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Harper LL, Desy J, Davis M, Weeks S, McLaughlin K. Personal career decisions during medical training are not complicated, they are complex. MEDICAL EDUCATION 2024; 58:1042-1048. [PMID: 38888176 DOI: 10.1111/medu.15466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/23/2024] [Accepted: 05/29/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND For medical training to be deemed successful, in addition to gaining the skills required to make appropriate clinical decisions, trainees must learn how to make good personal decisions. These decisions may affect satisfaction with career choice, work-life balance, and their ability to maintain/improve clinical performance over time-outcomes that can impact future wellness. Here, the authors introduce a decision-making framework with the goal of improving our understanding of personal decisions. METHODS Stemming from the business world, the Cynefin framework describes five decision-making domains: clear, complicated, complex, chaotic, and confusion, and a key inference of this framework is that decision-making can be improved by first identifying the decision-making domain. Personal decisions are largely complex-so applying linear decision-making strategies is unlikely to help in this domain. RESULTS The available data suggest that the outcomes of personal decisions are suboptimal, and the authors propose three mechanisms to explain these findings: (1) Complex decision is susceptible to attribute substitution where we subconsciously trade these decisions for easier decisions; (2) predictions are prone to cognitive biases, such as assuming our situation will remain constant (linear projection fallacy), believing that accomplishing a goal will deliver lasting happiness (arrival bias), or overestimating benefits and underestimating costs of future tasks (planning fallacy); and (3) complex decisions have an inherently higher failure rate than complicated decisions because they are the result of an ongoing, dynamic person-by-situation interaction and, as such, have more time to fail and more ways to do so. DISCUSSION Based upon their view that personal decisions are complex, the authors propose strategies to improve satisfaction with personal decisions, including increasing awareness of biases that may impact personal decisions. Recognising that the outcome of personal decisions can change over time, they also suggest additional interventions to manage these decisions, such as different forms of mentoring.
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Affiliation(s)
- Lea Lea Harper
- Office of Postgraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Janeve Desy
- Office of Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Melinda Davis
- Office of Postgraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Weeks
- Office of Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin McLaughlin
- Office of Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Balkhair AM, Almaghrabi MM, Banjer HM, Waznah R, Almadani M, Hariri J. Analysis of Influencing Factors for Choosing Dermatology as a Future Career: A Cross-Sectional Study Among Medical Students at King Abdulaziz University. Cureus 2024; 16:e66021. [PMID: 39221409 PMCID: PMC11366280 DOI: 10.7759/cureus.66021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Determining the influencing factors of choice of medical specialty is key to a balanced distribution of physicians across specialties. Dermatology, the specialty concerned with treating skin disorders, is known for being among the most wanted; however, studies identifying the factors that attract students to this specialty are lacking. Our study aimed to investigate the influencing factors of the choice of dermatology as a career in clinical-year medical students. METHODS We conducted a cross-sectional study with a sample of clinical-year medical students from King Abdulaziz University, Jeddah, Saudi Arabia, between 2020 and 2021. We collected data using an online self-administered questionnaire; we replicated a questionnaire present in prior research. We compared categorical data using the chi-square and Fisher's exact tests. Results: In total, there were 252 participants, with 30 (11.9%) choosing dermatology as a specialty. Over half showed an average grade of more than 4.5 (66.7%), and 83.3% were female. The significant influencing factors of students' choice of dermatology as a career were: the likelihood of dermatologists influencing patients' lives (p=0.000), opportunities to conduct research in dermatology (P=0.000), how Dermatology allows people to have a satisfying family life (P=0.001), and opportunities for part-time work in dermatology (p=0.000). CONCLUSION Many factors influenced the choice of a future medical specialty in our sample. Focusing on these factors while guiding students to choose their specialty may enable a promising next generation of physicians.
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Affiliation(s)
| | | | - Hanin M Banjer
- Dermatology, King Abdulaziz University Hospital, Jeddah, SAU
| | - Roba Waznah
- Dermatology, King Abdulaziz University Hospital, Jeddah, SAU
| | - Malika Almadani
- Dermatology, King Abdulaziz University Hospital, Jeddah, SAU
| | - Jehad Hariri
- Dermatology, King Abdulaziz University Hospital, Jeddah, SAU
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Balas M, Scheepers RM, Zador Z, Ibrahim GM, Premji L, Witiw CD. Profiling medical specialties and informing aspiring physicians: a data-driven approach. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:829-840. [PMID: 37698730 DOI: 10.1007/s10459-023-10283-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/03/2023] [Indexed: 09/13/2023]
Abstract
A detailed, unbiased perspective of the inter-relations among medical fields could help students make informed decisions on their future career plans. Using a data-driven approach, the inter-relations among different medical fields were decomposed and clustered based on the similarity of their working environments.Publicly available, aggregate databases were merged into a single rich dataset containing demographic, working environment and remuneration information for physicians across Canada. These data were collected from the Canadian Institute for Health Information, the Canadian Medical Association, and the Institute for Clinical Evaluative Sciences, primarily from 2018 to 2019. The merged dataset includes 25 unique medical specialties, each with 36 indicator variables. Latent Profile Analysis (LPA) was used to group specialties into distinct clusters based on relatedness.The 25 medical specialties were decomposed into seven clusters (latent variables) that were chosen based on the Bayesian Information Criterion. The Kruskal-Wallis test identified eight indicator variables that significantly differed between the seven profiles. These variables included income, work settings and payment styles. Variables that did not significantly vary between profiles included demographics, professional satisfaction, and work-life balance satisfaction.The 25 analyzed medical specialties were grouped in an unsupervised manner into seven profiles via LPA. These profiles correspond to expected and meaningful groups of specialties that share a common theme and set of indicator variables (e.g. procedurally-focused, clinic-based practice). These profiles can help aspiring physicians narrow down and guide specialty choice.
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Affiliation(s)
- Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Zsolt Zador
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Department of Surgery, University of Toronto, 30 Bond Street, M5B 1W8, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Laila Premji
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christopher D Witiw
- Division of Neurosurgery, Department of Surgery, University of Toronto, 30 Bond Street, M5B 1W8, Toronto, ON, Canada.
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada.
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Ashley L, McDonald I. When the Penny Drops: Understanding how social class influences speciality careers in the UK medical profession. Soc Sci Med 2024; 348:116747. [PMID: 38547804 DOI: 10.1016/j.socscimed.2024.116747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 04/29/2024]
Abstract
In the UK, the medical profession is socially exclusive and socially stratified as doctors from more advantaged backgrounds are more likely to train for specialities with more competitive entry. However, in research to date the causes and consequences of social stratification have been overlooked. We explore this subject here, drawing on a qualitative study comprising in-depth interviews with 30 medical students and doctors from less advantaged socio-economic backgrounds negotiating medical school and early careers. Using Bourdieu's 'theory of practice' we show how socialisation in the family and at school influences how aspirant medics from less advantaged backgrounds view the world, suggesting some inclination towards more community orientated careers, which may be less competitive. However, these tendencies are encouraged as they lack stocks of social, economic and cultural capital, which are convertible to power and position in the field. While allowing for both choice and constraint our core argument is that speciality outcomes are sometimes inequitable and potentially inefficient, as doctors from more advantaged backgrounds have privileged access to more competitive careers for reasons not solely related to ability or skill. Our main theoretical contribution is to literature in the sociology of medical education where ours is the first study to open-up the 'black box' of causal factors connecting medical students' resources on entering the field of education and training with speciality outcomes, though our findings also have important implications for practitioners, the profession and for patients. We discuss the implications for safe and effective healthcare and how this informs directions for future research.
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Affiliation(s)
- Louise Ashley
- School of Business and Management, Queen Mary University of London, Mile End Road, London, E1 4NS, UK.
| | - Ian McDonald
- School of Business and Management, Royal Holloway University of London, Egham Hill, Egham, TW1 0EX, UK
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Dawod MS, Alswerki MN, Al-Takhaineh MA. Factors that influence medical students' decision to pursue a career in orthopaedics: a comprehensive analysis. INTERNATIONAL ORTHOPAEDICS 2024; 48:1139-1147. [PMID: 38436709 DOI: 10.1007/s00264-024-06132-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Selecting a postgraduate medical or surgical specialty is a significant decision for medical students, influenced by factors such as demographics, academic performance, satisfaction, work environments, personal aspirations, passion for a specific specialty, exposure to different fields during medical education, lifestyle considerations, financial factors, job market conditions, and prospects. Our research focused on orthopaedic surgery, a highly competitive specialty with many applicants and a low acceptance rate. We aimed to investigate the factors that contribute to the sustained interest in this specialty despite the challenges of securing a residency position. Hence, this study aims to examine the potential factors that influence students' decision to pursue a career as an orthopaedic surgeon. METHODS This cross-sectional study explores the perspectives and attitudes of 211 fifth-year medical students towards orthopaedic surgery after completing their clinical rotation at Mutah University's School of Medicine in 2022. The inclusion criteria for the study were limited to fifth-year medical students who successfully finished the orthopaedic rotation. A questionnaire was employed to evaluate students' firm commitment to orthopaedics as a prospective career and the degree of their current interest in the specialty. RESULTS The study involved 210 participants, with 99 selecting orthopaedics as their specialty and 111 pursuing alternatives. Furthermore, 41.4% expressed the intention to apply for orthopaedic residencies. Factors impacting orthopaedics selection included family/peer input (p = 0.002), prestige (p = 0.002), research prospects (p = 0.005), leadership potential (p = 0.011). Chi-square analysis showed associations between choosing orthopaedics and male gender (p = 0.028), parental occupation in musculoskeletal fields (p = 0.038), and elective rotations (p = 0.016). CONCLUSION This study examines the factors that influence medical students' career preferences in orthopaedic surgery, highlighting the significance of familial and peer influences, job prestige perceptions, gender considerations, parental involvement, elective rotations, research and teaching potential assessments, and aspirations for leadership roles. These findings reveal the complex array of factors that guide medical students toward orthopaedic surgery.
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Affiliation(s)
- Moh'd S Dawod
- Faculty of Medicine, Mutah University, Al-karak, Jordan
| | - Mohammad N Alswerki
- Department of Orthopedics, Jordan University Hospital, P.O. Box: 13046, Amman, 11942, Jordan.
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Ní hÉalaithe C, Howard A, Corcoran P, McCarthy CM, Horgan M, Bennett D, O'Donoghue K, O'Sullivan S. Factors influencing medical students' decision to pursue a career in obstetrics and gynaecology. PLoS One 2023; 18:e0288130. [PMID: 38051720 DOI: 10.1371/journal.pone.0288130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/20/2023] [Indexed: 12/07/2023] Open
Abstract
INTRODUCTION The career intentions of medical students can exert influence on service provision and medical staffing in the health services. It is vital for a specialty's development and sustainability that it has a constant stream of trainees into it annually. An appreciation of how a specialty is viewed by medical students can be used as an opportunity for early intervention in order to improve perception of the specialty and reduce future workforce problems, such as retention and attrition within obstetrics and gynaecology (O&G). We aimed to analyse positive and negative factors of the specialty of O&G as perceived by medical students in order to gain insight into changes that need to be made to improve recruitment and retention into the specialty. METHODS A 70-item structured questionnaire consisting of demographic information and 5-point Likert scale questions relating to O&G was administered to final year medical students in the Republic of Ireland. Data were analysed with descriptive statistics, logistic regression, and odds ratios as appropriate. RESULTS Of 195 medical students approached, 134 completed the questionnaire, a response rate of 68.7%. The majority were female (55.2%, n = 74) and 76.1% of respondents (n = 102) were Direct Entry Medicine students, with the remainder Graduate Entry Medicine students. 30.8% (n = 41) of students who responded scored 6 or more on a 10-point Likert scale when asked about their likelihood of considering a career in O&G. Students' clerkship experience factored heavily into their perception of the specialty and was more likely to be positive if they experienced direct consultant engagement and the opportunity for hands-on experience. Lifestyle factors, litigation and media were found to be deterrents to considering the specialty after graduation. CONCLUSIONS This study demonstrates the importance of good clerkship experience in fostering an interest amongst undergraduates in O&G. Educators and those working within the specialty should showcase the strengths of the specialty during undergraduate education, and work on ameliorating deterrents to ultimately provide a structured approach to improving recruitment into O&G.
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Affiliation(s)
- Caoimhe Ní hÉalaithe
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Aoife Howard
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Paul Corcoran
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | | | - Mary Horgan
- Royal College of Physicians of Ireland, Dublin, Ireland
| | - Deirdre Bennett
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
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Banner K, Alberti H, Khan SA, Jones MM, Pope LM. 'They say': medical students' perceptions of General Practice, experiences informing these perceptions, and their impact on career intention-a qualitative study among medical students in England. BMJ Open 2023; 13:e073429. [PMID: 37949618 PMCID: PMC10649761 DOI: 10.1136/bmjopen-2023-073429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES The number of UK graduates choosing General Practice training remains significantly lower than the current numbers required to meet the demands of the service. This work aims to explore medical students' perceptions of General Practice, experiences which lead to the development of these perceptions, and the ultimate impact of these on career intention. DESIGN This mixed-methods, qualitative study used focus groups, semistructured interviews, longitudinal audio diary data and debrief interviews to explore and capture the experiences and perceptions of students in their first and penultimate years of university. SETTING Three English medical schools. PARTICIPANTS Twenty students were recruited to focus groups from first and fourth/fifth year of study. All students in these years of study were invited to attend. Six students were recruited into the longitudinal diary study to further explore their experiences. RESULTS This work identified that external factors, internal driving force and the 'they say' phenomenon were all influential on the development of perceptions and ultimately career intention. External factors may be split into human or non-human influences, for example, aspirational/inspirational seniors, family, peers (human), placements and 'the push' of GP promotion (non-human). Driving force refers to internal factors, to which the student compares their experiences in an ongoing process of reflection, to understand if they feel General Practice is a career they wish to pursue. The 'they say' phenomenon refers to a passive and pervasive perception, without a known source, whereby usually negative perceptions circulate around the undergraduate community. CONCLUSION Future strategies to recruit graduates to General Practice need to consider factors at an undergraduate level. Positive placement experiences should be maximised, while avoiding overtly 'pushing' GP onto students.
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Affiliation(s)
- Kimberley Banner
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Hugh Alberti
- School of Medical Education, Newcastle University, Medical School, Newcastle upon Tyne, UK
| | - Shehleen Arbab Khan
- Community Based Medical Education (CBME), Manchester Medical School, University of Manchester, Manchester, UK
| | - Melvyn Mark Jones
- Research Department of Primary Care and Population Health, University College London Medical School, London, UK
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Russell DJ, Monani D, Martin P, Wakerman J. Addressing the GP vocational training crisis in remote Australia: Lessons from the Northern Territory. Aust J Rural Health 2023; 31:967-978. [PMID: 37607122 DOI: 10.1111/ajr.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/24/2023] [Accepted: 07/30/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE GP vocational training enrolments are declining Australia-wide and, in the Northern Territory (NT), considered by some as '…the litmus test for the national scene' the decline is precipitous. This research investigates the drivers of declining GP training uptake in the NT and identifies and ranks potential solutions. SETTING NT, Australia. PARTICIPANTS Ten senior medical students, 6 junior doctors, 11 GP registrars, 11 GP supervisors and 31 stakeholders. DESIGN Mixed methods: scoping review of Australian literature mapping key concepts to GP training pathway stages and marketing/communications; secondary data analyses; key informant interviews; and a stakeholder validation/prioritisation workshop. Interview data were thematically analysed. Workshop participants received summarised study findings and participated in structured discussions of potential solutions prior to nominating top five strategies in each of five categories. RESULTS Highly prioritised strategies included increasing prevocational training opportunities in primary care and selecting junior doctors interested in rural generalism and long-term NT practice. Also ranked highly were: [Medical School] ensuring adequate infrastructure; [Vocational Training] offering high quality, culturally sensitive, flexible professional and personal support; [General Practice] better remunerating GPs; and [Marketing] ensuring positive aspects such as diversity of experiences and expedited GP career opportunities were promoted. CONCLUSION Multifaceted strategies to increase GP training uptake are needed, which target different stages of GP training. Effective action is likely to require multiple strategies with coordinated action by different jurisdictional and national key stakeholder agencies. Foremost amongst the interventions required is the urgent need to expand primary care training opportunities in NT for prevocational doctors.
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Affiliation(s)
- Deborah Jane Russell
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - Devaki Monani
- Charles Darwin University, Darwin, Northern Territory, Australia
| | - Priya Martin
- Faculty of Medicine, Rural Clinical School, University of Queensland, Brisbane, Queensland, Australia
| | - John Wakerman
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
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Jebram L, Prediger S, Oubaid V, Harendza S. Matching of advanced undergraduate medical students' competence profiles with the required competence profiles of their specialty of choice for postgraduate training. BMC MEDICAL EDUCATION 2023; 23:647. [PMID: 37679688 PMCID: PMC10485971 DOI: 10.1186/s12909-023-04632-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Matching between undergraduate students and their chosen specialty has implications for their personal job satisfaction and performance as well as societies' needs regarding health care quality. Knowledge regarding student-specialty fit can help improve students' decisions and detect potential deficiencies in specific competences. In this study, we compare self-assessed competence profiles of medical students close to graduation with the competence profiles of their specialty of choice for postgraduate training. METHODS Self-assessed competence profiles were collected with the modified requirement-tracking (R-Track) questionnaire from 197 final-year medical students close to graduation in 2022. To determine student-specialty fit, difference scores between students' self-assessed competences and physicians' requirements for specific specialties were calculated across the R-Track's six competence areas "Motivation", "Personality traits", "Social interactive competences", "Mental abilities", "Psychomotor & multitasking abilities", and "Sensory abilities", which were assessed on a 5-point Likert scale (1: "very low" to 5: "very high"). Mean difference scores across competence areas were calculated and compared between specialties with multivariate analysis of variance. Student-specialty fit was also calculated independent of students' choices. RESULTS The competence area "Motivation" scored highest for both students and physicians across specialties. However, students' scores were lower than physicians' requirements for "Motivation" as well as "Personality traits" across all specialties. Difference scores for "Social interactive competences" were either close to zero or showed higher scores for students. A similar competence pattern for internal medicine, general medicine, paediatrics, and gynaecology was identified with higher than required student scores for "Mental abilities", "Psychomotor & multitasking abilities", and "Sensory abilities". All other specialties showed higher physicians' requirements for at least one of these competence areas. Independent of students' specialty choice, we found the highest difference score in favour of student scores for general medicine (0.31) and the lowest difference score for internal medicine (-0.02). CONCLUSIONS Students' competence profiles overall show better fit with person-oriented specialties. "Mental abilities", "Psychomotor & multitasking abilities", and "Sensory abilities" show higher requirement scores for more technique-oriented specialties. Students interested in such specialties could focus more on basic skill development in undergraduate training or will develop specific skills during residency.
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Affiliation(s)
- Lea Jebram
- III. Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Prediger
- III. Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Sigrid Harendza
- III. Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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Alwadany MM, Al Ojail HY, Almousa AS, Al Wadany FM. Factors Influencing Medical Students' Interest in Dermatology: A Cross-Sectional Study in the Eastern Province of Saudi Arabia. Cureus 2023; 15:e42313. [PMID: 37614258 PMCID: PMC10442597 DOI: 10.7759/cureus.42313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2023] [Indexed: 08/25/2023] Open
Abstract
Introduction The demand for dermatologists is increasing due to the rising prevalence of skin diseases and the growing importance of dermatological care. However, there is limited research investigating the factors that influence medical students' interest in pursuing dermatology as a career option in Saudi Arabia, specifically in the Eastern Province. Methods This cross-sectional study aimed to assess the impact of dermatology rotation experience on the interest and perception of medical students and interns in the Eastern Province of Saudi Arabia. The participants consisted of medical students and interns located specifically in the Eastern Province. Data were collected through an online self-administered questionnaire that captured socio-demographic characteristics and evaluated the impact of dermatology rotation experience using a 3-point Likert scale. Convenient non-probability sampling was employed by sharing the questionnaire link on popular social media platforms. Results A total of 697 medical students from the Eastern Province of Saudi Arabia participated in this study, with an almost equal distribution between genders. A substantial proportion of participants expressed a strong preference for dermatology as their future career. While approximately 60% had completed a dermatology rotation, more than half found the process tiring. However, most participants agreed that dermatology offers flexible working hours, a better lifestyle, superior career options, and higher earnings compared to other healthcare professions. The study also revealed that factors such as age, marital status, academic level, GPA (grade point average), and income influenced the impact of the dermatology rotation. Conclusion This study sheds light on the factors influencing medical students' interest in dermatology and their perceptions of dermatology rotations. The findings emphasize the importance of diversity, early exposure, educational interventions, and supportive environments in promoting dermatology as a career choice. Overcoming barriers, enhancing transparency in assessment systems, and improving educational experiences can further foster interest in dermatology among medical students and address the growing demand for dermatological care.
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Spain E, Tumelty ME, Hannigan A, Cinnamond K, Cheema A, Cotter A. Factors impacting on the decision of graduate entry medical school students to pursue a career in obstetrics and gynecology in Ireland. BMC MEDICAL EDUCATION 2023; 23:449. [PMID: 37337239 DOI: 10.1186/s12909-023-04425-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Challenges in recruiting appropriately trained obstetricians and gynaecologists have been identified across the world. Given well documented staff shortages within obstetrics and gynaecology in Ireland, it is increasingly important to understand the factors which influence medical students to choose or reject a career in the speciality. The aim of this study was to ascertain the perceptions of final year graduate entry medical students of obstetrics and gynaecology, including the factors which may influence a student's decision to pursue in a career in the speciality. METHODS Paper-based surveys of graduate entry medical students (n = 146) were conducted at the beginning and end of a six week rotation in obstetrics and gynaecology in Ireland. Responses to the surveys pre- and post-rotation were matched and changes in career choices, merits and demerits over time were analysed. All analysis was conducted using SPSS for Windows version 25. RESULTS The responses of 72 students to both questionnaires could be matched (response rate of 49.3%). No male students expressed an interest in obstetrics, gynaecology or both as a first choice of career in the pre rotation survey. Obstetrics as a first choice of career increased from 6.9% pre rotation to 19.4% post rotation (p = 0.04) and this increase was seen in male and female students. Gynaecology as a first choice increased slightly from 1.4 to 4.2% (p = 0.50) and the dual speciality increased from 6.9 to 13.9% (p = 0.23). Students identified many merits of obstetrics pre-rotation with more than 60% identifying it as exciting, interesting fulfilling and challenging. However, incompatibility with family life was cited as a demerit by 72% of respondents and 68.1% identified fear of litigation as a demerit. Participants were less positive overall about the merits of a career in gynaecology with less than 40% viewing it as exciting, fulfilling, and varied. CONCLUSIONS While respondents were positive about the merits of a career in obstetrics and gynecology, concerns remain about work-life balance, career opportunities, and the high-risk nature of the specialty. These concerns should be addressed by the profession and policy makers if they wish to attract sufficient numbers to address anticipated need in the coming years. Gender differences in speciality choice were also evident. If males are to be recruited into obstetrics and gynaecology, consideration should be given to the positive impact of internship.
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Affiliation(s)
- Eimear Spain
- School of Medicine, University of Limerick, Limerick, Ireland.
| | | | - Ailish Hannigan
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Ayesha Cheema
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Amanda Cotter
- School of Medicine, University of Limerick, Limerick, Ireland
- University Maternity Hospital Limerick, Limerick, Ireland
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Li W, Gillies RM, Liu C, Wu C, Chen J, Zhang X, Cheng B, Dai J, Fu N, Li L, Liu S, Sun H. Specialty preferences of studying-abroad medical students from low- and middle-income countries. BMC MEDICAL EDUCATION 2023; 23:158. [PMID: 36922811 PMCID: PMC10015544 DOI: 10.1186/s12909-023-04123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND This study explored the specialty preferences of China-educated international medical students (IMSs), who are mainly from low- and middle-income countries (LMICs) and constitute a potential medical workforce both for their home countries and foreign countries, and the influence of migration intentions on their specialty preferences. METHODS A cross-sectional, questionnaire-based survey was conducted at 5 universities in China. The questionnaire link was distributed electronically among the IMSs at the 5 universities via emails. The questionnaire enquired IMSs' demographic information, migration intentions and their specialty preferences. The Chi-square test was applied to determine the influence of the respondent's gender, intention to practise in the home country and intention to practise in a high-income country on their specialty choices. The Chi-square test was also applied to determine the influence of the respondent's gender, year of study and country of origin on their preferences for generalist-orientated or non-generalist orientated specialties. RESULTS Altogether, 452 IMSs returned their responses, yielding a response rate of 64.1%. Approximately half of the IMSs planned to not return to their home country. The most selected specialty was general surgery and the least selected specialty was physical medicine and rehabilitation. No significant differences were evident in most specialty preferences between those who intended to return home and those who intended to stay abroad. Among the IMSs having intentions of returning to their home country, male students tended to choose a generalist-orientated specialty, while female students tended to choose a non-generalist-orientated specialty. CONCLUSION China-educated IMSs could play important roles in the primary care services as well as other shortage specialties both for their home countries or foreign countries. Therefore, it is recommended that governments in these countries plan migration and recruitment policies that cater for these studying-abroad medical students from LMICs, especially in this challenging time during the COVID-19 pandemic.
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Affiliation(s)
- Wen Li
- School of International Education, Xuzhou Medical University, No.209 of Tongshan Road, Yunlong District, 221004, Xuzhou, Jiangsu, China
- School of Education, The University of Queensland, 4072, Brisbane, Australia
| | - Robyn M Gillies
- School of Education, The University of Queensland, 4072, Brisbane, Australia
| | - Chang Liu
- School of International Education, Xuzhou Medical University, No.209 of Tongshan Road, Yunlong District, 221004, Xuzhou, Jiangsu, China
| | - Changhao Wu
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, GU2 7XH, Guildford, Surrey, UK
| | - Jiayi Chen
- School of International Education, Xuzhou Medical University, No.209 of Tongshan Road, Yunlong District, 221004, Xuzhou, Jiangsu, China
| | - Xiaoning Zhang
- School of Management, Xuzhou Medical University, 221004, Xuzhou, China
| | - Bin Cheng
- School of International Education, Weifang Medical University, 261053, Weifang, China
| | - Jing Dai
- College of International Education, Guilin Medical University, 541199, Guilin, China
| | - Ning Fu
- School of International Education, Shandong First Medical University & Shandong Academy of Medical Sciences, 271016, Tai'an, China
| | - Lin Li
- Language and Literature School, Hebei North University, 075000, Zhangjiakou, China
| | - Shenjun Liu
- School of International Education, Xuzhou Medical University, No.209 of Tongshan Road, Yunlong District, 221004, Xuzhou, Jiangsu, China.
| | - Hong Sun
- School of Basic Medicine, Xuzhou Medical University, Xuzhou, China.
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Osmond D, Shcherbakova N, Huston S. Prestige and financial stability: motivating factors to pursue a doctor of pharmacy degree. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:95-101. [PMID: 36367376 DOI: 10.1093/ijpp/riac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 10/18/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aims to identify factors influencing students' decision to pursue a doctorate in pharmacy (PharmD). METHODS Focus-group interviews and quantitative surveys were used in sequence to investigate pharmacy students' motivations. A total of 36 current PharmD students from two US colleges of pharmacy participated in five focus groups. The resulting qualitative findings, along with existing literature, informed the development of a survey questionnaire, which was then administered to two cohorts of first-year pharmacy students at one of the participating colleges. KEY FINDINGS Identified themes include prestige of a doctorate, patient interaction, career versatility, and pharmacy school's lower intensity vis-à-vis medical school. A total of 110 first-year pharmacy students from a 4-year program (average (SD) age 23 (5); 65% female) completed the survey (98.5% response rate). The order of factors that respondents ranked as important or somewhat important for choosing pharmacy include: financial stability (n = 107 (97%)), prestige of a doctorate degree ((n = 97 (88%)), good work-life balance ((n = 96 (87%)), the opportunity to use critical thinking skills ((n = 93 (85%)), having patient interaction and communication ((n = 91 (83%)), and being in a profession or service ((n = 91 (83%)). CONCLUSIONS US PharmD students are mainly drawn by job and financial stability, prestige of a doctorate, and a good work-life balance.
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Affiliation(s)
- Dane Osmond
- Keck Graduate Institute School of Pharmacy and Health Sciences, Claremont, CA, USA
| | - Natalia Shcherbakova
- Western New England University College of Pharmacy and Health Sciences, Springfield, MA, USA
| | - Sally Huston
- Keck Graduate Institute School of Pharmacy and Health Sciences, Claremont, CA, USA
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van Bilsen MWT, van der Burgt SME, Peerdeman SM. Motivators of becoming and staying a neurosurgeon in the Netherlands: a survey and focus group. Acta Neurochir (Wien) 2023; 165:1-10. [PMID: 36534184 DOI: 10.1007/s00701-022-05439-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of this study was to gain insight in motivators and demotivators of the Dutch neurosurgical residents and neurosurgeons. METHODS A mixed method study was conducted. A survey was sent by the Dutch Neurosurgical Society to all Dutch neurosurgeons and residents in the framework of the yearly national quality conference. The focus groups were held during the Dutch national training days for neurosurgical residents. Baseline statistics were made of all survey data. Focus group recordings were transcribed verbatim and open coded in a constant comparative manner. RESULTS The survey yielded a response rate of 47.3% of neurosurgeons and 72.5% of residents. 42.5% of residents participated in the focus groups. Overall, motivators according to residents and neurosurgeons were divided between autonomous and controlled motivation. For residents, the motivators to become a neurosurgeon were mostly patient-centered. Neurosurgeons had the same general motivators as residents. Around one-third of neurosurgeons considered ending their career as a neurosurgeon. Among residents, 9.5% considered quitting residency. Neurosurgeons and residents indicated that no time for their family life, increased administrative burden and non-patient-related tasks were reasons to consider leaving the profession. Also, less perceived respect from patients and society was a reason to consider ending their career as a neurosurgeon. CONCLUSION Neurosurgeons and residents in neurosurgery are mostly motivated by intrinsic motivators. Factors such as administrative burden, less perceived respect from patients and society, and increase in non-patient-related tasks are large demotivators for both neurosurgeons and residents.
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Affiliation(s)
- M W T van Bilsen
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - S M E van der Burgt
- Teaching & Learning Centre (TLC) Faculty of Medicine - Faculty of Medicine - University of Amsterdam, Amsterdam UMC Location AMC, Amsterdam, the Netherlands
| | - S M Peerdeman
- Teaching & Learning Centre (TLC) Faculty of Medicine - Faculty of Medicine - University of Amsterdam, Amsterdam UMC Location AMC, Amsterdam, the Netherlands
- Department of Neurosurgery, Amsterdam UMC Location VUmc, Amsterdam, the Netherlands
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Nappier MT, Corrigan VK, Borowski S, Lusk D. Veterinary medical student perceptions of companion animal primary care as a career choice over an academic year. Front Vet Sci 2022; 9:989678. [PMID: 36187814 PMCID: PMC9523915 DOI: 10.3389/fvets.2022.989678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/25/2022] [Indexed: 11/25/2022] Open
Abstract
Despite companion animal primary care being the most common career choice for veterinarians, relatively little is known about students' perception of this career choice. In this study, the authors examined students' (233 at Time 1 and 119 at Time 2) perceptions of careers in companion animal primary care and whether perceptions changed over the course of an academic year or differed by year in veterinary school. The study was conducted by an online questionnaire sent to the student email listserv and the results analyzed by Mixed ANOVAs for each perception outcome. The study concluded that a majority of veterinary students have companion animal primary care as their preferred career choice and have a positive perception of it as a career choice. This positive perception increased over the course of an academic year, but did not differ significantly by year in school. First year students had a decrease in perception of level of training over time. This study sets a baseline for students' perceptions of companion animal primary care as a career choice at one college of veterinary medicine.
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Affiliation(s)
- Michael T. Nappier
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
- *Correspondence: Michael T. Nappier
| | - Virginia K. Corrigan
- The Veterinary Technology Program, Department of Rural Resiliency and Innovation, Appalachian State University, Boone, NC, United States
| | - Shelby Borowski
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
| | - Danielle Lusk
- The Edward Via College of Osteopathic Medicine, Blacksburg, VA, United States
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Considerations for Training and Workforce Development to Enhance Rural and Remote Ophthalmology Practise in Australia: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148593. [PMID: 35886446 PMCID: PMC9315488 DOI: 10.3390/ijerph19148593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/11/2022]
Abstract
Australia has one of the lowest per capita numbers of ophthalmologists among OECD countries, and they predominantly practise in metropolitan centres of the country. Increasing the size and distribution of the ophthalmology workforce is of critical importance. The objective of this review was to investigate the context of rural ophthalmology training and practise in Australia and how they relate to future ophthalmology workforce development. This scoping review was informed by Arksey and O’Malley’s framework and the methodology described by Coloqhuon et al. The search yielded 428 articles, of which 261 were screened for eligibility. Following the screening, a total of 75 articles were included in the study. Themes identified relating to rural ophthalmology training and practise included: Indigenous eye health; access and utilisation of ophthalmology-related services; service delivery models for ophthalmic care; ophthalmology workforce demographics; and ophthalmology workforce education and training for rural and remote practise. With an anticipated undersupply and maldistribution of ophthalmologists in the coming decade, efforts to improve training must focus on how to build a sizeable, fit-for-purpose workforce to address eye health needs across Australia. More research focusing on ophthalmology workforce distribution is needed to help identify evidence-based solutions for workforce maldistribution. Several strategies to better prepare the future ophthalmology workforce for rural practise were identified, including incorporating telehealth into ophthalmology training settings; collaborating with other health workers, especially optometrists and specialist nurses in eyecare delivery; and exposing trainees to more patients of Indigenous background.
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Alsaloum P, Alsaloum M, Kim TJ, Zheng DX, Valentim CCS, Muste JC, Goshe JM, Singh RP. Evaluation of the Content of Ophthalmology Fellowship Program Web sites. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2022. [DOI: 10.1055/s-0042-1747673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Purpose To assess the availability and content of fellowship program Web sites (FPWs) among ophthalmology subspecialties.
Design This is a cross-sectional study.
Subjects Web sites of all Association of University Professors of Ophthalmology-accredited fellowship programs in five subspecialties (i.e., surgical retina and vitreous; cornea, external disease, and refractive surgery; glaucoma; neuro-ophthalmology; and pediatric ophthalmology).
Methods FPWs were assessed for the presence of 26 key content criteria encompassing program demographics (n = 13), features (n = 10), and social life (n = 3). The presence of each content criterion as well as the content criteria groups were compared across subspecialties.
Main Outcome Measures The main outcome measured is the average percentage of key content criteria present among ophthalmology fellowship Web sites.
Results Among 266 accredited fellowship programs, 240 (90.2%) had Web sites. On average, Web sites reported 14.9 of 26 key content criteria (57.2%), 8.29 of 13 demographic criteria (63.8%), 5.84 of the 10 program features criteria (58.4%), and 0.705 of the 3 social life criteria (23.5%). Significant differences were identified among subspecialties in the presence of program description (p = 0.046), hospital affiliation (p < 0.001), names of current fellows (p = 0.004), case diversity (p = 0.001), and surgical statistics (p = 0.015). The average number of key criteria differed between subspecialties (p < 0.001).
Conclusion There is significant heterogeneity in program fellowship Web site content among ophthalmology subspecialties. Information regarding social life, such as wellness programs and community information, was largely absent across all disciplines. Addressing missing information on ophthalmology FPWs may help optimize program-applicant fit.
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Affiliation(s)
- Peter Alsaloum
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Matthew Alsaloum
- Medical Scientist Training Program, Yale School of Medicine, New Haven, Connecticut
| | - Tyler J. Kim
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David X. Zheng
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Carolina C. S. Valentim
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Justin C. Muste
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
- Transitional Year Residency, Richmond Medical Center, Richmond, Ohio
| | - Jeffrey M. Goshe
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rishi P. Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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Misky AT, Shah RJ, Fung CY, Sam AH, Meeran K, Kingsbury M, Salem V. Understanding concepts of generalism and specialism amongst medical students at a research-intensive London medical school. BMC MEDICAL EDUCATION 2022; 22:291. [PMID: 35436928 PMCID: PMC9017034 DOI: 10.1186/s12909-022-03355-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Many prominent UK medical organisations have identified a need for more generalist clinicians to address the complex requirements of an aging society. We sought to clarify attitudes towards "Specialists" and "Generalists" amongst medical students and junior doctors at Imperial College School of Medicine. METHODS A survey exploring medical students' beliefs was followed up by qualitative analysis of focus groups of medical students and Imperial-graduate foundation year doctors. RESULTS First year medical students associated specialists with academia and higher income, and generalists with ease of training and job availability. Senior (Years 5/6) medical students associated specialists even more firmly with broader influence and academic work, whilst generalists were assigned lower prestige but the same workload as specialists. The medical student focus group discussed concepts of Generalism pertaining only to Primary Care. In contrast, the foundation year doctor focus group revealed that Generalism was now seen to include some hospital care, and the perception that generalists sat lower in a knowledge hierarchy had been challenged. CONCLUSION Perceptions that Generalism is associated with lower prestige in the medical profession are already present at the very start of medical school and seem to be reinforced during undergraduate training. In early postgraduate clinical practice, the perceived knowledge and prestige hierarchy lessens. These findings can help inform curriculum redesign and the promotion of Generalism as a rewarding career aspiration.
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Affiliation(s)
- Adam T Misky
- Imperial College School of Medicine, Imperial College London, London, England
| | - Ronak J Shah
- Imperial College School of Medicine, Imperial College London, London, England
| | - Chee Yeen Fung
- Imperial College School of Medicine, Imperial College London, London, England
| | - Amir H Sam
- Imperial College School of Medicine, Imperial College London, London, England
| | - Karim Meeran
- Imperial College School of Medicine, Imperial College London, London, England
| | - Martyn Kingsbury
- Centre for Higher Education Research and Scholarship, Imperial College London, London, England
| | - Victoria Salem
- Imperial College School of Medicine, Imperial College London, London, England.
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Roche SD, Johansson AC, Giannakoulis J, Cocchi MN, Howell MD, Landon B, Stevens JP. Patient and Clinician Perceptions of Factors Relevant to Ideal Specialty Consultations. JAMA Netw Open 2022; 5:e228867. [PMID: 35467730 PMCID: PMC9039767 DOI: 10.1001/jamanetworkopen.2022.8867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Inpatient subspecialty consultations, a common and expensive practice within inpatient medicine, do not always go well; however, little is known about the failure modes of consultation, thus making it difficult to identify interventions to improve consultation quality. OBJECTIVE To understand how stakeholders envision the ideal inpatient consultation and identify how and why consultations commonly fall short of this ideal. DESIGN, SETTING, AND PARTICIPANTS This qualitative study used in-depth, semistructured interviews collected from April to October 2017 and analyzed from January 2018 to February 2020 using conventional content analysis. The setting was a single academic medical center in Boston, Massachusetts. Participants were hospitalists and specialists who had requested or performed a consultation for a non-intensive care unit patient in the previous 4 months, patients who had received a consultation while hospitalized at the medical center in the previous 15 months, and family members of such patients. MAIN OUTCOMES AND MEASURES Consultation experiences reported by participants. Clinicians were asked about characteristics of the ideal consultation, positive and negative consultation experiences, costs and benefits, and suggested improvements. Patients and family members were asked about their consultation experience, changes in care, communication preferences, and suggested improvements. RESULTS The study included 38 participants: 17 specialists, 13 hospitalists, 4 patients, and 4 family members. More than half (21 of 38) of the participants were female. There were 11 key information exchanges identified that occur among the specialist team, primary team, and patient/family during an ideal consultation. These exchanges are time sensitive and primarily carried out through unwritten protocols. We also identified 6 defects (process failures) that commonly derail information exchanges (complete omission, exclusion of a key stakeholder, poor timing, incomplete or inaccurate information, and misinterpretation) and 5 contextual factors (roles and boundaries, professionalism, team hierarchy, availability, and operational know-how) that influence how information exchange unfolds, making some consultations more prone to defects. CONCLUSIONS AND RELEVANCE Successful inpatient consultation requires a complicated, sequenced series of time-sensitive information exchanges that are highly vulnerable to failure. Maximizing the benefit of consultations will likely entail not only minimizing low-value consultations but also actively preventing defects, such as information inaccuracies and misinterpretation, that commonly derail the consultation process.
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Affiliation(s)
- Stephanie D. Roche
- Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Center for Health Care Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Anna C. Johansson
- Center for Health Care Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jaclyn Giannakoulis
- Patient and Family Advisory Council, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael N. Cocchi
- Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Bruce Landon
- Center for Health Care Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Jennifer P. Stevens
- Center for Health Care Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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20
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Ellis R, Cleland J, Lee AJ, Scrimgeour DSG, Brennan PA. A cross-sectional study examining MRCS performance by core surgical training location. MEDICAL TEACHER 2022; 44:388-393. [PMID: 34727832 DOI: 10.1080/0142159x.2021.1995599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND In the UK, core surgical training (CST) is the first specialty experience that early-career surgeons receive but training differs significantly across CST deaneries. To identify the impact these differences have on trainee performance, we assessed whether success at the Membership of the Royal College of Surgeons (MRCS) examinations is associated with CST deanery. METHODS A retrospective cohort study of UK trainees in CST who attempted MRCS between 2014 and 2020 (n = 1104). Chi-squared tests examined associations between locality and first-attempt MRCS performance. Multivariate logistic regression models identified the likelihood of MRCS success depending on CST deanery. RESULTS MRCS Part A and Part B pass rates were associated with CST deanery (p < 0.001 and p = 0.013, respectively). Candidates that trained in Thames Valley (Odds Ratio [OR] 2.52 (95% Confidence Interval [CI] 1.00-6.42), North Central and East London (OR 2.37 [95% CI 1.04-5.40]) or South London (OR 2.36 [95% CI 1.09-5.10]) were each more than twice as likely to pass MRCS Part A at first attempt. Trainees from North Central and East London were more than ten times more likely to pass MRCS Part B at first attempt (OR 10.59 [95% CI 1.23-51.00]). However, 68% of candidates attempted Part A prior to CST and 48% attempted Part B before or during the first year of CST. CONCLUSION MRCS performance is associated with CST deanery; however, many candidates passed the exam with little or any CST experience suggesting that some deaneries attract high academic performers. MRCS performance is therefore not a suitable marker of CST training quality.
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Affiliation(s)
- Ricky Ellis
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Urology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Amanda J Lee
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Peter A Brennan
- Department of Maxillo-Facial Surgery, Queen Alexandra Hospital, Portsmouth, UK
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Begeny CT, Grossman RC, Ryan MK. Overestimating women's representation in medicine: a survey of medical professionals' estimates and their(un)willingness to support gender equality initiatives. BMJ Open 2022; 12:e054769. [PMID: 35318233 PMCID: PMC8943774 DOI: 10.1136/bmjopen-2021-054769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/28/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Amidst growing numbers of women in certain areas of medicine (eg, general practice/primary care), yet their continued under-representation in others (eg, surgical specialties), this study examines (1) whether medical professionals mistakenly infer that women are now broadly well represented, overestimating women's true representation in several different areas and roles; and (2) whether this overestimation of women's representation predicts decreased support for gender equality initiatives in the field, in conjunction with one's own gender. DESIGN Cross-sectional survey. SETTING UK-based medical field. PARTICIPANTS 425 UK medical consultants/general practitioners and trainees (ST/CT1+/SHO/Registrar); 47% were female. MAIN OUTCOME MEASURES Estimates of women's representation in different areas/roles within medicine, examined as a composite estimate and individually; and a multi-item measure of support for gender-based initiatives in medicine. RESULTS Medical professionals tended to overestimate women's true representation in several different areas of medicine (general practice, medical specialties, surgical specialties) and in various roles (consultants/general practitioners, trainees, medical school graduates). Moreover, these erroneous estimates predicted a decreased willingness to support gender-based initiatives, particularly among men in the field: composite overestimation*respondent gender interaction, B=-0.04, 95% CI -0.07 to -0.01, p=0.01. Specifically, while female respondents' (over)estimates were unrelated to their level of support (B=0.00, 95% CI -0.02 to 0.02, p=0.92), male respondents' tendency to overestimate the proportion of women in medicine predicted lower support for gender-based initiatives (B=-0.04, 95% CI -0.06 to -0.02, p<0.001). CONCLUSIONS While some progress has been made in gender representation in the medical field, this research illustrates that there are still barriers to gender equality efforts and identifies who within the field is focally maintaining these barriers. It is those individuals (particularly men) who overestimate the true progress that has been made in women's representation who are at highest risk of undermining it.
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Affiliation(s)
| | - Rebecca C Grossman
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Michelle K Ryan
- Psychology, University of Exeter, Exeter, UK
- Global Institute for Women's Leadership, The Australian National University, Canberra, Australian Capital Territory, Australia
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Pfarrwaller E, Voirol L, Piumatti G, Karemera M, Sommer J, Gerbase MW, Guerrier S, Baroffio A. Students' intentions to practice primary care are associated with their motives to become doctors: a longitudinal study. BMC MEDICAL EDUCATION 2022; 22:30. [PMID: 35016672 PMCID: PMC8750802 DOI: 10.1186/s12909-021-03091-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medical schools can contribute to the insufficient primary care physician workforce by influencing students' career preferences. Primary care career choice evolves between matriculation and graduation and is influenced by several individual and contextual factors. This study explored the longitudinal dynamics of primary care career intentions and the association of students' motives for becoming doctors with these intentions in a cohort of undergraduate medical students followed over a four-year period. METHODS The sample consisted of medical students from two classes recruited into a cohort study during their first academic year, and who completed a yearly survey over a four-year period from their third (end of pre-clinical curriculum) to their sixth (before graduation) academic year. Main outcome measures were students' motives for becoming doctors (ten motives rated on a 6-point scale) and career intentions (categorized into primary care, non-primary care, and undecided). Population-level flows of career intentions were investigated descriptively. Changes in the rating of motives over time were analyzed using Wilcoxon tests. Two generalized linear mixed models were used to estimate which motives were associated with primary care career intentions. RESULTS The sample included 217 students (60% females). Career intentions mainly evolved during clinical training, with smaller changes at the end of pre-clinical training. The proportion of students intending to practice primary care increased over time from 12.8% (year 3) to 24% (year 6). Caring for patients was the most highly rated motive for becoming a doctor. The importance of the motives cure diseases, saving lives, and vocation decreased over time. Primary care career intentions were positively associated with the motives altruism and private practice, and negatively associated with the motives prestige, academic interest and cure diseases. CONCLUSION Our study indicates that career intentions are not fixed and change mainly during clinical training, supporting the influence of clinical experiences on career-related choices. The impact of students' motives on primary care career choice suggests strategies to increase the attractivity of this career, such as reinforcing students' altruistic values and increasing the academic recognition of primary care.
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Affiliation(s)
- Eva Pfarrwaller
- University Institute for Primary Care (IuMFE), Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Genève 4, Switzerland.
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Lionel Voirol
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
| | - Giovanni Piumatti
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute of Public Health, Faculty of BioMedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Mucyo Karemera
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
| | - Johanna Sommer
- University Institute for Primary Care (IuMFE), Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Genève 4, Switzerland
| | - Margaret W Gerbase
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Guerrier
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
- Faculty of Science, University of Geneva, Geneva, Switzerland
| | - Anne Baroffio
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Vanstone M, Grierson L. Thinking about social power and hierarchy in medical education. MEDICAL EDUCATION 2022; 56:91-97. [PMID: 34491582 DOI: 10.1111/medu.14659] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Social power has been diversely conceptualised in many academic areas. Operating on both the micro (interactional) and macro (structural) levels, we understand power to shape behaviour and knowledge through both repression and production. Hierarchies are one organising form of power, stratifying individuals or groups based on the possession of valued social resources. DISCUSSION Medicine is a highly organised social context where work and learning are contingent on interaction and thereby influenced greatly by social power and hierarchy. Despite the relevance of power to education research, there are many unrealized opportunities to use this construct to expand our understanding of how physicians work and learn. Hierarchy, when considered in our field, is typically gestured to as an omnipresent feature of the clinical environment that harms low-status individuals by repressing their ability to communicate openly and exercise their agency. This may be true in many circumstances, but this conceptualization of hierarchy neglects consideration of other aspects of hierarchy that may be generative for understanding the experiences of medical learners. For example, medical learners may experience the superimposition of multiple hierarchies, some of which are fluid and some of which are calcified, some of which are productive and helpful and some of which are oppressive and harmful. Power may work 'up' and 'across' hierarchical ranks, rather than just from higher status to lower status individuals. CONCLUSION The conceptualizations of how social power shapes human behaviour are diverse. Often paired with hierarchy, or social arrangement, these social scientific ideas have much to offer our collective study of the ways that health professionals learn and practice. Accordingly, we posit that a consideration of the ways social power works through hierarchies to nurture or harm the growth of learners should be granted explicit consideration in the framing and conduct of medical education research.
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Affiliation(s)
- Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster FHS Program for Education Research, Innovation and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Grierson
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster FHS Program for Education Research, Innovation and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada
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Tesio L, Buzzoni M. The illness-disease dichotomy and the biological-clinical splitting of medicine. MEDICAL HUMANITIES 2021; 47:507-512. [PMID: 32994200 PMCID: PMC8639948 DOI: 10.1136/medhum-2020-011873] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/22/2020] [Indexed: 05/04/2023]
Abstract
In a recent paper, Sharpe and Greco (2019) argue that some clinical conditions, such as chronic fatigue syndrome (sometimes called myalgic encephalomyelitis), should be treated by altering the patient's experience and response to symptoms without necessarily searching for an underlying cause. As a result, we should allow for the existence of 'illnesses without (underlying) diseases'. Wilshire and Ward (2019) reply that this possibility requires unwarranted causal assumptions about the psychosocial origins of conditions not predicted by a disease model. In so doing, it is argued that Sharpe and Greco introduce epistemological and methodological problems with serious medical consequences, for example, patients feel guilt for seeking treatment for illnesses that only exist 'all in the mind', and medical researchers are discouraged from looking for more effective treatments of such conditions. We propose a view that integrates the insights of both papers. We abandon both the strict distinction between disease and illness and the naïve unidirectional account of causality that accompanies it. This, we claim, is a step towards overcoming the current harmful tendencies to conceptually separate (1) Symptom management and disease-modifying treatments. (2) Rehabilitative-palliative care and 'causal' curing. (3) Most importantly, biomedicine and clinical medicine, where the latter is currently at risk of losing its status as scientific.
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Affiliation(s)
- Luigi Tesio
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Milano, Italy
| | - Marco Buzzoni
- Dipartimento di Studi Umanistici, Università degli Studi di Macerata, Macerata, Italy
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25
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Krachler B, Jerdén L, Tönnesen H, Lindén C. Medical licensing examinations in both Sweden and the US favor pharmacology over lifestyle. Prev Med Rep 2021; 23:101453. [PMID: 34194960 PMCID: PMC8227799 DOI: 10.1016/j.pmedr.2021.101453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/18/2021] [Accepted: 04/25/2021] [Indexed: 11/16/2022] Open
Abstract
Low priority of disease prevention and health promotion in medical education may contribute to lack of lifestyle-counseling in clinical practice. Pharmacology-related knowledge is valued 5 times higher compared to lifestyle-related knowledge in examinations on noncommunicable diseases (NCDs) in undergraduate medical education in Sweden. This study aims to establish (i) whether medical licensing examinations are biased to favor pharmacology- over lifestyle-related knowledge and (ii) whether such a bias is present in both Sweden and the US. We identified 204 NCD-related questions from previous Swedish licensing examinations, and 77 cases from a U.S. question bank commonly used to prepare for the United States Medical Licensing Examination® (USMLE®) Step 3. With the help of expected correct answers, we determined distribution of points attainable for knowledge in the respective category (lifestyle / pharmacology / other) for 5 major NCDs: coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), diabetes, hypertension, and stroke. The percentage of points attainable for lifestyle-related knowledge was 6.7 (95% CI 4.1-9.3) in Sweden and 4.6 (95%CI 0.0-9.1) in the U.S. The respective percentages for pharmacology-related knowledge were 32.6 (95% CI 26.3-38.8) and 44.5 (95% CI 33.2-55.8) percent. The pharmacology vs. lifestyle-quotas were 4.9 in Sweden and 9.8 in the U.S. Likelihoods of equal emphasis on lifestyle and pharmacology in NCDs was < 0.001 in both countries. There is a marked preference for pharmacology over lifestyle in medical licensing examinations in both Sweden and the U.S. Newly qualified doctors may be inadequately prepared to address preventable causes of NCDs.
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Affiliation(s)
- B. Krachler
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - L. Jerdén
- Center for Clinical Research Dalarna-Uppsala University, Falun, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - H. Tönnesen
- Clinical Health Promotion Centre, WHO-CC, Region Skåne and Department of Health Sciences, Faculty of Medicine, Lund University, Sweden
| | - C. Lindén
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden
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Thi Nguyen VA, Könings KD, Scherpbier AJJA, van Merriënboer JJG. Attracting and retaining physicians in less attractive specialties: the role of continuing medical education. HUMAN RESOURCES FOR HEALTH 2021; 19:69. [PMID: 34011364 PMCID: PMC8132429 DOI: 10.1186/s12960-021-00613-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/12/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Less attractive specialties in medicine are struggling to recruit and retain physicians. When properly organized and delivered, continuing medical education (CME) activities that include short courses, coaching in the workplace, and communities of practice might offer a solution to this problem. This position paper discusses how educationalists can create CME activities based on the self-determination theory that increase physicians' intrinsic motivation to work in these specialties. MAIN CONTENT The authors propose a set of guidelines for the design of CME activities that offer physicians meaningful training experiences within the limits of the available resources and support. First, to increase physicians' sense of professional relatedness, educationalists must conduct a learner needs assessment, evaluate CME's long-term outcomes in work-based settings, create social learning networks, and involve stakeholders in every step of the CME design and implementation process. Moreover, providing accessible, practical training formats and giving informative performance feedback that authentically connects to learners' working life situation increases physicians' competence and autonomy, so that they can confidently and independently manage the situations in their practice contexts. For each guideline, application methods and instruments are proposed, making use of relevant literature and connecting to the self-determination theory. CONCLUSIONS By reducing feelings of professional isolation and reinforcing feelings of competence and autonomy in physicians, CME activities show promise as a strategy to recruit and retain physicians in less attractive specialties.
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Affiliation(s)
- Van Anh Thi Nguyen
- Department of Medical Education and Skills Laboratory, Hanoi Medical University, Room 504, B Building, 1 Ton That Tung Street, Dongda, Hanoi, 10000 Vietnam
| | - Karen D. Könings
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Albert J. J. A. Scherpbier
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jeroen J. G. van Merriënboer
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Trinh LN, O'Rorke E, Mulcahey MK. Factors Influencing Female Medical Students' Decision to Pursue Surgical Specialties: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2021; 78:836-849. [PMID: 32933885 DOI: 10.1016/j.jsurg.2020.08.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/02/2020] [Accepted: 08/29/2020] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
- Lily N Trinh
- Tulane University School of Medicine, New Orleans, Louisiana.
| | - Erin O'Rorke
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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MacNevin W, Poon E, Skinner TA. Technology readiness of medical students and the association of technology readiness with specialty interest. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:e31-e41. [PMID: 33995718 PMCID: PMC8105587 DOI: 10.36834/cmej.70624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Technology readiness (TR) is a construct which characterizes an individual's propensity to utilize new technology. Despite increased technology use in healthcare, limited data exists on medical student TR and the relation of TR with specialty interest. This study assesses the TR of 2nd year medical students and its association with specialty interest. METHODS Respondents completed a survey assessing their most preferred specialty, specialty interests, and technology readiness using a 5-point Likert scale. Using Chi-square analysis, we examined the relation between demographics, TR, and specialty interest. RESULTS This study obtained a 45.7% (n = 53/116) response rate demonstrating that 79.2% (n = 42/53) of students were "technology ready." Male students were more likely to be technology ready (95.2%, n = 20/21, vs 68.8%, n = 22/32, p = 0.02) when compared to female students. Technology ready students were associated with being more interested in "Technology-Focused" specialties compared to students who were not technology ready (88.5%, n = 23/26 vs 70.4%, n = 19/27, p = 0.104). CONCLUSIONS As a cohort, most medical students were technology ready. It is inconclusive if technology ready students are more likely to be interested in technology-focused specialties due to the limited sample size of this study, although with an increased sample size, an improved understanding on technology readiness and its potential impact on student specialty interest may be obtained. Furthermore, knowledge of TR may aid in developing targeted technology-based education programs and in improving remedial approaches for students who are less comfortable with new technology.
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Affiliation(s)
- Wyatt MacNevin
- Faculty of Medicine, Dalhousie University, Nova Scotia, Canada
| | - Eric Poon
- Faculty of Medicine, Dalhousie University, Nova Scotia, Canada
| | - Thomas A Skinner
- Faculty of Medicine, Dalhousie University, Nova Scotia, Canada
- Department of Urology, Queen Elizabeth II Health Sciences Centre, Nova Scotia, Canada
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29
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Chang YC, Xiao X, Nkambule N, Ngerng RYL, Bullock A, Monrouxe LV. Exploring emergency physicians' professional identities: a Q-method study. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:117-138. [PMID: 32383067 PMCID: PMC7900058 DOI: 10.1007/s10459-020-09973-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/27/2020] [Indexed: 06/01/2023]
Abstract
Professional identities research in medical education has made significant contributions to the field. However, what comprises professional identities is rarely interrogated. This research tackles this relatively understudied component of professional identities research by understanding emergency medicine physicians' perspectives on the important elements that comprise their professional identities. Q-methodology was used to identify different clusters of viewpoints on professional identities; by extension, the core components that comprise emergency medicine physicians' professional identities are disclosed. Thirty-three emergency medicine physicians were recruited, through purposive sampling, from five hospitals across Taiwan. R software was used to analyse the Q-sorts, determine loadings on each viewpoint and formulate the viewpoint array. Analysis of interview data enhanced our understanding of these viewpoints. In total, twenty-five emergency medicine physicians loaded onto four distinct viewpoints, reflecting dominant perspectives of emergency medicine physicians' understanding of their professional identities. These distinct viewpoints demonstrated what emergency medicine physicians deemed significant in how they understood themselves. The viewpoints comprised: skills acquisition, capabilities and practical wisdom; coping ability and resilience; professional recognition and self-esteem; and wellbeing and quality of life. All viewpoints stressed the importance of trust between colleagues. These findings demonstrate the multitude of ways in which seemingly unified professional identities diverge across groups of individuals. An enhanced understanding of speciality work culture is gained. By understanding facets of professional identities, the development of future educational interventions and departmental initiatives, which might support key components of professional identities, can be explored.
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Affiliation(s)
- Yu-Che Chang
- Chang Gung Medical Education Research Centre (CGMERC), Chang Gung Memorial Hospital, Linkou, Taiwan (R.O.C.)
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan (R.O.C.)
- Chang Gung University College of Medicine, Taoyuan, Taiwan (R.O.C.)
| | - Xaviera Xiao
- Chang Gung Medical Education Research Centre (CGMERC), Chang Gung Memorial Hospital, Linkou, Taiwan (R.O.C.)
| | - Nothando Nkambule
- Chang Gung Medical Education Research Centre (CGMERC), Chang Gung Memorial Hospital, Linkou, Taiwan (R.O.C.)
| | - Roy Y L Ngerng
- Risk Society and Policy Research Center, National Taiwan University, Taipei, Taiwan (R.O.C.)
| | - Alison Bullock
- Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), School of Social Sciences, Cardiff University, Cardiff, Wales, UK
| | - Lynn V Monrouxe
- The Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia.
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Raj M, Platt JE, Anthony DL, Fitzgerald JT, Lee SYD. Exploring How Personal, Social, and Institutional Characteristics Contribute to Geriatric Medicine Subspecialty Decisions: A Qualitative Study of Trainees' Perceptions. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:425-432. [PMID: 33031118 DOI: 10.1097/acm.0000000000003784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To explore internal medicine residents' and geriatrics fellows' perceptions of how personal, social, and institutional characteristics contribute to their professional identity and subspecialty decisions related to geriatric medicine. METHOD The authors conducted 23 in-depth, semistructured interviews with internal medicine residents, with and without an interest in geriatrics, and geriatrics fellows across 3 academic medical centers in the United States from October 2018 through June 2019. They then used a qualitative narrative approach to analyze the interview data. RESULTS Trainees related personal experiences, such as exposure to physicians and experiences with grandparents, to their interest in medicine. Trainees with an interest in geriatrics at 2 institutions did not feel supported, or understood, by peers and mentors in their respective institutions but maintained their interest in the field. The following variations between institutions that are supportive and those that are not were noted: the number of geriatricians, the proximity of the institution to geriatrics clinics, and the ways in which institutional leaders portrayed the prestige of geriatric medicine. Institutional characteristics influenced trainees' understanding of what it meant to be a doctor, what meaning they garnered from work as a physician, and their comfort with different types of complexity, such as those presented when providing care to older adults. CONCLUSIONS Institutional characteristics may be particularly important in shaping trainee interest in geriatric medicine. Institutions should encourage leadership training and opportunities for geriatricians so they can serve as role models and as hands-on mentors for trainees beginning in medical school. Increasing the number of geriatricians requires institutions to increase the value they place on geriatrics to generate a positive interest in this field among trainees. Institutions facilitating formation of professional identity and sense of purpose in work may consider engaging geriatricians in leadership and mentoring roles as well as curriculum development.
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Affiliation(s)
- Minakshi Raj
- M. Raj is assistant professor, Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Champaign, Illinois; ORCID: http://orcid.org/0000-0002-1457-7850
| | - Jodyn E Platt
- J.E. Platt is assistant professor, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Denise L Anthony
- D.L. Anthony is professor, Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - James T Fitzgerald
- J.T. Fitzgerald is professor, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Shoou-Yih Daniel Lee
- S.-Y.D. Lee is professor, Department of Health Administration, Virginia Commonwealth University, Richmond, Virginia
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Explaining health system responses to public reporting of cardiac surgery mortality in England and the USA. HEALTH ECONOMICS POLICY AND LAW 2021; 16:183-200. [PMID: 33455616 DOI: 10.1017/s1744133120000444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Public reporting of clinical performance is increasingly used in many countries to improve quality and enhance accountability of the health system. The assumption is that greater transparency will stimulate improvements by clinicians in response to peer pressure, patient choice or competition. The international diffusion of public reporting might suggest greater similarity between health systems. Alternatively, national and local contexts (including health system imperatives, professional power and organisational culture) might continue to shape its form and impact, implying continued divergence. The paper considers public reporting in the USA and England through the lens of Scott's 'pillars' institutional framework. The USA was arguably the first country to adopt public reporting systematically in the late 1980s. England is a more recent adopter; it is now being widely adopted through the National Health Service (NHS). Drawing on qualitative data from California and England, this paper compares the behavioural and policy responses to public reporting by health system stakeholders at micro, meso and macro levels and through the intersection of ideas, interests, institutions and individuals through. The interplay between the regulative, normative and cultural-cognitive pillars helps explain the observed patterns of on-going divergence.
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Bochatay N, Kuna Á, Csupor É, Pintér JN, Muller-Juge V, Hudelson P, Nendaz MR, Csabai M, Bajwa NM, Kim S. The Role of Power in Health Care Conflict: Recommendations for Shifting Toward Constructive Approaches. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:134-141. [PMID: 33394664 DOI: 10.1097/acm.0000000000003604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE The combination of power and conflict is frequently reported to have a detrimental impact on communication and on patient care, and it is avoided and perceived negatively by health care professionals. In view of recent recommendations to explicitly address power and conflict in health professions education, adopting more constructive approaches toward power and conflict may be helpful. This study examined the role of power in conflicts between health care professionals in different cultural contexts to make recommendations for promoting more constructive approaches. METHOD The authors used social bases of power (positional, expert, informational, reward, coercive, referent) identified in the literature to examine the role of power in conflicts between health care professionals in different cultural settings. They drew upon semistructured interviews conducted from 2013 to 2016 with 249 health care professionals working at health centers in the United States, Switzerland, and Hungary, in which participants shared stories of conflict they had experienced with coworkers. The authors used a directed approach to content analysis to analyze the data. RESULTS The social bases of power tended to be comparable across sites and included positional, expert, and coercive power. The rigid hierarchies that divide health care professionals, their professions, and their specialties contributed to negative experiences in conflicts. In addition, the presence of an audience, such as supervisors, coworkers, patients, and patients' families, prevented health care professionals from addressing conflicts when they occurred, resulting in conflict escalation. CONCLUSIONS These findings suggest that fostering more positive approaches toward power and conflict could be achieved by using social bases of power such as referent power and by addressing conflicts in a more private, backstage, manner.
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Affiliation(s)
- Naike Bochatay
- N. Bochatay is a postdoctoral scholar, School of Medicine, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0002-6098-4262
| | - Ágnes Kuna
- Á. Kuna is assistant professor, Department of Applied Linguistics and Phonetics, Eötvös Loránd University, Budapest, Hungary
| | - Éva Csupor
- É. Csupor is a clinical psychologist, Department of Child and Adolescent Psychiatry, Pediatric Clinic, University of Szeged, Szeged, Hungary
| | - Judit Nora Pintér
- J.N. Pintér is associate professor, Department of Psychology of Counseling, Eötvös Loránd University, Budapest, Hungary; ORCID: https://orcid.org/0000-0002-2580-588X
| | - Virginie Muller-Juge
- V. Muller-Juge is an associate specialist, School of Medicine, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0002-2346-8904
| | - Patricia Hudelson
- P. Hudelson is a medical anthropologist, Department of Primary Care, Geneva University Hospitals, and lecturer, Faculty of Medicine, University of Geneva, Geneva, Switzerland; ORCID: https://orcid.org/0000-0003-2601-7479
| | - Mathieu R Nendaz
- M.R. Nendaz is professor and vice-dean, Department of Medicine and Unit of Development and Research in Medical Education, University of Geneva, Geneva, Switzerland; ORCID: https://orcid.org/0000-0003-3795-3254
| | - Marta Csabai
- M. Csabai is professor and head of department, Department of Personality, Clinical, and Health Psychology, University of Szeged, Szeged, Hungary
| | - Nadia M Bajwa
- N.M. Bajwa is residency program director, Department of General Pediatrics, Children's Hospital, Geneva University Hospitals, and faculty member, Unit of Development and Research in Medical Education, University of Geneva, Geneva, Switzerland; ORCID: https://orcid.org/0000-0002-1445-4594
| | - Sara Kim
- S. Kim is research professor, Department of Surgery, School of Medicine, University of Washington, Seattle, Washington; ORCID: https://orcid.org/0000-0002-6623-5393
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Anderson E, Solch AK, Fincke BG, Meterko M, Wormwood JB, Vimalananda VG. Concerns of Primary Care Clinicians Practicing in an Integrated Health System: a Qualitative Study. J Gen Intern Med 2020; 35:3218-3226. [PMID: 32918198 PMCID: PMC7661604 DOI: 10.1007/s11606-020-06193-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/08/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Clinician well-being is a major priority for healthcare organizations. However, the impact of workplace environment on clinicians' well-being is poorly understood. Integrated health systems are a particularly relevant type of practice environment to focus on, given the increasing rates of practice consolidation and integration. OBJECTIVE To improve understanding of the concerns of primary care clinicians (PCCs) practicing in an integrated health system. DESIGN We analyzed free-text comment box responses offered on a national survey about care coordination by 555 PCCs in the Veterans Health Administration, one of the largest integrated health systems in the USA. PARTICIPANTS A total of 555 PCCs who left free-text comments on a national survey of care coordination in the VHA (30% out of 1862 eligible respondents). Demographics and coordination scale scores were similar between respondents who left comments vs. those who did not. APPROACH The data were coded and analyzed in line with the grounded theory approach. Key themes were identified by team consensus and illustrative quotations were chosen to illustrate each theme. KEY RESULTS VHA PCCs described some pressures shared across practice environments, such as prohibitive administrative burden, but also reported several concerns particular to integrated settings, including "dumping" by specialists and moral distress related to a concern for patients. Frustrations due to several aspects of responsibility around referrals may be unique to integrated health systems with salaried clinicians and/or where specialists have the ability to reject referrals. CONCLUSION PCCs in integrated health systems feel many of the same pressures as their counterparts in non-integrated settings, but they are also confronted with unique stressors related to these systems' organizational features that restrict clinicians' autonomy. An understanding of these concerns can guide efforts to improve the well-being of PCCs in existing integrated health systems, as well as in practices on their way to integration.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA.
| | - Amanda K Solch
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
| | - B Graeme Fincke
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Mark Meterko
- VHA Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID), Bedford, MA, USA
| | - Jolie B Wormwood
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
- University of New Hampshire, Durham, NH, USA
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
- Boston University School of Medicine, Boston, MA, USA
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Villanueva M, Castro R. Hierarchy systems of the medical field in Mexico: a sociological analysis. CIENCIA & SAUDE COLETIVA 2020; 25:2377-2386. [PMID: 32520282 DOI: 10.1590/1413-81232020256.28142019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/15/2019] [Indexed: 11/22/2022] Open
Abstract
The aim of this paper is to describe the main systems of hierarchization in the Mexican medical field (and those of other similar Latin American countries). Drawing on Bourdieu's genetic structuralism, our hypothesis is that the structure of the medical field is closely correlated with the schemes of perception and appreciation of the medical field's agents. These schemes are rooted in hierarchical classifications by which work is organized and the main agents' prestige is allocated. Empirical data include focus groups, interviews and observations in hospitals, as well as images, memes and other graphic displays found in Facebook and other public internet locations. The analysis sought to identify the main systems of hierarchization that structure both the academic training and the professional practice of physicians. Four systems of hierarchization are identified: professional, by subfields, by specialties, and by division of labor. These systems of hierarchization, reciprocally entangled with one another, are part of the complex structure of positions within the medical field, as well of the agents' schemes of perception and appreciation which are embodied under the form of habitus.
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Affiliation(s)
- Marcia Villanueva
- Centro Regional de Investigaciones Multidisciplinarias, Universidad Nacional Autonoma de Mexico. Av. Universidad s/n, Circuito 2, Col. Chamilpa. 62210, Cuernavaca, Morelos, Mexico.
| | - Roberto Castro
- Centro Regional de Investigaciones Multidisciplinarias, Universidad Nacional Autonoma de Mexico. Av. Universidad s/n, Circuito 2, Col. Chamilpa. 62210, Cuernavaca, Morelos, Mexico.
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Wiersma M, Kerridge I, Lipworth W. Status, Respect, and Stigma: A Qualitative Study of Non-financial Interests in Medicine. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:203-216. [PMID: 32162158 DOI: 10.1007/s11673-020-09970-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 02/26/2020] [Indexed: 06/10/2023]
Abstract
Conflicts of interest (COI) in health and medicine have been the source of considerable public and professional debate. Much of this debate has focused on financial, rather than non-financial COI, which is a significant lacuna because non-financial COI can be just as influential as financial COI. In an effort to explore the nature and effects of non-financial, as well as financial COI, we conducted semi-structured interviews with eleven Australian medical professionals regarding their experiences of, and attitudes towards, COI. We found that this group of medical professionals saw non-financial interests-most notably the pursuit of status and respect and the avoidance of stigma-as potentially conflicting with other important interests (such as patient care).
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Affiliation(s)
- Miriam Wiersma
- The University of Sydney, Sydney Health Ethics, Level 1, Medical Foundation Building, K25, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Ian Kerridge
- The University of Sydney, Sydney Health Ethics, Level 1, Medical Foundation Building, K25, University of Sydney, Sydney, NSW, 2006, Australia
- Haematology Department, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW, 2065, Australia
| | - Wendy Lipworth
- The University of Sydney, Sydney Health Ethics, Level 1, Medical Foundation Building, K25, University of Sydney, Sydney, NSW, 2006, Australia
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Johannessen LEF, Album D, Rasmussen EB. Do nurses rate diseases according to prestige? A survey study. J Adv Nurs 2020; 76:1691-1697. [PMID: 32310319 DOI: 10.1111/jan.14394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/25/2020] [Accepted: 04/06/2020] [Indexed: 11/26/2022]
Abstract
AIMS To see whether nurses rate diseases according to prestige and, if so, how their ratings compare to the disease prestige hierarchy previously uncovered among physicians. DESIGN Cross-sectional survey. METHODS In 2014, 122 nurses in a continuing education programme for healthcare personnel in Norway rated a sample of 38 diseases according to how prestigious they see these as being among healthcare workers in general. RESULTS The nurses were found to rank myocardial infarction, leukaemia, and brain stroke at the top of the prestige hierarchy and depressive neurosis, anxiety neurosis, and fibromyalgia at the bottom. Their rankings overlap significantly with those previously documented for physicians and suggest that nurses assess the diseases through a 'cure' rather than a 'care' perspective on health care. CONCLUSION The nurses ordered diseases in a prestige hierarchy and their rankings are strikingly like those of physicians. The findings are of significant relevance to nursing practice and set a new course for future research into prestige and nursing culture. IMPACT The findings should encourage nurses - individually and collectively - to reflect on whether and how notions of disease prestige influence their decision-making. By showing that nurses as well as physicians are able to rate diseases according to prestige, the study suggests new avenues for future disease prestige research.
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Affiliation(s)
- Lars E F Johannessen
- Department of Social Work, Child Welfare and Social Policy, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Dag Album
- Department of Sociology and Human Geography, University of Oslo, Oslo, Norway
| | - Erik B Rasmussen
- Department of Social Work, Child Welfare and Social Policy, OsloMet - Oslo Metropolitan University, Oslo, Norway
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Eden AR, Barreto T, Hansen ER. Experiences of new family physicians finding jobs with obstetrical care in the USA. Fam Med Community Health 2020; 7:e000063. [PMID: 32148712 PMCID: PMC6910746 DOI: 10.1136/fmch-2018-000063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/20/2019] [Accepted: 02/22/2019] [Indexed: 11/04/2022] Open
Abstract
Objective This study aimed to explore how new family medicine graduates who want to include obstetrics in their scope of practice identify and select jobs and to understand how employment influences scope of practice in family medicine, particularly the ability to provide maternity care and deliver babies. Design Mixed-methods study including a survey and qualitative interviews conducted in 2017. Setting We electronically surveyed US family physicians and followed up with a purposeful subsample of these physicians to conduct in-depth, semistructured telephone interviews. Participants 1016 US family medicine residency graduates 2014-2016 who indicated that they intended to deliver babies in practice completed a survey; 56 of these were interviewed. Main outcome measures The survey measured the reasons for not doing obstetrics as a family physician. To identify themes regarding finding family medicine jobs with obstetrics, we used a team-based, immersion-crystallisation approach to analyse the transcribed qualitative interviews. Results Survey results (49% response rate) showed that not finding a job that included obstetrics was the primary reason newly graduated family physicians who intended to do obstetrics were not doing so. Qualitative interviews revealed that family physicians often find jobs with obstetrics through connections or recruitment efforts and make job decisions based on personal considerations such as included geographical preferences, family obligations and lifestyle. However, job-seeking and job-taking decisions are constrained by employment-related issues such as job structure, practice characteristics and lack of availability of family medicine jobs with obstetrics. Conclusions While personal reasons drove job selection for most physicians, their choices were constrained by multiple factors beyond their control, particularly availability of family medicine jobs allowing obstetrics. The shift from physician as practice owner to physician as employee in the USA has implications for job-seeking behaviours of newly graduating medical residents as well as for access to healthcare services by patients; understanding how employment influences scope of practice in family medicine can provide insight into how to support family physicians to maintain the scope of practice they desire and are trained to provide, thus, ensuring that families have access to care.
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Affiliation(s)
- Aimee R Eden
- Department of Research and Policy, American Board of Family Medicine, Lexington, Kentucky, USA
| | - Tyler Barreto
- Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Elizabeth Rose Hansen
- Department of Research and Policy, American Board of Family Medicine, Lexington, Kentucky, USA
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Russo G, Cassenote AJF, Guilloux AGA, Scheffer MC. The role of private education in the selection of primary care careers in low and middle-income countries. Findings from a representative survey of medical residents in Brazil. HUMAN RESOURCES FOR HEALTH 2020; 18:11. [PMID: 32066457 PMCID: PMC7027019 DOI: 10.1186/s12960-020-0456-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/06/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Primary health care (PHC) doctors' numbers are dwindling in high- as well as low-income countries, which is feared to hamper the achievement of Universal Health Coverage goals. As a large proportion of doctors are privately educated and private medical schools are becoming increasingly common in middle-income settings, there is a debate on whether private education represents a suitable mean to increase the supply of PHC physicians. We analyse the intentions to practice of medical residents in Brazil to understand whether these differ for public and private schools. METHODS Drawing from the literature on the selection of medical specialties, we constructed a model for the determinants of medical students' intentions to practice in PHC, and used secondary data from a nationally representative sample of 4601 medical residents in Brazil to populate it. Multivariate analysis and multilevel cluster models were employed to explore the association between perspective physicians' choice of practice and types of schools attended, socio-economic characteristics, and their values and opinions on the profession. RESULTS Only 3.7% of residents in our sample declared an intention to practice in PHC, with no significant association with the public or private nature of the medical schools attended. Instead, having attended a state secondary school (p = 0.028), having trained outside Brazil's wealthy South East (p < 0.001), not coming from an affluent family (p = 0.037), and not having a high valuation of career development opportunities (p < 0.001) were predictors of willingness to practice in PHC. A low consideration for quality of life, for opportunities for treating patients, and for the liberal aspects of the profession were also associated with future physicians' intentions to work in primary care (all p < 0.001). CONCLUSIONS In Brazil, training in public or private medical schools does not influence the intention to practice in PHC. But students from affluent backgrounds, with private secondary education, and graduating in the rich South East were found to be overrepresented in both types of training institutions, and this is what appears to negatively impact the selection of PHC careers. With a view to increasing the supply of PHC practitioners in middle-income countries, policies should focus on opening medical schools in rural areas and improving access for students from disadvantaged backgrounds.
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Affiliation(s)
- Giuliano Russo
- Institute of Population Health Sciences, Queen Mary University of London, 58 Turner street, E1 2AB, London, United Kingdom.
| | - Alex J Flores Cassenote
- Departamento da Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, CEP:01246-903, Av. Dr Arnaldo, 455, São Paulo, Brazil
| | - Aline G Alves Guilloux
- Departamento da Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, CEP:01246-903, Av. Dr Arnaldo, 455, São Paulo, Brazil
| | - Mário César Scheffer
- Departamento da Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, CEP:01246-903, Av. Dr Arnaldo, 455, São Paulo, Brazil
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Oliver H, Hudson B, Oliver C, Oliver M. UK undergraduate aspirations and attitudes survey: do we have a perception problem in clinical radiology? Clin Radiol 2020; 75:158.e15-158.e24. [DOI: 10.1016/j.crad.2019.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
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Razack S, Risør T, Hodges B, Steinert Y. Beyond the cultural myth of medical meritocracy. MEDICAL EDUCATION 2020; 54:46-53. [PMID: 31464349 DOI: 10.1111/medu.13871] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 01/14/2019] [Accepted: 02/12/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND We examine the cultural myth of the medical meritocracy, whereby the "best and the brightest" are admitted and promoted within the profession. We explore how this narrative guides medical practice in ways that may no longer be adequate in the contexts of practice today. METHODS Narrative analysis of medical students' and physicians' stories. RESULTS Hierarchies of privilege within medicine are linked to meritocracy and the trope of the "hero's story" in literature. Gender and other forms of difference are generally excluded from narratives of excellence, which suggests operative mechanisms that may be contributory to observed differences in attainment. We discuss how the notion of diversity is formulated in medicine as a "problem" to be accommodated within merit, and posit that medical practice today requires a reformulation of the notion of merit in medicine, valorising a diversity of life experience and skills, rather than "retrofitting" diversity concerns as problems to be accommodated within current constructs of merit. CONCLUSIONS Three main action-oriented outcomes for a better formulation of merit relevant to medical practice today are suggested: (a) development of assessors' critical consciousness regarding the structural issues in merit assignment; (b) alignment of merit criteria with relevant societal outcomes, and (c) developing inclusive leadership to accommodate the greater diversity of excellence needed in today's context of medical practice. A reformulation of the stories through which medical practitioners and educators communicate and validate aspects of medical practice will be required in order for the profession to continue to have relevance to the diverse societies it serves.
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Affiliation(s)
- Saleem Razack
- Department of Pediatrics and Centre for Medical Education, McGill University, Montreal, Quebec, Canada
| | - Torsten Risør
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, and Norwegian Centre for E-health Research, Tromso, Norway
| | - Brian Hodges
- Department of Psychiatry, Faculties of Medicine and the Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario,, Canada
| | - Yvonne Steinert
- Family Medicine, Centre for Medical Education, McGill University, Montreal, Quebec, Canada
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Harris M, Wainwright D, Wainwright E. What influences young doctors in their decision-making about general practice as a possible career? A qualitative study. EDUCATION FOR PRIMARY CARE 2019; 31:15-23. [DOI: 10.1080/14739879.2019.1697967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Michael Harris
- Department for Health, University of Bath, Bath, UK
- Institute of Primary Health Care Bern (BIHAM), University of Bern, Bern, Switzerland
| | | | - Elaine Wainwright
- Department for Health, University of Bath, Bath, UK
- Applied Psychology, Bath Spa University, Bath, UK
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Lefebvre C, Hartman N, Tooze J, Manthey D. Determinants of medical specialty competitiveness. Postgrad Med J 2019; 96:511-514. [PMID: 31780597 DOI: 10.1136/postgradmedj-2019-137160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/30/2019] [Accepted: 11/10/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Although the concept of medical specialty competitiveness may seem intuitive, there are very little existing empirical data on the determinants of specialty competitiveness in USA. An understanding of the determinants of specialty competitiveness may inform career choices among students and their advisors. Specialty competitiveness correlates with availability and appeal. METHODS This narrative review examines 2019 National Resident Matching Program (NRMP) data and the existing literature to define the determinants of specialty competitiveness. A statistical analysis of key elements of the 2019 NRMP data was performed. RESULTS Using US senior applicant fill rate as a measure of competitiveness, medical specialty competitiveness follows general principles of supply and demand. The demand, or appeal, of a specialty correlates with several factors, including salary, prestige and lifestyle. Salary correlates strongly with US senior fill rate (r=0.78, p=0.001). Relatively few positions are available for the most competitive specialties in the NRMP match. The negative correlation between US senior fill rate and position availability is also strong (r=-0.85; p<0.0001). CONCLUSION A 'competitive specialty' correlates strongly with high earnings potential and limited position availability. In an ideal world, a student's pursuit of a medical specialty should be guided by interest, qualifications and ability to succeed in that field. However, students must contend with the realities of competition created by the residency matching system.
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Affiliation(s)
- Cedric Lefebvre
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nicholas Hartman
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Janet Tooze
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David Manthey
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Gutiérrez-Cirlos C, Naveja JJ, García-Minjares M, Martínez-González A, Sánchez-Mendiola M. Specialty choice determinants among Mexican medical students: a cross-sectional study. BMC MEDICAL EDUCATION 2019; 19:420. [PMID: 31727026 PMCID: PMC6854711 DOI: 10.1186/s12909-019-1830-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The choice of medical specialty is related to multiple factors, students' values, and specialty perceptions. Research in this area is needed in low- and middle-income countries, where the alignment of specialty training with national healthcare needs has a complex local interdependency. The study aimed to identify factors that influence specialty choice among medical students. METHODS Senior students at the National Autonomous University of Mexico (UNAM) Faculty of Medicine answered a questionnaire covering demographics, personal experiences, vocational features, and other factors related to specialty choice. Chi-square tests and factor analyses were performed. RESULTS The questionnaire was applied to 714 fifth-year students, and 697 provided complete responses (response rate 81%). The instrument Cronbach's alpha was 0.8. The mean age was 24 ± 1 years; 65% were women. Eighty percent of the students wanted to specialize, and 60% had participated in congresses related to the specialty of interest. Only 5% wanted to remain as general practitioners. The majority (80%) wanted to enter a core specialty: internal medicine (29%), general surgery (24%), pediatrics (11%), gynecology and obstetrics (11%) and family medicine (4%). The relevant variables for specialty choice were grouped in three dimensions: personal values that develop and change during undergraduate training, career needs to be satisfied, and perception of specialty characteristics. CONCLUSIONS Specialty choice of medical students in a middle-income country public university is influenced by the undergraduate experience, the desire to study a subspecialty and other factors (including having skills related to the specialty and type of patients).
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Affiliation(s)
- Carlos Gutiérrez-Cirlos
- National Institute of Medical Sciences and Nutrition “Salvador Zubirán”, Mexico City, Mexico
- Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - J. Jesús Naveja
- Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Manuel García-Minjares
- Coordinador de Desarrollo Educativo e Innovación Curricular, Universidad Nacional Autónoma de México, Circuito Centro Cultural, S/N. Edificio CIPPS, 1er Piso, Ciudad Universitaria, Del. Coyoacán, Ciudad de México, CdMx, 04510 México
| | - Adrián Martínez-González
- Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
- Coordinador de Desarrollo Educativo e Innovación Curricular, Universidad Nacional Autónoma de México, Circuito Centro Cultural, S/N. Edificio CIPPS, 1er Piso, Ciudad Universitaria, Del. Coyoacán, Ciudad de México, CdMx, 04510 México
| | - Melchor Sánchez-Mendiola
- Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
- Coordinador de Desarrollo Educativo e Innovación Curricular, Universidad Nacional Autónoma de México, Circuito Centro Cultural, S/N. Edificio CIPPS, 1er Piso, Ciudad Universitaria, Del. Coyoacán, Ciudad de México, CdMx, 04510 México
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Lambert TW, Smith F, Goldacre MJ. Career choices for obstetrics and gynaecology: recent updates from 40 years of national surveys of UK medical graduates. JRSM Open 2019; 10:2054270419861611. [PMID: 31620304 PMCID: PMC6775562 DOI: 10.1177/2054270419861611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To report doctors' early career choices for obstetrics and gynaecology, their eventual career destinations and factors influencing their career pathways. Design Multi-cohort multi-purpose national questionnaire surveys of medical graduates in selected graduation years between 1974 and 2015. Setting UK. Participants UK-trained medical graduates. Main outcome measures Career specialty choices; certainty about specialty choice; factors which influenced doctors' career choices; career specialty destinations 10 years after graduation. Results Obstetrics and Gynaecology was the first choice of career for 5.7% of post-2002 graduates in year 1, 4.3% in year 3 and 3.8% in year 5. A much higher percentage of women than men specified Obstetrics and Gynaecology as their first choice: in year 1, 7.7% of women and 2.3% of men did so. The gender gap has widened since the 1970s and 1980s. In recent years, of those who specified Obstetrics and Gynaecology as their first choice in year 1 after graduation, 48% were working in Obstetrics and Gynaecology in year 10 (63% of men, 45% of women). Looking backwards from career destinations, 85% of doctors working in Obstetrics and Gynaecology in year 10 had specified Obstetrics and Gynaecology as a first, second or third choice of preferred career in year 1. Conclusions Interest in Obstetrics and Gynaecology among UK graduates appears to be exceeding the demand for new specialists. Policy needs to address risks of over-production of trainees and ensure that some graduates interested in Obstetrics and Gynaecology consider alternative careers. The large gender imbalance should encourage consideration of the reasons for men choosing Obstetrics and Gynaecology in falling numbers.
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Affiliation(s)
- Trevor W Lambert
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
| | - Fay Smith
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
| | - Michael J Goldacre
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
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Vohra A, Ladyshewsky R, Trumble S. Factors that affect general practice as a choice of medical speciality: implications for policy development. AUST HEALTH REV 2019; 43:230-237. [PMID: 29179809 DOI: 10.1071/ah17015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 10/04/2017] [Indexed: 11/23/2022]
Abstract
Objective This article critically appraises the range of personal, professional and social factors that affect the choice of speciality across medical students, prevocational doctors, general practice registrars and general practitioners. Methods This qualitative study applied constructs from the fields of decision theory and career theory to better understand the complex nature of choosing a speciality. In all, 47 in-depth interviews were conducted with participants at different stages of their career cycle. The data was codified and analysed using NVivo to identify key factors that influenced speciality choice. Results The research identified 77 individual findings influencing general practice as a choice of medical speciality. These were distilled into a matrix to show that factors such as money, prestige and peer interaction did not have a compelling effect, whereas clinical and academic role models, flexibility, work-life balance, scope of practice, connection with patients, training environment and practical opportunities did. Conclusion The findings indicate that the decision in relation to the choice of medical speciality is a complex cognitive process that is undertaken within a personal, social and professional context particular to each individual. What is known about the topic? Current literature aims to quantify changes in attitudes towards choice of speciality or the effect of particular variables in isolation while ignoring the complexity of this decision process and how the numerous variables compare with each other. What does this paper add? The present study is the first intergenerational research on this topic in the Australian context and the paper dismisses the role of prestige and remuneration as key drivers of choice in picking general practice as a speciality, noting that money is merely a 'hygiene factor'. What are the implications for policy makers? A policy framework outlining 10 key principles is presented to assist policy makers seeking to affect workforce outcomes by applying policy levers to influence doctors' choice of speciality.
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Affiliation(s)
- Amit Vohra
- Sonic Clinical Services Pty Ltd, Level 32, 60 Margaret Street, Sydney, NSW 2000, Australia
| | - Richard Ladyshewsky
- Curtin Business School, Curtin Graduate School of Business, Curtin University, GPO Box U1987, Perth, WA 6845, Australia. Email
| | - Stephen Trumble
- Department of Medical Education, Level 7 East Melbourne Medical School, University of Melbourne, VIC 3010, Australia. Email
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Olsson C, Kalén S, Ponzer S. Sociological analysis of the medical field: using Bourdieu to understand the processes preceding medical doctors' specialty choice and the influence of perceived status and other forms of symbolic capital on their choices. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2019; 24:443-457. [PMID: 30656525 PMCID: PMC6647503 DOI: 10.1007/s10459-018-09872-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/21/2018] [Indexed: 06/09/2023]
Abstract
Several studies have demonstrated that medical students and doctors rank specialties differently in terms of perceived status and prestige. At the same time some of the specialties have problems with recruiting and retaining staff. This study aimed to understand what constitutes status and prestige in the medical field and how it influences medical doctors' choice of specialty. By using a sociological perspective and applying Bourdieu's theoretical concepts of field, symbolic capital and perceived status, we analysed young doctors' journeys towards their chosen specialty. We conducted 15 in-depth semi-structured interviews. The data was analysed using content analysis. The findings suggest that medical specialties carry different social status. In the field of power, surgery is seen as the most prestigious of all specialties. However, in the future it might be a less attractive choice when young doctors tend to view their profession less as an identity and more like a job. For specialties perceived as low status, the challenge is to raise popularity by better describing to young doctors the characteristics and advantages of these specialties.
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Affiliation(s)
- Caroline Olsson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Forskningscentrum, Sjukhusbacken 10, 118 46, Stockholm, Sweden.
| | - S Kalén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Forskningscentrum, Sjukhusbacken 10, 118 46, Stockholm, Sweden
- Stockholm'S läns Landsting (Stockholm County Council), Stockholm, Sweden
| | - S Ponzer
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Forskningscentrum, Sjukhusbacken 10, 118 46, Stockholm, Sweden
- Orthopaedics Department and the head of Research, Education, Development and Innovation, Södersjukhuset (SÖS), Stockholm, Sweden
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Cowdell F. Knowledge mobilisation: an ethnographic study of the influence of practitioner mindlines on atopic eczema self-management in primary care in the UK. BMJ Open 2019; 9:e025220. [PMID: 31350238 PMCID: PMC6661925 DOI: 10.1136/bmjopen-2018-025220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 05/24/2019] [Accepted: 06/10/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To explore how atopic eczema specific mindlines are developed by primary care practitioners. DESIGN Ethnographic study. SETTING One large, urban general practice in central England. PARTICIPANTS In observation, all practitioners and support staff in the practice and in interviews a diverse group of practitioners (n=16). RESULTS Observation of over 250 hours and interview data were combined and analysed using an ethnographic approach through the lenses of mindlines and self-management. Three themes were identified: beliefs about eczema, eczema knowledge and approaches to self-management. Eczema mindlines are set against a backdrop of it being a low priority and not managed as a long-term condition. Practitioners believed that eczema is simple to manage with little change in treatments available and prescribing limited by local formularies. Practice is largely based on tacit knowledge and experience. Self-management is expected but not often explicitly facilitated. Clinical decisions are made from knowledge accumulated over time. Societal and technological developments have altered the way in which practitioner mindlines are developed; in eczema, for most, they are relatively static. CONCLUSIONS The outstanding challenge is to find novel, profession and context-specific, simple, pragmatic strategies to revise or modify practitioner mindlines by adding reliable and useful knowledge and by erasing outdated or inaccurate information thus potentially improve quality of eczema care.
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Affiliation(s)
- Fiona Cowdell
- Faculty of Health Education and Life Sciences, Birmingham City University, Birmingham, UK
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Kelly PD, Voce DJ, Sivaganesan A, Wellons JC. The Legacy of a Neurosurgeon: A U.S.-Based Obituary Analysis. World Neurosurg 2019; 130:e908-e914. [PMID: 31299311 DOI: 10.1016/j.wneu.2019.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Textual analysis of obituaries provides insight into the shared values of a profession or community. Neurosurgeon obituaries are frequently published in both the medical literature and the lay press, but the content of these works has never been analyzed. METHODS Using obituary pieces from Neurosurgery, Journal of Neurosurgery, and the New York Times, frequent terms were quantified through preliminary text analysis to derive the relative importance of concepts such as innovation, research, training and family. The sentiment of these obituaries was qualitatively reviewed to approximate perceptions of neurosurgical legacy within the profession and the general public. RESULTS Thirty relevant obituaries with full text available were identified in the Journal of Neurosurgery, 14 were identified in Neurosurgery, and 23 were identified in the New York Times. Both neurosurgical journals and lay press articles relied on linear narratives, with greater emphasis on professional leadership and residency training in neurosurgical journals and proportionally greater mention of family in the lay press. CONCLUSIONS Our preliminary text analysis of neurosurgeon obituaries suggest what values are shared among the professional community and general public regarding the legacy of a neurosurgeon.
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Affiliation(s)
- Patrick David Kelly
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - David James Voce
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ahilan Sivaganesan
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John Clifton Wellons
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Phillips JP, Wilbanks DM, Rodriguez-Salinas DF, Doberneck DM. Specialty income and career decision making: a qualitative study of medical student perceptions. MEDICAL EDUCATION 2019; 53:593-604. [PMID: 30821014 DOI: 10.1111/medu.13820] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/10/2018] [Accepted: 01/09/2019] [Indexed: 06/09/2023]
Abstract
CONTEXT Medical educators in the USA are interested in the ways medical students make career choices because shortages in key specialties, particularly primary care specialties, limit access to care. Although anticipated specialty income is a strong predictor of student interest, no studies have qualitatively explored the reasons why income is important to students. By better understanding students' perspectives on income and specialty choice, educators can help students make choices that fit their goals and better educate students about the specialties in which the need for expansion is greatest. METHODS In 2012, Year-2 students at one USA medical school were invited to write an essay about how debt and anticipated income levels influence their career choices. A total of 132 essays (response rate: 67%) were qualitatively analysed using a hermeneutic phenomenology approach to conventional content analysis, in which themes emerge inductively from the data. Researchers employed peer debriefing, modified member checking, thick description, code-recode strategies, audit trails and reflexivity to ensure quality and rigour. Although this analysis initially focused on student perceptions of specialty income, prestige also emerged as an important related theme. RESULTS Three major findings emerged. Income is of varying importance to different students. Students value income because it provides freedom and flexibility, and power and security. Students recognise that high income confers social prestige. Students also define specialty prestige in other ways, including match competitiveness, perceived expertise, opportunities for advancement through fellowships, and power and autonomy. CONCLUSIONS Medical students' perspectives of specialty income, specialty choice and prestige are more complex than previously reported. Medical educators should frame conversations about specialty choices in ways that incorporate varied perspectives on income and prestige. Health policymakers should recognise that income and prestige influence medical students' decisions in complex ways. These insights may inform strategies to counteract shortages in key specialties, including primary care specialties.
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Affiliation(s)
- Julie P Phillips
- Sparrow-MSU Family Medicine Residency Program, College of Human Medicine, Michigan State University, Lansing, Michigan, USA
- Office of Student Affairs and Services, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Deana M Wilbanks
- Office of Student Affairs and Services, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Diana F Rodriguez-Salinas
- Peoria Family Medicine Residency Program, University of Illinois College of Medicine, Peoria, Illinois, USA
| | - Diane M Doberneck
- National Collaborative for the Study of University Engagement, Michigan State University, East Lansing, Michigan, USA
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Gutmann L, Cahill C, Jordan JT, Gamaldo CE, Santini V, Ali I, Soni M, Wilson RB, Said R, Czeisler BM, Smith AG. Characteristics of graduating US allopathic medical students pursuing a career in neurology. Neurology 2019; 92:e2051-e2063. [DOI: 10.1212/wnl.0000000000007369] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/03/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectivesTo identify factors associated with medical students becoming neurologists because, despite the increasing burden of neurologic disorders, there is a growing neurologist shortage.MethodsDeidentified data from the Association of American Medical Colleges Matriculating Student Questionnaire (MSQ) and Graduation Questionnaire (GQ) were obtained for the graduation years 2013 to 2014 through 2016 to 2017. Logistic regression was used to assess demographic characteristics and responses to training and career-related questions in association with specialty choice (intent to enter neurology).ResultsOf the 51,816 students with complete data, 1,456 (2.8%) indicated an intent to enter a neurology residency. Factors associated with an increased likelihood of entering neurology were a student's rating of excellent for their basic neuroscience course and neurology clerkship, participation in an MD/PhD program, majoring in neuroscience or psychology as an undergraduate, a selection response of “content of the specialty was a strong influence on career choice,” and indicating interest in neurology on the MSQ. Factors associated with a decreased likelihood of entering neurology were a higher-priority response on the GQ for salary, work/life balance, and personal fit of the specialty.ConclusionData from surveys at the entry into and graduation from medical school suggest several approaches to increase the number of medical students entering neurology, including a focus on the student-reported quality of the basic neuroscience course and neurology clerkships, targeted engagement with MD/PhD students, and mentoring programs for students interested in neurology. Efforts to improve salaries for neurologists, to reduce medical school debt, and to improve work/life balance may also help to attract more students.
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