Changes in U.S. medical students' specialty interests over the course of medical school

Evolution of Medical Students' Interest in Orthopaedic Surgery Careers from Matriculation to Graduation

Introduction

Little is known about risk factors for changes in students' interest in orthopaedics during medical school. We aimed to identify variables associated with diminished (vs. sustained) and emerging (vs. no) plans to become board certified in orthopaedic surgery.

Methods

We conducted a retrospective national-cohort study of students who matriculated in US MD-granting medical schools in academic years 1993 to 1994 through 2000 to 2001. The outcome measure was the evolution of students' board-certification plans in orthopaedic surgery from matriculation to graduation using responses on the Association of American Medical Colleges' Matriculating Student Questionnaire and Graduation Questionnaire. Covariates included demographic, attitudinal, experiential, and career intention variables.

Results

Of 53,560 graduates with complete data, 2,765 students reported diminished interest in becoming board certified in orthopaedics, 1,345 reported emerging interest, and 1,327 reported sustained interest. In multivariable logistic regression models, students who were female (adjusted odds ratio [aOR] 1.83, 95% confidence interval [CI] 1.43-2.34), Asian (aOR 1.46, 95% CI 1.18-1.82), reported greater importance of social responsibility (aOR 1.16, 95% CI 1.02-1.33) and prestige (aOR 1.20, 95% CI 1.10-1.30) in choosing a medicine career, and planned full-time university faculty careers (aOR 1.58, 95% CI 1.33-1.89) at graduation were independently more likely to have diminished (vs. sustained) interest. Students who participated in research and/or authorship electives (aOR 3.50, 95% CI 3.00-4.07) and who attended private institutions (aOR 1.23, 95% CI 1.10-1.39) were more likely to have emerging (vs. no) interest.

Conclusions

Twice as many students lost interest than gained interest in orthopaedics during medical school, and the cohort of students interested in orthopaedics became less diverse over the course of medical school. Several risk factors amenable to change were identified. Interventions that target these risk factors are warranted to increase the diversity of the orthopaedic surgery workforce.

Association of county-level provider density and social vulnerability with colorectal cancer-related mortality

BACKGROUND

Health care providers play a crucial role in increasing overall awareness, screening, and treatment of cancer, leading to reduced cancer mortality. We sought to characterize the impact of provider density on colorectal cancer population-level mortality.

METHODS

County-level provider data, obtained from the Area Health Resource File between 2016 and 2018, were used to calculate provider density per county. These data were merged with county-level colorectal cancer mortality 2016-2020 data from the Centers for Disease Control and Prevention. Multivariable regression was performed to define the association between provider density and colorectal cancer mortality.

RESULTS

Among 2,863 counties included in the analytic cohort, 1,132 (39.5%) and 1,731 (60.5%) counties were categorized as urban and rural, respectively. The colorectal cancer-related crude mortality rate was higher in counties with low provider density versus counties with moderate or high provider density (low = 22.9, moderate = 21.6, high = 19.3 per 100,000 individuals; P < .001). On multivariable analysis, the odds of colorectal cancer mortality were lower in counties with moderate and high provider density versus counties with low provider density (moderate odds ratio 0.97, 95% confidence interval 0.94-0.99; high odds ratio 0.88, 95% confidence interval 0.86-0.91). High provider density remained associated with a lower likelihood of colorectal cancer mortality independent of social vulnerability index (low social vulnerability index and high provider density: odds ratio 0.85, 95% confidence interval 0.81-0.89; high social vulnerability index and high provider density: odds ratio 0.93, 95% confidence interval 0.89-0.98).

CONCLUSION

Regardless of social vulnerability index, high county-level provider density was associated with lower colorectal cancer-related mortality. Efforts to increase access to health care providers may improve health care equity, as well as long-term cancer outcomes.

Changes in the attractiveness of medical careers and career determinants during the bachelor's program at Zurich medical schools

BACKGROUND

Monitoring the career intentions of medical students during their undergraduate studies could help to address the shortage of physicians, particularly in general practice. This study aimed to investigate changes in medical students' career openness, attractiveness and determinants of medical career choice during their bachelor's studies.

METHODS

The design was cross-sectional, recruiting all medical students who started a bachelor's program in one of the four different educational tracks in Zurich, Switzerland, in the fall of 2019 (first survey) and completed it in the summer of 2022 (second survey). Students' perceptions of the attractiveness and determinants of different medical career options were assessed using a structured online questionnaire. Absolute changes between the two-time points were reported in percentage points overall and by educational track. Regression analysis was used to examine the association of student characteristics and determinants of career options with the attractiveness of each option.

RESULTS

We surveyed 354 medical students at the beginning and 433 at the end of the bachelor's program (participation rate: 71.1% and 86.9%, respectively). Overall, the proportion of students open to all proposed medical career options decreased (from 52.8% to 43.8%, p = 0.004). The attractiveness of outpatient gynecology or pediatrics increased (from 27.4% to 43.4%, p < 0.001), whereas the attractiveness of both general and specialized inpatient care decreased (from 47.8% to 40.3%, p = 0.05 and from 71.1% to 61.1%, p = 0.006 respectively). There was an increase in the proportion of students who perceived part-time work, autonomy and relationships with patients as important career determinants (from 47.3% to 64.7%, p < 0.001; from 63.3% to 77.8%, p < 0.001; from 80.8% to 89.3%, p = 0.002 respectively), while the importance of reputation and career opportunities decreased (from 42.6% to 26.2%, p < 0.001; from 79.2% to 63.6%, p < 0.001 respectively). The importance of part-time work and relationships with patients were positively associated with the attractiveness of general practice.

CONCLUSIONS

During the bachelor's program, the attractiveness of a career in general practice tended to decrease, but the importance of part-time work, autonomy and relationships with patients as career determinants increased. Helping students understand how these determinants relate to general practice may increase their interest in the profession.

TRIAL REGISTRATION

Not applicable.

Students Matriculating into Integrated Plastic Surgery: Are all Medical Schools Equal?

INTRODUCTION

Becoming a craniofacial/pediatric plastic surgeon depends on completing a plastic surgery (PS) residency. As medical school curricula for PS exposure are highly inconsistent, the authors investigated whether there was an association between the presence of PS elective rotations and/or home programs in medical schools with the proportion of students matriculating into integrated PS residency.

METHODS

A list of 198 medical schools was compiled from the Association for American Medical Colleges and the American Association of Colleges of Osteopathic Medicine. Plastic surgery residency programs were identified by the American Society of Plastic Surgery and the American Council of Educators in Plastic Surgery. Plastic surgery elective rotation offerings and recent matches (2021-2022) were obtained from school websites. Mean proportions of students matriculating into PS between schools that did versus did not have PS elective rotations and/or home PS residency programs were compared.

RESULTS

One hundred fifty-nine medical schools were included. Seventy-seven of 159 (48%) had both PS elective rotations and home program(s), 63/159 (40%) offered PS elective rotations only, and 19/159 (12%) had neither. The mean proportions of students matriculating differed significantly (P<0.001) among schools without PS electives or a home program [0.09%, 95% confidence interval (CI): -0.04% to 0.21%), PS elective only (0.51%, 95% CI: 0.25%-0.77%), and both PS elective and home program(s) (1.14%, 95% CI: 0.92%-1.37%).

CONCLUSION

The presence of elective PS rotations and a home PS residency program significantly increase the chances of matriculation into integrated PS residency programs.

The state of vascular surgery education in the United States

With the growing proportion of elderly population in the US and a relatively fixed supply of well-trained vascular surgeons, there is a serious concern that we will be facing a shortage of vascular surgery workforce in the near future. One of the main reasons why there is a shortage of vascular surgeons in the US is due to the fact that many students don't get exposed to this field throughout their student lives and a recent survey of medical students from a non-urban tertiary care academic institution showed that early exposure of the medical students to the surgical careers is correlated with an increased interest in the surgical field. This review of the state of vascular surgery education in the US at the undergraduate level describes in detail the importance of an early introduction to vascular surgery in the education curricula, the current state of the education, potential avenues to improve the exposure of students to the field of vascular surgery and the importance of this effort in matching the increasing need for vascular surgeons for an aging population which is likely to require dedicated care by vascular surgeons of the future. At the present time, the two pathways by the Accreditation Council for Graduate Medical Education (ACGME) to obtain dedicated vascular surgery training in the US include either enrolling in a two year clinical fellowship after completion of general surgery training or to match in a five year vascular surgery integrated residency program after successful completion of medical degree.

Paediatric shadowing: a student-led initiative to increase medical student interest in paediatric careers

INTRODUCTION

Clinical exposure to paediatrics increases student interest in the specialty. However, the paediatric placement is relatively short and usually falls towards the end of medical school in the UK. A student-led shadowing scheme was developed to provide opportunities for medical students, including those at an early stage, to experience clinical paediatrics.

METHODS

Paediatric society members could apply for a shadowing day in the scheme run in 2022 and 2023. Feedback was collected following the day. Free text answers on learning points and the impact of shadowing on views of paediatrics were analysed using a framework approach. Knowledge of the role of a paediatrician and consideration of a career in paediatrics were rated on a 5-point Likert scale before and after the shadowing day.

RESULTS

66 and 37 students completed shadowing days in cycles 1 and 2, respectively. Students' knowledge of the role of the paediatrician and consideration of a career in paediatrics increased significantly after the shadowing scheme. The key themes that participating year 1-2 students gained from the scheme were: increased interest in paediatrics, increased knowledge about the specialty, challenges and decision-making in paediatrics, variety within paediatrics, communication skills, working with families, improving practical skills and some overwhelming first clinical experiences.

DISCUSSION

A student-run shadowing scheme is a novel and sustainable way to provide early exposure to paediatrics in medical school. This will help to develop interest in paediatrics from the start of medical school, as clinical exposure is a key factor in choosing paediatrics once qualified.

Addressing Barriers to Entry and Retention of Women in Interventional Vascular Specialties With Proposed Solutions: A Scientific Statement From the American Heart Association

Representation of women in interventional vascular fields (interventional cardiology, interventional radiology, and vascular surgery) lags behind that in other specialties. With women representing half of all medical school graduates, encouraging parity of women in these fields needs to start in medical school. Barriers to pursuing careers in vascular intervention include insufficient exposure during core clerkships, early mentorship, visibility of women in the field, length of training, lifestyle considerations, work culture and environment, and concerns about radiation exposure. This scientific statement highlights potential solutions for both the real and perceived barriers that women may face in pursuing careers in vascular intervention, including streamlining of training (as both interventional radiology and vascular surgery have done with a resultant increase in percentage of women trainees), standardization of institutional promotion of women in leadership, and professional and industry partnerships for the retention and advancement of women.

Perceived barriers to a career in pain medicine in the Republic of Ireland

BACKGROUND

As the population ages, musculoskeletal disorders are a prominent contributory factor to loss of mobility and autonomy. Pain is a predictor of disability and worsening frailty and the role of the chronic pain specialist in the management of this cohort cannot be overstated. With growing requirements for pain specialists, we sought to identify barriers to recruitment within this specialty.

AIMS

Establish baseline attitudes and perceived barriers towards a career in pain medicine among Irish anaesthesiology trainees. Suggest a framework to improve recruitment to the specialty.

METHODS

Ethical approval was obtained. A web-based questionnaire was sent to all anaesthesiologists in training in the Republic of Ireland. Data was analyzed using SPSS.

RESULTS

Two hundred forty-eight trainees received the questionnaire, 59 responded. 54.2% male, 45.8% female. 79.7% had previous clinical exposure to pain medicine, most of whom had spent over one month with a service. Only 10.2% of respondents were considering a career in pain medicine. Factors that attracted trainees to the subspeciality included: interventional practice (81%), variation in clinical practice (66.7%), autonomy of practice (61.9%) and perceived good work-life balance (42.9%). Deterrents from the subspecialty included a psychologically challenging patient cohort (69.5%), frequency of clinics (50.8%), and additional exams (32.2%). When asked how to improve engagement with the speciality, 62% suggested earlier exposure to the speciality and 32.2% suggested increased frequency of formal teaching and workshops.

CONCLUSIONS

Increased exposure of trainees to the specialty during early stages of training may improve future recruitment to the subspecialty in Ireland.

Gender trends in Canadian medicine and surgery: the past 30 years

BACKGROUND

While the number of women entering medicine has steadily increased since the 1970s in Canada, the gender composition along each stage of the medical training pathway has not been comprehensively reported. We therefore sought to systematically examine the gender composition of students, residents, and practicing physicians over the past 30 years in Canada.

RESULTS

In this cross-sectional analysis of Canadian medical trainees including MD applicants (137,096 male, 169,099 female), MD students (126,422 male, 152, 967 female), MD graduates (29,413 male, 34,173 female), residents by the decade (24,425 male, 28,506 female) and practicing surgeons (total 7,457 male, 3,457 female), we find that increased female representation in medicine is not matched by representation in surgery, with the key being the specialty choice process. The likelihood of female applicants matriculating to medical school was less than male applicants in the 90s (OR 0.92, 95% CI 0.92-0.93), greater in the early 2000s (OR 1.03, 95% CI 1.03-1.04), and has since balanced out (OR 1.00, 95% CI 1.00-1.01), with medical school classes being nearly 60% female for the past two decades. Despite this, females have remained underrepresented in most surgical residency programs, with odds of female medical students entering surgical residency other than Ob/Gyn being about half that of male students (OR 0.56, 95% CI 0.44-0.71), resulting in a slow increase in practicing female surgeons of less than 0.5% per year in many surgical disciplines and projected parity decades or centuries in the future.

CONCLUSIONS

While undergraduate medical education has been majority female in Canada for nearly three decades, females remain greatly underrepresented in the physician workforce within surgical specialties. To build a representative medical workforce equipped to care for diverse patient populations, factors influencing the specialty choices of early career physicians will need to be examined and addressed.

Diversity in Radiology Residents Relative to Other Specialties- Trends Over the Past Decade

RATIONALE AND OBJECTIVES

The objective of this study was to assess diversity among radiology residents relative to other specialties and compare it with historical trends.

MATERIALS AND METHODS

The Graduate Medical Education results from 2010-2011 to 2020-2021 were accessed for demographic information for major medical specialties (number of residents > 500 as of the 2020-2021 report). Subspecialties and fellowship programs were not included in this analysis. The racial and ethnicity breakdowns were extracted, including Black, White/Caucasian, Asian, Hispanic, and others. The changes in racial and ethnicity composition of residents in radiology was compared to other specialties using the Chi Squared test using a significance level of p < 0.05.

RESULTS

In 2020-2021, radiology ranked ninth in total resident enrollment among the 21 largest ACGME training programs, unchanged when compared to 2010-2011. Amongst all specialties, Radiology ranked 10th for Black and 9th for Hispanic representation in 2020-2021.The percentage of Black residents increased from 3.07% in 2010-2011 to 3.83% in 2020-2021. The percentage of Hispanic Radiology residents increased from 4.83% to 7.35%, constituting the third largest increase amongst all specialties.

CONCLUSION

The representation of Blacks and Hispanics in Radiology has improved relative to other medical specialties in the last decade.

The perceived impact of curricular and non-curricular factors on specialty interests and choice during medical school at a single center in the United States

BACKGROUND

Limited information exists regarding how medical students' specialty interests evolve throughout medical school, particularly interest in surgical versus non-surgical specialties. Our objective was to identify medical students' specialty interests before and after medical school and the most important curricular and non-curricular factors that shaped their specialty choice.

METHODS

An online 22-question voluntary, anonymized survey was designed to assess specialty interests and factors impacting specialty choice at a single medical school in the United States. The study was pilot-tested with focus groups. The final questionnaire was distributed to final-year medical students from the Classes of 2020 and 2021. Responses were measured on a 5-point Likert scale (1 = strong negative impact to 5 = strong positive impact).

RESULTS

102 of 184 students (55%) from Class of 2020 and 85 of 174 students (49%) from Class of 2021 participated. Of 187 respondents, the majority (60%) decided on their specialty during third year. 74 of 147 students (50%) pursued a specialty among their initial specialty interests. Students with initial surgical interests were significantly (p < 0.001) less likely to choose surgical specialties (42%) compared to students with initial non-surgical interests choosing non-surgical specialties (79%). Pre-clinical years (3.67 ± 0.96) were perceived to have a significantly (p < 0.001) less positive impact on specialty interests and choice compared to clinical years. Among pre-clinical factors, physician shadowing (3.80 ± 0.83) was perceived to have the significantly (p < 0.001) greatest positive impact. During clinicals, 34% of respondents indicated that order of clerkships impacted specialty choice. 112 of 171 respondents (65%) indicated that mentorship impacted specialty choice. Physicians in the chosen specialty were perceived to have the strongest impact (4.67 ± 0.49). 65 of 171 respondents (38%) indicated that peers impacted specialty choice with classmates (3.98 ± 0.87) and near-peers (3.83 ± 0.74) perceived to have a positive impact.

CONCLUSIONS

Specialty interests changed during medical school for a significant portion of students (50%). Those with initial surgical interests were more likely to change their specialty interests. Pre-clinicals were reported to have less impact on specialty choice compared to clinicals. Implementing factors such as shadowing and physician/peer mentorship, which may positively impact specialty choice, into pre-clinical curricula warrants further investigation.

Investigating factors that influence residency program selection among medical students

BACKGROUNDS

Medical students and interns face several decisions during their career development. One of the most critical decisions they have to make is choosing a residency program that suits their career goals and aspirations. The selection process can be challenging, as several factors can influence the decision-making process. There was limited research on the role of GPA and opportunities in residency program selection. Therefore, this study examines the factors that influence interns' and 5th-year medical students' choices of residency programs.

METHODS

Observational and analytical cross-sectional studies were conducted at King Saud University (KSU) in Riyadh, Saudi Arabia. A sample of 5th-year medical students as well as medical interns was included in the study. This study only includes students who were interested in choosing a residency program in one of these eight domains: Medicine, Family Medicine, Orthopedics, Pediatrics, Radiology, Surgery, Obstetrics/Gynecology, and Ophthalmology.

RESULTS

The total number of students with 5th-year medical students was 205 (60.1%) and the number of students with medical interns was 135 (39.5%). The majority of students (51.0%) had a GPA above 4.5 out of 5, followed by 3.5 to 4.5 among 146 (42.8) students, and only 21 (6.2) had a GPA below 3.5. Those students with less than a 3.5 GPA out of 5 were found not to have any favorite residency program specialties when it came to academic achievement. Furthermore, in the case of those students whose GPA was 3.5 to 4.5, they had a certain mindset when it came to choosing a residency program. A 1.9 times greater likelihood of selecting obstetrics and gynecology (OR = 1.9, p = 0.19) was achieved by students with GPAs between 3.5 and 4.5, followed by a 1.5 times greater probability of selecting radiology (OR = 1.5; p = 0.55). High achievers, ophthalmology (OR = 1.7; p = 0.32) and surgery (OR = 1.4; p = 0.31) were the most popular residency programs. A student with a high GPA (mean score = 7.3) also chooses his or her career based on better opportunities than a student with a low GPA (mean score = 6.8).

CONCLUSIONS

The study highlights the correlation between academic achievement and preferred specialties for future careers among medical students. While the study's findings should be considered in the context of various other factors such as lifestyle, social life, and income can influence students' preferred specialties for residency programs.

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.

Pathology education project (PEP): A pilot program to spark student understanding in pathology as a career

According to the National Resident Matching Program in 2022, 631 pathology positions were offered. In total, 248 senior applicants from United States (US) allopathic schools filled 36.6% of these positions. To bolster medical student understanding of pathology, a medical school pathology interest group organized a multi-day activity to introduce rising second-year medical students to pathology as a career. Five students completed both pre- and post-activity surveys assessing their knowledge of the specialty. All five students had a BA/BS degree as their highest level of education. Only one student indicated that he or she had previously shadowed a pathologist as a medical laboratory scientist for a duration of four years. Two students indicated that they were interested in internal medicine, one indicated radiology, one forensic pathology or radiology, and one was undecided. During the activity, students biopsied tissue from cadavers in the gross anatomy lab. Thereafter, students participated in the standard tissue processing by shadowing a histotechnologist. Under the guidance of a pathologist, students microscopically examined slides and discussed the clinical findings. Post-activity survey results indicated that participation increased their knowledge of pathology as a career with a median increase of 0.8 points (range: 0.2 to 1.6) on a 5-point Likert scale. Students also indicated that their participation increased their knowledge of pathology skills and techniques-median increase of 1.2 (range: 0.8 to 1.8). This activity can be implemented by medical educators to expose medical students to pathology as a career with the benefit of increasing student knowledge in the specialty.

Dynamics of career intentions in a medical student cohort: a four-year longitudinal study

BACKGROUND

Medical students' career intentions often change between matriculation and graduation, yet little is known about the precise timing and dynamics of individual students' career decisions. This study expands on previous research by exploring the stability of individual students' career intentions over four years and by analyzing associations between unstable career intentions and students' characteristics.

METHODS

Medical students from two classes were recruited into a cohort during their first academic year and completed a yearly survey over a four-year period (end of pre-clinical curriculum to graduation). Measures included career intention (specialty and practice type), personality, coping strategies, empathy, and motives for becoming a physician. The authors developed a score ranging from 0 to 10 quantifying instability of career intentions (0 = stable; 10 = unstable). The distribution of the score was analyzed descriptively, and the association between the score and other variables was quantified using a stepwise beta regression model.

RESULTS

The sample included 262 students (61% females). The mean score was 3.07 with a median of 3. 18% of students (N = 46) did not change their specialty intention over the four years, whereas 10% (N = 26) changed every year. No further subgroups were identified between these extremes. An intention to work in private practice in year 3 and the motive care for patients were significantly associated with more stable career intentions.

CONCLUSION

Most students are situated on a continuum between the two extremes of being firmly committed and undecided. Extrinsic factors may be more important drivers of these fluctuations than personal characteristics and should be explored in future research. This study's findings also provide avenues for supporting students in their career decision-making.

Going Virtual: A Virtual Summer Physical Medicine and Rehabilitation Externship Experience for Medical Students

ABSTRACT

Opportunities for early medical student exposure to the field of physical medicine and rehabilitation (PM&R) are desirable for promoting the field as a career choice and are useful for introducing students to the care of people with disabilities. The COVID-19 pandemic disrupted medical education and caused the cancellation of many in-person clinical programs, including the Medical Student Summer Clinical Externship in PM&R supported by the Association of Academic Physiatrists. This article describes the process by which an in-person summer clinical externship program was effectively converted into a Virtual PM&R Experience using a combination of independent assignments and small-group sessions. A total of 87 medical students completed the Virtual PM&R Experience over two summers. The participants of the program met the program learning objectives, including enhancing their understanding of physiatry as a career and recognizing the medical and social issues that affect persons with disability.

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

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

CONCLUSION

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

WHAT IS KNOWN

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

WHAT IS NEW

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

The Experiences, Influences and Concerns of Future Orthopaedic Surgeons: Comparing Uk and non-UK Perspectives

AIMS/BACKGROUND

This study aims to identify and analyse the factors that influence or discourage junior doctors in the UK and across the world from wanting to pursue a career in orthopaedics.

METHODS

A prospective, cohort study was carried out via an online questionnaire targeted at aspiring orthopaedic surgeons.

RESULTS

A total of 654 respondents met inclusion criteria; 370 (56.6%) were UK-based and 284 (43.4%) were based abroad. The practical and technical nature of orthopaedics was the biggest influencing factor globally. UK respondents were notably more concerned by the financial impact of training (49%) followed by poor work-life balance (36%). Themes from the comments section revealed concern regarding gender bias and a lack of diverse role models within orthopaedics.

CONCLUSIONS

Reducing the cost and length of training, diversification of role models, removal of bias and increasing positive early experiences may help to encourage people of all backgrounds to pursue a career in orthopaedic surgery.

The impact of volunteering with a student-run free clinic on medical student specialty selection

BACKGROUND

The shortage of primary care physicians in the United States is expected to grow to 17,800-48,000 physicians by 2034. Student Run Free Clinics are an increasingly popular component of medical schools and may provide an avenue for increasing medical student interest in primary care specialties. However, there is limited research on the impact of Student Run Free Clinics on medical student specialty choice. This investigation sought to determine whether volunteering with the Interprofessional Community Clinic (ICC), the Student Run Free Clinic associated with Chicago Medical School, was associated with an increased likelihood of matching into primary care specialties. Secondarily, the authors investigated associations between volunteering and matching into family practice. Finally, the authors explored associations between volunteering and the competitiveness of specialty choice.

METHODS

This retrospective review utilized data on medical school graduates from 2015 - 2021 including their matched specialties, the number of ICC shifts they volunteered for, and whether they held an ICC leadership position (executive officers). Primary care specialties were defined as internal medicine, family practice, pediatrics, or combined internal medicine/pediatrics. Residency fill rate was used as a proxy for competitiveness.

RESULTS

This analysis included 506 medical students (254 ICC volunteers and 252 non-volunteers). Among ICC volunteers, 47.2% matched into a primary care specialty compared to 36.5% of non-volunteers (RR 1.29, 95% CI 1.05-1.59). Each additional shift worked at the ICC was correlated with increased odds of matching into family practice by a factor of 1.042 (95% CI 1.005-1.079).

CONCLUSIONS

Medical students who volunteered with the ICC were more likely to match into primary care residencies. Students who volunteered more frequently were more likely to match into family practice. Further investigation is warranted to determine whether these associations are causative and could thus be leveraged to encourage medical students to pursue primary care careers.

Survey showed that very few paediatric residents in Southwest Nigeria were interested in specialising in gastroenterology

AIM

Paediatric gastroenterology remains an under-recognised sub-speciality in Africa. We determined the preferred sub-specialities among paediatric residents in Southwest Nigeria and what influenced whether they chose paediatric gastroenterology.

METHODS

This was a cross-sectional survey of paediatric residents in seven teaching hospitals in Southwest Nigeria. A self-administered questionnaire was used to obtain information on their socio-demographics, educational attainment, choice of sub-speciality and the factors influencing that choice.

RESULTS

Of 144 eligible paediatric residents, 124 (86.1%) completed the survey. Their mean age was 35.0 ± 1.7 years and 83 (66.9%) were females. The majority (94.4%) had already chosen their sub-speciality and nearly two-thirds (65.0%) made the decision during training. The most popular sub-speciality was neonatology (30.6%) and only three (2.4%) residents chose gastroenterology. Factors influencing the choice of sub-speciality were perceived ability (85.3%) and academic experience (83.8%). Financial reasons were less frequent (32.5%). Lack of diagnostic equipment (30.6%) and role models (21.0%) were the most frequent reasons for residents being disinterested in paediatric gastroenterology.

CONCLUSION

Few residents were interested in paediatric gastroenterology and there is a need to encourage interest in this subject at an early stage in their training and provide more diagnostic equipment and greater mentorship.

Retrospective Study on the Effect of the Timing of Exposure on Confidence Level in Applying to Physical Medicine and Rehabilitation Residency Programs

ABSTRACT

Residency specialty choice, a complex decision-making process, is often influenced by confidence level built upon knowledge, experience, and fit with the specialty. Despite the need for physiatrists with population growth, especially people with disability and older patients, limited growth in the number of residency positions and delayed exposure to the field of physical medicine and rehabilitation potentially contribute to a lack of confidence in pursuing physical medicine and rehabilitation. Early introduction to a specialty has been shown to impact specialty selection. Thus, this study aims to explore the impact of timing of exposure to physiatry on the confidence level of physical medicine and rehabilitation residents in their specialty choice. A survey for current physical medicine and rehabilitation residents was developed and distributed to residency program directors with a request to forward it to all residents. The response rate was low at 13%; however, the results provide a window into the experience of today's medical and premedical students. Interestingly, of the 175 respondents, a similar number reported first exposure to physiatry during third year and before medical school. In addition, earlier exposure was associated with higher confidence levels in specialty choice, the most powerful factor being the exposure to the specialty before starting medical school or during the preclinical years in medical school. These findings highlight opportunities to improve the physiatry workforce by providing earlier exposure to the specialty, even before medical school. Based on the results of the survey and ongoing discussions among medical students, residents, and faculty leaders, the authors review current recruitment efforts and new ideas.

Racial and Ethnic Differences in Medical Student Timing and Perceived Quality of Exposure to Urology

OBJECTIVE

To contextualize the low representation of Under-Represented in Medicine (URiM) in urology, we examine differences in timing and perceived quality of urology clinical and research exposures for medical students across race/ethnicity.

METHODS

A cross-sectional survey was distributed to all medical students at UCLA. Dependent variables were timing of urology exposure and perceived quality of urology exposure. Descriptive statistics and multivariate analyses were used to compare variables across race/ethnicity. Logistic regression was used to determine odds of early exposure to urology across race/ethnicity.

RESULTS

Black and Latinx students were significantly less likely to discover urology before MS3 (P<.001). Although URiM students were more likely to recall receiving a urology interest group invitation (Asian 46%, Black 53%, Latinx 67%, White 48%, P=.03), they were less likely to attend an event (Asian 23%, Black 4%, Latinx 3% and White 15%, P<.001) despite being more likely to be interested in urology (Asian 32%, Black 38%, Latinx 50%, White 28%, P=.01). Black students were more likely to gain exposure via family/friend with a urological diagnosis. Black and Latinx students were twice as dissatisfied with timing and method of medical school exposure to urology versus their peers. There were differences across race/ethnicity for whether or not a student had engaged in urology research (Asian 10%, Black 5%, Latinx 2%, White 2%, P=.01).

CONCLUSIONS

Racial/ethnic disparities exist in early exposure to urology, involvement in urology interest group, access to research, and satisfaction with exposure to urology. Interventions addressing the timing and quality of urology exposures may optimize recruitment of URiM students into urology.

Breast Imaging and Social Media: A Model Specialty for Increasing Interest and Awareness of Radiology in Pre-Medical Students

OBJECTIVE

To assess how a virtual shadowing (VS) session on breast imaging (BI), shared through social media, can increase interest and awareness of radiology in pre-medical students.

METHODS

This study was IRB exempt. A VS slide presentation on BI mentorship, didactic lecture, and deidentified image-rich, case-based learning was created. This session was advertised and presented live through an Instagram page (Pre-Health Virtual Shadowing, @virtualshadowing) geared toward pre-health students. Students were asked to complete a two-question self-assessment using a 5-point Likert scale on which 1 was "least" and 5 was "most." Question 1 read: "Please rate your overall knowledge about radiology and what a radiologist does," and question 2 read: "Please rate your interest in possibly looking into radiology as a potential career."

RESULTS

A total of 420 participants logged into the VS session; 82% (345/420) answered the pre-session survey and 48% (202/420) answered the post-session survey. Of post-survey respondents, 84% (170/202) were female and 70% (143/202) were 22 years old or younger. There was a significant difference in mean pre-session survey responses to question 1 when compared to mean post-session survey responses (2.67 vs 3.55, P < 0.001). There was also a significant difference in mean pre-session survey responses to question 2 when compared to mean post-session survey responses (3.16 vs 3.58, P < 0.001). Our VS session remains on YouTube and has 6157 views to date.

CONCLUSION

When shared through VS on social media, breast imaging can increase interest and awareness of radiology in pre-medical students.

Attractiveness of medical disciplines amongst Swiss first-year medical students allocated to different medical education tracks: cross-sectional study

BACKGROUND

As most countries, Switzerland is experiencing a shortage of physicians especially in general practice and new medical education tracks with respective focusses have been started in response. This study investigated Swiss medical students' career openness and attractiveness of different medical disciplines as well as the concordance of students' career intentions with assigned medical education tracks.

METHODS

Cross-sectional study surveying first year medical students assigned to four different Swiss medical education tracks with distinctive additional education focuses (ETH Zurich: medical technology and engineering, University of St. Gallen and University of Lucerne: primary healthcare and University of Zurich: no distinctive focus).

RESULTS

We surveyed 354 medical students (response rate across all included medical education tracks 71.1%), 64.8% female, mean age 20 years. Regarding career openness, we found that 52.8% of medical students had neither a strong commitment nor a strong reservation for any of the proposed career options and 17.0% had a strong commitment. Among medical disciplines, medical subspecialties were attractive to the largest part of students (inpatient subspecialties attractive for 71%, outpatient for 58%), attractiveness of general practice was moderate (30%), academic (22%) and industrial sector (17%) careers were least attractive. Proportions of medical students attracted to general practice were similar at medical education tracks with focus on primary healthcare compared to other medical education tracks (32.2% vs. 25.8%, p = 0.391). Conversely, proportions of medical students attracted to academic or industry careers were significantly higher at the ETH Zurich compared to other medical education tracks (37.2%, vs. 13.1%, p < 0.001 and 31.9%, vs. 8.8%, p < 0.001 respectively).

CONCLUSION

While most first-year medical students were open to careers in many medical disciplines, attractiveness of disciplines varied strongly. Students attracted to academic or industrial careers accumulated at the medical education track with concordant teaching focus but students attracted to general practice did not accumulate at medical education tracks focused on primary healthcare. For medical education tracks with primary care teaching focus this is both a challenge and an opportunity to specifically counteract the shortage of general practitioners in Switzerland.

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

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

Reported completion of the USMLE Step 1 and match outcomes among senior osteopathic students in 2020

Context

The United States Medical Licensing Examination (USMLE) is not required for osteopathic students to match into postgraduate programs; however, it is unknown if taking the test improves their chances of matching.

Objectives

Our objective was to determine the association between taking the USMLE Step 1 and matching into the applicant’s preferred specialty for senior osteopathic students applying to the 10 specialties to which students applied most in 2020.

Methods

We performed a secondary analysis of the free and publicly available 2020 National Residency Match Program (NRMP) published match report for senior osteopathic students. First, we determined the number of senior osteopathic students that matched into their preferred specialty vs those that did not and stratified them by reported completion of the USMLE Step 1 within each specialty. Next, we calculated odds ratios (ORs) within each specialty for senior osteopathic students matching into their preferred specialty with and without the USMLE Step 1 utilizing the Fisher’s exact test. Finally, we repeated the analysis with only senior osteopathic students who had reported USMLE Step 1 scores in ranges including or below the mean for those who matched in their specialty.

Results

For senior osteopathic students, reported completion of the USMLE Step 1 was associated with matching for those who applied to Internal Medicine (OR 3.3 [95% confidence interval 2.07 to 5.48]), Emergency Medicine (2.1 [1.35 to 3.17]), Pediatrics (4.4 [1.38 to 18.63]), Psychiatry (2.5 [1.34 to 4.98]), Anesthesiology (3.4 [1.57 to 7.32]), and General Surgery (3.1 [1.56 to 6.14]). After repeating the analysis with only senior osteopathic students who reported low USMLE Step 1 scores, the association remained significant for those who applied to Internal Medicine (2.5 [1.49 to 4.28]), Anesthesiology (2.6 [1.17 to 5.54]), and General Surgery (2.5 [1.24 to 5.04]).

Conclusions

In 2020, reported completion of the USMLE Step 1 by senior osteopathic students was associated with matching for those who applied to Internal Medicine, Emergency Medicine, Pediatrics, Psychiatry, Anesthesiology, and General Surgery. In addition, reported completion of the USMLE Step 1 with a low score was associated with matching for those who applied to Internal Medicine, Anesthesiology, and General Surgery.

Medical student residency preferences and motivational factors: a longitudinal, single-institution perspective

BACKGROUND

A high proportion of medical school graduates pursue specialties different from those declared at matriculation. While these choices influence the career paths, satisfaction, and potential regret students will experience, they also impact the supply and demand ratio of the shorthanded physician workforce across many specialties. In this study, we investigate how the choice of medical specialty and the factors motivating those choices change between the beginning and end of medical school training.

METHODS

A questionnaire was administered annually from 2017 to 2020 to a cohort of medical students at the University of Connecticut to determine longitudinal preferences regarding residency choice, motivational factors influencing residency choice, future career path, and demographic information.

RESULTS

The questionnaire respondent totals were as follows: n = 76 (Year 1), n = 54 (Year 2), n = 31 (Year 3), and n = 65 (Year 4). Amongst newly matriculated students, 25.0% were interested in primary care, which increased ~ 1.4-fold to 35.4% in the final year of medical school. In contrast, 38.2% of matriculated students expressed interest in surgical specialties, which decreased ~ 2.5-fold to 15.4% in the final year. Specialty choices in the final year that exhibited the largest absolute change from matriculation were orthopedic surgery (- 9.9%), family medicine (+ 8.1%), radiology (+ 7.9%), general surgery (- 7.2%), and anesthesiology (+ 6.2%). Newly matriculated students interested in primary care demonstrated no differences in their ranking of motivational factors compared to students interested in surgery, but many of these factors significantly deviated between the two career paths in the final year. Specifically, students interested in surgical specialties were more motivated by the rewards of salary and prestige compared to primary care students, who more highly ranked match confidence and family/location factors.

CONCLUSIONS

We identified how residency choices change from the beginning to the end of medical school, how certain motivational factors change with time, how these results diverge between primary care and surgery specialty choice, and propose a new theory based on risk-reward balance regarding residency choice. Our study promotes awareness of student preferences and may help guide school curricula in developing more student-tailored training approaches. This could foster positive long-term changes regarding career satisfaction and the physician workforce.

Education and training in psychiatry in South Asian countries

"Show me a sane man and I will cure him for you."-Carl Jung. Essentially, Jung was saying that a sane man does not exist. Emotional problems and difficulties are present in a benign form in the vast majority of people. Therefore, psychiatric education should focus on the very common nature of mental and emotional problems. Training of psychiatrists to provide the best quality care and conduct the highest quality research continues to remain a priority across the globe. The treatment and training gaps in many countries continue despite the sustained efforts at improving these, especially in low- and middle-income (LAMI) countries. Although many LAMI countries have improved curricula for undergraduate and postgraduate training, yet the treatment and training gap continues. This article will look to explore education and training in psychiatry in some of the South Asian countries with a special focus on India.

Exploring Doctors' Emerging Commitment to Rural and General Practice Roles over Their Early Career

Producing enough doctors working in general practice or rural locations, or both, remains a key global policy focus. However, there is a lack of evidence about doctors' emerging commitment to these decisions. This study aimed to explore changes in the level of certainty about career interest in working in general practice and working rurally, as doctors pass through various early career stages. The participants were 775 eligible respondents to a 2019 survey of medical graduates of The University of Queensland from 2002-2018. Certainty levels of specialty choice were similar between GPs and specialists up until the beginning of registrar training. At that point, 65% of GPs compared with 80% of other specialists had strong certainty of their specialty field. Consistently (and significantly) less of those working rurally had strong certainty of the location where they wanted to practice medicine at each career time point. At the start of registrar training, a similar gap remained (strong certainty: 51% rural versus 63% metropolitan). This study provides new evidence that career intent certainty is more delayed for the cohort choosing general practice and rural practice than the other options. The low level of certainty in early career highlights the importance of regular positive experiences that help to promote the uptake of general practice and rural practice.

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.

Impact of COVID-19 on residency choice: A survey of New York City medical students

Objectives

The Coronavirus disease 2019 (COVID-19) pandemic disrupted medical student education, particularly in New York City (NYC). We aimed to assess the impact of the COVID-19 pandemic on medical students’ residency choices.

Methods

The authors conducted a cross-sectional survey of medical students in all years of study at four NYC medical schools (Columbia, Cornell, NYU, and SUNY Downstate). The survey was fielded from 19 Aug 2020 to 21 Sep 2020. Survey questions included items assessing COVID-19 impact on residency choices, personal impact of COVID-19, residency/specialty choices, and factors influencing these choices.

Results

A total of 2310 students received the survey, with 547 (23.7%) providing partial responses and 212 (9.2%) providing valid responses for our primary analysis. 59.0% of participants thought that COVID-19 influenced their choice of residency/specialty, with 0.9% saying the influence was to a great extent, 22.2% to some extent, and 35.8% very little. On multivariable analysis, factors that were independently associated with COVID-19 impacting residency choice included low debt ($1 to $99,999: _adjOR 2.23, 95%CI 1.02–5.03) compared with no debt and Other race/ethnicity (_adjOR 0.26, 95%CI 0.10–0.63) compared with White race/ethnicity. On secondary analysis of all participants answering survey items for logistic regression regardless of survey completion, direct personal impact of COVID-19 was significantly associated with COVID-19 impacting specialty choice (_adjOR 1.90, 95%CI 1.04–3.52). Moreover, 24 students (11.6%) reported a change in their top residency choice from before to during/after COVID-19, citing concerns about frontline work, work-life balance, and risk of harm.

Conclusions

Our study found that 3 in 5 (59.0%) participants felt that COVID-19 impacted their residency choice, with 11.6% of respondents explicitly changing their top specialty choice. Investigating the impact of the pandemic on medical student residency considerations is crucial to understand how medical career outlooks may change in the future.

Exploring Careers in Medicine: Implementation and Perceived Value of a Multi-Specialty Elective

INTRODUCTION

Choosing a medical specialty is one of the most crucial and difficult decisions made during medical school. Given that specialty exposure is among the most important factors in decision-making, the Careers in Medicine (CiM) multi-specialty elective was designed to provide clerkship students an avenue to explore three or more specialties of interest during a single elective.

METHODS

A cross-sectional study was conducted at Vanderbilt University School of Medicine using anonymous surveys and de-identified written reflections submitted by students enrolled in the CiM course between August 2015 and June 2018. Data were analyzed using a mixed-methods approach.

RESULTS

The majority of students reported the elective guided them in ruling out (80%) and ruling in (65%) specialties. About half (51%) of students decided between the procedural versus critical-thinking dichotomy. Finally, 80% of students reported that they would take the course again rather than a focused elective. Major themes identified from student reflections included course attributes, specialty impacts, and student values.

DISCUSSION

Implementation of a multi-specialty elective during the clerkship year was an effective way to help students understand their career values, gain early exposure to specialties not featured in core clinical curriculums, and determine future fields of interest.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01311-0.

What Will It Mean for Me? Perceptions of the ECFMG 2023 Accreditation Requirement from an Online Forum

In 2010, the Educational Commission for Foreign Medical Graduates (ECFMG) announced that as of 2023, physicians applying to train and practice in the United States will be required to graduate from a medical school that has been accredited using criteria such as those developed by the World Federation for Medical Education. This study analyzed posts on the Student Doctor Network (SDN) online forum that refer to this accreditation requirement to investigate how it has been perceived and understood by current and prospective medical students. A keyword search of relevant terms was used to identify posts discussing the accreditation requirement on the SDN online forum, which were subjected to thematic analysis. There were a total of 83 posts from 49 distinct user accounts between May 2012 and January 2020. Seven themes were identified in total; four whose overall purpose was to seek or offer advice and three whose overall purpose was commentary. Themes relating to advice included applications and admissions, future career planning, personal circumstances, and countryspecific issues. Themes relating to commentary included the accreditation requirement policy itself, the potential implications of the requirement, and the educational quality of non-U.S. medical schools. Only half of web links on these posts were to the ECFMG website for official information about the requirement. Although a variety of different perspectives about the ECFMG accreditation requirement were expressed on an online forum for student doctors, the overall number of posts was low, which suggests that the requirement has not been a frequent topic of discussion on this platform. The insights gained from posts suggest personal opinions about the requirement and consequences for individual student application and career choices were the main areas of interest. Signposting to official information channels may help to raise awareness about the requirement and tackle areas of uncertainty and confusion about its implementation.

6th year medical students' future specialty preferences: A cross-sectional study

BACKGROUND

Studying career preferences can help in designing and improving health service systems. Determining the preferred specialty and understanding the compulsion affecting specialty choice will provide clues to influence such choice in the future to shift the balance of specialties among practitioners. The current study aimed to determine medical students' preferable specialty choices and the factors influencing their choices and their attitude towards postgraduate medical education in Jordan and abroad.

MATERIALS AND METHODS

The descriptive cross-sectional study design included 6th-year medical students in medical faculties in Jordan. An online questionnaire was created on Google Forms and posted on platforms accessible by medical students at level six. Numbers and percentages were presented for all variables. Frequency distributions were also presented. Chi-square distribution was used to measure the association between categorical data. Alpha level of 0.05 was used.

RESULTS

Most students 188 (74.3%) preferred to continue their post-graduate training abroad, while only 65 (25.7%) favored Jordan. 150 (59.3%) of the respondents are interested in the medical - non-surgical - specialties. The most important factor that encouraged the students to choose a specialty was Job opportunity (32.5%) followed by the number of years required to complete the training and the expected income (27.7%) each.

CONCLUSION

Supportive steps should be undertaken to motivate medical graduates toward the needed specialties. Moreover, local Specialty training programs need to be -reevaluated to ensure proper post graduate medical learning.

A scoping review of vascular surgery education in the medical school curriculum

OBJECTIVE

Despite the high burden of vascular disease that is assessed, investigated, and managed by generalists, no specific medical school curriculum is in use for vascular surgery (VS). In the present scoping review, we aimed to map the available evidence on the provision of VS education in the medical school curriculum worldwide.

METHODS

The present review was conducted in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analysis) extension for scoping reviews. The inclusion criterion was reported research studies on VS education in the medical curriculum.

RESULTS

A total of 20 studies were included. Three main themes were identified. VS was perceived as an essential part of the general medical student curriculum by VS applicants. Exposure to VS varied considerably, and students generally expressed a need for an increase in VS coverage. The most important positive determinants when choosing VS as a career were having a VS mentor, the technical aspects of VS, and participation in a VS rotation. Frequently cited deterrents were the long training time and demanding lifestyle potentially compromising family life.

CONCLUSIONS

The present scoping review has provided a starting point to better understand the provision of VS education in medical schools across the world. Our review has demonstrated the variability in VS exposure at medical school and described students' sentiments toward VS. We have highlighted the need to determine whether the current curricula are adequate from the perspective of multiple stakeholders (eg, vascular surgeons, educators, general practitioners, a variety of specialists) with a crucial role in the treatment of patients with vascular conditions.

Factors Influencing Female Medical Students' Decision to Pursue Surgical Specialties: A Systematic Review

INTRODUCTION

Gender inequality within the medical field continues to be a prominent issue, particularly for surgical specialties. The purpose of this systematic review was to evaluate the factors that influence female medical students' decision to pursue a career in surgery, including general surgery and surgical subspecialties.

METHODS

A literature search was conducted by 2 independent researchers searching PubMed, Embase, Medline, Web of Science, and Science Direct databases, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Keywords included "female," "medical students," "surgery," "gender," "career," "surgical subspecialty," "plastic surgery," "otolaryngology," "neurosurgery," "orthopedics," and "urology." Studies evaluating factors that influenced female medical students' decision to pursuing surgical specialties were identified.

RESULTS

The initial search identified 2200 articles. Five hundred twenty-seven duplicates were removed, and 1993 studies were eliminated based on inclusion and exclusion criteria. Sixty-one articles underwent full-text review. Twenty-six additional studies were identified from references. A total of 14 articles were included in the review. Female medical students were positively influenced by mentorship, intellectual challenge, the rewarding nature of surgery, and specialty exposure. Gender discrimination, surgical lifestyle, and societal and cultural barriers were deterrents for female medical students. Compared to male, females minimized the importance of prestige and expected financial rewards.

CONCLUSIONS

This systematic review identifies mentorship, specialty exposure, nature of the surgical field, gender discrimination, and personal factors to be major determinants in female medical students' decisions to pursue a career in surgery. While factors such as inherent interest in surgery may not be easily modified, improvements in gender discrimination, access to mentorship, and specialty exposure can attract more female trainees to surgical specialties. Specifically, improving parental leave policies, reducing pregnancy-related stigma, eliminating gender-discrimination, matching medical students with role models early, and implementing outreach programs designed for women may increase students' interest in a surgical career.

Considerations in Specialty Selections: What Medical Students Think, Know, and Think They Know about Interventional Radiology

PURPOSE

To compare the motivation, deterrents, knowledge, exposure, and other specialty considerations of first- to fourth-year medical students interested in interventional radiology (IR) with those who are not.

MATERIALS AND METHODS

Matriculants of 5 medical schools varying by region, public/private, class size, and National Institutes of Health research ranking received a 19-question survey with questions about demographics, specialty interests, motivations/deterrents, knowledge, and exposure to IR.

RESULTS

A total of 25.8% (611/2370) of students completed the survey, of which 20.5% (125/611) expressed interest in IR, and 25% (47/186), 26% (40/153), 24% (34/143), and 3% (3/117) of first-year, second-year, third-year, and fourth-year medical students, respectively, were seriously considering IR. Those interested in IR were less motivated by direct patient care (mean, 2.8/5; 95% confidence interval [CI], 2.6-3.0) and longitudinal patient care (mean, 1.6/5; 95% CI, 1.4-1.7) (both, P < .01) and more motivated by salary (2.6/5; 95% CI, 2.3-2.9), job market (2.8/5; 95% CI, 2.6-2.9), and procedures (3.1/5; 95% CI, 2.8-3.4) compared with their peers (all P < .05). Those interested in IR were more certain about their IR knowledge (mean range, 1.6-2.0/3.0; 95% CI, 1.3-2.3) than their peers (mean range, 1.9-2.4/3.0; 95% CI, 1.6-2.1, in which 0 = certain, P ≤ .01); however, both groups scored low in actual knowledge (those considering IR: 35.0-73.2% correct; 95% CI, 23.5-81.4; those who were not: 26.6-66.7% correct; 95% CI, 24.3-75.9, P > .05).

CONCLUSIONS

Although medical students showed interest in IR, they had a limited understanding of IR. IR educators may increase IR interest and understanding among medical students by clarifying the procedural aspects and longitudinal care present in a comprehensive IR practice.

Retaining VA Women's Health Primary Care Providers: Work Setting Matters

BACKGROUND

When an experienced provider opts to leave a healthcare workforce (attrition), there are significant costs, both direct and indirect. Turnover of healthcare providers is underreported and understudied, despite evidence that it negatively impacts care delivery and negatively impacts working conditions for remaining providers. In the Veterans Affairs (VA) healthcare system, attrition of women's health primary care providers (WH-PCPs) threatens a specially trained workforce; it is unknown what factors contribute to, or protect against, their attrition.

OBJECTIVE

Based on evidence that clinic environment, adequate support resources, and workload affect provider burnout and intent to leave, we explored if such clinic characteristics predict attrition of WH-PCPs in the VA, to identify protective factors.

DESIGN

This analysis drew on two waves of existing national VA survey data to examine predictors of WH-PCP attrition, via logistic regression.

PARTICIPANTS

All 2,259 providers from 140 facilities VA-wide who were WH-PCPs on September 30, 2016.

MAIN MEASURES

The dependent variable was WH-PCP attrition in the following year. Candidate predictors were clinic environment (working in: a comprehensive women's health center, a limited women's health clinic, a general primary care clinic, or multiple clinic environments), availability of co-located specialty support resources (mental health, social work, clinical pharmacy), provider characteristics (gender, professional degree), and clinic workload (clinic sessions per week).

KEY RESULTS

Working exclusively in a comprehensive women's health center uniquely predicted significantly lower risk of WH-PCP attrition (adjusted odds ratio 0.40; CI 0.19-0.86).

CONCLUSIONS

A comprehensive women's health center clinical context may promote retention of this specially trained primary care workforce. Exploring potential mechanisms-e.g., shared mission, appropriate support to meet patients' needs, or a cohesive team environment-may inform broader efforts to retain front-line providers.

Inspiring the future generation of oncologists: a UK-wide study of medical students' views towards oncology

BACKGROUND

One in 2 people born in the UK after 1960 are expected to require oncology input in their lifetime. However, only 36% of UK medical schools provide dedicated oncology placements and teaching indicating a discordance between public health impact and training. We designed a UK-wide survey to capture medical students' views on current oncology teaching and the potential role of a national undergraduate oncology symposium as an educational, networking and motivational tool.

METHODS

We undertook a national cross-sectional survey of UK medical students' views in oncology and satisfaction with teaching using pre-designed questionnaires. We also distributed a dedicated survey (pre and post-conference) to compare medical students' motivation towards a career in oncology after attending the national symposium. This study was prospectively approved by QMUL Ethics Committee (Reference number QMREC2348). Statistical analysis included univariate inferential tests on SPSS and GraphPad software.

RESULTS

The national survey was completed by 166 students representing 22 UK medical schools. Students reported limited interest, knowledge and exposure to oncology, lack of confidence in skills, and teaching dissatisfaction. Oncology was perceived as a challenging specialty (mean 4.5/5 ± 0.7), yet most students estimate receiving only 1-2 weeks of dedicated oncology teaching. The national symposium generated a statically significant increase in students' interest, knowledge, and confidence in skills surrounding oncology, improving students' perceived ability to cope with the emotional challenges in this field.

CONCLUSION

Students' views towards oncology alongside their teaching dissatisfaction underpin the need to revisit and strive to improve current undergraduate oncology curricula. Increasing medical student oncology exposure by proposing outcome-based guidelines and adopting a standardised undergraduate oncology curriculum should be the foremost priority in inspiring future oncologists to ensure excellent cancer patient care.

Barriers to Women Entering Surgical Careers: A Global Study into Medical Student Perceptions

BACKGROUND

Barriers to female surgeons entering the field are well documented in Australia, the USA and the UK, but how generalizable these problems are to other regions remains unknown.

METHODS

A cross-sectional survey was developed by the International Federation of Medical Students' Associations (IFMSA)'s Global Surgery Working Group assessing medical students' desire to pursue a surgical career at different stages of their medical degree. The questionnaire also included questions on students' perceptions of their education, resources and professional life. The survey was distributed via IFMSA mailing lists, conferences and social media. Univariate analysis was performed, and statistically significant exposures were added to a multivariate model. This model was then tested in male and female medical students, before a further subset analysis by country World Bank income strata.

RESULTS

639 medical students from 75 countries completed the survey. Mentorship [OR 3.42 (CI 2.29-5.12) p = 0.00], the acute element of the surgical specialties [OR 2.22 (CI 1.49-3.29) p = 0.00], academic competitiveness [OR 1.61 (CI 1.07-2.42) p = 0.02] and being from a high or upper-middle-income country (HIC and UMIC) [OR 1.56 (CI 1.021-2.369) p = 0.04] all increased likelihood to be considering a surgical career, whereas perceived access to postgraduate training [OR 0.63 (CI 0.417-0.943) p = 0.03], increased year of study [OR 0.68 (CI 0.57-0.81) p = 0.00] and perceived heavy workload [OR 0.47 (CI 0.31-0.73) p = 0.00] all decreased likelihood to consider a surgical career. Perceived quality of surgical teaching and quality of surgical services in country overall did not affect students' decision to pursue surgery. On subset analysis, perceived poor access to postgraduate training made women 60% less likely to consider a surgical career [OR 0.381 (CI 0.217-0.671) p = 0.00], whilst not showing an effect in the men [OR 1.13 (CI 0.61-2.12) p = 0.70. Concerns about high cost of training halve the likelihood of students from low and low-middle-income countries (LICs and LMICs) considering a surgical career [OR 0.45 (CI 0.25-0.82) p = 0.00] whilst not demonstrating a significant relationship in HIC or UMIC countries. Women from LICs and LMICs were 40% less likely to consider surgical careers than men, when controlling for other factors [OR 0.59 CI (0.342-1.01 p = 0.053].

CONCLUSION

Perceived poor access to postgraduate training and heavy workload dissuade students worldwide from considering surgical careers. Postgraduate training in particular appears to be most significant for women and cost of training an additional factor in both women and men from LMICs and LICs. Mentorship remains an important and modifiable factor in influencing student's decision to pursue surgery. Quality of surgical education showed no effect on student decision-making.

Reflection on career choices in clinical neurosciences

Medical faculties are responsible for high-level training, not only on clinical skills but also on scientific research and medical advances. There is an evident need to promote academic careers to ensure the continuity and improvement of top-notch health care. Even if Switzerland is one of the countries with the highest medical density per inhabitant, the lack of interest for academic careers has increased, resulting in difficulties to form clinician-scientists and ensure succession. In this article, we reflect on the challenges and the potential solutions in the training of an academic career.

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.

Proposed Changes to the 2021 Residency Application Process in the Wake of COVID-19

The COVID-19 pandemic has brought unique challenges to the delivery of undergraduate medical education, particularly for current third-year medical students who are preparing to apply to residency. In mid-March, medical schools suspended all clinical rotations for the remainder of the 2019-2020 academic year. As such, third-year medical students may not be able to complete sufficient clinical experiences to make important career choices before they have to submit their residency applications. While the decision to suspend clinical rotations was necessary to protect students, specialty organizations and residency programs must mitigate the deficits in students' clinical education caused by the COVID-19 pandemic.In this Perspective, the authors identify potential challenges for third-year medical students and advocate for solutions to improve the residency application process for students and programs. First, they propose delaying the date that programs can access applicant data through the Electronic Residency Application Service, thereby affording students more time to complete clinical experiences, solidify their specialty decision, and strengthen their residency application. Second, the authors recommend a restriction on the number of visiting rotations that students are expected to complete to allow for a more equitable distribution of these important experiences. Third, they suggest that program directors from each specialty agree on a maximum number of applications per applicant (based on historical data) to curb an upsurge in applications that may stem from the unique circumstances created by COVID-19 without causing applicants undue stress. Lastly, the authors advocate that residency programs develop infrastructure to conduct video-based interviews and engage students through virtual networking events.Amidst the unique environment created by COVID-19, the authors urge governing bodies, specialty organizations, and residency programs to consider these recommendations to improve the efficiency and reduce the stress surrounding the 2021 Match.

Student Exposure to Cancer Patients: an Analysis of Clinical Logbooks and Focus Groups in Clinical Year Medical Students

Despite cancer being the leading cause of mortality, cancer education and patient exposure are lacking in many medical schools. The aim of this study was to evaluate the nature of cancer patient exposure, relative to the clinical setting for medical students on placement and to explore their experiences. Participants were asked to maintain a logbook of cancer patient encounters and were invited to attend a structured focus group upon completion of the academic year. Eleven students submitted logbooks (rr = 6.15%) and eight participated in the focus groups (4.47%). A total of 247 cancer patient encounters were recorded. Third-year students primarily saw cancer patients in surgery (18.62%) and general practice (8.50%), whilst final year students saw cancer patients most frequently in palliative care (35.22%) and ENT surgery (13.77%). Students highlighted that the quality of their interactions with cancer patients varied significantly between clinical settings. Outpatient clinics and surgical in-patients had the lowest level of interaction, with students having a predominantly observatory role. Repeated themes of uncertainty and awkwardness regarding history, examination and discussing death and dying were outcomes of the thematic analysis. Exposure to cancer patients remains highly variable and opportunistic. Students voiced concerns for preparedness to practice and many found it worrisome that they will likely examine a primary cancer when they have graduated, without having done so during their training. Our study suggests that a more structured approach to teaching and clinical exposure to cancer patients is required.

[Factors influencing the choice of a career in primary care among medical students in Central America]

Objectives

To identify the preferred specialties, salary perception and other factors that influence the choice of a career in primary care among last-year medical students or social service students in Central America.

Methods

A cross-sectional, multicenter study using a survey that investigated demographic information, preferred specialty, salary perception, and other factors that influence the choice of a specialty.

Results

A total of 1 722 students from 31 universities participated and identified as future specialties: surgery (11.7%), gynecology/obstetrics (10.3%), pediatrics (9.9%) and internal medicine (6.6%). General medicine was preferred by 3.8% and family medicine by 1.1%. On grouping them, the greatest interest was observed for medical specialties (49.7%), followed by surgical specialties (31.7%). Primary care registered an interest of 17.1%. Surgical specialties were perceived as having the highest income (USD 36 000); primary care was perceived as having the lowest income (USD 24 000). Income (23.6%), future work (19.7%) and "making a difference in people" (8.9%) were the main factors involved in the choice. "Working with people with low access" was significantly associated with preference for primary care. Preference for other specialties was influenced by "perceived prestige" and "enjoying life" (P < 0.05). Most participants who chose primary care were studying at a public university (P < 0.05), highlighting the role of public institutions of higher education.

Conclusions

There is a combination of facilitating factors and barriers that affect the low interest in primary care careers. There is a need for strategies from academia and the government sector, as well as the definition of public policies, that support the choice of primary care.

An Evaluation of the SCORE Program: A Novel Research and Mentoring Program for Medical Students in Obstetrics/Gynecology and Otolaryngology

BACKGROUND

There has been a steady decrease in the number of physician-scientists and a lack of diversity and inclusion of underrepresented minorities (URMs) in medicine.

OBJECTIVE

To assess the research productivity, interest, and experience of medical students, including URMs, and resident and faculty mentors of the Kaiser Permanente Oakland Medical Center's 8-week, intensive, mentored Summer Clinical Otolaryngology and Obstetrics/Gynecology Research (SCORE) Program for second-year medical students.

METHODS

A database of SCORE Program research projects was generated from 2016, when the program was launched, through 2018. SCORE Program students and faculty completed a brief, mixed-methods, anonymous exit survey that captured respondents' experiences, perceived program strengths, and opportunities for improvement. The number of peer-reviewed manuscripts produced were counted.

RESULTS

A total of 16 SCORE Program students (50% female and 38% URMs) between 2016 and 2018 and 8 residents and 8 faculty members in 2018 completed a brief, mixed-methods, anonymous exit survey that captured respondents' experiences, perceived program strengths, and opportunities for improvement. The medical students coauthored 12 published peer-reviewed articles, 25 abstracts or national posters, and 1 opinion editorial. According to the program's annual exit survey, 87% of students reported an increased interest in pursuing research, 93% had an increased interest in their respective specialties, and 93% believed they had positive mentorship experiences. Similarly, faculty and residents enjoyed mentoring students, thought that students positively contributed to their projects, and would support the SCORE Program in the future.

CONCLUSION

Structured research and mentoring experiences, such as the SCORE Program, may encourage students, including URMs, to pursue research throughout their careers in addition to adding research to their curriculum vitae to strengthen their residency applications.

The Significance of Experiencing Clinical Responsibilities for Specialty Career Choice

AIM

Medical trainees make career choices in the final year of medical school or after graduation, if they do not continue with residency directly. Most Dutch medical students are trained in vertically integrated (VI) curricula, with early clinical experience and a gradual increase in clinical responsibilities. Students in such curricula have been reported to make career choices at an earlier stage than graduates from more traditionally designed curricula. Many Dutch graduates build further clinical experience after graduation as physicians-not-in-training (PNITs) before beginning residency. We explored how students make career choices and whether pre-residency clinical responsibilities influence this choice.

METHOD

A qualitative study with a phenomenology approach was used. The authors conducted a longitudinal interview study of medical students with two intervals over a 2-year period. The interview questions covered how trainees establish career preferences and which factors affect preference and choice over time.

RESULTS

Experiencing clinical responsibility was a key factor for career preference during all interview rounds. Being a PNIT who makes diagnostic and therapeutic decisions, have their own patients and have significant patient care responsibilities creates opportunities to build an image of a future context of employment. Some participants mentioned that their experience of having full responsibility as a PNIT was pivotal in a career preference change.

CONCLUSION

Clinical responsibility as a student or a PNIT appears to be important for career preference and choice. The experience of responsibility as a medical doctor forces trainees to reflect on personal needs and to consider which career preference fits best.

Specialty and Lifestyle Preference Changes during Medical School

PURPOSE

Medical student specialty choices have significant downstream effects on the availability of physicians and, ultimately, the effectiveness of health systems. This study investigated how medical student specialty preferences change over time in relation to their demographics and lifestyle preferences.

METHOD

Students from ten medical schools were surveyed at matriculation (2012) and graduation (2016). The two surveys included questions about specialty and lifestyle preferences, demographics, educational background, and indebtedness. Student data from 2012 to 2016 were paired together and grouped into those whose specialty preferences remained constant or switched.

RESULTS

Response rates in 2012 and 2016 were 65% (997/1530) and 50% (788/1575), respectively. Fourth-year students ranked "enjoying the type of work I am doing" as less important to a good physician lifestyle than did first-year students (from 59.6 to 39.7%). The lifestyle factors "having control of work schedule" and "having enough time off work" were ranked as more important to fourth-year students than first-year students (from 15.6 to 18.2% and 14.8 to 31.9%, respectively). The paired dataset included 19% of eligible students (237/1226). Demographic and lifestyle factors were not significantly associated with specialty preference switching. Additionally, no significant association existed between changing lifestyle preferences and switching specialty preference (p = 0.85).

CONCLUSIONS

During the course of medical school, lifestyle preferences became more focused on day-to-day factors and less on deeper motivational factors. Neither demographics nor lifestyle preferences appear to relate to a student's decision to switch specialty preference during medical school. These findings represent an important step in uncovering causes of specialty preference trends.