment. However this should not be a deterrent to Australia's commitment to an MD-PhD pathway, but rather a challenge to help ensure our future healthcare is guided by highly trained and competent clinician-scientists.

Research Interest in Pediatric Emergency Medicine Fellows

OBJECTIVE

Factors predictive of research career interest among pediatric emergency medicine (PEM) fellows are not known. We sought to determine the prevalence and determinants of interest in research careers among PEM fellows.

METHODS

We performed an electronically distributed national survey of current PEM fellows. We assessed demographics, barriers to successful research, and beliefs about research using 4-point ordinal scales. The primary outcome was the fellow-reported predicted percentage of time devoted to clinical research 5 years after graduation. We measured the association between barriers and beliefs and the predicted future clinical research time using the Spearman correlation coefficient.

RESULTS

Of 458 current fellows, 231 (50.4%) submitted complete responses to the survey. The median predicted future clinical research time was 10% (interquartile range, 5%-20%). We identified no association between sex, residency type, and previous research exposure and predicted future research time. The barrier that most correlated with decreased predicted clinical research time was difficulty designing a feasible fellowship research project (Spearman coefficient [ρ], 0.20; P = 0.002). The belief that most correlated with increased predicted clinical research time was excitement about research (ρ = 0.69, P < 0.001).

CONCLUSIONS

Most fellows expect to devote a minority of their career to clinical research. Excitement about research was strongly correlated with career research interest.