Research in choice of medical specialty: a review of the literature 1977-87

Why UK medical students change career preferences: an interview study

INTRODUCTION

Medical career preferences are influenced by a multitude of factors. Currently several specialties are undergoing recruitment problems; we must develop our understanding of medical career decision-making to ensure the production of an appropriate workforce. We aimed to explore the changing career preferences of students during medical school, to better understand this.

METHODS

This was an interpretivist, qualitative study. Data were collected through semi-structured interviews with seven final-year students to explore why their career preferences had changed during medical school. Transcripts of these interviews were thematically analysed.

RESULTS

Three overarching themes emerged from the analysis: The 'influence of medical school', 'perceived suitability to specialty' and 'belonging and fitting in'. A thematic map captured the participants' perceptions on why their preferences had changed, with major influences echoing existing research. However, novel findings included participants' personalities and enthusiasm changing over time, the need for a 'sense of belonging' and participants defining the term 'variety' uniquely, perceiving their current specialty preference to match their definition.

DISCUSSION

This was an original, in-depth study on changing career preferences, which is an ill-defined subject within the literature. Analysis revealed preferences changed for a variety of medical school, personal and specialty reasons, leading to the construction of an updated model of medical career decision-making. Medical career preference remains a dynamic and ever-evolving phenomenon, influenced by an intricate interplay of internal and external factors. An understanding of this is crucial for future workforce planning.

Personality and Medical Specialty Choice: A Literature Review and Integration

This review examines the literature on personality and medical specialty choice. First, it describes studies categorized by medical specialties that to date have used the same measures: Adjective Check List, California Psychological Inventory, Sixteen Personality Factor Questionnaire, and Myers-Briggs Type Indicator. Then it integrates these results using the framework provided by the Five-Factor Model of personality. This model provides a method to organize the personality descriptors associated with medical specialties and to summarize information in an understandable and meaningful way. Conclusions drawn from the review suggest a loose association between a few personality factors and particular medical specialties. Recommendations for further research on personality and medical specialties encourage shifting from the “variable” to the “person” approach and studying how different personalities succeed in the same specialty.

Person-oriented versus technique-oriented specialties: early preferences and eventual choice

BACKGROUND

Students' selection of a specialty is an important decision in their career as a physician. While distinguishing primary care physicians from non-primary care specialists has served a purpose for how medicine is practiced and managed, considering alternative ways of grouping specialties is appropriate when exploring specialty decisions.

PURPOSE

This study explored how early specialty preferences correspond to eventual specialty choice using the person-oriented versus technique-oriented taxonomy.

METHOD

Participants were 349 students who completed a career plan survey during the first semester of medical school and later graduated.

RESULTS

Chi-square analysis showed a statistically significant difference between students' early preference for a person-oriented or technique-oriented specialty and the specialty they chose for their residency.

CONCLUSION

Students with an early preference for person-oriented specialties were more likely to choose a person-oriented specialty, whereas students with an early preference for technique-oriented specialties were less likely to enter a technique-oriented specialty.

The Development and Initial Validation of Social Cognitive Career Theory Instruments to Measure Choice of Medical Specialty and Practice Location

Social cognitive career theory served as the basis for the instrument development for scales assessing self-efficacy, outcome expectations, and goals to predict medical career choice. Lent and Brown's conceptualization of social cognitive constructs guided the development of items to measure choice of medical specialty and practice location. Study 1 involved four stages: identification of attitudes and beliefs, generation of scale items, evaluation of scale items by experts, and a pilot study. The pilot study tested the item pool with 293 medical students and allowed item and exploratory factor analyses. Study 2 administered the scales to a second sample of 499 medical students. Confirmatory factor analysis assessed consistency and validity, and identified six psychometrically sound instruments. Initial validity for the scales was found encouraging, with further testing of these measures expected to support their use. Implications for use in research are discussed.

Understanding primary care residency choices: a test of selected variables in the Bland-Meurer model

PURPOSE

This study tested the predictive validity of variables related to student characteristics of the Bland-Meurer Model of Career Decision-Making.

METHOD

A study was conducted using Association of American Medical Colleges' Graduate Student Questionnaire and career data from one medical school. Logistic regression analyses generated predictive models of primary care residency choice, including family medicine, general internal medicine, and pediatrics for 555 medical school graduates over five years.

RESULTS

Variables predictive of primary care residency choice were gender; student ratings of psychiatry, surgery, and internal medicine clerkships; not having participated in a research project in medical school; attitudes toward "the changing health care system on physicians" and "access to medical care"; and planned practice in a medically underserved area. Results differed for each field within each residency choice.

CONCLUSIONS

The Bland-Meurer Model may be used for variable selection in multivariate predictive models of family medicine, internal medicine and pediatrics residency choice. The authors' results may help guide admissions decisions, while providing medical educators and health care policymakers with a clearer picture of residency choice and a better understanding of how to meet the demands of selected patient populations.

Relationship between specialty choice and medical student temperament and character assessed with Cloninger Inventory

BACKGROUND

Multiple variables affect medical specialty choice, including temperament, sociodemographic factors, and personal experiences. Many studies address specific variables for specific specialties, but few assess the relative impact of each factor.

PURPOSE

To identify the relative influence of temperament in choosing a specialty.

METHODS

A sociodemographic and personal experiences questionnaire and a 240-question temperament and character inventory was distributed to 682 medical students. Their scores for 6 medical specialties were examined using analyses of variance, multivariate analyses of variance, and discriminant analysis.

RESULTS

Students choosing surgery, emergency medicine, and obstetrics and gynecology were higher on novelty seeking than other students. Future surgeons were lower in harm avoidance and reward dependence (RD) than the others. Students choosing primary care specialties, emergency medicine, and obstetrics and gynecology were all high on RD; with pediatrics being highest. Students differed from college students, the women differed from the men, and the Asian Americans differed from the other groups.

CONCLUSION

The implications of these findings are discussed for career counseling and future research.

What predicts medical student career choice?

The literature on medical student career choice has identified several influences that can be categorized as student demographics, medical school characteristics, students' perceptions of specialty characteristics, and student-held values. A logistic regression model that included demographics, medical school, and student-rated influences as a proxy for perceptions and values was used to determine their relative contribution to student career choice for three consecutive cohorts of senior medical students attending two schools (n = 649). This model identified a positive relation between choice of primary care career and both student-rated influences and one student demographic characteristic, but not between career choice and school attended. Variables positively correlated with primary care career choice were related to working with people and marital status. Negatively correlated variables were related to income and prestige.

Medical students' specialty choice and the need for primary care. Our future

Recent changes in the health care environment have directed increasing attention to the recognized oversupply of specialists and relative lack of primary care physicians. Despite this imbalance and the need for more primary care physicians, US medical schools are not producing them in adequate numbers. To effect change in the production of primary care physicians, a comprehensive approach that addresses key factors in medical student specialty choice is needed. This article discusses such factors and how they affect medical students during the course of their training. Issues concerning primary care specialty choice and the physician work force are important to the development of the future US health care system.

Physicians' intention to stay in or leave primary care specialties and variables associated with such intention

A national mail survey of primary care physicians was conducted in 1993 to examine the differences between those who planned to leave and those who planned to stay in primary care disciplines. The physicians who planned to stay in primary care were those who, at the time of choosing primary care specialties, were more influenced by factors such as personal social values, religion, and the presence of a role model prior to medical school. Physicians' race, sex, workload, debt, place where they grew up, family income as a child, and timing when they made the decision to enter primary care disciplines are not associated with their plans to stay in or leave primary care disciplines. Findings indicated that personal social values, religious beliefs, and the presence of a role model prior to medical school not only influenced physicians' choice of primary care, but had a lasting effect on their commitment to such choice.

The osteopathic distinction: fact or fancy?

Since osteopathic medicine's inception its distinction has been proclaimed steadfastly in the osteopathic literature. The uniqueness has been claimed to reside in: (1) rigid adherence to A.T. Still's tenets; (2) osteopathic manipulative treatment (OMT); (3) claims of "holism"; (4) "osteopathic principles", (5) esoteric definitions; and (6) other suggested differences. None of these claims can be successfully defended. An aspect of the osteopathic distinction may lie in the didactic of OMT per se. Certain experiences in medical school contribute to the "reconstruction" of the student's view of the patient. Touch, through OMT, may be a quality that affects this change and helps make the osteopathic physician different. When blended with traditional medical modalities this may result in a unique medical perspective. The ideal approach for the osteopathic profession would be an honest evaluation of its function in society and its uniqueness in medicine. The profession may discover a uniqueness with touch as an integral part.

Childhood through the eyes of child psychiatrists and paediatricians

Attitudes to childhood in general and towards one's own childhood in particular are compared in a survey of 152 Australian and New Zealand child psychiatric and paediatric trainees. Results confirm the findings of Enzer et al that paediatricians view childhood more positively than do child psychiatrists. Although there is a significant difference between the two groups on measures of their perceptions of the parenting they received with child psychiatrists rating their own parents as less caring than do paediatricians, there is no relationship between attitudes to childhood and perceptions of the parenting they received. Implications of these findings are examined, both in terms of motivation for choosing one or other specialty and for the working relationship between the two professions.