The relationship between specialty choice and gender of U.S. medical students, 1990-2003

Factors Affecting Specialty Training Preference Among UK Medical Students (FAST): Protocol for a National Cross-Sectional Survey

BACKGROUND

The UK medical education system faces a complex landscape of specialty training choices and heightened competition. The Factors Affecting Specialty Training Preference Among UK Medical Students (FAST) study addresses the need to understand the factors influencing UK medical students' specialty choices, against a backdrop of increasing challenges in health care workforce planning.

OBJECTIVE

The primary objectives of the FAST study are to explore UK medical students' preferred specialties and the factors that influence these choices. Secondary objectives are to evaluate students' confidence in securing their chosen specialty, to understand how demographic and academic backgrounds affect their decisions, and to examine how specialty preferences and confidence levels vary across different UK medical schools.

METHODS

A cross-sectional survey design will be used to collect data from UK medical students. The survey, comprising 17 questions, uses Likert scales, multiple-choice formats, and free-text entry to capture nuanced insights into specialty choice factors. The methodology, adapted from the Ascertaining the Career Intentions of UK Medical Students (AIMS) study, incorporates adjustments based on literature review, clinical staff feedback, and pilot group insights. This approach ensures comprehensive and nondirective questioning. Data analysis will include descriptive statistics to establish basic patterns, ANOVA for group comparisons, logistic regression for outcome modeling, and discrete choice models for specialty preference analysis.

RESULTS

The study was launched nationally on December 4, 2023. Data collection is anticipated to end on March 1, 2024, with data analysis beginning thereafter. The results are expected to be available later in 2024.

CONCLUSIONS

The FAST study represents an important step in understanding the factors influencing UK medical students' career pathways. By integrating diverse student perspectives across year groups and medical schools, this study seeks to provide critical insights into the dynamics of specialty, or residency, selection. The findings are anticipated to inform both policy and educational strategies, aiming to align training opportunities with the evolving needs and aspirations of the future medical workforce. Ultimately, the insights gained may guide initiatives to balance specialty distribution, improve career guidance, and improve overall student satisfaction within the National Health Service, contributing to a more stable and effective health care system.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55155.

Medical students' career preferences in Bangladesh

AIM

This study aimed to investigate the career preferences among Bangladeshi medical students, identify the factors that influence their present choices, and additionally report the role of gender and academic year behind their decisions.

METHODS

This cross-sectional study conducted in Bangladesh from August 2022 to April 2023 included 801 medical students conveniently selected from medical colleges in eight divisions. Data were collected using a web-based survey and analysed using STATA version 16.0. Statistical tests included the Kolmogorov-Smirnov test, arithmetic mean, standard deviation, frequency, and Kruskal-Wallis H test. The response rate was 94.6%, and the CHERRIES guideline was followed for reporting the results.

RESULT

The majority of the participants were female (64.42%) and under the age of 23 years (58.8%). The study revealed that medicine was the preferred career choice for the majority of students (65%), with surgery being the most popular first choice (30.21%) among them. Female medical students showed a significantly higher preference for gynaecology & obstetrics (p < 0.001), while male students had a significantly higher tendency to choose general practice (p = 0.002). There is a significant gender difference (p < 0.05) in the career preference factors, including professional prestige, role model influence, easy money, family time, promotion opportunities, income for lifestyle, and research opportunities. Academic year differences were also observed, with increasing interest in medicine and public health (p < 0.001), a decrease in interest in surgery (p < 0.001), and a decline in preference for non-medical careers as students progressed through their MBBS life (p < 0.05).

CONCLUSION

Overall, medicine was the most popular speciality choice, however, male students preferred general practice and female students preferred gynaecology and obstetrics more. Personal passion, opportunities for contribution to society, professional prestige, having a direct dealing with patients, and income will allow an enjoyable lifestyle were the most important factors in the choice of their career.

Factors influencing medical students' decision to pursue a career in obstetrics and gynaecology

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.

Specialty impact on residents' perceived quality of life, stress, and job satisfaction: a comparative study

Purpose

Specialty choice in residency training has a significant impact on an individual's career and satisfaction, as well as the supply-demand imbalance in the healthcare system. The current study aimed to investigate the quality of life (QOL), stress, self-confidence, and job satisfaction of residents, and to explore factors associated with such variables, including postgraduate year, sex, and especially specialty, through a cross-sectional survey.

Methods

An online survey was administered to residents at 2 affiliated teaching hospitals. The survey had a total of 46 items encompassing overall residency life such as workload, QOL, stress, confidence, relationship, harassment, and satisfaction. Related survey items were then reconstructed into 4 key categories through exploratory factor analysis for comparison according to group classification.

Results

The weekly work hours of residents in vital and other specialties were similar, but residents in vital specialties had significantly more on-call days per month. Residents in vital specialties had significantly lower scores for QOL and satisfaction. Specifically, vital-surgical residents had significantly lower QOL scores and higher stress scores than the other specialty groups. Satisfaction scores were also lowest among vital-surgical residents, with a marginal difference from vital-medical, and a significant difference from other-surgical residents. Female residents had significantly lower satisfaction scores than their male counterparts.

Conclusion

Residents in vital specialties, particularly vital-surgical specialties, experience significantly worse working conditions across multiple dimensions. It is necessary to improve not only the quantity but also the quality of the system in terms of resource allocation and prioritization.

Representation of women in orthopaedic surgery: perception of barriers among undergraduate medical students in Saudi Arabia

BACKGROUND

While female participation has improved in several surgical specialties over time globally, no such increase has been observed in orthopaedic surgery over the past decades. The potential barriers to female participation are likely present from the beginning of medical education. Therefore, this study assessed the apparent lag in equal representation among men and women in orthopaedic surgery in the Kingdom of Saudi Arabia.

METHODS

This cross-sectional study used a questionnaire survey to investigate medical students' and interns' perceptions of women participating in orthopaedic surgery, their subspeciality preferences, and barriers preventing them from pursuing an orthopaedic career. The responses were analysed to understand general perceptions, gender-based differences, impact of clinical experiential learning, and exposure to orthopaedic surgery.

RESULTS

Approximately 565 medical students (49% females, 51% males) participated in the survey. Only 17% of students (11% females, 23% males) considered orthopaedic surgery as their future career option. While 31% of female and 17% of male students disagreed with the concept of female-appropriate orthopaedic subspecialties, most of the remaining male and female students perceived paediatric orthopaedics as a female-appropriate subspecialty. Concerning equal representation of women, gender bias and lack of a strong physique were the most frequently selected barriers by female and male students, respectively. Patient preference for male orthopaedicians, gender discrimination, social and family commitments, and need for physical strength were all perceived as barriers for women in orthopaedics. Overall, clinical experience and orthopaedic exposure did not significantly improve the likelihood of female students in choosing orthopaedic surgery as a career.

CONCLUSIONS

The bias against women in orthopaedic careers is prevalent among medical students early in their academic years. Clinical experience and exposure to orthopaedic surgery should be improved to make a significant impact on female participation in orthopaedic careers. Career building efforts in terms of improved career opportunities, career counselling, flexible working hours, social and family related adjustments and implementation of mentorship/research/fellowship programmes for females are needed to reduce gender discrimination and improve female orthopaedic participation. Furthermore, process improvements may yield greater flexibility for women pursuing the challenging field while accommodating other barriers faced by women in orthopaedic surgery.

Examination of Motivational Influences on Clinical-Year Veterinary Students' Career Decisions

The purpose of this study was to identify motivations for fourth-year veterinary students to choose future career paths based on post-graduation employment or post-graduation education. Approximately 500 students from four institutions were invited to participate in an online survey. Surveys were based on the cognitive evaluation theory, a minitheory within the self-determination macrotheory framework developed by Deci and Ryan. Intrinsic motivational factors were categorized by autonomy, competence, and relatedness, and extrinsic motivators were categorized by environmental and interpersonal factors. Students pursuing post-graduation education have intrinsic motivators that aligned with competence and were extrinsically motivated by a mentor, while students interested in post-graduation employment had intrinsic motivators that were more focused on autonomy with extrinsic motivational influences of debt/finances and geographic location.

Factors influencing burnout in millennial medical students during the COVID-19 pandemic!

Background

Burnout among millennial medical students is an important health issue with a possibility of potential professional dissatisfaction. The reason for burnout is multifactorial. The gender of the medical student may play a significant role when choosing a residency specialty and making a career choice. Gender may also influence while establishing the burnout seen in students. Here we tested the association between burnout in medical students based on gender and residency specialty choice during COVID-19.

Methods

A multicentric cross-sectional study, using a questionnaire-based survey on the items related to gender, educational interest, status, residency aspiration, changes to career aspiration based on gender, and COVID-19 and an indigenous burnout assessment tool that was administered to all the medical students in the study. Reliability and validity of the tool were assessed, and the burnout was calculated for emotional exhaustion, personal achievement, and depersonalization domain.

Results

A total of 487 medical students (42.5% males, 57.2% females) completed the survey. A higher number of female participants felt that COVID-19 affected their energy levels (68.9%), interest in education (53.2%), and developed reservations about residency specialty of choice (46%); emotional and physical exhaustion (2.88 ± 0.69 & 2.34 ± 0.76) was higher than the male participants (3.16 ± 0.67 & 2.75 ± 0.85).

Conclusion

More female participants experienced emotional distress, depersonalization or professional disengagement, and psychological and physical stress and exhaustion due to the COVID-19 pandemic. An important association observed in the study was between residency choice and burnout.

Supplementary information

The online version contains supplementary material available at 10.1007/s11845-022-03016-8.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Why Ophthalmology: A Cross-Sectional Study of the Motivating Factors Influencing the Choice of Ophthalmology as a Career Among Medical Students in Saudi Arabia

Background: Choosing a future career is a frightening and anxious decision for medical students; understanding any factor that influences making such a decision will be helpful for the medical students to reach it with satisfaction.

Aim: The aim of this study was to determine the factors that would influence the choice of ophthalmology as a future career among medical students in multi-medical colleges in Saudi Arabia.

Methods: This cross-sectional study was conducted for pre-clinical and clinical medical students from February 2021 to May 2021 in multi-medical colleges in Saudi Arabia. The questionnaire used was from previously published research, and it was modified and validated by a board-certified ophthalmologist.

Results: A total of 6.1% of all medical students considered ophthalmology as their first choice as a future career; factors that influenced choosing ophthalmology were personal interest, satisfaction from improving patient quality of vision, good patient prognosis, and the appeal of being an ophthalmologist; these factors showed a highly significant difference in comparison to other factors.

Conclusion: Several factors are explored for choosing ophthalmology as a future specialty; understanding these factors can help medical students determine their choices for a future career. 

A Holistic Approach of Personality Traits in Medical Students: An Integrative Review

Personality is one of the most crucial aspects of human life, since it influences all human behaviours in both personal and social life, and might also trigger important conflicts with a person’s surroundings in the setting of incompatible traits and characteristics. It is true that ‘one must be born’ for a certain medical specialty, but several components of personality might be educated with proper training. Increased levels of Conscientiousness, Agreeableness, and Openness associated with lower levels of Neuroticism might represent the key combination for achieving professional satisfaction in the medical profession. Medical students should receive proper interprofessional education, since effective interprofessional relationships among healthcare providers definitely improve patients’ safety. Empathy contributes to effective patient–physician communication, improving patient trust, compliance, and satisfaction, being positively correlated with Openness, Agreeableness, Conscientiousness and Extraversion. Emotional intelligence—the capacity to respond to one’s own and others’ emotions—was proven to contribute, in a synergistic way with empathy, to increasing empathic ability. Clinical communication skills represent a key component in medical students in order to achieve the best patient care, and they are certainly related and/or influenced by empathy, interprofessional collaboration skills, emotional intelligence and, especially, personality traits. Taking into account the complex interactions mentioned above, the implementation of effective courses based on these concepts in medical students, intending to promote the development of clinical communication skills, represents a real emergency, since it might result in a reduction in medical errors and subsequent related deaths. A thorough understanding of students’ personality is mandatory before designing these courses in order to provide a training tailored to their personality styles.

Medical students' experiences in learning to perform pelvic examinations: a mixed-methods study

OBJECTIVES

We aimed to explore learning experiences among medical students learning to perform pelvic examinations and to identify factors that facilitate their training.

METHODS

A mixed-methods study including a web-based survey and focus group discussions (FGDs) was conducted among medical students who had completed their obstetrics and gynaecology (ObGyn) clerkship. The FGDs were recorded, transcribed and analysed using qualitative content analysis with systematic text condensation. Survey factors were compared using the χ² test or Fisher's exact test.

RESULTS

160 students (97 female, 61 male, two other) at six universities in Sweden responded to the survey. Two mixed FGDs were conducted. The majority (87%) of the students experienced confidence in performing pelvic examinations, stating that sufficient, repeated training opportunities and support from a clinical tutor were crucial components of the learning experience. Prior to the ObGyn clerkship, negative expectations were more common among male students. The male participants experienced having a disadvantage because of their gender, while female students considered their gender an advantage (p<0.001, N=121, Fisher's Exact Test). The clinical tutor and the use of professional patients (PPs) had a fundamental role in providing learning opportunities by including the student in patient care activities.

CONCLUSIONS

The importance of the clinical tutor, as well as the use of PPs, are important factors when planning education in pelvic examinations, and this knowledge could be used when educating other intimate examinations during medical school. In addition, similar investigations on students' experience in training other intimate examinations could be considered.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A National Survey on the characteristics of Iranian General Practitioners and Their Preferred Specialty: A Need to Transition toward Preventive Medicine

Background:

The shortage and unbalanced distribution of physicians has adverse effects on the provision of equitable services at all levels of health care and especially at the prevention and primary care levels. The choice of specialty can seriously change the structure and composition of the physician workforce. Therefore, this study aimed to investigate the relationship between background characteristics of Iranian general practitioners' (GPs) and their preferred specialty fields.

Methods:

In this mixed-method study, first, 12 medical doctors participated in a nominal group technique to determine the most important background characteristics that affect GPs' preferences for specialty selection. In the second phase, we conducted a survey among 680 GPs in six provinces from different geographic regions. We gathered data using a researcher-made checklist and analyzed them using an adjusted multivariate regression.

Results:

The adjusted analysis showed that being female, being married, being in an older age group, having children, graduation from universities located in the provincial centers, and decision for living and practicing in the less-populated areas were significantly associated with the Iranian GPs' preferences for non-surgical specialties.

Conclusions:

This study provided evidence that could inform national health workforce policy-makers to avoid unbalanced distribution of physicians and accordingly to ensure the provision of equitable services at all levels of healthcare and especially at the primary care level. Other effective factors on the selection of specialty should be evaluated at the national level using specific surveys and econometrics studies such as discrete selection experiment to move toward preventive medicine.

Choosing Primary Care: Factors Influencing Graduating Osteopathic Medical Students

Context

Access to primary care (PC) improves health outcomes and decreases health care costs. The shortage of PC physicians and shifting physician workforce makes this an ongoing concern. Osteopathic medical schools are making strides to fill this void. Considering the critical need for PC physicians in the United States, this study aims to identify factors related to choosing a PC specialty.

Objective

To understand possible motivations of osteopathic medical students pursuing a career in PC specialties by examining the role of sex and the influence of 5 key factors in this decision.

Methods

Responses from the annual American Association of Colleges of Osteopathic Medicine graduate survey (2007-2016) were analyzed. Self-reported practice decision considerations of 5 key factors, including (1) intellectual and technical content, (2) debt level, (3) lifestyle, (4) prestige/income level, and (5) personal experience and abilities were summarized, and their subjective value was contrasted between osteopathic medicine graduates pursuing PC specialties vs those pursuing non-PC specialties.

Results

The mean percentage of graduates pursuing PC and non-PC specialties from 2007 to 2016 was 31.3% and 68.7%, respectively. Women were 1.75 times more likely to choose PC than men (95% CI, 1.62-1.89). Regardless of specialty choice, lifestyle was the most important factor each year (1027 for PC [75.3%] vs 320 for non-PC [63.3%] in 2016; P<.0001). Students entering PC were more likely to report prestige and income level to be "no or minor influence" compared with students entering non-PC specialties (P<.0001). Debt level was more likely to be a "major influence" to students choosing to enter non-PC specialties than to those entering PC (P<.0001), and the percentage of non-PC students has grown from 383 in 2007 (22.9%) to 833 in 2016 (30.6%).

Conclusion

Sex was found to significantly influence a graduate's choice of specialty, and female graduates were more likely to enter practice in PC. Each of the 5 survey factors analyzed was significantly different between students entering PC and students entering non-PC specialties. Lifestyle was deemed a major influencing factor, and responses suggested that debt level is a strong influencing factor among students pursuing non-PC specialties.

Is Lactating in the Emergency Department a Letdown? Exploring Barriers and Supports to Workplace Lactation in Emergency Medicine

STUDY OBJECTIVE

To explore the social and environmental conditions in emergency departments that contribute to perceived barriers and supports for workplace lactation among individuals working in emergency medicine.

METHODS

Constructivist grounded theory was used by our team to understand the social processes and behaviors associated with workplace lactation for health care professionals working in EDs. A total of 24 interviews of individuals in EDs with recent return-to-work experience after childbirth were performed. The interviews yielded 36 unique experiences (from 21 faculty, 12 trainees, and 3 nurses) because some participants had more than 1 child, in which case all lactation experiences were discussed. Interview transcriptions were coded and analyzed iteratively for the development of themes, per constructivist grounded theory.

RESULTS

Using constant comparative inductive methods, we describe 3 pervasive themes as they relate to workplace lactation that emerged from the analysis of interview data: (1) emergency medicine culture, (2) workplace lactation policies, and (3) supports for workplace lactation.

CONCLUSION

Although formalized workplace lactation policies and other identifiable supports for workplace lactation aid individuals desiring to lactate after returning to work in EDs, many individuals still experience cultural barriers to their desired lactation habits. Policies and individual support systems may continue to fall short of meeting the needs of lactating individuals in emergency medicine unless broader cultural change occurs. Our work offers initial recommendations for shifting the landscape of lactation practices in emergency medicine.

Career choice and influential factors among medical students majoring in psychiatry in China

BACKGROUND

The undergraduate program of psychiatry has been widely established in recent years to improve the education and recruitment of psychiatrists in China. We aim to investigate the career choice of medical students majoring in psychiatry in China and the influential factors.

METHOD

This multicenter study was conducted in 26 medical schools in China from May to October of 2019. Participants included 4610 medical students majoring in psychiatry and 3857 medical students majoring in clinical medicine. Multivariable logistic regression was used to investigate the influential factors of students' choices of psychiatry at matriculation and as a career.

RESULTS

44.08% of psychiatry majored students gave psychiatry as a first choice at matriculation, and 56.67% of them would choose psychiatry as a career, which was in sharp contrast to the proportion of clinical medicine majored students who would choose psychiatry as a career (0.69%). Personal interest (59.61%), suggestions from family members (27.96%), and experiencing mental problems (23.19%) were main reasons for choosing psychiatry major at matriculation. Personal interest (odds ratio [OR] = 2.12, 95% confidence interval [CI] = 1.87-2.40), experiencing a psychiatry clerkship (OR = 1.99, 95% CI = 1.28-3.08), being female (OR = 1.50, 95% CI = 1.30-1.68), experiencing mental problems (OR = 1.33, 95% CI = 1.28-1.56), and suggestions from family members (OR = 1.25, 95% CI = 1.08-1.46) correlated positively with students' choice of psychiatry as career. Students who lacked psychiatry knowledge (OR = 0.49, 95% CI = 0.29-0.85) or chose psychiatry because of lower admission scores (OR = 0.80, 95% CI = 0.63-0.97) were less likely to choose psychiatry as a career.

CONCLUSION

More than half of psychiatry majored medical school students planned to choose psychiatry as their career, whereas very few students in the clinic medicine major would make this choice. Increasing students' interest in psychiatry, strengthening psychiatry clerkships, and popularizing psychiatric knowledge are modifiable factors to increase the psychiatry career intention. The extent to which medical students' attitudes toward psychiatry can be changed through medical school education and greater exposure to psychiatry will need further investigation.

A thematic network for factors affecting the choice of specialty education by medical students: a scoping study in low-and middle-income countries

BACKGROUND

Medical specialty selection is a complex phenomenon that can affect the performance of health systems, community health, and physicians' lives. It is essential to identify the key factors influencing the choice of specialty for evidence-based policymaking. This scoping review aimed to provide a comprehensive map of evidence regarding the factors influencing the choice of specialty by medical students (MS) in low-and middle-income countries (LMICs) and also to determine knowledge gaps.

METHODS

We carried out a systematic search on six online databases from January 2000 to May 2020. We used a five-step scoping review method proposed by Arksey and O'Malley. We synthesized the data using a quantitative content analysis approach. Then, we developed a thematic network as a conceptual map for a better understanding of the concept.

RESULTS

The analysis led to the development of five main themes, including personal determinants, life fulfillment aspects, influential career aspects, educational determinants, and interpersonal effects. Moreover, the most frequent sub-themes were specific personal factors, controllable lifestyle, quality of working life, and future working conditions.

CONCLUSION

This review provided evidence on the factors influencing the choice of specialties. In order to support physician workforce policy with more precise evidence, it is necessary to explore the weight and ranking of these factors based on the socioeconomic contexts of the countries. This study also indicated that factors such as ethical values, various aspects of medical philosophy, and immigration tendencies are areas for further investigations.

Defining competence profiles of different medical specialties with the requirement-tracking questionnaire - a pilot study to provide a framework for medial students' choice of postgraduate training

BACKGROUND

The medical specialties are characterised by a great diversity in their daily work which requires different sets of competences. A requirement analysis would help to establish competence profiles of the different medical specialities. The aim of this pilot study was to define competence profiles for individual medical specialties. This could provide a framework as support for medical graduates who wish to choose a medical specialty for their postgraduate training.

METHODS

In February 2020, physicians were invited via the State Chamber of Physicians' monthly journal to electronically fill out the requirement tracking (R-Track) questionnaire. It contains 63 aspects assigned to six areas of competence: "Mental abilities", "Sensory abilities", "Psychomotor and multitasking abilities", "Social interactive competences", "Motivation", and "Personality traits". The expression of the different aspects was assessed on a 5-point Likert scale (1: "very low" to 5: "very high"). Sociodemographic data and information about the current workplace (hospital or practice) were also collected.

RESULTS

In total, 195 practicing physicians from 19 different specialities followed the invitation by the State Chamber of Physicians to participate in this survey. For almost all medical specialties, the competence area "Motivation" reached rank 1. "Psychomotor and multitasking abilities" received high ranks among specialties performing surgical activities, while "Social interactive competences" and "Personality traits" were highly rated by specialties with an intense level of patient-physician-interaction. "Mental abilities" were only rated highly by radiologists (rank 2) and physiologists (rank 3) while "Sensory abilities" were generally rated very low with the expression (rank 4) for anaesthesiology and ENT.

CONCLUSIONS

In this pilot study, a first outline of competences profiles for 17 medical specialties were defined. The specific "Motivation" for a medical specialty seemed to play the greatest role for most specialties. This first specialty specific competence framework could provide a first insight into specific competences required by medical specialties and could serve medical graduate as a decision aid when looking for a medical specialty for their postgraduate training.

Análisis bibliométrico del balance vida/trabajo en mujeres médicas

Objetivo Realizar un análisis bibliométrico para conocer las tendencias de publicación en calidad de vida y balance vida/trabajo de mujeres médicas.

Métodos Se realizó un análisis bibliométrico retrospectivo de la literatura médica disponible desde 1996 hasta 2019 en la base de datos de MEDLINE, utilizando las herramientas estadísticas de FABUMED y PubReminer para la obtención de la información de las variables. Se utilizó el Journal Citation Reports 2017/2018 para el factor de impacto y el programa de software VOSviewer para el análisis de mapeo bibliométrico.

Resultados De un total de 204 referencias en 115 revistas, se presentó un crecimiento del 70,5% de las publicaciones los últimos años. El país, revista e institución con mayor número de manuscritos fue Estados Unidos (22.5%), Acad Med (4.9%) con factor de impacto de 4,9 years Harvard medical School, respectivamente. El autor con mayor número de artículos fue Nomura K con 6 publicaciones y un HI de 21. El mapeo y análisis de las evoluciones de las palabras clave con respecto a la línea de tiempo, se centró principalmente en: balance vida –trabajo, sexismo, liderazgo mentoría, mujeres cirujanas.

Conclusiones Las publicaciones sobre el tema balance vida/trabajo se han incrementado, permitiendo visualizar esta problemática y quizá lograr un impacto en el diseño de estrategias que permitan una mejor calidad de vida especialmente a las mujeres, quienes siguen teniendo una alta exigencia y responsabilidad en su vida familiar y a su vez, barreras profesionales e inequidad laboral.

The role of gender in the decision to pursue a surgical career: A qualitative, interview-based study

BACKGROUND

Previous literature has explored the underrepresentation of women in surgery. However, this research has often been quantitative or limited by considering only the perspectives and experiences of women at more advanced career stages. Here, we use a qualitative methodology and a sample of women and men across the career continuum to identify the role that gender plays in the decision to pursue a surgical career.

METHODS

We audio-recorded and transcribed semi-structured interviews conducted with 12 women and 12 men ranging in their level of medical training from medical students to residents to staff surgeons. We used Braun and Clarke's six-step approach to thematic analysis to analyze the data, maintaining trustworthiness and credibility by employing strategies including reflexivity and participant input.

RESULTS

Our findings suggested that the characteristics of surgery and early exposure to the profession served as important factors in participants' decisions to pursue a surgical career. Although not explicitly mentioned by participants, each of these areas may implicitly be gendered. Gender-based factors explicitly mentioned by participants included the surgical lifestyle and experiences with gender discrimination, including sexual harassment. These factors were perceived as challenges that disproportionately affected women and needed to be overcome when pursuing a surgical career.

CONCLUSIONS

Our findings suggest that gender is more likely to act as a barrier to a career in surgery than as a motivator, especially among women. This suggests a need for early experiences in the operating room and mentorship. Policy change promoting work-life integration and education to target gender discrimination is also recommended.

Career decision making in undergraduate medical education

BACKGROUND

It is unclear how medical students prioritize different factors when selecting a specialty. With rising under and unemployment rates a novel approach to career counselling is becoming increasingly important. A better understanding of specialty selection could lead to improved career satisfaction amongst graduates while also meeting the health care needs of Canadians.

METHODS

Medical students from the University of Toronto participated in a two-phase study looking at factors impacting specialty selection. Phase I consisted of focus groups, conducted independently for each year, and Phase II was a 21-question electronic survey sent to all students.

RESULTS

Twenty-one students participated in the focus group phase and 95 in the survey phase. Primary themes related to career selection identified in Phase I in order of frequency included personal life factors (36), professional life factors (36), passion/interest (20), changing interests (19) and hidden curriculum (15). The survey phase had similar results with passion (83), lifestyle (79), flexibility (75), employment opportunities (60) and family (50) being ranked as the factors most important in specialty selection.

CONCLUSION

Personal factors, professional factors and passion/interest may be key themes for medical students when deciding which specialty to pursue. Targeting career counselling around these areas may be important.

Trends in medical students' career choice of emergency medicine: A 14-year study

INTRODUCTION

The long-term trends of medical students' choice for emergency medicine (EM) in Turkey are unclear. With this background, we aimed to determine the change in the rate of EM preferences of students over the years.

METHODS

This was a cross-sectional study originated from 6^th-year medical students' feedback forms, to examine trends of EM carrier preferences between 2005 and 2018 in a tertiary care academic emergency department. There are two main questions containing "would you choose EM as a specialty?" and "why?" as open-ended questions in the form. The answers to the open-ended question were classified as six main factors, which were perception of work, lifestyle, nature of work, personal job preference, mentorship/department experiences, and income.

RESULTS

During the study, 2957 forms (80.6% of 3668) were completed by 6^th-year medical students. Of the students, 26.5% (n = 784) responded "yes" to the question, which was "would you choose EM as a specialty?," 6.1% (n = 181) responded "do not know," and 67.4% (n = 1992) responded "no." In 2005, 15% of students stated that they would choose EM, while this rate increased to 29% in 2018 (χ ²: 9.67; P trend = 0.003). Perception of work was the most common reason for "yes" (46.3%), "no" (46%), and "do not know" answers.

CONCLUSION

The rate of EM choice of medical students doubled during the study, and approximately one in three students stated that they could choose EM as their future career in the past year. Perception of work was the main factor for choosing or rejecting to EM.

Impact of artificial intelligence on the choice of radiology as a specialty by medical students from the city of São Paulo

OBJECTIVE

To evaluate the impact of artificial intelligence (AI) on undergraduate medical students' choice of radiology as a specialty.

MATERIALS AND METHODS

In February 2019, an anonymous online survey was sent to medical students. The research contemplated questions on how much students think they know about AI technologies, how much AI discourages them from choosing radiology as a specialty, and whether they believe there is a threat to the radiology job market.

RESULTS

A total of 101 students, most of them doing their internship, answered the questionnaire. More than half of them (52.5%) said they believe AI poses a threat to the radiology job market, but 64.3% claimed not to have proper knowledge about these new technologies, and 31.7% said they would like more information on the technologies' operation and progress before making a decision on whether or not to practice radiology as a specialty.

CONCLUSION

A significant proportion of the surveyed students perceive AI as a threat to the radiological practice, which impacts their career choice. However, the majority claims to have insufficient knowledge of it and believes more information is needed for decision-making.

A growing trend of females and dermatologists among top medical graduates in 30 years

BACKGROUND

Career outcomes of top medical graduates (TMG) are seldom studied. The Tsungming Tu Foundation (TTF) has awarded the number one graduate from each medical school in Taiwan since 1981. We aimed to study whether TMG differ from all medical graduates (AMG) in gender, specialty, and geographic regions in the last 30 years.

METHODS

Overall, 322 TMG and 40,075 AMG were identified from 1981 to 2017 from TTF and Taiwan healthcare public data, respectively. Subjects were further grouped by their graduation year: 1981-1994, 1995-2001, 2002-2011, and after 2012. Ranges were based on implementation dates of new health care policies.

RESULTS

The percentages of female AMG increased from 10.9% before 1994 to 32.6% after 2012 (linear trend, P < 0.001). Similarly, the percentages of female TMG increased from 23.1% before 1994 to 42.4% after 2012 (linear trend, P = 0.003). In contrast to 2% of AMG, the percentages of TMG who became dermatologists increased from 11% to 20.5% (linear trend, P = 0.024). TMG favored dermatology, ophthalmology, and neurology, and avoided general surgery (P < 0.001). While still higher than AMG, the percentages of TMG working in medical centers dropped significantly from 58% during 1981-1994 to 33.3% during 1995-2001 (P = 0.035). This coincided with the launch of National Health Insurance in 1995. Finally, though more than half of TMG previously worked in Northern Taiwan, they have recently moved to Central Taiwan.

CONCLUSIONS

The percentages of female AMG and TMG reached 32.6% and 42.4%, respectively, after 2012. TMG prefer to choose dermatology, ophthalmology, and neurology, but avoid general surgery. Changes in health policy, reimbursement policy, and medical education may be associated with AMG and TMG career choices.

Factors that predict for representation of women in physician graduate medical education

Background/Objective: To identify factors associated with underrepresentation of women in the largest medical specialties. Methods: The authors obtained specialty-specific data from the Association of American Medical Colleges, National Residency Match Program and Journal of the American Medical Association Graduate Medical Education Supplement from 2014 on the gender of trainees and faculty members, residency program director (PD)-rated importance of interview selection and rank list formation criteria, and characteristics of matched NRMP participants. They used linear regression to evaluate whether factors were associated with representation of female trainees in the 18 largest specialties that participated in the NRMP. They hypothesized that factors representing lower student exposure or higher research requirements would be associated with lower representation of women. Results: In 2014, representation of women as trainees ranged from 13.7% in Orthopedic Surgery to 82.5% in OB/Gyn. On multivariable analysis, the factors associated with specialties having lower percentages of female trainees were: not being part of the third year core (slope = 0.141, p = 0.002), having lower specialty mean step 1 scores (slope = 0.007, p = 0.017), and having lower percentages of female faculty members. For each 1% increase in female faculty, the percentage of female trainees increased by 1.45% (p < 0.001). Conclusions: Two exposure-related factors, percentage of female faculty members and being part of the third year core, were associated with underrepresentation of women as trainees. Future research could help examine whether these are causal associations. Medical schools and training specialties should investigate whether strategies to enhance mentorship and increase exposure to non-core specialties will increase the proportion of women in fields in which they are underrepresented.

The impact of general practitioners' gender on process indicators in Hungarian primary healthcare: a nation-wide cross-sectional study

OBJECTIVES

The objectives of our study were (1) to investigate the association between gender of the general practitioner (GP) and the quality of primary care in Hungary with respect to process indicators for GP performance and (2) to assess the size of the gender impact.

STUDY DESIGN

A nation-wide cross-sectional study was performed in 2016.

SETTING AND PARTICIPANTS

The study covered all general medical practices in Hungary (n=4575) responsible for the provision of primary healthcare (PHC) for adults. All GPs in their private practices are solo practitioners.

MAIN OUTCOME MEASURES

Multilevel logistic regression models were used to analyse the association between GP gender and process indicators of PHC, and attributable proportion (AP) was calculated.

RESULTS

48% of the GPs (n=2213) were women in the study. The crude rates of care provided by female GPs were significantly higher for seven out of eight evaluated indicators than those provided by male GPs. Adjusted for practice, physician and patient factors, GP gender was associated with the haemoglobin A1c (HbA1c) measurement: OR=1.18, 95% CI (1.14 to 1.23); serum creatinine measurement: OR=1.14, 95% CI (1.12 to 1.17); lipid measurement: OR=1.14, 95% CI (1.11 to 1.16); eye examination: OR=1.06, 95% CI (1.03 to 1.08); mammography screening: OR=1.05, 95% CI (1.03 to 1.08); management of patients with chronic obstructive pulmonary disease: OR=1.05, 95% CI (1.01 to 1.09) and the composite indicator: OR=1.08, 95% CI (1.07 to 1.1), which summarises the number of care events and size of target populations of each indicator. The AP at the specific indicators varied from 0.97% (95% CI 0.49% to 1.44%) of influenza immunisation to 8.04% (95% CI 7.4% to 8.67%) of eye examinations.

CONCLUSION

Female GP gender was an independent predictor of receiving higher quality of care. The actual size of the gender effect on the quality of services seemed to be notable. Factors behind the gender effect should receive more attention in quality improvement particularly in countries where the primary care is organised around solo practices.

Effect of sex on specialty training application outcomes: a longitudinal administrative data study of UK medical graduates

OBJECTIVES

To examine sex differences in the specialty training recruitment outcomes of UK medical graduates; and whether sex differences were explained by prior academic attainment and previous fitness to practise (FtP) declarations.

DESIGN

Retrospective longitudinal cohort study.

SETTING

Administrative data on entrants to all UK medical schools from the UK Medical Education Database.

PARTICIPANTS

10 559 doctors (6 155; 58% female) who entered a UK medical school in 2007 or 2008 and were eligible to apply for specialty training by 2015.

PRIMARY OUTCOME MEASURE

Odds of application, offer and acceptance to any specialty training programme, and on to each of the nine largest training programmes, adjusting for sex, other demographics, prior academic attainment, FtP declaration and medical school.

RESULTS

Across all specialties, there were no sex differences in applications for specialty training, but women had increased odds of getting an offer (OR=1.40; 95% CI=1.25 to 1.57; p<0.001) and accepting one (OR=1.43; 95% CI=1.19 to 1.71; p<0.001). Seven of the nine largest specialties showed significant sex differences in applications, which remained after adjusting for other factors. In the adjusted models, Paediatrics (OR=1.57; 95% CI=1.01 to 2.46; p=0.046) and general practice (GP) (OR=1.23; 95% CI=1.03 to 1.46; p=0.017) were the only specialties to show sex differences in offers, both favouring women. GP alone showed sex differences in acceptances, with women being more likely to accept (OR=1.34; 95% CI=1.03 to 1.76; p=0.03). Doctors with an FtP declaration were slightly less likely to apply to specialty training overall (OR=0.84; 95% CI=0.71 to 1.00; p=0.048) and less likely to accept an offer to any programme (OR=0.71; 95% CI=0.52 to 0.98; p=0.036), after adjusting for confounders.

CONCLUSIONS

Sex segregation between medical specialties is due to differential application, although research is needed to understand why men are less likely to be offered a place on to GP and Paediatrics training, and if offered GP are less likely to accept.

Systematic review of interventions to encourage careers in academic medicine

AIMS

Academic medicine is a career route that historically struggles to recruit and retain suitable doctors. The aim of this paper is to review the evidence for interventions to encourage careers in academic medicine by way of a descriptive systematic review.

METHODS

Key databases were searched in February 2017. Studies that evaluated interventions to encourage careers in academic medicine and that used a pre-post analysis or included a comparison group were included. Interventions reporting only learner satisfaction were excluded. The review was specific to medical students and graduates.

RESULTS

Twenty-four studies were identified for inclusion within the review. The included studies identified interventions across five domains: postgraduate funding, postgraduate training, mentoring, undergraduate interventions, and institutional change. The papers varied in terms of strength of conclusion and method of analysis with broad, structured, well-funded programs having the most palpable results.

CONCLUSIONS

The five domains identified offer a framework that can be used by institutions who wish to develop similar programs. It also offers a body of research on which an evidence base can be built.

Surgical gender gap: a curriculum concordance and career vector perspective

INTRODUCTION

Women's participation in medicine has increased dramatically during the last 50 years, yet Office for National Statistics data (2016) regarding annual pay continue to show an unequivocal 34% deficit in female doctors' remuneration compared with their male counterparts. This study aimed to identify whether there are measurable differences in the training, career vectors and profiles of higher general surgical trainees (HSTs), related to gender.

METHOD

The Deanery roster supplemented with Intercollegiate Surgical Curriculum Programme and Scopus data was used to identify the profiles of 101 consecutive HSTs (38 women, 63 men, single UK deanery). Primary outcome measures were training programme attrition rate, time to completion of training and achievement of third level 4 competence (3L4C) in indicative operations. Secondary outcomes were publication number, citations and Hirsch Indices (HIs).

RESULTS

Attrition rates were similar irrespective of gender (female n=3 (7.9%) vs male n=6 (9.5%), p=0.871). Training duration was on average 16 months longer in women (94 (72-134) months) than men (78 (72-112), p=0.002). Operative learning curve trajectories were similar; median operations required to achieve 3L4C was 380 (f) versus 410 (m, p=1.00). Academic profiles of men were stronger than women, specifically higher degrees; men (n=31, 83.8%), women (n=6, 16.2%, p=0.001); median (range) publication number 8 (0-57) versus 3 (0-38, p=0.003), citations 43 (0-1600) versus 9 (0-774, p=0.001), and HI 3 (0-26) versus 2 (0-12, p=0.002).

CONCLUSION

A complex variable gender gap was apparent related to time in training and academic profile, but not training attrition or operative learning curve trajectory.

Mapping the factors that influence the career specialty preferences by the undergraduate medical students

It is often perceived that undergraduate medical students do not select their career specialty until they are graduated. This study aimed to probe the preferences of undergraduate medical students about their career specialty and the factors influencing their choices. A self-administered questionnaire was distributed to 3rd through 5th year undergraduate medical students to record their choices of specialties and to identify the factors that influence their career selection. Out of 220 respondents, 29 (13.2%) students selected General Surgery, 24 (10.9%) Pediatrics, and 18 (8.2%) Internal Medicine as their career specialties; whereas 24 (10.9%) students were not able to select a major specialty. The least popular specialties were Gynecology and Obstetrics, Oncology, Histopathology, Orthopedics, Genetics, Psychology, each selected by one student. One hundred and seventeen (53.1%) thought their selected specialty 'matched their capabilities' and 82 (37.2%) perceived their selection as "innovative field in medicine". Career advice by friends and families and the desire to serve academic institutions could not influence career selection. Career preferences by medical students result from the interplay of a range of factors. General Surgery, Pediatrics and Internal Medicine were the most preferred specialties. The professional grooming programs to target specialties matching the trainees' capabilities and the specialties with state-of-the-art innovative technologies attract medical undergraduate students. The attained knowledge is vitally important for the policy makers in modifying the existing framework that can cater the popular and favored specialties.

Association of Mindfulness With Residency Preference and Curriculum Selection in Preclinical Osteopathic Medical Students

Context

Recent studies suggest the shortage of US primary care physicians will be more than 50,000 by the year 2025. Mindful osteopathic medical students may be more inclined to pursue a career in primary care practice than those demonstrating lower levels of mindfulness. If so, assessing mindfulness before and after admission to medical school may reduce this shortage.

Objective

In this cross-sectional survey-based study, the authors assessed whether mindfulness among preclinical osteopathic medical students was associated with (a) their current preference for primary care practice as a residency, and (b) their choice between 2 alternative curricula.

Method

Participants were first- and second-year osteopathic medical students enrolled at the New York Institute of Technology College of Osteopathic Medicine (NYITCOM). They completed a 7-factor questionnaire of demographic variables and the online Five Facet Mindfulness Questionnaire (FFMQ) to determine their mindfulness score. They also identified their current preference for a residency. Data were then presented using various descriptive statistics and analyzed using independent t tests, χ2 tests, and multiple logistic regression.

Results

Among the 208 respondents, authors found that osteopathic medical students who expressed a preference for primary care practice showed no significant differences in mindfulness compared with those interested in specialist fields, as indicated by mean (SD) mindfulness scores of 3.34 (0.44) vs 3.33 (0.41), respectively (P=.88). However, among demographic variables, female students expressed a preference for primary care practice fields at significantly higher rates than male students (OR, 4.4; 95% CI, 2.2-8.5; P<.001). Also, students who matriculated less than 6 months after completing their undergraduate education were drawn to primary care practice at higher rates than those who delayed enrollment (OR, 2.3; 95% CI, 1.2-4.5; P=.016). None of the remaining demographic variables were associated with students’ residency preference.

Conclusion

Being female and matriculating immediately after undergraduate education was associated with a preference for primary care residency. However, no significant association was found between mindfulness and either residency preference or choice of alternative curricula.

Is there an association between nurse, clinical teacher and peer feedback for trainee doctors' medical specialty choice? An observational study in Taiwan

OBJECTIVES

This study explored whether there is an association between medical trainees' future specialty choices and the 360-degree feedback they receive. We hypothesised that the higher the scores that teachers, trainees and/or nurses give to postgraduate year 1s (PGY1s) in any given specialty, the more likely that they will choose that specialty for their residency.

SETTING

The study was conducted in a large regional teaching hospital in Taiwan.

PARTICIPANTS

The participants of this study were n=66 PGY1s who had completed their medical studies domestically or internationally and had received their PGY1 training in a single teaching hospital in southern Taiwan. Data from 990 assessments were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

Logistic regression analyses for teachers', nursing staff and peers' authentic assessments of trainees were undertaken for (1) desired specialty, (2) applied specialty, (3) enrolled specialty, (4) consistency between desired and applied specialties, (5) consistency between applied and enrolled specialties and (6) consistency between desired and enrolled specialties. Alpha was set at p<0.05.

RESULTS

Nursing staff scores were significantly associated with all six dependent variables. Furthermore, teachers' scores were significantly associated with trainees' desired specialty and the consistency between desired and enrolled specialty. Peers' scores were not significantly associated with any dependent variable.

CONCLUSIONS

Trainees' specialty choices are associated with scores given by nursing staff and clinical teachers. We suggest that qualitative research methods should further explore this association to ascertain whether PGY1s are consciously influenced by these scores and if so, in what way.

Compliance With a National Standard by Norwegian Helicopter Emergency Physicians

OBJECTIVE

The "National Standard Requirements for Helicopter Emergency Medicine Services Physicians" gives recommendations on medical requirements for flight physicians. This study describes the level of formal competence, experience, and guideline compliance of Norwegian helicopter emergency medical service (HEMS) physicians.

METHODS

In May 2013, all HEMS physicians with full-time engagement at Norwegian HEMS bases were invited to participate in a cross-sectional survey using a structured, Web-based questionnaire.

RESULTS

A total of 108 (79%) of 136 physicians replied to the survey, and all bases were represented. The majority (89%) had specialist training, and more than 60% had longer than 6 years of experience as a flight physician. Over 60% had attended trauma, pediatric, and incubator courses, and all physicians worked regularly in an anesthesia department. Most physicians were participating in simulation and procedure training.

CONCLUSION

Many of the basic requirements of the guidelines were met by HEMS physicians, but room exists for improvements. Norwegian HEMS physicians are experienced, but a need exists for a more structured curriculum in emergency medicine for HEMS physicians based on the broad spectrum of presented medical conditions to ensure optimal quality of care and safety for all patients in Norway.

Examining Medical Student Specialty Choice Through a Gender Lens: An Orientational Qualitative Study

Phenomenon: A growing number of women are entering the medical workforce, yet their distribution across medical specialties remains nonuniform. We sought to describe how culture, bias, and socialization shape gendered thinking regarding specialty choice at a Canadian undergraduate medical institution.

APPROACH

We analyzed transcripts from the Career Choices Project: 16 semistructured focus group discussions with 70 students graduating from Memorial University of Newfoundland in 2003, 2006, 2007, and 2008. The questions and prompts were designed to explore factors influencing specialty choice and did not specifically probe gender-based experiences. Focus groups were audio-recorded, transcribed, and deidentified before analysis. Analysis was inductive and guided by principles of orientational qualitative inquiry using a gender-specific lens.

FINDINGS

The pursuits of personal and professional goals, as well as contextual factors, were the major themes that influenced decision-making for women and men. Composition of these major themes varied between genders. Influence of a partner, consideration of familial commitments (both present and future), feeling a sense of connectedness with the field in question, and social accountability were described by women as important. Both genders hoped to pursue careers that would afford "flexibility" in order to balance work with their personal lives, though the construct of work-life balance differed between genders. Women did not explicitly identify gender bias or sexism as influencing factors, but their narratives suggest that these elements were at play. Insights: Our findings suggest that unlike men, women's decision-making is informed by tension between personal and professional goals, likely related to the context of gendered personal and societal expectations.

Trends in the training of female urology residents in Canada

INTRODUCTION

There is limited research on why women do or do not choose a career in urology. Considering the increasing proportion of female medical students, we assessed for trends in female applicants to urology programs in Canada and their post-residency career choices.

METHODS

Data from the Canadian Residency Matching Service (CaRMS) was used (1998-2015). Trends in the proportions of females applying and matching to surgical subspecialties, and applying and matching to urology were computed. Surveys were sent to urology program directors to assess female residents' chosen career paths over the last decade.

RESULTS

A significant increasing trend in the proportion of females applying to urology as their first choice program was found (0.19 in 1998-99 to 0.27 in 2012-15; p=0.04). An increasing trend in the proportion of females successfully matching to urology was found, although it was not statistically significant (0.13 in 1998-99 to 0.24 in 2012-15; p=0.07). This was in keeping with the trends found for surgical programs overall. Female graduates choose a variety of career paths, with urogynecology being the most common fellowship (26%).

CONCLUSIONS

The last two decades has seen an increase in the proportion of female students applying to urology in Canada. Female urology graduates pursue a variety of career paths. It remains imperative that both female and male medical students have early exposure and education about our subspecialty to ensure we continue to recruit the most talented candidates.

The role of controllable lifestyle in the choice of specialisation among Hungarian medical doctors

BACKGROUND

Hungary has been serious facing human resources crisis in health care, as a result of a massive emigration of health workers. The resulting shortage is unevenly distributed among medical specialisations. The findings of research studies are consistent in that the most important motivating factor of the choice of the medical career and of medical specialisations is professional interest. Beyond this, it is important to examine other reasons of why students do or do not choose certain specialisations. The lifestyle determined by the chosen speciality is one such factor described in the literature.

METHODS

Using convenient sampling, first year resident medical doctors from each of the four Hungarian universities with a medical faculty were asked to participate in the study in 2008. In total 391 first year resident medical doctors completed the self-administered questionnaire indicating a 57.3% response rate. On the basis of the work of Schwartz et al. (Acad Med 65(3):207-210, 1990), the specialisation fields were divided into the two main categories of non-controllable (NCL) or controllable lifestyles (CL). We carried out a factor analysis on motivating factors and set up an explanatory model regarding the choice of CL and NCL specialisations.

RESULTS

Two maximum likelihood factors were extracted from the motivational questions: "lifestyle and income" and "professional interest and consciousness". The explanatory model on specialisation choice shows that the "professional interest and consciousness" factor increases the likelihood of choosing NCL specialisations. In contrast the "lifestyle and income" factor has no significant impact on the choice of CL/NCL specialisations in the model.

CONCLUSIONS

Our results confirm the important role of professional interest in the choice of medical specializations in Hungary. On the other hand, it seems surprising that we found no significant difference in the "lifestyle and income" related motivation among those medical residents, who opted for CL as opposed to those, who opted for NCL specialisations. This does not necessarily mean that lifestyle is not an important motivating factor, but that it is equally important for both groups of medical residents.

Assessment of Female Medical Students' Interest in Careers in Cardiothoracic Surgery

OBJECTIVE

Although over half of medical students are females, women comprise only 21% of cardiothoracic (CT) surgery residency applicants and 5% of the CT workforce. We sought to gain insight into female medical students' perceptions of CT surgery and identify targets to increase interest.

DESIGN

A 33-question survey queried career selection factors, perceptions of CT surgery, and ways to increase interest in the field. Responses were stratified by sex and preclinical versus clinical years.

SETTING

Women at 13 US medical schools were compared to men at a Midwest medical school.

PARTICIPANTS

Surveys were distributed to approximately 4400 women and were completed by 372 (8.5%) women. Comparison surveys were distributed to approximately 170 preclinical men and were completed by 98 (57.6%) men.

RESULTS

Preclinical woman had broad interests, whereas clinical women were more interested in primary care (p = 0.0124). Intellectual interest and lifestyle were important in specialty selection for men and women (91% versus 90%; 78% versus 86%). Although preclinical men valued perceived prestige and salary significantly more than preclinical women (39% versus 20%, p = 0.0014; 64% versus 48%, p = 0.0173), preclinical women valued caring for specific ethnicities and addressing health disparities significantly more than preclinical men (26% versus 15%, p = 0.0173; 53% versus 33%, p = 0.0019). Making family plans was cited by 83% of women as difficult if they choose to become a CT surgeon. Women thought that attaining their career interests and life goals (76%) or access to female CT surgery mentors (63%) would make the field more appealing. Over 70% of preclinical women were interested in shadowing a CT surgeon. Of these women, 12% attempted to shadow.

CONCLUSIONS

Although baseline interest in CT surgery is low among women, there are many targets for increasing interest especially during preclinical years. Residency programs have the opportunity to entice women to the field by addressing their priorities of lifestyle, family planning, and addressing health disparities.

The role of same-sex mentorship and organizational support in encouraging women to pursue surgery

INTRODUCTION

While women represent approximately half of all medical students, only 38% of general surgery residents are women. The objective of this study is to explore how access to mentors and organizational support affects career choices.

METHODS

In June of 2016, a survey was sent to medical students at a single institution (n = 472). Questions utilized a 5-point Likert scale. A two-sample t-test was used to evaluate data.

RESULTS

A total of 160 students participated in the survey. Among MS1/MS2 students, women were more likely to rank same-sex role models as a positive influence (mean 3.1 vs. 2.4; p < 0.05). Similar results were seen among MS3/MS4 students (mean 3.6 vs. 2.5; p < 0.05). More women ranked the presence of organizations that support women in surgery as being important (mean 4.6 vs. 4.1; p < 0.05).

CONCLUSION

Exposure to same-sex mentors was highly rated among female participants. These findings encourage the creation of national mentorship programs. Early involvement in organizations can positively influence career choice. Addressing gaps in mentorship opportunities and widening accessibility to national organizations are important in reducing barriers.