Medical students' perceptions of general practice as a career; a phenomenological study using socialisation theory

Revitalising interest in general practice: innovative educational strategies to transform medical student perceptions in the UK

BACKGROUND

The UK faces a decline in medical students' interest in general practice (GP), crucial for its healthcare system. This trend endangers primary care sustainability and broader healthcare infrastructure, necessitating innovative educational approaches to improve perceptions of general practice.

OBJECTIVE

To assess the impact of a pilot programme integrating innovative educational strategies on medical students' perceptions of general practice, aiming to highlight potential reforms for medical education and primary care's future in the UK.

METHODS

A longitudinal pilot study with eighteen fifth-year medical students from Queen Mary University of London employed a diverse educational approach over thirty-six months. The programme encompassed mentorship, storytelling, community home visits, interactive patient cases, and GP speciality clinics, covering six GP practice domains. Data were collected through mid-placement and end-of-placement questionnaires to evaluate students' perceptions and interest in GP careers.

RESULTS

The programme significantly improved students' perceptions of general practice. Mentorship and storytelling saw an 83% to 94% increase in appreciation for GP complexities and impact. Community home visits enhanced cultural sensitivity and holistic health views among 67% to 89% of participants. Interactive patient cases and GP speciality clinics notably advanced understanding of GP's multidisciplinary nature. Exposure to GP-led research and business initiatives heightened awareness of entrepreneurial and innovative opportunities within general practice.

CONCLUSIONS

Innovative educational strategies can substantially influence medical students' perceptions and interest in general practice. The study suggests that enriching medical education with real-world experiences, mentorship, and comprehensive general practice exposure can counter declining interest, showcasing general practice as a dynamic and fulfilling career.

'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

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.

Career intentions of medical students in the UK: a national, cross-sectional study (AIMS study)

OBJECTIVE

To determine current UK medical students' career intentions after graduation and on completing the Foundation Programme (FP), and to ascertain the motivations behind these intentions.

DESIGN

Cross-sectional, mixed-methods survey of UK medical students, using a non-random sampling method.

SETTING

All 44 UK medical schools recognised by the General Medical Council.

PARTICIPANTS

All UK medical students were eligible to participate. The study sample consisted of 10 486 participants, approximately 25.50% of the medical student population.

OUTCOME MEASURES

Career intentions of medical students postgraduation and post-FP, motivations behind these career intentions, characterising the medical student population and correlating demographic factors and propensity to leave the National Health Service (NHS).

RESULTS

The majority of participating students (8806/10 486, 83.98%) planned to complete both years of the FP after graduation, with under half of these students (4294/8806, 48.76%) intending to pursue specialty training thereafter. A subanalysis of career intentions after the FP by year of study revealed a significant decrease in students' intentions to enter specialty training as they advanced through medical school. Approximately a third of surveyed students (3392/10 486, 32.35%) intended to emigrate to practise medicine, with 42.57% (n=1444) of those students not planning to return. In total, 2.89% of students intended to leave medicine altogether (n=303). Remuneration, work-life balance and working conditions were identified as important factors in decision-making regarding emigration and leaving the profession. Subgroup analyses based on gender, type of schooling, fee type and educational background were performed. Only 17.26% of surveyed students were satisfied or very satisfied with the overall prospect of working in the NHS.

CONCLUSIONS

The Ascertaining the career Intentions of UK Medical Students study highlights UK students' views and career intentions, revealing a concerning proportion of those surveyed considering alternative careers or emigration. Addressing factors such as remuneration, work-life balance and working conditions may increase retention of doctors and improve workforce planning efforts.

Ascertaining the Career Intentions of Medical Students (AIMS) in the United Kingdom Post Graduation: Protocol for a Mixed Methods Study

BACKGROUND

Among doctors in the United Kingdom, there is growing sentiment regarding delaying specialist training, emigrating to practice medicine abroad, or leaving the profession altogether. This trend may have substantial implications for the future of the profession in the United Kingdom. The extent to which this sentiment is also present in the medical student population is not well understood.

OBJECTIVE

Our primary outcome is to determine current medical students' career intentions after graduation and upon completing the foundation program and to establish the motivations behind these intentions. Secondary outcomes include determining which, if any, demographic factors alter the propensity to pursue different career paths available to a medical graduate, determining which specialties medical students plan on pursuing, and understanding current views on the prospect of working in the National Health Service (NHS).

METHODS

The Ascertaining the Career Intentions of Medical Students (AIMS) study is a national, multi-institution, and cross-sectional study in which all medical students at all medical schools in the United Kingdom are eligible to participate. It was administered via a novel, mixed methods, and web-based questionnaire and disseminated through a collaborative network of approximately 200 students recruited for this purpose. Both quantitative and thematic analyses will be performed.

RESULTS

The study was launched nationally on January 16, 2023. Data collection was closed on March 27, 2023, and data analysis has commenced. The results are expected to be available later in the year.

CONCLUSIONS

Doctors' career satisfaction within the NHS is a well-researched topic; however, there is a shortage of high-powered studies that are able to offer insight into medical students' outlook on their future careers. It is anticipated that the results of this study will bring clarity to this issue. Identified areas of improvement in medical training or within the NHS could be targeted to improve doctors' working conditions and help retain medical graduates. Results may also aid future workforce-planning efforts.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/45992.

Barriers and facilitators to primary care research: views of GP trainees and trainers

Background

Primary care plays an important role in the conception and delivery of transformational research but GP engagement is lacking, prompting calls for the promotion of academic opportunities in primary care.

Aim

To identify potential barriers and facilitators among GP trainees and trainers in primary care research to inform support given by Local Clinical Research Networks (LCRNs).

Design & setting

A cross-sectional online survey was developed and distributed by the CRN to GP trainees and trainers in the North East and North West.

Method

The survey covered areas including demographics, career intentions, current and potential engagement with research, as well as their general understanding of research in primary care, which included barriers and facilitators to primary care research.

Results

Trainees had low intentionality to pursue research and half of trainees did not engage with any research activity. Despite one in five trainees reporting intentions to include research in their career, only 1% would undertake a solely academic career. Medical school region was the only strongly associated factor with academic career intention. Just under 30% of trainers reported engagement in research, but far fewer (8.6%) were interested in contributing to research, and only 10% felt prepared to mentor in research.

Conclusion

Among trainees, there is limited engagement in and intentionality to pursue research, and this was crucially reflected by responses from trainers. This study identified the need for LCRNs to assist with training in research mentoring and skills, funding opportunities, and to develop resources to promote research in primary care.

Denigration of general practice as a career choice: The students' perspective. A qualitative study

Background

General practice in the UK and other parts of the world is facing a recruitment crisis with insufficient numbers of medical students selecting it as a career choice. Denigration of general practice has been postulated as one of the contributing factors.

Aim

To explore comments about general practice as a career made by clinical teachers from the medical student’s perspective, and in doing so to further understand the current difficulties of recruiting into general practice.

Design & setting

A qualitative, explorative study of three focus groups of medical students from two medical schools in northern England.

Method

A semi-structured interview format was utilised. The following four questions were posed to the participants about choosing general practice as a career: had they heard negative comments? Had they heard positive comments? Do they think comments influence student career decisions or is it a problem? Could they suggest any solutions to the issue? Results were analysed using thematic analysis.

Results

Students reported hearing both positive and negative comments about general practice as a career choice. They perceived the comments to potentially influence student career choice. Three underlying themes emerged: the individual (personal characteristics of students affecting the influence that comments have on them); the curriculum (presence and content of general practice teaching); and culture (in the medical school and profession). These were used to postulate a model that may explain how negative comments shape students’ perceptions of general practice.

Conclusion

Denigration of general practice is an ongoing problem within the medical profession and strategies to address it must be developed or recruitment to the specialty will continue to decline. This study suggests a model that can help to understand the complex relationship between different factors that result in negative comments being taken on board by medical students.

Intellectual stimulation in family medicine: an international qualitative study of student perceptions

Background

Globally, medical schools struggle to ensure there is a sufficient number of graduates choosing family medicine as a career to meet societal needs. While factors impacting career choice are complex, one possible disincentive to choosing family medicine is the perception that it is less intellectually stimulating than specialty care.

Aim

The study sought to elicit student views on intellectual stimulation in family medicine, and their understanding of academic family medicine.

Design & setting

This is a qualitative focus group study of volunteer students from the University of Calgary, Canada, and Newcastle University, UK.

Method

Six focus groups were conducted with 51 participants. The data were analysed thematically.

Results

Students associated intellectual stimulation in family medicine with clinical practice. Intellectual stimulation was related to problem solving and the challenge of having to know a little about everything, along with clinical uncertainty and the need to be vigilant to avoid missing diagnoses. Student awareness of academic family medicine was limited, and students identified it with teaching rather than research.

Conclusion

Promoting intellectual stimulation in family medicine requires educators to highlight the breadth and variety of knowledge required in family medicine, as well as the need to manage clinical uncertainty and to be vigilant to avoid missing diagnoses. Exposure to academic family medicine could enhance students’ understanding and appreciation of the role of research in family medicine.