Who wants to become a general practitioner? Student and curriculum factors associated with choosing a GP career--a multivariable analysis with particular consideration of practice-orientated GP courses

To be or not to be supervisors for medical students in general practice clinical placements: a questionnaire study from Norway

OBJECTIVE

Many countries experience challenges in recruiting and retaining general practitioners (GPs) as supervisors for medical students in clinical placements. We aimed to investigate the opportunities, capacities and limitations of Norwegian GPs to become supervisors.

DESIGN

Web-based cross-sectional questionnaire study.

SETTING

Norwegian general practice.

SUBJECTS

All GPs in Norway, including locums and those on leave, both active supervisors, and GPs who are not presently supervising medical students.

MAIN OUTCOME MEASURES

GPs' terms of salary, office facilities, limiting factors, capacity and needs for becoming or continuing as supervisors.

RESULTS

Among 5145 GPs, 1466 responded (29%), of whom 498 (34%) were active supervisors. Lack of a dedicated student office was the most reported limitation for both active supervisors (75%) and other GPs (81%). A high proportion (67%) of active supervisors reported that they could host more students per year, given financial support for equipped offices and higher salaries. With this kind of support, 48% (n = 461) of the GPs who were not supervisors for medical students were positive about a future supervisor role. By adjusted regression analysis, female GPs had lower likelihood of being supervisors, OR (95% CI) 0.75 (0.59-0.95) than male colleagues. GPs in the North, Mid and West regions had higher odds (OR 3.89, 3.10 and 2.42, respectively) than those in the South-East region. Teaching experience also increased the odds (2.31 (1.74-3.05).

CONCLUSIONS

There seems to be capacity among both active and potential supervisors if increased salaries and financial support for office facilities are made available.

Missing topics for a newly established general practice curriculum for medical students in Hesse - a qualitative study

BACKGROUND

To address the declining numbers of general practitioners (GPs) in rural areas and a lack of medical students pursuing a career in primary care, a general practice-based curriculum coupled with additional university admissions for students has been established at three universities in Hesse, Germany. This study aims to analyze potential topics which students striving to become a GP will benefit from. Teaching such topics will prepare them for their chosen career and working in rural areas. We aimed to explore the views of both specialists and GPs on chief topics and necessary skills in primary care.

METHODS

In our study we used semi-structured interviews with outpatient specialists and specialists in clinical practice and semi-structured group interviews with GPs in training. The topic guide addressed contents of the curriculum for medical students with an extracurricular focus (addressing additional topics) on primary care. Data analysis was carried out using qualitative content analysis according to Mayring.

RESULTS

GPs in training and specialists agreed on the importance of knowledge in the fields of medical history, physical examination, communication as well as common diseases in primary care. Essential competences mentioned were: inducing medical treatment, decision-making and triage, conducting structured conversations, having patient knowledge (hard skills) as well as an interest in continuous learning, empathy, personal commitment, listening and down-to-earthness (soft skills). Case reports, symptom-based learning, practical training, lessons with simulated patients and the integration of role models were regarded as useful teaching methods.

CONCLUSIONS

General practice-based curriculums should not only focus on the transfer of knowledge. Equally important is the training of soft and hard skills to prepare future GPs for their work in primary care. Special teaching methods as well as practical training should be the heart of a newly established curriculum.

Factors associated with medical students' career choice in different specialties: a multiple cross-sectional questionnaire study at a German medical school

BACKGROUND

Given the shortage and unequal distribution of physicians across specialties, we aimed to evaluate factors associated with medical students' career choices, including background, personality traits, educational experience, personal interests, lifestyle considerations, and the awareness of work requirements.

METHODS

We conducted multiple cross-sectional surveys of students; a 159-item online questionnaire was designed and students from three different stages of the six-year medical degree course (outset, clinical phase, and on graduation) were invited to complete the survey. Data were collected between May 2021 and April 2023.

RESULTS

The questionnaire was sent to 1406 students, of whom 683 replied (49%); 481 respondents were female (70%). The top specialty choices across the respondents were internal medicine, surgery, and general practice, with anaesthesiology, paediatric and adolescent medicine (ranging 11-15%), and obstetrics and gynaecology also receiving interest, with 6% undecided. In particular, female students lost interest in surgery during the course of study in favour of the other options. The choice of general practice was associated with more vocational training, prior positive experiences with the specialty, and lower grades in the university entry examination. Clinical clerkships in a specific (freely chosen) specialty aligned with career choice, while the final practical year did not have an impact on career decision-making. All students highly desired regulated working hours and work-life-balance; however, students choosing surgery rated these items as less important. Willingness to work in a hospital environment was highly associated with choosing anaesthesiology and surgery, whereas rural areas and practices were associated with general practice. Higher scores at agreeableness were associated with choosing paediatric and adolescent medicine by more female students, whereas lower neuroticism values were associated with the choice of anaesthesiology.

CONCLUSIONS

The results highlight the intricate nature of decision-making and shed light on various aspects that contribute to the process of selecting a specialty. By identifying and addressing influencing factors, we can develop targeted interventions and policies to enhance diversity and distribution across medical specialisations and to aim for high-quality and equitable healthcare that matches the specific needs of both individuals and the population as a whole.

[How to Motivate Medical Students to Practice in Rural Areas]

BACKGROUND

The excellent project "LandArztMacher" is an attempt to work against the predicted shortage of rural doctors in Germany with diverse approaches.

METHOD

"LandArztMacher" is a clinical traineeship with four weeks of practical training in general practices and clinics in the Bavarian countryside, accompanied by joint professional teaching. Participants were asked before and after the internship about the topics "importance of an internship in rural areas"; "attractiveness of rural areas" (scale: 0/no agreement to 10/full agreement). Ideas about the tasks of a general practitioner were assessed (scale: 0/no idea at all to 100/exact idea). The present study is a repeated cross-sectional study. The median is reported as the location measure and the interquartile range as the dispersion measure.

RESULTS

Participants (n=363, 74% female, n=267, age: range 19-46 years, mean: 23.2 years, SD: 2.41 years) from the clinical section of the medical studies considered an internship in the rural area before and after the internship very important (median: 8 and 9, respectively) and could well imagine working in the countryside (median: 7 and 8, respectively). Their attitude towards the cultural offerings or the infrastructure did not change (median: 6 in each case). After the internship, the students had a more precise idea of what a general practitioner tasks are (median: 65 and 90, respectively).

SUMMARY

A well-structured four-week rural internship can enhance the appeal of future rural employment through individual supervision and collaborative training.

Development, implementation, and evaluation of an undergraduate family medicine program in the United Arab Emirates

BACKGROUND

Healthcare systems rely on well-trained family medicine physicians who can offer continuous quality services to their communities and beyond. The American Academy of Family Physicians and the World Organization of Family Doctors recommend that medical curricula should have adequately supervised education and training of the learners in family medicine during their preclinical and clinical placements. However, some medical schools don't have a comprehensive family medicine program to prepare graduates who can meet the community needs. This work aims to report the essential steps for the development, implementation, and evaluation of the family medicine program at the College of Medicine at the University of Sharjah in United Arab Emirates.

METHODS

We used the Kern's 6-step model to describe the development, implementation, and evaluation of the family medicine program. This includes problem identification, needs assessment, goals setting, educational strategies, implementation, and evaluation. During 2014-2022, we longitudinally collected essential information about the family medicine program from different stakeholders including the feedback of clinical coordinators, adjunct clinical faculty, and medical students at the end-of-clerkship. All responses were analysed to determine the effective implementation and evaluation of the family medicine program.

RESULTS

Over the course of 8 academic years, 804 medical students, 49 adjunct clinical faculty and three College of Medicine faculty participated in the evaluation of the family medicine program. The majority of respondents were satisfied with various aspects of the family medicine program, including the skills gained, the organisation of program, and the variety of clinical encounters. The medical students and adjunct clinical faculty suggested the inclusion of e-clinics, faculty development program, and the expansion of more clinical sites for the effectiveness of the family medicine program.

CONCLUSIONS

We report a successful development, implementation, and evaluation of the family medicine program in United Arab Emirates with a positive and impactful learning experience. More attention should be paid towards a suitable representation of family medicine program in the medical curriculum with focused and targeted educational plans for medical students.

Attitudes towards career choice and general practice: a cross-sectional survey of medical students and residents in Tyrol, Austria

BACKGROUND

The global primary healthcare workforce is declining, leading to a shortage of general practitioners. Although various educational models aim to increase interest in general practice, effective interventions are limited. The reasons for this low appeal among medical graduates remain unclear.

METHODS

This cross-sectional study surveyed medical students' and residents' attitudes towards general practice in Tyrol, Austria. The online questionnaire addressed professional values, general practice-related issues, personal professional intentions, and demographics. Data analysis employed chi-square tests and multivariate logistic regression to explore predictors of interest in general practice.

RESULTS

The study included 528 students and 103 residents. Key values identified were stable positions, assured income, and work-family reconciliation. General practice was recognised for long-term patient relationships and patient contact, with students attributing more positive work-environmental characteristics and higher reputation to it than residents. Few participants (students: 3.2%, residents: 11.7%) had opted for general practice; about half were considering it as career option. Reasons not to choose general practice were preferences for other specialties, intrinsic characteristics of general practice, workload, insufficient time for the patients, financial pressures, low reputation, and perceived mediocre training quality. Predictors of interest in general practice included perception of independent decision-making, importance of work-family balance (students), better practical experiences in general practice during medical school (students and residents), younger age, and perceiving general practice as offering a promising future (residents). Both groups felt underprepared by medical school and/or general practice training for general practice roles. The attractiveness of specialist medicine over general practice was related to clearer content boundaries, better career opportunities, and higher incomes.

CONCLUSIONS

According to these results, measures to improve attractiveness of general practice should focus on (i) high-quality undergraduate education including practical experiences, and (ii) on ensuring professional autonomy, work-family reconciliation, and job stability. Efforts to encourage more graduates to pursue this essential healthcare sector are crucial for strengthening primary healthcare and public health services.

TRIAL REGISTRATION

The study has not been registered as it did not include a direct medical intervention on human participants.

Experiences of hospital rotation from family medicine residents' points of view an empirical holistic study

OBJECTIVE

Trainees or medical residents' experiences of hospital rotations and training have not been sufficiently studied. More empirical holistic studies of experiences of General Practice/Family Medicine (GP/FM) residents in Sweden are needed. The purpose of this study was to describe experiences of hospital rotation during residency.

DESIGN

Empirical-holistic study.

SETTING

GP/FM residents were invited by email to participate in the study. They could describe their experiences anonymously by answering two questions via an esMaker internet survey. Analyses of the responses were carried out with content analysis as the analytical methodology. Both manifest and latent responses were analyzed.

SUBJECTS

Fifty-nine GP/FM residents participated in the study.

MAIN OUTCOME MEASURE

The results identified four main topics: structure, resources, effects, and constructive supervision.

RESULTS

GP/FM residents experienced hospital rotations as effective when there was a structured schedule and adequate time allotted for introduction and meeting patients. Hospital rotations that lacked, or had unstructured, supervision caused uncertainty and insecurity, which led to rotations being experienced as less beneficial, which was, from a GP/FM perspective, not constructive.

CONCLUSION

The study suggests that family medicine residents required a structured and planned schedule during hospital rotations. This study may contribute to increased quality of hospital rotations during residency as a family physician.

Would you like to be a general practitioner? Baseline findings of a longitudinal survey among Danish medical trainees

BACKGROUND

Recruiting and securing primary care physician workforce has been the center of international attention for decades. In Denmark, the number of general practitioners has decreased by 8.5% since 2013. However, a rising population age and increasing prevalence of chronic diseases and multimorbidity place an even greater future need for general practitioners in Denmark. The choice of general practice as specialty has been associated with a range of both intrinsic and extrinsic factors, however, few studies have examined the recruitment potential that lies within medical trainees' who are undecided about general practice specialization. The aim of this study was, therefore, to explore how medical trainees who are undecided about general practice specialization (GP-positive/undecided) differ from medical trainees who are either committed (GP-committed) or not committed to a general practice career (GP-non-committed) regarding factors related to future work life.

METHODS

The present study concerns baseline findings from a longitudinal survey study. An online questionnaire was e-mailed to a national cohort of medical trainees during their transition from under- to postgraduate education. The associations between orientations towards general practice specialization and work-related factors and potential influencing factors, respectively, were analyzed using uni- and multivariable modified Poisson regression models.

RESULTS

Of 1,188 invited participants, 461 filled out key study variables concerning specialty preferences and rejections, corresponding to a response rate of 38.8%. We found significant positive associations between GP-positive/undecided orientation and valuing a good work/life balance and the opportunity to organize own working hours when compared to GP-non-committed respondents. Compared to the GP-committed orientations, the GP-positive/undecided orientation was associated with a positive attitude towards technology, working shift hours, and an openness towards several career paths. Across all orientations, undergraduate exposure to the specialties was found to be highly influential on the specialty preferences.

CONCLUSION

GP-positive/undecided medical trainees value autonomy over their working hours more than the GP-non-committed, but less than the GP-committed. However, the GP-positive/undecided respondents present more openness to different career opportunities and the use of technology in daily work. We suggest using this knowledge in the planning of recruitment strategies aiming to increase interest in general practice specialization.

Medical trainees' speciality considerations at their transition from under- to postgraduate education: a descriptive, cross-sectional study

PURPOSE

This paper aims to provide knowledge on medical trainees' considerations about specialisation as they move from undergraduate to postgraduate medical education; especially their interest in general practice compared to other specialities.

METHOD

We developed and content-validated a questionnaire to examine medical trainees' speciality considerations and conducted a descriptive, cross-sectional study. All medical trainees initiating their internship in Denmark in 2022 (N = 1,188) were invited to participate in the study. Medical specialities were categorised as hospital service specialities, internal medicine specialities, primary care, psychiatry specialities and surgery and emergency specialities. Descriptive statistics were used to describe the cohort and examine the participants' speciality considerations by assigning them to one of the following three orientations: committed, undecided or non-committed to a speciality.

RESULTS

The response rate was 38.8% (n = 461), and participants' mean age was 27.4 years with a majority of females (68.1%). Nearly 25% of the participants had general practice as speciality preference, and only 13.9% had excluded general practice for future specialisation. Overall, around half of the participants had general practice as a first, second or third preference for specialisation.

CONCLUSION

Danish medical trainees show considerable interest in general practice at the time of their transition from undergraduate to postgraduate education. However, to meet future demands on the primary care, further recruitment of general practitioners is still needed. This knowledge of the specialities' recruitment potential will likely be of interest to medical educators and healthcare planners alike.

Long-term mentoring relationships in undergraduate longitudinal general practice tracks - a qualitative study on the perspective of students and general practitioners

BACKGROUND

Longitudinal general practice tracks have been established in medical faculties in Europe and worldwide to attract more graduates to general practice careers. In many programs, long-term mentoring relationships play an important role in providing students with positive role models, regular practical experiences, and acquisition of clinical skills in a community context. However, little is known about students' and general practitioner mentors' expectations, experiences, challenges, and ideas for improvement within these long-term mentoring relationships in general practice in our medical education system.

METHODS

Qualitative study based on semi-structured interviews with 15 students and 13 mentors. Interviews were audio-recorded and transcribed verbatim. MAXQDA was used for data analysis, following a mixed deductive/inductive approach.

RESULTS

Both groups had few and rather unstated expectations, particularly regarding their relationships. Consequently, expectations were often not clearly communicated. Nevertheless, a high level of satisfaction and good opportunities for teaching were achieved for both sides. The evolving familiarity facilitated a positive learning environment. Students valued independent medical tasks continuously adjusted to their current abilities. However, some felt a reluctance to demand their mentor's time and consideration. Conversely, the mentors criticized a lack of initiative from some of the students and wished that they would get more actively involved. Students, in contrast, wished for more guidance at the start of the project and joint events to deepen the relationship.

CONCLUSIONS

With this study, we gained detailed insights into and understanding of the nature of long-term relationships between students and mentors. Points for improvement revealed included: 1) education of both participating groups on the goals and benefits of mentoring, including binding expectations for the participants; 2) intensified support and training of teaching physicians; 3) structured and accompanied establishment of initial contact between mentor and mentee; and 4) encouraged additional shared (teaching) time, individualized timing, and intensification, if desired.

Rural family medicine as a career option among Hungarian medical students

BACKGROUND

The shortage of family physicians is a considerable challenge in Hungary. The number of vacant practices is increasing and the rural and deprived areas are more affected.

OBJECTIVES

This study aimed to investigate medical students' attitudes towards rural family medicine.

METHODS

The current study used a cross-sectional design with a self-administered questionnaire. Each of the four Hungarian medical universities was represented by their medical students from December 2019 to April 2020.

RESULTS

The response rate was 67.3% (n = 465/691). Only 5% of the participants plan to be a family doctor, 5% of the students plan to work in rural areas. On a 5-point Likert scale (1 = 'surely not', 5 = 'surely yes'), half of the participants answered 1 or 2 to choose rural medical work, while 17.5% answered 4 or 5. There was a significant relationship between rural working plans and rural origin (OR = 1.97; p = 0.024), and the plan to work in family practice (OR = 4.90; p < 0.001).

CONCLUSION

Family medicine is not a popular career option among Hungarian medical students and rural medical work is even less attractive. Medical students with a rural origin and an interest in family medicine are more likely to plan to work in rural areas. More objective information and experience need to be given to medical students about rural family medicine to increase the attractiveness of the speciality.

Preparing future general practitioners: the effects of individual, familial, and institutional characteristics

BACKGROUND

There is a substantially increasing need for general practitioners (GPs) for future unpredictable pandemic crises, especially at the community-based health services (CBHS) level to protect the vast and varied grassroot-level population in China. Thus, it is crucial to understand the factors that affect Chinese medical students' GP career choices and commitments to CBHS.

METHODS

Leveraging the self-administered data collected across the country, this study conducted logistic regressions with 3,438 medical students. First, descriptive statistics of outcome variables and independent variables were provided. Then, stepwise logistic regression models were built, starting from adding individual characteristics, and then familial and institutional characteristics. Last, post-estimation was conducted to further assess whether there were significant marginal effects.

RESULTS

Results showed that women students were 24% less likely to choose GP careers but were 1.25 times more likely to commit to CBHS than their men peers, holding other individual, familial, and institutional characteristics constant. In addition, students who major in GP-orientated were more likely to choose GP careers and commit to CBHS, respectively, than those who major in clinical medicine. Furthermore, familial characteristics like annual income and mother's educational level only significantly predicted commitments to CBHS. Notably, sex-related differences in GP career choices and commitments to CBHS - by different regions - were observed.

CONCLUSIONS

Understanding the factors that affect medical students' GP career choices sheds light on how medical education stakeholders can make informed decisions on attracting more medical students to GP-orientated majors, which in turn cultivates more GP professionals to meet the nation's demand for GPs. In addition, by understanding the factors that influence medical students' commitment to CBHS, policymakers could make beneficial policies to increase medical students' motivations to the grassroot-level health institutions, and devote to CBHS as gatekeepers for a large population of residents' health.

Impact of Increased Patient-Clinician Virtual Visits During the COVID-19 Pandemic on Medical Student Enthusiasm for Future General Practice Careers

BACKGROUND

The COVID-19 pandemic restricted the availability of face-to-face primary care visits. This rapidly increased the proportion of primary care patient-clinician visits conducted virtually and asynchronously (remote consultations via video, telephone, and web-based text/email), altering the educational environment for medical students. Our study explored the impact of the increased proportion of primary care visits conducted virtually and asynchronously, on medical students' self-reported interest in pursuing a career in general (family) practice.

METHODS

We conducted a cross-sectional survey study of medical students at six universities within England and Wales to explore the impact of the increased proportion of primary care visits conducted virtually and asynchronously on medical students' interest in pursuing a career in general practice.

RESULTS

One hundred fifty-four medical students were recruited between December 2020 and May 2021; 79 (51%) of the participants reported being less interested in pursuing a career in general practice as a result of the increased proportion of virtual and asynchronous primary care visits during the COVID-19 pandemic. This increased to 104 (68%) of the participants reporting being less interested should primary care visits continue to be delivered virtually or asynchronously by default. Analysis of open-ended survey questions identified a poorer educational experience, concerns regarding the impact on patient care, an isolated working environment and technological challenges as key negative themes.

CONCLUSIONS

Sociable, supportive working and learning environments and offering equitable care are important motivators for the future workforce. There is a need to develop robust training and assessment in patient-clinician virtual visits and asynchronous communication and to integrate this into curricula.

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

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

CONCLUSION

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

WHAT IS KNOWN

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

WHAT IS NEW

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

The impact of role modelling on the future general practitioner workforce: a systematic review

Role modelling has been identified as an important phenomenon in medical education. Key reports have highlighted the ability of role modelling to support medical students towards careers in family medicine although the literature of specific relevance to role modelling in speciality has not been systematically explored. This systematic review aimed to fill this evidence gap by assimilating the worldwide literature on the impact of role modelling on the future general practitioner (GP) workforce. A systematic search was conducted in Medline, Embase, Scopus, Web of Science, Cochrane, ERIC and CINAHL, and all authors were involved in the article screening process. A review protocol determined those articles selected for inclusion, which were then quality assessed, coded and thematically analysed. Forty-six articles were included which generated four broad themes: the identity of role models in general practice, role modelling and becoming a doctor, the impact of role modelling on attitudes towards the speciality, and the subsequent influence on behaviours/career choice. Our systematic review confirmed that role modelling in both primary and secondary care has a crucial impact on the future GP workforce, with the potential to shape perceptions, to attract and deter individuals from the career, and to support their development as professionals. Role modelling must be consciously employed and supported as an educational strategy to facilitate the training of future GPs.

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.

Students' motivation in choosing general practice for their career pathway: a middle-income country report, Indonesia

OBJECTIVES

To understand the medical students' perspectives and influential factors on their career pathway decision to be a General Practitioners (GP) in Indonesia.

METHODS

This research used sequentially mixed methods. The qualitative study was conducted using focus group discussions with 30 third-year students, followed by in-depth interviews with 15 students from one Indonesian institution with the highest level of accreditation. The qualitative data, together with the literature review, were used to construct an online questionnaire with three types of questions.

RESULTS

The survey response rate reached 81% from 2,240 students across 64 faculties of medicine in Indonesia. Responses indicated that GP is not preferred as the leading career choice, and 67% of students prefer to become hospital specialists. The qualitative data revealed several influencing factors in choosing GP as their ultimate career choice: more family time, being closer to the community, and interest in bio-psycho-social subjects. Meanwhile, the reasons not to choose GP as a career choice were: imbalance in work and life, less authority, being at the lowest level position in the health care system, high uncertainty, and low financial incentives.

CONCLUSIONS

GP is not an interesting career option for most medical students in this study. Considering GP works strategically in primary care settings aiming at better health outcomes and optimizing the health care financial system with greater patient satisfaction, influential positive factors to be GP should be nurtured in the medical curriculum.

Geneva medical students increasingly identify primary care physicians as role models after introduction of a compulsory clerkship

Background

Role modelling is recognised as an important element in career choice. In strongly hospital-based medical education settings, students identify few primary care physicians as positive role models, which might impact their career plans and potentially contribute to primary care workforce shortage. At Geneva Faculty of Medicine (Switzerland), a compulsory final-year clerkship in primary care practices was introduced to strengthen primary care teaching in the curriculum.

Objectives

To assess the proportion of graduating students identifying a primary care physician as positive role model, before and after the introduction of the clerkship.

Methods

Cross-sectional survey in four consecutive classes of graduating medical students one year before and three years after the introduction of the clerkship. The main outcome measure was the proportion of students in each class citing a primary care physician role model. Comparisons were analysed using Pearson’s Chi-square test and one-way ANOVA.

Results

The total sample included 505 students. The proportion of students recalling a primary care physician role model increased steadily from 8% (before introduction of the clerkship) to 13, 16, and 21%, respectively, at 1, 2 and 3 years after the introduction of the clerkship (p = 0.03).

Conclusion

Our exploratory study suggests that introducing a compulsory primary care clerkship may have contributed to increasing the visibility of primary care physicians as role models. Future research should explore primary care physicians’ awareness of role modelling and its contribution to career choices.

Early generalist placements are associated with family medicine career choice: A systematic review and meta-analysis

INTRODUCTION

Many developed countries have reported shortages of Primary Care (PC) physicians. The lack of a regular primary physician is associated with inferior health outcomes. One strategy to address this shortage is to increase the proportion of medical students selecting a Family Medicine (FM) or PC career. The purpose of this systematic review is to identify whether pre-clerkship general practice placements increase students' interest in, and selection of FM or PC residencies.

METHODS

Three databases (PubMed, Embase, Web of Science) searched for interventional studies of pre-clerkship generalist placements in medical school. Pooled statistical analysis and meta-analysis were performed, along with narrative summaries when possible. Intervention participants (IP) were compared to controls matched (MC) for baseline interest in FM and an unmatched sample (UC) of contemporary students.

FINDINGS

A 11 studies were identified including a total of 5430 students (2428 intervention participants and 3002 controls). IPs were more likely to match to FM than both MC (Risk Ratio: 1.62 [95% CI: 1.03-2.55]) and UC (RR: 2.04 [1.46-2.86]). Participation in long interventions (4-11 weeks) matched to FM at higher rates than short (25-40 hours) interventions (RR: 3.15 [2.28-4.35]). The percentage of students with FM/PC as their top specialty of interest increased after the placements (mean difference: +12.8%, n = 586).

CONCLUSIONS

Medical students who participated in pre-clerkship general practice placements were more likely to match to a FM residency. Longer pre-clerkship placements had a stronger association with FM specialty choice. The implementation of longitudinal block generalist placements in the pre-clerkship years is one strategy for increasing interest in generalist careers.

LEVEL OF EVIDENCE

IV, systematic review of level III and IV studies.

Attitudes of medical students to general practice: a multinational cross-sectional survey

BACKGROUND

A shortage of general practitioners (GPs) is common to many European countries. To counteract this, it is essential to understand the factors that encourage or discourage medical students from choosing to become a GP.

OBJECTIVE

To evaluate medical students' attitudes towards general practice and to identify factors that discourage them from considering a career as a GP.

METHODS

In this multinational cross-sectional online survey, 29 284 students from nine German, four Austrian and two Slovenian universities were invited to answer a questionnaire consisting of 146 closed and 13 open-ended items.

RESULTS

Of the 4486 students that responded (response rate: 15.3%), 3.6% wanted to become a GP, 48.1% were undecided and 34.6% did not want to be a GP. Significant predictors for interest in becoming a GP were higher age [odds ratio (OR) = 1.06; 95% confidence interval (CI) = 1.02-1.10], positive evaluation of the content of a GP's work (OR = 4.44; 95% CI = 3.26-6.06), organizational aspects (OR = 1.42; 95% CI = 1.13-1.78), practical experience of general practice (OR = 1.66; 95% CI = 1.08-2.56) and the country of the survey [Slovenian versus German students (Reference): OR = 2.19; 95% CI = 1.10-4.38; Austrian versus German students (Reference): OR = 0.50; 95% CI = 0.32-0.79].

CONCLUSION

Strategies to convince undecided students to opt for a career as a GP should include a positive representation of a GP's work and early and repeated experience of working in a general practice during medical school.

General practitioner trainees' career perspectives after COVID-19: a qualitative study in China

Background

The coronavirus disease 2019 (COVID-19) has been a worldwide public health emergency that has put great pressure on medical workers and the medical system. General Practitioners (GPs) played an important role in controlling the epidemic, and GP trainees also took an active part in this approach. This study was to explore Chinese GP trainees’ career perspectives after COVID-19.

Methods

We conducted a qualitative research study which included 12 GP trainees from three teaching hospitals in China. Semi-structured telephone interviews were conducted. Grounded theory and thematic analysis were used to code the data and identify categories and factors.

Results

Eleven participants chose to continue a GP career after COVID-19, and nearly half of the participants strengthened their determination to dedicate themselves to this career. Only one participant decided to change the career choice because of interest in another specialty. Four main themes influencing GP trainees’ perceptions of career development after COVID-19 emerged from the interviews: changes of GPs’ work content in COVID-19, challenges of being a GP, psychological changes of the career, how to provide better primary care. Although some negative psychological changes existed, most of participants were inspired by role models and medical colleagues. They had more in-depth understanding of GPs’ role and responsibility during COVID-19, and exhibited intensions for self-improvement in career development, especially in public health education and self-protection in preventing infectious diseases. In addition, the wide use of telemedicine provided a new work way for GP trainees. However, challenges, such as increased workloads, low income, lack of resources in primary medical institutions, and distrust of GPs are faced by trainees during the outbreak.

Conclusions

Overall, no substantial changes were seen in the career choice of GP trainees after COVID-19 outbreak. However, they were inspired and had an in-depth understanding about the GP’s work and responsibility during an epidemic. Owing to the challenges faced by the GPs, measures are needed to improve the GP education and work environment in the training phase.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-020-01364-x.

Factors associated with the entry to general practice training: A multicentre study

BACKGROUND

Despite recent studies regarding general practice (GP) career decision-making, the impact of primary care exposure during undergraduate study on career-decision-making remain unclear.

PURPOSE

To examine the association between primary care exposure with the entry to GP training.

METHODS

An unmatched case-control study design was employed. A total of 130 trainees in GP training and 260 trainees in other speciality training were randomly selected from speciality training registration. Questionnaires were used to identify primary care exposure and factors associated with career-decision making. Odds ratios (OR) and logistic regression were used to examine the association between the entry to GP training and those factors.

RESULTS

The response rate was 66.4%. Three variables were found associated with entering GP training, including timetabled primary care sessions in all three clinical years (adjusted OR = 2.91; 95% CI = 1.23 - 6.88), enrolling in rural medical student recruitment schemes (adjusted OR = 3.07; 95% CI = 1.05 - 8.99) and valuing core values of GP (adjusted OR = 8.46; 95% CI = 3.27 - 21.88).

CONCLUSION

Our findings suggest that timetabled primary care sessions in all three clinical years has a positive influence on entering GP training. This research extends our knowledge of primary care exposure regarding continuity of the exposure.

What factors influence medical students to enter a career in general practice? A scoping review

BACKGROUND

Internationally, healthcare systems are providing more community-based care. Consequently, there is an increasing demand for GPs and other healthcare professionals to work in primary care and this has implications for undergraduate medical education.

AIMS

In this scoping review, we aim to examine 'What factors positively influence medical students to pursue a career in general practice?'

METHODS

The five-stage framework developed by Arksey and O'Malley (2005) was utilized to review the extant literature. Fourteen records were included in the review.

RESULTS

Medical students are influenced to pursue a career in general practice due to curriculum factors such as exposure, positive clinical rotation experiences, positive GP role models and maintaining a positive view of the profession at an early stage of their time as a medical student. Intrinsic factors such as student attributes, the influence of family, friends and the community where people live and having a strong orientation to social concerns were factors that make students more likely to pursue a career in the specialty. There is a shortage of literature from an Irish context examining the career intentions of medical students specifically. However, those studies which were conducted in Ireland reported similar findings to those conducted elsewhere.

CONCLUSIONS

Curriculum and personal factors have a key role in influencing students to pursue a career in general practice. As much of the existing research involves cross-sectional designs involving small numbers of participants, further research adopting prospective, quasi-experimental designs involving larger cohorts is a priority.

Effect of an intercalated research degree on general practice careers: a matched cohort study

INTRODUCTION Intercalated degrees are one of the most focused undergraduate research training activities offered to medical students worldwide. The effect of intercalating on actual career choices has not been previously investigated. AIM To examine the effect of obtaining an intercalated research degree on choosing general practice as a career. METHODS This was a retrospective, matched cohort study of intercalating students at the University of Otago, New Zealand (1995-2008). Medical students who completed the intercalated Bachelor of Medical Sciences with Honours, BMedSc(Hons), degree were retrospectively identified. Gender- and graduation year-matched controls were identified from a publicly available graduate database in a 1:1 ratio. MEDLINE® and Google Scholar-indexed publications resulting from BMedSc(Hons) projects were determined using standardised search criteria. Speciality choice was obtained from online lists of registered doctors. RESULTS Over the 14-year period, 99 (3.9%) students completed an intercalated degree with a publication rate of 36.4%. Of these, 42 (42.4%) were female and over two-thirds (68.7%) of projects were laboratory-based. The median follow-up period after graduation was 14 years (range 7.7-21.7 years). The congruence between students' BMedSc(Hons) research subject area and clinical speciality was 9.1%. Sixteen (16.2%) intercalating students chose general practice as a career, whereas 83 (83.8%) chose 19 different hospital-based specialties. Compared to controls, students who completed an intercalated degree were significantly less likely to pursue a career in general practice (odds ratio 0.37; 95% confidence interval=0.18 - 0.77; P=0.007). DISCUSSION The present study findings suggest that completing an intercalated degree is associated with lower odds of pursuing a career in general practice. Future research should explore reasons for this observation to help develop strategies to promote primary care and general practice careers among medical graduates, including those interested in research careers.

The "practice track" - How can teaching content related to outpatient healthcare be integrated into medical studies? Learning objectives, conception and implementation of a specialized voluntary program

The "practice track" (PAT) at Goethe University Frankfurt provides students with the opportunity to focus on outpatient care during their medical studies. The aim of this article is to describe the objectives, conception and implementation of the program. At the Institute of General Practice, a new teaching concept has been developed in cooperation with the Dean's Office of the Faculty of Medicine at Goethe University and further partners. Medical students generally receive their training in highly specialized hospitals. However, the new concept will allow them to gain a practical insight into the outpatient care provided by physicians in private practice during their medical studies. Every year, 15 interested students will be able to participate in the longitudinal program, which includes internships, seminars and mentoring sessions. In the three current PAT cohorts, all 45 places have been taken up, and the first cohort has now completed the program. In addition to practical skills in the disciplines of family medicine, internal medicine, surgery, gynecology and pediatrics, it has been possible to show students the full scope of ambulatory health care. However, legal limitations to the implementation of the program in registered medical practices have meant that some parts of it could only be carried out voluntarily. Against the background of the current and future situation in health care, it makes sense that registered physicians in private practice should teach medical students about outpatient care during their medical studies. In order to establish such programs and permit their complete integration into the medical curriculum, it is essential that the necessary changes are made to medical licensing regulations.

Medical students' perspectives on earning opportunities of self-employed physicians - realistic and relevant for the process of career choice?

BACKGROUND

Several studies report a substantial impact of financial considerations on the process of specialty choice and the willingness to establish one's own practice. In Germany, reliable information on self-employed physicians' earning opportunities is basically available, but not easily accessible and understandable for medical students. Misperceptions might contribute to recruitment problems in some fields, particularly in general practice. In order to identify a possible need for action, we investigated current German medical students' level of information regarding future earnings, and whether net earnings of general practitioners and other physicians working self-employed are estimated realistically. Additionally, we explored students' self-assessments regarding the extent of the impact of expected earnings on their personal career choice process.

METHODS

We conducted a cross-sectional questionnaire survey among fourth year (of six) medical students at one medical school (Leipzig). The participants estimated the net earnings of different physicians working self-employed. These estimations were compared with actual earnings data derived from a large German practice panel.

RESULTS

Response rate was 73.6% (231/314). The participants' mean age was 24.9 years and 59.1% were women. On a 10-point scale ranging from 1 = 'no influence' to 10='very big influence', 92.6% of the participants described at least some (≥2) influence of earning expectations on their career choice process, and 66.2% stated this influence to be 5 or higher. Every fourth student (26.4%) would rather or definitely reject a certain specialty because of expected low earning opportunities. While 60.4% had already thought about future earnings, only 26.8% had obtained concrete information. Compared with the data derived from the practice panel, the participants substantially underestimated the earning opportunities in self-employed settings, including general practice (median: 4500 vs. 6417€). However, depending on the single estimations, between 87.7 and 95.6% of the students stated they were 'rather uncertain' or 'very uncertain' regarding their estimations.

CONCLUSIONS

Despite confirming a relevant impact of financial considerations on career choice, German fourth year medical students are not well informed about earning opportunities in self-employed settings. Providing easily understandable information could enhance transparency and might help students to consider financial issues of career choice on a realistic basis.

Which positive view of general practice do medical students and trainees have? A systematic literature review

Background: Despite several studies focusing on the negative aspects of general medicine, the speciality seems attractive for students. Researchers from the European General Practice Research Network created a group to study job satisfaction in general practice. The aim of this eight-country European study was to determine which positive view students have about general practice.Method: Systematic review of the literature from Pubmed, Embase and Cochrane databases. Articles published between 01/01/2000 and 12/31/2018 were searched and analysed by two researchers working blind. The data on satisfaction factors were extracted from the full text article used as verbatims. Then the data were coded with a thematic analysis.Results: 24 articles out of 414 were selected. Satisfaction factors were classified: teaching of general practice, workplace and organisational freedom, quality of life, variety in practice, workload balance and income. The analysis highlighted intellectual stimulation and the relationship built with patients and other professionals.Conclusion: Literature on the appeal of general practice for students revealed many factors of job satisfaction in general practice. It is possible to create a global view of a satisfied GP on the students' opinion. Courses and clerkships in general practice with positive role models are determining factors in career choice.

"Landpartie 2.0" - Conceptual development and implementation of a longitudinal priority program to promote family medicine in rural areas

Objective: This article reports on the conceptual development and subsequent implementation of a targeted and attractive general practice teaching program in a rural area for students of human medicine at the medical faculty of Goethe University, Frankfurt am Main. Project description: Since the 2016/2017 winter semester, usually up to 15 interested students a year have had the opportunity to participate in the longitudinal priority program "Landpartie 2.0". The program runs for six semesters during the clinical stage of medical studies and consists of regular internships during which the students receive one-to-one support in a family practice, and participate in a series of seminars and an annual one-day excursion. The aim is to enable students, early on in their studies and without any obligations, to gain uninterrupted experience of providing patient care, and to find out what it means to pursue a career in family medicine. Results: Since the beginning of the annual program, 62 students have been included in it. The initial results show that the different elements of the program fulfil the expectations and requirements of participants and that their overall level of satisfaction is high. Almost 95% of students reported that they felt their knowledge had increased as a result of the internships, and they rated them as a useful part of their medical education. Despite the rural focus of the program, around half of the participants were of urban origin. Conclusion: The "Landpartie 2.0" provides students with the opportunity to familiarize themselves with family health care in a rural area. Further studies should investigate to what extent the program encourages students to continue their training with a view to pursuing a career in family medicine.

LeiKA: an optional German general practice teaching project for first-semester medical students: who is taking part and why? A cross-sectional study

OBJECTIVES

This study investigates students' adoption of LeiKA, a new extracurricular longitudinal general practice (GP) teaching project. LeiKA aims to attract a broad range of students, not only those who are already planning to become GPs. This study compares participants' and non-participants' characteristics, career preferences and job-related value orientations to assess the programme's initial potential to increase the number of students subsequently entering GP careers. Additionally, students' motives for taking part in the programme were explored.

DESIGN

We analysed administrative data and data from a cross-sectional questionnaire survey for the first three cohorts. LeiKA participants were compared with non-participants regarding baseline characteristics, career intentions and attitudes associated with GP careers. There was also a qualitative analysis of the reasons for taking part.

SETTING

Faculty of Medicine, University of Leipzig, Germany.

PARTICIPANTS

First-semester medical students in the years 2016-2018.

RESULTS

In the first 3 years, 86 of 90 LeiKA slots were taken, 9.0% (n=86/960) of those eligible to apply. LeiKA participants were a mean of 0.6 years older (LeiKA: 21.5 vs whole cohort: 20.9 years, p<0.001) and slightly more interested in long-term doctor-patient relationships (3.6 vs 3.3, scale from 1 'unimportant' to 5 'very important', p=0.018), but did not differ regarding other characteristics and attitudes. Although more participants definitely favoured a GP career (13.1% vs 4.9%, p=0.001), it was a possible option for most students in both groups (78.6% vs 74.0%). Early acquisition of skills and patient contact were the main motives for taking part, stated by 60.7% and 41.7% of the participants, respectively.

CONCLUSIONS

The extracurricular programme was taken up by a broad range of students, indicating its potential to attract more students to become GPs. The reasons for taking part that we identified may guide the planning of other similar projects.

Why do Danish junior doctors choose general practice as their future specialty? Results of a mixed-methods survey

Background: A well-staffed and an efficient primary healthcare sector is beneficial for a healthcare system but some countries experience problems in recruitment to general practice.

Objectives: This study explored factors influencing Danish junior doctors’ choice of general practice as their specialty.

Methods: This study is based on an online questionnaire collecting quantitative and qualitative data. Two focus-group interviews were conducted to inform the construction of the questionnaire to ensure high content validity. All Danish junior doctors participating in general practice specialist training in 2015 were invited to participate in the survey, from which both qualitative and quantitative data were collected. The data was analysed using systematic text condensation and descriptive statistics.

Results: Of 1099 invited, 670 (61%) junior doctors completed the questionnaire. Qualitative data: junior doctors found educational environments and a feasible work–life balance were important. They valued patient-centred healthcare, doctor–patient relationships based on continuity, and the possibility of organizing their work in smaller, manageable units. Quantitative data: 90.8% stated that the set-up of Danish specialist-training programme positively influenced their choice of general practice as their specialty. Junior doctors (80.4%) found that their university curriculum had too little emphasis on general practice, 64.5% agreed that early basic postgraduate training in general practice had a high impact on their choice of general practice as their specialty.

Conclusion: Several factors that might positively affect the choice of general practice were identified. These factors may hold the potential to guide recruitment strategies for general practice.

Community Preceptors' Motivations and Views about Their Relationships with Medical Students During a Longitudinal Family Medicine Experience: A Qualitative Case Study

Phenomenon: Although current evidence emphasizes various benefits of community-oriented programs, little is still known about the nature of the relationships that students and family physicians develop in this educational setting. Our aim in this study was twofold: to identify family physicians' motivations to enroll as preceptors in a longitudinal undergraduate family medicine program and to explore the nature of the student-preceptor relationships built during the course. Approach: This was a qualitative exploratory case study. The case was the first edition of a longitudinal family medicine experience (LFME), a course that makes up part of the novel Medicinae Doctor et Chirurgiae Magister curriculum in place in a Canadian medical school since August 2013. All 173 family physician community preceptors of the academic year 2013-2014 were considered key informants in the investigation. Forty-three preceptors finally participated in one of six focus groups conducted in the spring of 2014. Several organizational documents relative to the LFME course were also gathered. Inductive semantic thematic analysis was performed on verbatim interview transcripts. Documents helped contextualize the major themes emerging from the focus groups discussions. Findings: Enjoying teaching, promoting family medicine, and improving medical education where salient motivations for family physicians to become LFME preceptors. The findings also pointed out the complexity of the student-preceptor exchanges that unfolded over the academic year, and the ambiguous and changing nature of the role that LFME preceptors adopted in their relationships with students: from simply being facilitators of students' clinical observership to behaving as their mentors. Insights: Family physicians were highly motivated to become LFME preceptors of 1st-year medical students. Whereas they consistently valued the relationships built during the academic year with the students assigned to them, they also considered that exchanges did not always happen without difficulties, and gauged the roles they played as complex, ambiguous, and necessarily evolving over time.

Factors influencing subspecialty choice among medical students: a systematic review and meta-analysis

OBJECTIVE

To characterise the contributing factors that affect medical students' subspecialty choice and to estimate the extent of influence of individual factors on the students' decision-making process.

DESIGN

Systematic review and meta-analysis.

METHODS

A systematic search of the Cochrane Library, ERIC, Web of Science, CNKI and PubMed databases was conducted for studies published between January 1977 and June 2018. Information concerning study characteristics, influential factors and the extent of their influence (EOI) was extracted independently by two trained investigators. EOI is the percentage level that describes how much each of the factors influenced students' choice of subspecialty. The recruited medical students include students in medical school, internship, residency training and fellowship, who are about to or have just made a specialty choice. The estimates were pooled using a random-effects meta-analysis model due to the between-study heterogeneity.

RESULTS

Data were extracted from 75 studies (882 209 individuals). Overall, the factors influencing medical students' choice of subspecialty training mainly included academic interests (75.29%), competencies (55.15%), controllable lifestyles or flexible work schedules (53.00%), patient service orientation (50.04%), medical teachers or mentors (46.93%), career opportunities (44.00%), workload or working hours (37.99%), income (34.70%), length of training (32.30%), prestige (31.17%), advice from others (28.24%) and student debt (15.33%), with significant between-study heterogeneity (p<0.0001). Subgroup analyses revealed that the EOI of academic interests was higher in developed countries than that in developing countries (79.66% [95% CI 70.73% to 86.39%] vs 60.41% [95% CI 43.44% to 75.19%]; Q=3.51, p=0.02). The EOI value of prestige was lower in developed countries than that in developing countries (23.96% [95% CI 19.20% to 29.47%] vs 47.65% [95% CI 34.41% to 61.24%]; Q=4.71, p=0.01).

CONCLUSIONS

This systematic review and meta-analysis provided a quantitative evaluation of the top 12 influencing factors associated with medical students' choice of subspecialty. Our findings provide the basis for the development of specific, effective strategies to optimise the distribution of physicians among different departments by modifying these influencing factors.

Doctors' career choices in health systems constrained by national medical exams: A discrete choice experiment

Previous studies that addressed factors influencing junior doctors' career decisions have failed to consider that the market for medical specialty is regulated and doctors are not always able to pursue their career of choice. There is the concern that the National Medical Exam that doctors have to take in many countries conditions their career choices and is behind the low efficacy of policies for retaining doctors in rural areas. In this paper, we use data from a Discrete Choice Experiment applied to a large sample of Portuguese junior doctors (N = 503) who had already taken their Medical Exam but had not chosen their medical specialty yet. We show that the exam score is de facto a strong predictor for (different) job preferences, but only for doctors who are amongst the highest and the lowest exam scores. For all others-almost half of our sample-geographical attachment (having lived or studied in rural areas or in metropolis) is more relevant in determining specialization decisions. Having a good work-life balance, specially amongst female physicians, is also an important determinant of specialty choice. Using latent-class analysis may help policymakers profiling different groups of doctors and tailoring incentive packages according to their characteristics.

Factors Determining Pakistani Medical Students' Career Preference for General Practice Residency Training

Background

Few studies have explored factors affecting preference of medical students towards general practice as a career choice. We conducted a survey in Karachi across various public and private sector medical colleges to examine factors associated with students’ general practice career aspirations in Karachi, Pakistan.

Methods

From January to March 2018, we distributed a 21-item questionnaire to final year medical students in eight medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item.

Results

A total of 1400 responses were obtained. The top five specialty fields chosen by students with their numbers were: internal medicine, 898 (64.2%); general practice, 337 (24.1%); pediatrics, 449 (32.1%); surgery, 380 (27.2%); and emergency medicine, 243 (17.4%). The “intent to inherit existing practice” and “other academic or professional experiences prior to medical school” had a positive association with choosing general practice while “having a physician parent’’ had a negative association among the medical students demographics after adjusting for other covariates in the multivariable logistic regression. Medical students who ranked “clinical diagnostic reasoning”, “community-oriented practice”, “involvement in preventive medicine”, and “frequent patient communication” as highly important were more likely to choose general practice, whereas, “access to advanced medical fields”, “mastering advanced procedures”, and “depth rather than breadth of practice” were less likely to be associated with general practice aspiration.

Conclusion

The study’s results depicted limited interest of family medicine as a career option in graduating students, and pointed out the factors that likely influence the choice of general practice as a career are clinical diagnostic reasoning, community-oriented practice and preventive medicine.

UK medical students' attitudes towards their future careers and general practice: a cross-sectional survey and qualitative analysis of an Oxford cohort

BACKGROUND

Against the background of the recruitment crisis in general practice, we aimed to determine what United Kingdom (UK) medical students value in their future careers, how they perceive careers in general practice (GP) and what influences them.

METHODS

Cross-sectional survey of 280 final and penultimate year medical students at the University of Oxford, with questions relating to career choices, factors of importance when choosing a career and attitudes towards general practice as a career. Quantitative methods included cluster analysis, chi squared tests of independence and logistic regression analysis. Qualitative data were analysed thematically using the Framework method.

RESULTS

Response rate was 89% (280/315). 40% of participants said that general practice was an attractive or very attractive career option. Respondents valued job satisfaction, work-life balance and close relationships with patients. However, fewer than 20% of respondents agreed that community-based working was important to them and many (often citing particular GPs they had observed) felt that general practice as currently structured may not be satisfying or fulfilling because of high workload, financial pressures and externally imposed directives. 63% perceived GPs to have lower status than hospital specialties and 49% thought the overall culture of their medical school had negatively influenced their views towards general practice. Some respondents considered that general practice would not be intellectually challenging or compatible with a research career; some appeared to have had limited exposure to academic primary care.

CONCLUSIONS

With the caveat that this was a sample from a single medical school, medical students may be put off careers in general practice by three main things: low perceived value of community-based working and low status of general practice (linked to a prevailing medical school culture); observing the pressures under which GPs currently work; and lack of exposure to academic role models and primary care-based research opportunities. To improve recruitment of the next generation of GPs, medical schools must provide high quality placements in general practice, expose students to academic role models and highlight to policymakers the links between the current pressures in UK general practice and the recruitment crisis.

What determines medical students' career preference for general practice residency training?: a multicenter survey in Japan

BACKGROUND

Few studies have systematically explored factors affecting medical students' general practice career choice. We conducted a nationwide multicenter survey (Japan MEdical Career of Students: JMECS) to examine factors associated with students' general practice career aspirations in Japan, where it has been decided that general practice will be officially acknowledged as a new discipline.

METHODS

From April to December 2015, we distributed a 21-item questionnaire to final year medical students in 17 medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item.

RESULTS

A total of 1264 responses were included in the analyses. The top three specialty choice were internal medicine: 833 (65.9%), general practice: 408 (32.3%), and pediatrics: 372 (29.4%). Among demographic factors, "plan to inherit other's practice" positively associated with choosing general practice, whereas "having physician parent" had negative correlation. After controlling for potential confounders, students who ranked the following items as highly important were more likely to choose general practice: "clinical diagnostic reasoning (adjusted odds ratio (aOR): 1.65, 95% CI 1.40-1.94)", "community-oriented practice (aOR: 1.33, 95% CI 1.13-1.57)", and" involvement in preventive medicine (aOR: 1.18, 95% CI 1.01-1.38)". On the contrary, "acute care rather than chronic care", "mastering advanced procedures", and "depth rather than breadth of practice" were less likely to be associated with general practice aspiration.

CONCLUSIONS

Our nationwide multicenter survey found several features associated with general practice career aspirations: clinical diagnostic reasoning; community-oriented practice; and preventive medicine. These results can be fundamental to future research and the development of recruitment strategies.

Student characteristics, professional preferences, and admission to medical school

Objectives: A potential new avenue to address the shortage of country doctors is to change the rules for admission to medical school. We therefore study the link between high-school grade point average and prospective physicians' choice to work in rural areas. To further inform the discussion about rules for admission, we also study the effects of other predictors: a measure of students' attitudes towards risk; whether they waited for their place of study (Wartesemester); whether their parents worked as medical doctors; and whether they have some practical experience in the medical sector. Methods: We conducted two internet surveys in 2012 and 2014. In the first survey, the sample comprised 701 students and in the second, 474 students. In both surveys, we asked students for their regional preferences; in the 2014 survey, we additionally asked students for their first, second, and third preferences among a comprehensive set of specializations, including becoming a general practitioner. In both surveys, we asked students for basic demographic information (age and gender), their parents' occupation, a measure of subjective income expectations, a measure of risk attitudes, and their high-school grade point average (Abiturnote), and First National Boards Examination grade (Physikum). In 2014, we additionally asked for waiting periods (Wartesemester) as well as for prior professional experience in the health-care sector. Results: We find that three factors increase the probability of having a preference for working in a rural area significantly, holding constant all other influences: having a medical doctor among the parents, having worse grades in the high-school grade point average, and being more risk averse. Moreover, we find that those willing to work in the countryside have significantly more experience in the medical sector before admission to medical school. Discussion: Our results suggest that a change in the selection process for medical school may increase the supply of country doctors. Instead of focusing on the high-school grade point average, universities could even more intensely screen for study motivation through interviews or by taking into account students' background, extracurricular activities, or waiting periods.

Pilot phase evaluation of the elective general practice class: results of student surveys of the first two years

Background: Primary health care in rural regions is currently undergoing a global crisis in respect of the next generation of practitioners. National and international recommendations advise placing greater emphasis upon practical skills and competences in medical studies. It is also in the interest of training the next generation to include mentoring and longitudinal integration of contact to teaching practices for general medicine in an early stage. Consequently, the General Practice Class (KAM) was introduced in Halle in 2011 as an elective with 20 individually mentored students per year, beginning with the first subject-related semester. We are now reporting on the results of the evaluation for the first two years. Method: A standardised online survey was carried out with all students who took part in the KAM in the two years 2011 and 2012 (N=38). For both years the survey was made at the end of the first summer semester on the basis of an adapted version of the Heidelberger Inventar zur Lehrevaluation (Heidelberg Inventory for the Evaluation of Teaching, HILVE-II) and the Berliner Evaluationsinstrument für selbsteingeschätzte, studentische Kompetenzen (Berlin Evaluation Instrument for the self-assessment of student competences, BEvaKomp). Furthermore, each year the preference for the choice of specialty and location of a medical practice was queried. Predictors for the preference of the chosen specialty and the location of a medical practice were estimated by binary logistic regression analysis. Via univariate evaluations the number of students who reported an increase in knowledge in different areas of competence as a result of the KAM was counted. Correlations between the intention to remain in the KAM and the quality of teaching were evaluated on the basis of bivariate correlations. Results: 48% of the students agreed partly or fully that the KAM seminars enhanced their specialist competence. This individual acquiring of competence in the model project represented a significant predictor for the preferred choice of the area (OR 7.98; 95% CI [1.27-50.27], p=0.027). Students who assessed the commitment (r=0.504), support (r=0.526) and interaction management (r=0.529) of the mentors positively were more likely inclined to continue their participation in the KAM. Conclusion: The successful conveyance of care-relevant competences to students proved to be an important predictor in our project for the preference of the specialty general practice. This requires that the medical mentors are suitably trained and that the students are specifically prepared for practical experience.

Intended Career Choice in Family Medicine in Slovenia: An Issue of Gender, Family Background or Empathic Attitudes in Final Year Medical Students?

Background:

Among a variety of complex factors affecting a decision to take family medicine as a future specialisation, this study focused on demographic characteristics and assessed empathic attitudes in final year medical students.

Methods:

A convenience sampling method was employed in two consecutive academic years of final year medical students at the Faculty of Medicine in Ljubljana, Slovenia, in May 2014 and May 2015. A modified version of the 16-item Jefferson Scale of Empathy – Student Version (JSE-S) was administered to examine self-reported empathic attitudes. An intended career in family medicine was reported using a five-point Likert scale.

Results:

Of the 175 medical school seniors in study year 2013/14, there were 64 (36.6%) men and 111 (63.4%) women, while in the second group (study year 2014/5), there were 68 (40.5%) men and 100 (59.5%) women; 168 students in total. They were 24.9±1.6 (generation 2013/4) and 24.9±1.7 (generation 2014/15) years old. Thirty-six percent of the students in the academic year 2013/14 intended to choose family medicine as a future career, and a similar proportion in academic year 2014/15 (31.7%). Gender (χ²=6.763, p=0.034) and empathic attitudes (c²=14.914; p=0.001) had a bivariate association with an intended career choice of family medicine in the 2014/15 generation. When logistic regression was applied to this group of students, an intended career choice in family medicine was associated with empathic attitudes (OR 1.102, 95% CI 1.040-1.167, p=0.001), being single (OR 3.659, 95% CI 1.150-11.628, p=0.028) and the father having only primary school education (OR 142.857 95% CI 1.868, p=0.025), but not with gender (OR 1.117, 95% CI 0.854-1.621, p=0.320).

Conclusion:

The level of students’ father’s education, and not living in an intimate partnership, increased the odds on senior medical students to choose family medicine, yet we expected higher JSE-S scores to be associated with interest in this speciality. To deepen our understanding, this study should be repeated to give us solid grounded insight into the determinants of career choice; associations with gender in particular need to be re-tested.

Private or salaried practice: how do young general practitioners make their career choice? A qualitative study

BACKGROUND

Young French postgraduates in general practice increasingly prefer salaried practice to private practice in spite of the financial incentives offered by the French government or local communities to encourage the latter. This study aimed to explore the determinants of choice between private or salaried practice among young general practitioners.

METHODS

A qualitative study was conducted in the South West of France. Semi-structured interviews of young general practitioners were audio-recorded until data saturation. Recordings were transcribed and then analyzed according to Grounded Theory by three researchers working independently.

RESULTS

Sixteen general practitioners participated in this study. For salaried and private doctors, the main factors governing their choice were occupational factors: working conditions, need of varied scope of practice, quality of the doctor-patient relationship or career flexibility. Other factors such as postgraduate training, having worked as a locum or self-interest were also determining. Young general practitioners all expected a work-life balance. The fee-for-service scheme or home visits may have discouraged young general practitioners from choosing private practice.

CONCLUSIONS

National health policies should increase the attractiveness of ambulatory general practice by promoting the diversification of modes of remuneration and encouraging the organization of group exercises in multidisciplinary medical homes and community health centers.

Choosing to become a general practitioner - What attracts and what deters? An analysis of German medical graduates' motives

BACKGROUND

To be able to counter the increasing shortage of general practitioners (GPs) in many countries, it is crucial to remain up-to-date with the decisive reasons why young physicians choose or reject a career in this field.

MATERIALS AND METHODS

Qualitative content analysis was performed using data from a cross-sectional survey among German medical graduates (n = 659, response rate = 64.2%). Subsequently, descriptive statistics was calculated.

RESULTS

The most frequent motives to have opted for a GP career were (n = 74/81): Desire for variety and change (62.2%), interest in a long-term bio-psycho-social treatment of patients (52.7%), desire for independence and self-determination (44.6%), positively perceived work-life balance (27.0%), interest in contents of the field (12.2%), and reluctance to work in a hospital (12.2%). The most frequent motives to have dismissed the seriously considered idea of becoming a GP were (n = 207/578): Reluctance to establish a practice or perceived associated risks and impairments (33.8%), stronger preference for another field (19.3%), perception of workload being too heavy or an unfavorable work-life balance (15.0%), perception of too low or inadequate earning opportunities (14.0%), perception of the GP as a distributor station with limited diagnostic and therapeutic facilities (11.6%), perception of too limited specialization or limited options for further sub-specialization (10.6%), rejection of (psycho-) social aspects and demands in general practice (9.7%), and perceived monotony (9.7%).

CONCLUSION

While some motives appear to be hard to influence, others reveal starting points to counter the GP shortage, in particular, with regard to working conditions, the further academic establishment, and the external presentation of the specialty.

General practitioners' and students' experiences with feedback during a six-week clerkship in general practice: a qualitative study

OBJECTIVE

Feedback may be scarce and unsystematic during students' clerkship periods. We wanted to explore general practitioners' (GPs) and medical students' experiences with giving and receiving supervision and feedback during a clerkship in general practice, with a focus on their experiences with using a structured tool (StudentPEP) to facilitate feedback and supervision.

DESIGN

Qualitative study.

SETTING

Teachers and students from a six-week clerkship in general practice for fifth year medical students were interviewed in two student and two teacher focus groups.

SUBJECTS

21 GPs and nine medical students.

RESULTS

We found that GPs first supported students' development in the familiarization phase by exploring the students' expectations and competency level. When mutual trust had been established through the familiarization phase GPs encouraged students to conduct their own consultations while being available for supervision and feedback. Both students and GPs emphasized that good feedback promoting students' professional development was timely, constructive, supportive, and focused on ways to improve. Among the challenges GPs mentioned were giving feedback on behavioral issues such as body language and insensitive use of electronic devices during consultations or if the student was very insecure, passive, and reluctant to take action or lacked social or language skills. While some GPs experienced StudentPEP as time-consuming and unnecessary, others argued that the tool promoted feedback and learning through mandatory observations and structured questions.

CONCLUSION

Mutual trust builds a learning environment in which supervision and feedback may be given during students' clerkship in general practice. Structured tools may promote feedback, reflection and learning. Key Points Observing the teacher and being supervised are essential components of Medical students' learning during general practice clerkships. Teachers and students build mutual trust in the familiarization phase. Good feedback is based on observations, is timely, encouraging, and instructive. StudentPEP may create an arena for structured feedback and reflection.

Impact of family medicine clerkships in undergraduate medical education: a systematic review

OBJECTIVE

Synthesise evidence about the impact of family medicine/general practice (FM) clerkships on undergraduate medical students, teaching general/family practitioners (FPs) and/or their patients.

DATA SOURCES

Medline, ERIC, PsycINFO, EMBASE and Web of Knowledge searched from 21 November to 17 December 2013. Primary, empirical, quantitative or qualitative studies, since 1990, with abstracts included. No country restrictions. Full text languages: English, French, Spanish, German, Dutch or Italian.

REVIEW METHODS

Independent selection and data extraction by two authors using predefined data extraction fields, including Kirkpatrick's levels for educational intervention outcomes, study quality indicators and Best Evidence Medical Education (BEME) strength of findings' grades. Descriptive narrative synthesis applied.

RESULTS

Sixty-four included articles: impact on students (48), teaching FPs (12) and patients (8). Sample sizes: 16-1095 students, 3-146 FPs and 94-2550 patients. Twenty-six studies evaluated at Kirkpatrick level 1, 26 at level 2 and 6 at level 3. Only one study achieved BEME's grade 5. The majority was assessed as grade 4 (27) and 3 (33). Students reported satisfaction with content and process of teaching as well as learning in FM clerkships. They enhanced previous learning, and provided unique learning on dealing with common acute and chronic conditions, health maintenance, disease prevention, communication and problem-solving skills. Students' attitudes towards FM were improved, but new or enhanced interest in FM careers did not persist without change after graduation. Teaching FPs reported increased job satisfaction and stimulation for professional development, but also increased workload and less productivity, depending on the setting. Overall, student's presence and participation did not have a negative impact on patients.

CONCLUSIONS

Research quality on the impact of FM clerkships is still limited, yet across different settings and countries, positive impact is reported on students, FPs and patients. Future studies should involve different stakeholders, medical schools and countries, and use standardised and validated evaluation tools.