Influences on students' career decisions concerning general practice: a focus group study

How do medical schools influence their students' career choices? A realist evaluation

INTRODUCTION

The career choices of medical graduates vary widely between medical schools in the UK and elsewhere and are generally not well matched with societal needs. Research has found that experiences in medical school including formal, informal and hidden curricula are important influences. We conducted a realist evaluation of how and why these various social conditions in medical school influence career thinking.

METHODS

We interviewed junior doctors at the point of applying for speciality training. We selected purposively for a range of career choices. Participants were asked to describe points during their medical training when they had considered career options and how their thinking had been influenced by their context. Interview transcripts were coded for context-mechanism-outcome (CMO) configurations to test initial theories of how career decisions are made.

RESULTS

A total of 26 junior doctors from 12 UK medical schools participated. We found 14 recurring CMO configurations in the data which explained influences on career choice occurring during medical school.

DISCUSSION

Our initial theories about career decision-making were refined as follows: It involves a process of testing for fit of potential careers. This process is asymmetric with multiple experiences needed before deciding a career fits ('easing in') but sometimes only a single negative experience needed for a choice to be ruled out. Developing a preference for a speciality aligns with Person-Environment-Fit decision theories. Ruling out a potential career can however be a less thought-through process than rationality-based decision theories would suggest. Testing for fit is facilitated by longer and more authentic undergraduate placements, allocation of and successful completion of tasks, being treated as part of the team and enthusiastic role models. Informal career guidance is more influential than formal. We suggest some implications for medical school programmes.

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.

Changes in the attractiveness of medical careers and career determinants during the bachelor's program at Zurich medical schools

BACKGROUND

Monitoring the career intentions of medical students during their undergraduate studies could help to address the shortage of physicians, particularly in general practice. This study aimed to investigate changes in medical students' career openness, attractiveness and determinants of medical career choice during their bachelor's studies.

METHODS

The design was cross-sectional, recruiting all medical students who started a bachelor's program in one of the four different educational tracks in Zurich, Switzerland, in the fall of 2019 (first survey) and completed it in the summer of 2022 (second survey). Students' perceptions of the attractiveness and determinants of different medical career options were assessed using a structured online questionnaire. Absolute changes between the two-time points were reported in percentage points overall and by educational track. Regression analysis was used to examine the association of student characteristics and determinants of career options with the attractiveness of each option.

RESULTS

We surveyed 354 medical students at the beginning and 433 at the end of the bachelor's program (participation rate: 71.1% and 86.9%, respectively). Overall, the proportion of students open to all proposed medical career options decreased (from 52.8% to 43.8%, p = 0.004). The attractiveness of outpatient gynecology or pediatrics increased (from 27.4% to 43.4%, p < 0.001), whereas the attractiveness of both general and specialized inpatient care decreased (from 47.8% to 40.3%, p = 0.05 and from 71.1% to 61.1%, p = 0.006 respectively). There was an increase in the proportion of students who perceived part-time work, autonomy and relationships with patients as important career determinants (from 47.3% to 64.7%, p < 0.001; from 63.3% to 77.8%, p < 0.001; from 80.8% to 89.3%, p = 0.002 respectively), while the importance of reputation and career opportunities decreased (from 42.6% to 26.2%, p < 0.001; from 79.2% to 63.6%, p < 0.001 respectively). The importance of part-time work and relationships with patients were positively associated with the attractiveness of general practice.

CONCLUSIONS

During the bachelor's program, the attractiveness of a career in general practice tended to decrease, but the importance of part-time work, autonomy and relationships with patients as career determinants increased. Helping students understand how these determinants relate to general practice may increase their interest in the profession.

TRIAL REGISTRATION

Not applicable.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Application of virtual diagnosis and treatment combined with medical record teaching method in standardized training of general practitioner

The aim of this study was to explore the effect of virtual diagnosis and treatment combined with the medical record teaching method in standardized training of general practitioners. Eighty students who had standardized general practice training, from March 2020 to March 2022, in the grassroots practice base of general practitioner training in the affiliated Hospital of our Medical College were retrospectively analyzed and divided into 2 groups according to the teaching method that they received. The differences in assessment scores, critical thinking, clinical thinking ability, learning autonomy ability, and classroom teaching effectiveness were compared, and the students' satisfaction with teaching was investigated. The scores of theoretical knowledge, skill operation, medical history collection, and case analysis in the study group were notably higher (P < .05). In the study group, scores in truth-seeking, openness to knowledge, analytical ability, systematic ability, self-confidence, curiosity, and cognitive maturity were significantly higher (P < .05). A notable improvement was observed in the study group's scores on systematic thinking ability and evidence-based thinking ability, as well as the scores on critical thinking ability after teaching (P < .05). The scores of learning interest, self-management, plan implementation, and cooperation ability improved notably after teaching (P < .05). Learning target, learning processes, learning effects, classroom environment construction, teaching strategy, and technology application in the study group were significantly higher than those in the control group (P < .05). The satisfaction rate in the study group was significantly higher than that in the control group (P < .05). Virtual diagnosis and treatment combined with case-based learning teaching has a very good effect in the standardized training of general practitioners. Students are generally satisfied with their learning experience, which can improve their critical thinking ability and clinical thinking skills. This teaching method is worth further popularizing.

The Impact of an Undergraduate Community-Based Medical Education Program in a Japanese Urban City

INTRODUCTION

 With an aging global population posing healthcare challenges, especially in community healthcare, training professionals for community healthcare remains a global educational challenge, including in Japan. While previous research shows increased student interest in community healthcare through practical experiences, the focus has primarily been on rural areas, leaving a gap in understanding urban-based community medical education. This study aimed to evaluate the impact of urban community-based medical education on students' understanding and attitudes toward community healthcare.

METHODS

 This study was conducted at Kyushu University in Fukuoka City, the sixth-largest city in Japan. For fifth-grade medical students, a community-based medical education program is mandatory, with a one-week schedule that includes orientation, one day in a clinic, and three days in a community hospital. The program aimed to expose students to various healthcare settings, emphasizing outpatient care, inpatient management, home health care, home nursing, and rehabilitation. A self-administered questionnaire referencing the Model Core Curriculum for medical education was administered immediately before and after the program, and the differences in students' perceptions were assessed using the Student's t-test.

RESULTS

 Findings from 188 students completing both pre- and post-program questionnaires revealed significant improvements in perceptions of students' knowledge and skills related to community healthcare. After the training, there was a noteworthy positive shift in attitudes toward community healthcare and increased interest in primary care physicians as a career choice. Although students maintained a preference for urban areas, there was a notable inclination towards rural settings. The study highlights the program's success in enhancing students' understanding and positive attitudes toward community healthcare within an urban context. It challenges prior notions regarding work-life balance and urban-rural preferences in career choices.

CONCLUSIONS

 Urban community-based medical education significantly improved students' perceptions and attitudes toward community healthcare. It offers valuable insights for curriculum planners, emphasizing the need for continued research into sustained effects and broader applicability.

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.

Identifying key policy objectives for strong primary care: a cross-sectional study

AIM

The aim of this study was to identify key policy objectives by investigating the perception of important stakeholders and affected professionals concerning relevance and feasibility of a successful primary care (PC) reform.

BACKGROUND

Since 2013, the Austrian PC system has been undergoing a reform process to establish multiprofessional primary care units. The reforms have various defined objectives and lack clear priorities.

METHODS

After the definition and consensus-based selection of 12 policy objectives, a cross-sectional online survey on their relevance and feasibility was distributed via email and social media to PC and public health networks. The survey was conducted in the period from January to February 2020. Results were analyzed descriptively, and further, Pearson Chi-Square Test or Fisher's Exact Test was performed for group comparison regarding respondents' characteristics. Open-ended responses were analyzed using qualitative content analysis.

FINDINGS

In total, 169 questionnaires were completed. A total of 46.3% of the responders had more than 20 years of professional experience (female: 60.5%). A mandatory internship in general practice, vocational training for general practice, and a modern remuneration system were the three top-rated policy objectives regarding relevance. A mandatory internship in general practice, specialization in general practice, and coding of services and diagnosis were assessed as the most feasible objectives. The group comparisons regarding working field, years of professional experience, age, and sex did not show any meaningful results in the evaluation of relevance and feasibility.

DISCUSSION

In the view of the study participants, easily obtainable objectives include adapting the duration and setting of internships for medical students, as well as mandatory vocational training for GP trainees. Further efforts are necessary to achieve complex objectives such as the adoption of a modern remuneration scheme and a comprehensive quality assurance program. Building capacity and creating team-oriented environments are also important aspects of a successful PC reform.

Specialty preferences of studying-abroad medical students from low- and middle-income countries

BACKGROUND

This study explored the specialty preferences of China-educated international medical students (IMSs), who are mainly from low- and middle-income countries (LMICs) and constitute a potential medical workforce both for their home countries and foreign countries, and the influence of migration intentions on their specialty preferences.

METHODS

A cross-sectional, questionnaire-based survey was conducted at 5 universities in China. The questionnaire link was distributed electronically among the IMSs at the 5 universities via emails. The questionnaire enquired IMSs' demographic information, migration intentions and their specialty preferences. The Chi-square test was applied to determine the influence of the respondent's gender, intention to practise in the home country and intention to practise in a high-income country on their specialty choices. The Chi-square test was also applied to determine the influence of the respondent's gender, year of study and country of origin on their preferences for generalist-orientated or non-generalist orientated specialties.

RESULTS

Altogether, 452 IMSs returned their responses, yielding a response rate of 64.1%. Approximately half of the IMSs planned to not return to their home country. The most selected specialty was general surgery and the least selected specialty was physical medicine and rehabilitation. No significant differences were evident in most specialty preferences between those who intended to return home and those who intended to stay abroad. Among the IMSs having intentions of returning to their home country, male students tended to choose a generalist-orientated specialty, while female students tended to choose a non-generalist-orientated specialty.

CONCLUSION

China-educated IMSs could play important roles in the primary care services as well as other shortage specialties both for their home countries or foreign countries. Therefore, it is recommended that governments in these countries plan migration and recruitment policies that cater for these studying-abroad medical students from LMICs, especially in this challenging time during the COVID-19 pandemic.

Career Intentions and the Determining Factors among Health Science Students: A Systematic Review

BACKGROUND

Health systemsneed adequate personnelin order to function; improvements in health-care services delivery, and coverage and the enjoyment of standard healthcare as a right, depend on the availability, mixture, quality, and accessibility of the health-care workforce.

PURPOSE

This review aimed to synthesize reliable evidence ondetermining factors among health science students' career choices to enhance policy advocacy for better health-care delivery.

METHOD

We sourced empirical studies from Scopus, PubMed, ScienceDirect and Google Scholar. From a total of 9,056 researcharticlesfrom 2010 to 2022, 27 studies with a total of 45,832 respondents met the inclusion criteria.

RESULTS

The majority of the studies were of medical students; internal medicine was the commonest choice (64.3%), with psychiatry and public health receiving lesser attention. In the four available studies of nursing students, midwifery was not chosen at all. There is a paucity of studies on this all-important concept for nursing students. The determining factors of choice of specialty were in four themes: personal, socioeconomic, professional, and educational/policy. Among the barriers to choosing particular specialties were low prestige among colleagues, stigma, long working hours, and poor public recognition.

CONCLUSION

The career choices of health science students do not reflect an adequate mix of health-care team members to meet the health-care needs of the world. Reforms of policy and educational training are needed.

House officers' specialist career choices and motivators for their choice- a sequential mixed-methods study from Malaysia

PURPOSE

Shortage and maldistribution of medical specialists hamper healthcare quality. The specialist career choices of house officers determines the future composition of healthcare systems. We studied house officers'' specialist career choices and motivators for their choice.

PARTICIPANTS AND METHODS

We conducted online in-depth interviews among seven house officers using an interview guide developed based on a literature review. The transcripts were analyzed. Major themes were identified. A 33-item questionnaire was developed, and the main and sub-themes were identified as motivators for specialist career choice. An online survey was done among 185 house officers. Content validation of motivators for specialist choice was done using exploratory factor analysis. First, second and third choices for a specialist career were identified. Multinomial logistic regression analyses were done to determine the socio-demographic factors and motivators associated with the first choice.

RESULTS

HOs perceived that specialist training opportunities provide a wide range of clinical competencies through well-structured, comprehensive training programs under existing specialist training pathways. Main challenges were limited local specialist training opportunities and hurdles for 'on-contract' HO to pursue specialist training. Motivators for first-choice specialty were related to 'work schedule', 'patient care characteristics', 'specialty characteristics', 'personal factors', 'past work experience', 'training factors', and 'career prospects.' House officers' first choices were specialties related to medicine (40.5%), surgery (31.5%), primary care (14.6%), and acute care (13.5%). On multivariate analysis, "younger age", "health professional in the family", "work schedule and personal factors", "career prospects" and "specialty characteristics" were associated with the first choice.

CONCLUSIONS

Medical and surgical disciplines were the most preferred disciplines and their motivators varied by individual discipline. Overall work experiences and career prospects were the most important motivators for the first-choice specialty. The information about motivational factors is helpful to develop policies to encourage more doctors to choose specialties with a shortage of doctors and to provide career specialty guidance.

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.

How Do Clinical Supervisors and Managers in Swedish Primary Care Perceive Their Opportunities to Meet the Learning Needs of Medical Students?

INTRODUCTION

Primary health care centers (PHCCs) in Sweden are struggling to maintain a balance between increasing demands of service and supervision and learning activities for a growing number of students. We sought a deeper understanding of primary care physicians and managers behavioral intention towards supervising, and their perceptions of the structural preconditions and support needed.

METHODS

The study combines two theoretical approaches, the Theory of Planned Behavior (TPB) and Social Practice Theory. A questionnaire with 22 items including an open-ended question was designed to collect quantitative and qualitative data and sent to clinical supervisors and managers at PHCCs in Southern Sweden. The aim was to map a) participants' behavioral intention and perceived capacity to act to improve supervision and b) their perceptions of structural prerequisites and support needed to sustain and develop clinical supervision practice.

RESULTS

A total of 181 questionnaires were returned, with a total response rate of 60.7%. Behavior predictors (attitudes, subjective norms, and perceived behavioral control) were positively correlated to behavioral intention towards supervising and building supervising competence. Three themes emerged from the content analysis of the qualitative data: "Time and distribution", "Improved communication and support systems" and "Elimination of structural barriers.".

DISCUSSION

The manager and supervisor reports suggest that the intentions and capacity of individuals (individuals' agency) is not a strong barrier to high-quality supervising and teaching in PHCC. Organizational preconditions for sustaining and developing supervision practice exist, and structural barriers for exercising agency could be eliminated according to PHCC managers and supervisors. However, a conclusion of our study from a practice theory perspective is that how and to what degree primary care physicians engage in supervision and competence building is determined by how the workplace - and the medical school - afford participation in supervision-related workplace activities. Improved communication between medical school, managers and supervising physicians and on-site faculty development integrated in daily clinical work were described as important facilitators of a favorable supervision and learning environment.

How do medical students' experiences inform their opinions of general practice and its potential as a future career choice?

Recruitment of general practitioners (GPs) in the UK has been suboptimal. There is a wealth of literature exploring recruitment into general practice and opinions of general practice, set in many contexts. This paper aims to synthesise all the elements and extract mechanisms to explain what works, for whom in what circumstances, to create a comprehensive understanding and highlight potential target areas for improvement to improve understanding and fuel interest in general practice careers. A realist review of literature and contemporary data was conducted in line with RAMESES standards. Analysis and synthesis were aided by NVivo. An initial program theory was developed following discussion with expert informers. Sections of text from included literature relating to program theory were extracted and synthesised into a final program theory using a realist logic of analysis in which recurring Context-Mechanism-Outcome configurations (CMOCs) were identified. Searches identified 27 relevant documents. Twenty recurring CMOCs were extracted, explaining how student perceptions of General Practice were influenced by placement experiences, comments from hospital doctors, medical school faculty, peers, GPs, student perceptions of lifestyle and the media. The GP placement environment plays an important role in the formation of opinions about the speciality. The impact of social influence varies depending on the student's desire to belong to a reference group and their level of self-monitoring behaviour. The 'GP lifestyle' was judged to be compatible with many students' needs. This realist review provides recommendations on how curricula can adapt to provide an accurate insight into general practice.

Evaluating educational performance and achievements of faculty in general medicine departments of Japanese universities

A cross‐sectional questionnaire‐based study was conducted to examine whether the educational performance and achievements are appropriately recognized and contribute to their promotion in university hospitals. We found that the chairpersons of those general medicine departments believed that educational performance had not been appropriately evaluated; educational achievements did not receive sufficient consideration for promotion compared with the performance and achievements related to clinical and research activities.

Professional stereotypes among specialties and fields of work within the veterinary community

BACKGROUND

Medical specialties hold varying degrees of prestige, stemming from the existence of stereotypes among them. These have been shown to lead to prejudice against specific specialists, which not only influences career choices but also affects the perception of equality among specialties.

METHOD

The aim of the research was to determine the presence of stereotypes in the UK veterinary community. Using an online questionnaire, participants were asked to provide an adjective that best characterises 15 specialties, in addition to their perceptions on prestige and gender association. Word cloud analysis coupled with sentiment analysis in Python using the language processing software Natural Language Toolkit (NLTK) was used to assess sentiments with respect to the adjectives.

RESULTS

There were 665 questionnaire respondents, and there was evidence of their construction of specialty-specific stereotypes. Some specialties were perceived more negatively than others, including equine general practitioners, surgeons, pathologists, dermatologists and public health veterinarians/epidemiologists. Gender bias was identified within this study, most prominently within production animal and behavioural medicine veterinarians. The most prestigious specialties were neurology, surgery and cardiology.

CONCLUSION

Specialty-specific stereotypes exist within the veterinary community. Acknowledging their existence is a first step to recognising the influence they have on career choices.

An exploratory study on the mode and method of general education and training for general practice undergraduates: a narrative review

Objective

To learn from the experience of foreign general practice education mode, and to exploratory study on the mode and method of general education and training for general practice undergraduates in China.

Background

The rise of general practice medicine addresses the lack of holistic attention to patients in specialist medicine. General practice education is an important means of training general practice skills, but the development of general practice education in China is not yet matured.

Methods

By using the method of comparative education, taking the United States, Australia, France and Britain as examples. This article makes a comparative analyzes the status of general practice education in foreign countries and discusses the development of undergraduate general practice education in China from four perspectives: national policy, teacher resources, curriculum system, and education training modes.

Conclusions

The four countries attach great importance to general practice education, with mature training methods, registered practice and continuing education. It is hoped that this article can establish and improve the policy system for the development of general subject teachers and optimize the inclusive, assessment and evaluation system of general practice teachers. In addition, more attention should be paid to general practice scientific research to create a teaching team with high standards, high quality, and high scientific research literacy and to form standardized scientific teaching methods that promote the development of general medicine education and training through high-quality teaching experiences. In addition, more attention should be paid to general practice scientific research to create a teaching team with high standards, high quality, and high scientific research literacy and to form standardized scientific teaching methods that promote the development of general medicine education and training through high-quality teaching experiences.

The "General practitioner learning stations"-development, implementation and optimization of an innovative format for sustainable teaching in general practice

BACKGROUND

Teaching general practice in a university setting is still challenging. In our department we have developed a teaching format with content from a previous lecture-style-teaching into an interactive small group format taught by frontline general practitioners (GPs). The "GP learning stations" introduce students to the skills and attributes of a GP working in primary care in a university setting. Our main objective was to understand whether the teaching format had proven itself sustainable in a university setting over eight years. Furthermore, we wanted to better understand the role of the GP as a medical educator.

METHODS

More than eight years of experience in organizational and staff expenses were collected and analyzed. In addition, the grade point average of the students' evaluation was calculated and their free text answers were categorized and evaluated descriptively. During two teach-the-teacher seminars attending GPs were asked why they teach and if they feel equipped to teach the format.

RESULTS

The initially high organizational and staff expenses were significantly reduced. The recruitment of GPs, their didactic contribution, and their joint creation of content went smoothly throughout the whole period. A total of 495 students participated in the regular evaluation. The analysis yielded a grade point average of 1.9, on a scale from 1 = very good to 6 = insufficient. In the free text answers students praised the educators, the format and the practical relevance. The interactive transfer of the content, the didactic competence of the educators and the spatial environment were viewed critically. Reasons for GPs to teach were the joy to pass on knowledge and experience, and to make the work of GPs more attractive to students. Most GPs felt prepared to teach through their experience as a physician although some felt unprepared to teach through their lack of didactic knowledge.

CONCLUSION

Despite reducing the costs of the format, a grade point average of 1.9 could be achieved in the long term. This supports the teaching concept of learning stations and its "mixture of discussion, scientific background and role play, combined with (…) experiences and exciting individual cases from (GPs) everyday life", hopefully making general practice more attractive to the students.

Impact of clinical placement sites on general practice as a career preference for Australian medical students

OBJECTIVE

This study investigates whether General Practice placement experience or locations (urban/metropolitan vs non-metropolitan) promote student interest in pursuing general practice.

DESIGN

SurveyMonkey was used in the design of the survey.

SETTING

The study was conducted online.

PARTICIPANTS

A total of 520 and 705 clinical-year students were surveyed in 2009 and 2019, respectively. The study was conducted online, using SurveyMonkey, and the participants were mostly non-indigenous Australian medical students, between the ages of 18 and 30.

INTERVENTIONS

Students were recruited from the General Practice Students' Network membership database to complete the survey online. Chi-squared testing, Pearson's correlation and a multivariate logistic regression analysis were used to investigate the correlation between general practice placements and intention to become a general practice.

MAIN OUTCOME MEASURES

The association and causation between general practice placement location, student experience and students' intended career outcomes.

RESULTS

In 2009, majority of students rated their general practice experience 'mostly positive' while most metropolitan participants and majority of non-metropolitan placement participants in the 2019 survey responded with 'mostly positive' in 2019. Based on 2009 and 2019 data, general practice placement location had no association with the likelihood of pursuing general practice as a career, while student experience had a stronger positive correlation with the likelihood of pursuing general practice as a career.

CONCLUSION

Our study shows that students' overall experience with their general practice placements significantly encourages medical students to pursue the general practice pathway. As such, increasing both metropolitan and non-metropolitan placement experiences can potentially overcome general practice shortage.

Involving medical students in the planning and delivery of a vaccination and health screening outreach clinic

Improving access to healthcare for people experiencing homelessness can be achieved via outreach clinics. Involving medical students in homeless healthcare projects leads to increased understanding of the social determinants of health and positive changes in student perception of this vulnerable patient group. Projects such as this can increase the social accountability of medical schools, with the potential to have a positive effect on health in the local community. Third-year medical students on GP placement were given the opportunity to design and deliver temporary clinics to the homeless population in Corby with the support of Public Health Northamptonshire. The study aimed to evaluate this educational intervention by exploring the students' motivation, experience and ideas on sustainability of the project via a focus group. Humanitarianism and the opportunity to meet patients face-to-face during the pandemic were motivating factors for joining the project. Students felt the educational experience was valuable, providing exposure to a patient group not often encountered in medical school. They gained an understanding of some of the challenges faced by this population. Some said this project forced them to address their unconscious biases and cited that to be a reason why projects like this should be mandatory. The learning experience made students consider funding and the organisation of healthcare. This study found that hands-on learning can provide educational and rewarding experiences for medical students. Positive experiences in the GP setting may impact career choices and allow them consider leadership and public health.

Perceptions of family medicine in Canada through the eyes of learners

OBJECTIVE

To examine the perceptions of family medicine (FM) residents about their chosen specialty and how they perceive that patients, other specialists, and the government value FM.

DESIGN

Self-report data from the Family Medicine Longitudinal Survey collected from 2014 (time 1 [T1]) to 2016 (time 2 [T2]).

SETTING

Canada.

PARTICIPANTS

Family medicine residents from 16 out of the 17 FM residency programs.

MAIN OUTCOME MEASURES

Responses to statements in the survey were evaluated using a 5-point Likert scale (from strongly disagree to strongly agree). Data were analyzed in 2 ways: cross sectionally (participation in either T1 or T2), and longitudinally (participation in both T1 and T2).

RESULTS

For both the cross-sectional cohorts (T1, n = 916; T2, n = 785) and the repeated-measures cohort (n = 420), most residents responded positively to feeling proud of becoming a family physician, with little change from entrance to exit. For both cohorts, a higher proportion of residents at the end of training reported that other medical specialists value the contributions of family physicians (P < .001); however, fewer believed that the government perceived FM as essential to the health care system (P < .001).

CONCLUSION

Most participating Canadian FM residents feel proud to become family physicians. This feeling may come from the perceptions of others who are believed to value FM, including other specialists. Measuring attitudinal perceptions offers a window to discover how FM is viewed and can offer a way to measure the effect of strategies implemented to advance the discipline of FM.

Medical students' experience of the hidden curriculum around primary care careers: a qualitative exploration of reflective diaries

OBJECTIVES

Primary healthcare internationally is facing a workforce crisis with fewer junior doctors choosing general practice (GP) as a career. In the UK, a national report on GP careers highlighted adverse influences during medical school on students' career choices. The authors explored these influences in two urban UK medical schools, both with relatively low numbers of students entering GP training.

DESIGN

Using a phenomenological approach, the authors thematically analysed the reflective diaries of four medical students who were recruited as 'participant researchers' over a period of 10 months. These students made regular reflexive notes about their experiences related to GP career perceptions in their academic and personal environments, aiming to capture both positive and negative perceptions of GP careers. The research team discussed emerging data and iteratively explored and developed themes.

SETTING

Two UK medical schools PARTICIPANTS: Undergraduate medical students RESULTS: Seven key themes were identified: the lack of visibility and physicality of GP work, the lack of aspirational GP role models, students' perceptions of a GP career as default, the performativity of student career choice with the perceptions of success linked to specialism, societal perceptions of GP careers, gender stereotyping of career choices and the student perception of life as a GP.

CONCLUSIONS

Students overwhelmingly reflected on negative cues to GP careers, particularly through their experience of the hidden curriculum. Three recommendations are made: the need for increased representation of GP role models in clinical curricula content delivery and senior leadership; ensuring GP clerkships involve an active and authentic student role with patients, enabling students to experience GP's 'work' including managing complexity, uncertainty and risk. Finally, institutions need to consider students' experiences of the hidden curriculum and the effect this can have on students' perception of careers, alongside the challenges of rankings and perceived hierarchical positioning of disciplines.

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

Background

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

Aim

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

Design & setting

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

Method

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

Results

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

Conclusion

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

GP Trainees experience of learning opportunities and support mechanisms on the GP training programme: a qualitative study

This article was migrated. The article was marked as recommended. Background: General Practice (GP) is the cornerstone of the NHS and has faced workload and workforce issues for many years. Enabling GP trainees to successfully complete their training and become independent practitioners is crucial to addressing these challenges. There is limited previous research exploring the postgraduate training experience specific to General Practice. Aim: To explore GP Trainees' experience of learning opportunities and support available during the three-year vocational training programme in the Southampton GP Education Unit. Design and Setting: 15 semi structured interviews were undertaken December 2016-2018 with participants recruited from four cohorts. Telephone interviews lasting between 30-60 minutes were audio-recorded and transcribed verbatim; and analysed using inductive thematic analysis. Results and Conclusion: Two themes were identified as affecting the training experience: 'Developing clinical competence' and 'Sources of support'. Trainees perceived developing competencies relevant to General Practice was key. Busier hospital rotations with limited time for formal teaching were viewed less favourably. Trainers and peers were the main sources of support. Despite seeking a broad range of participants, interviewing trainees in difficulty was hard to achieve.

Longitudinal GP placements - inspiring tomorrow's doctors?

General practice worldwide is facing a severe recruitment crisis, with significantly fewer medical students choosing to pursue careers in primary care than are required to meet society's growing demands. The role of GP placements and GP tutors has been highlighted as having a significantly positive influence on medical students' perceptions of general practice. However, how students perceive these experiences to have influenced their subsequent career preferences remains poorly understood.We sought to explore how a longitudinal GP placement influences medical students' preferences regarding a career in general practice, in order to gain a deeper understanding of the significance of such placements. Semi-structured interviews were undertaken with five fourth-year medical students using Interpretive Phenomenological Analysis methodology.Four overarching concepts were identified, with nine superordinate themes, to describe how a longitudinal placement had influenced medical students' preference regarding a career in general practice. There appears to have been a matching process between an expanding knowledge of the realities of being a GP and an increasing understanding of self. The GP tutor and 'authentic' experiences to consult patients themselves developed a growing sense of self-efficacy within students, all of which resulted in a significant internal desire to become future GPs.

Focus on medical education research in primary care: an undergraduate medical education faculty's journey

This paper provides a viewpoint on medical education research in primary care from undergraduate medical educators, discussing the issues and questions shared with other institutions, the role of medical education research in raising the profile of academic general practice, the challenges and opportunities faced and how education-based research can form an evidence-based approach to teaching.

Evaluating 10 years of state-funded GP training in GP offices in Switzerland

BACKGROUND

Switzerland lacks future general practitioners (GPs). Residents who wished to specialize as general practitioners were formerly trained solely in hospital settings. To better prepare and also attract more young doctors to become GPs, the canton of Bern (equivalent to a state) has implemented a partly state-funded vocational training program in GP practices. Our study examines the efficacy of this 10-year program, identifies factors that positively influence residents in their decision to become a GP and the distribution of new GPs in the canton of Bern, who had taken part in the traineeship.

METHODS

This cross-sectional survey among all residents, who participated in a traineeship in general practice from 2008 to 2017 in the canton of Bern asked if residents had taken a subsequent career choice as a GP and if so in which region. Residents scored the importance of their traineeship and their mentor's influence on becoming a GP. By using zip codes of work area of respondents already working as GPs and matching it with population census data, we could obtain the distribution of GPs on a per capita basis.

RESULTS

Out of 165 residents who participated in a traineeship, 151 (92%) completed our survey. 81% had chosen a career as a GP or were on track to become a GP. Almost half of the participants became GPs in the offices of their mentors or in the area. Our respondents emphasized the importance of their mentors' influence as well as the training program in their decision-making to become a GP. Most mentioned benefits of being a GP were broad field of medical care (37%) and a fulfilling doctor-patient relationship (34%). We could show an increase in GP practices in the canton of Bern, not only in urban but also accordingly in rural areas.

CONCLUSIONS

Most residents continued subsequent careers as general practitioners after having completed a GP traineeship, with almost half of them in the region of their training. A vocational training program helped motivating young doctors to become GPs and underserved regions of the canton of Bern to gain new GPs.

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.

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

Background

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

Aim

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

Design & setting

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

Method

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

Results

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

Conclusion

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

Promoting general practice as a career to medical students; a qualitative study of the approaches of undergraduate GP tutors

BACKGROUND

Undergraduate (UG) General Practice (GP) tutors have been identified in the literature and in key UK workforce planning documents as one of the main influences on medical students' decisions about pursuing a career in GP.

AIM

To explore the attitudes and educational approaches of UG GP tutors in promoting GP as a career.

DESIGN AND SETTING

A pragmatic constructivist qualitative study, interviewing 8 UG GP tutors supervising undergraduate final year medical students on placement.

METHOD

Interviews were transcribed, coded and grouped into themes using NVIVO11. Analysis was descriptive and interpretive using principles of thematic analysis.

RESULTS

Tutors saw their role as promoting GP, supporting informed career decisions, correcting misconceptions and giving honest views. They used tutorials, critical reflection, exposure to authentic GP and role-modelling to promote GP, challenge misconceptions, and showcase managing complexities..

DISCUSSION

By guiding students to identify, discuss and reflect on their beliefs and by using clinical encounters and role modelling with further reflection, tutors enabled students to get a true picture of GP to identify if they could handle the challenges and complexities of the job. Kolb's experiential learning cycle could form a framework to guide tutors in clinical settings supporting students making informed career decisions.

"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.

Street Medics: An innovative learning opportunity for UK medical students in a primary care outreach setting

It is well known that recruitment into general practice (GP) is low, particularly in deprived areas. Undergraduate medical students are encouraged to learn about health inequalities.However, teaching on this area has been perceived by some as uninspiring. Innovative teaching opportunities can engage students but more research is needed regarding exposure to deprived inner-city settings. Street Medics is an extra-curricular, educational initiative which enables students to join GPs doing street-outreach work. The aim of the study was to understand what motivates undergraduate medical students to engage with Street Medics and the impact of the experience. Focus group data were collected and thematically analysed. Motivating factor themes: appetite to explore; previous exposure including observation of perceived sub-optimal care to marginalised patients; perceived lack of exposure personally and in undergraduate teaching. Experience and impact themes: increased understanding of social determinants of health; change in perception; influence on career intentions; desire to incorporate into curriculum. Opportunities like Street Medics can supplement the undergraduate curriculum and not only challenge students' perceptions of marginalised patients but also ignite their enthusiasm for pursuing GP. By understanding the factors driving students' engagement in innovative educational opportunities, effective methods can be shared across undergraduate courses.

Medical schools, primary care and family medicine: clerkship directors' perceptions of the current environment

BACKGROUND

The culture at a medical school and the positive experiences in primary care clerkships influence student specialty choice. This choice is significant if the demand for primary care physicians is to be met. The aim of this study was to examine family medicine clerkship directors' perceptions of the medical school environment.

METHODS

Data were collected as part of the 2015 Council of Academic Family Medicine Educational Research Alliance Family Medicine Clerkship Director survey. Questions asked included how clerkship directors perceived the environment of their medical school towards family medicine, has the environment towards family medicine changed between 2010 and 2015, do they take action to influence student attitudes towards family medicine and whether faculty members in other departments make negative comments about family medicine.

RESULTS

The response rate was 79.4%. While most respondents indicated the environment of their medical school has become more positive towards family medicine, a majority of clerkship directors perceived the environment to be either very much against, slightly against or indifferent towards family medicine. Nearly one-half (41.4%) of the clerkship directors were notified more than once a year that a faculty member of another department made a negative comment about family medicine. Results varied among regions of the USA and between schools located in the USA and Canada.

CONCLUSION

Family medicine clerkship directors often perceived negativity towards family medicine, a finding that may limit the effectiveness of academic health centres in their mission to better serve their community and profession.

Students' perceptions of general medicine following community-based medical education in rural Japan

BACKGROUND

Japan's population is rapidly aging, and at the same time, the number of medical students interested in general or family medicine is declining. Community-based medical education (CBME) programs may be used to promote interest and competencies in general medicine among medical students.

METHOD

This mixed-method study investigated the perceptions of fifth- and sixth year undergraduate medical students who completed a two week CBME course in Unnan, a small city in rural Japan. The participants completed two survey questionnaires: (a) The achievement questionnaire administered pre- and posttraining, and (b) the curriculum content questionnaire administered posttraining. To understand the students' perceptions about general medicine further, semistructured interviews were conducted with each participant post-CBME training.

RESULTS

The participants' ratings on the achievement survey improved significantly from pre- to posttraining. The average ratings for the curriculum content survey indicated that the educational objectives were met in all but one area. A qualitative analysis of the interview data revealed that the participants had little exposure to general medicine at their university hospital, and there was a lack of understanding in other medical professionals regarding the roles of general medicine physicians.

CONCLUSION

This study demonstrates that there are educational gaps between medical universities and community hospitals regarding general medicine. Increased exposure, early exposure, and a clarification of the competencies were noted as areas to improve the students' understanding of general medicine. Undergraduates should be exposed to general medicine more frequently and from early training stages through effective collaborations between universities and hospitals.

Clinical specialty training in UK undergraduate medical schools: a retrospective observational study

OBJECTIVES

To determine if increased exposure to clinical specialties at medical school is associated with increased interest in pursuing that specialty as a career after foundation training.

DESIGN

A retrospective observational study.

SETTING

31 UK medical schools were asked how much time students spend in each of the clinical specialties. We excluded two schools that were solely Graduate Entry, and two schools were excluded for insufficient information.

MAIN OUTCOME MEASURES

Time spent on clinical placement from UK undergraduate medical schools, and the training destinations of graduates from each school. A general linear model was used to analyse the relationship between the number of weeks spent in a specialty at medical school and the percentage of graduates from that medical school entering each of the Core Training (CT1)/Specialty Training (ST1) specialties directly after Foundation Year 2 (FY2).

RESULTS

Students spend a median of 85 weeks in clinical training. This includes a median of 28 weeks on medical firms, 15 weeks in surgical firms, and 8 weeks in general practice (GP). In general, the number of training posts available in a specialty was proportionate to the number of weeks spent in medical school, with some notable exceptions including GP. Importantly, we found that the number of weeks spent in a specialty at medical school did not predict the percentage of graduates of that school training in that specialty at CT1/ST1 level (ß coefficient=0.061, p=0.228).

CONCLUSIONS

This study found that there was no correlation between the percentage of FY2 doctors appointed directly to a CT1/ST1 specialty and the length of time that they would have spent in those specialties at medical school. This suggests that curriculum adjustments focusing solely on length of time spent in a specialty in medical school would be unlikely to solve recruitment gaps in individual specialties.

The influence of training experiences on career intentions of the future GP workforce: a qualitative study of new GPs in England

BACKGROUND

The capacity of the UK GP workforce has not kept pace with increasing primary care workloads. Although many doctors successfully complete GP specialty training programmes, some do not progress to work in NHS general practice.

AIM

This article explores the training experiences and perceptions of newly qualified GPs to understand how their education, training, and early experiences of work influence their career plans.

DESIGN AND SETTING

A qualitative study of doctors in their final year of GP training (ST3) and within 5 years of completion of GP training (F5).

METHOD

Participants across England were recruited through training programmes, First5 groups, and publicity using social media and networks. Open narrative interviews were conducted with individuals and focus groups. Audiorecorded interviews were transcribed, and a thematic analysis was supported by NVivo and situational analysis mapping techniques.

RESULTS

Fifteen participants engaged in individual interviews and 10 focus groups were carried out with a total of 63 participants. Most doctors reported that training programmes had prepared them to deal confidently with most aspects of routine clinical GP work. However, they felt underprepared for the additional roles of running a practice and in their understanding of wider NHS organisational structures. Doctors wished to avoid unacceptably heavy workloads and voiced concerns about the longer-term sustainability of general practice.

CONCLUSION

Strategies to attract and retain enough GPs to support delivery of comprehensive primary care should consider how doctors' early career experiences influence their career intentions. A coherent plan is needed to improve their preparation and increase confidence that they can achieve a professionally satisfying, effective, and sustainable career in NHS general practice.

How does 'banter' influence trainee doctors' choice of career? A qualitative study

BACKGROUND

Negative comments from senior colleagues about specialties, such as general practice and psychiatry, are known to influence trainees' career choice, but little is known about the extent of this influence or the mechanism by which it works. There have been calls to ban these disparaging comments, also known as 'banter'. This study explored how recently qualified doctors make sense of banter in the context of other experiences and information.

METHODS

Semi-structured telephone interviews were conducted with 24 trainee doctors in their second postgraduate year in South West England. Thematic Analysis was used to code the data and organise them into themes.

RESULTS

Trainees are commonly exposed to banter about the merits of different specialties and those who work in them, but these messages are not received uncritically and are not perceived to be decisive in determining career choice. The views of senior doctors are assimilated with other experiences and information, as trainees strive to assess their 'fit' with a specialty. While banter is seen as positioning specialties in a status hierarchy, other factors such as work-life balance and feeling 'at home' in a specialty are often believed to be more significant factors in career choice. We posited two theories of banter; the 'propaganda model' and the 'person-specialty fit model,' and found the latter to provide a better understanding of how banter informs career choice.

CONCLUSIONS

Banter often comprises stereotypes and caricatures, but despite its biases and distortions, it may still aid career choice. The challenge is not to ban banter, but to provide more accurate and reliable knowledge and experiences of what working life is like in different specialties.

To select or be selected - gendered experiences in clinical training affect medical students' specialty preferences

BACKGROUND

The literature investigating female and male medical students' differing career intentions is extensive. However, medical school experiences and their implications for professional identity formation and specialty choice have attracted less attention. In this study we explore the impact of medical school experiences on students' specialty preferences, investigate gender similarities and differences, and discuss how both might be related to gender segregation in specialty preference.

METHODS

In a questionnaire, 250 Swedish final-year medical students described experiences that made them interested and uninterested in a specialty. Utilizing a sequential mixed methods design, their responses were analyzed qualitatively to create categories that were compared quantitatively.

RESULTS

Similar proportions of women and men became interested in a specialty based on its knowledge area, patient characteristics, and potential for work-life balance. These aspects, however, often became secondary to whether they felt included or excluded in clinical settings. More women than men had been deterred by specialties with excluding, hostile, or sexist workplace climates (W = 44%, M = 16%). In contrast, more men had been discouraged by specialties' knowledge areas (W = 27%, M = 47%).

CONCLUSIONS

Male and female undergraduates have similar incentives and concerns regarding their career. However, the prevalence of hostility and sexism in the learning environment discourages especially women from some specialties. To reduce gender segregation in specialty choice, energy should be directed towards counteracting hostile workplace climates that explain apparent stereotypical assumptions about career preferences of men and women.

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.

Specialty preferences and influencing factors: a repeated cross-sectional survey of first- to sixth-year medical students in Jena, Germany

BACKGROUND

Given the expected increase in those entering retirement, the number of practising physicians is predicted to decrease. Conversely, the number of physicians needed is set to increase, due to higher demands resulting from the increasing average age of the German population. This may cause a deficit in the availability and accessibility of medical care for the population in Germany, as well as in other countries. As such, there needs to be a specific focus on the next generation of physicians. Will they fill the gap in those medical specialties where it is most needed? This study aims to investigate (a) preferences for medical specialties over time and (b) the reasoning behind these preferences among students.

METHODS

Over three subsequent years, all medical students from the Jena Faculty of Medicine were repeatedly invited to participate in an online survey. The questionnaire consisted of three parts to explore the students' (1) preferred postgraduate specialty, (2) the reasons for their decision and (3) socio-demographic data. Data analysis was performed using Fisher's exact tests and logistic regression analysis.

RESULTS

The number of students completing the questionnaire in a given year ranged from 180 to 320, resulting in a total number of 720 completed questionnaires. Between 40 and 50% of the students preferred internal medicine as postgraduate specialty. About 25% of the students were interested in a surgical specialty. Diagnostics and psychiatric medical fields were preferred by about 10% of all students for each field in each year of the survey. A large percentage (about 18%) of the students remained undecided. The factors influencing the students' specialty preferences were most frequently reconciliation of work and family life, career goals as well as predicted workload. The factors depended on the preferred medical specialty.

CONCLUSION

The influencing factors should be taken into account for recruiting prospective residents. Doing so could increase the chance to attract the number of physicians needed to ensure adequate medical care in the field of interest, according to the growing health needs of the population.

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

The ageing population and push to community care has significantly increased the workload of General Practitioners (GPs) in the UK and internationally. In an attempt to tackle this, NHS England has promised 5000 more GPs by 2020/21; however, recruitment is in crisis with GP training posts remaining unfilled. Little research has been carried out to assess the fundamental questions of what medical students' perceptions of General Practice are and what shapes their perceptions at medical school. We aimed to explore medical students' conceptualisations of being a GP and specifically the role of the medical school in shaping their perceptions. Two focus groups of year one and year four medical students were undertaken using an interpretive phenomenological approach. Our study has revealed that medical students perceive General Practice to lack prestige and challenge. These perceptions come, at least in part, from a process of socialisation within medical school, whereby medical students internalise and adopt their role models' perceptions and values, and the values portrayed by the hidden curriculum in their medical school culture. Perceived external pressures to pursue a career in General Practice can have a negative influence and medical schools should be made aware of this.

Medical students' perceptions of a career in family medicine

Background

In Israel, there is a shortage of family medicine (FM) specialists that is occasioned by a shortage of students pursuing a FM career.

Methods

A questionnaire, based on methods adapted from marketing research, was used to provide insight into the medical specialty selection process. It was distributed to 6^th-year medical students from two Israeli medical schools.

Results

A response rate of 66% resulted in collecting 218 completed questionnaires. Nineteen of the students reported that they were interested in FM, 68% of them were women. When compared to students not interested in FM, the selection criteria of students interested in FM reflected greater interest in a bedside specialty which provides direct long-term patient care. These latter students were also more interested in a controllable lifestyle that allowed time to be with family and children and working outside the hospital especially during the daytime. These selection criteria aligned with their perceptions of FM, which they perceived as providing them with a controllable lifestyle, allowing them to work limited hours with time for family and having a reasonable income to lifestyle ratio. The students not interested in FM, agreed with those interested in FM, that the specialty affords a controllable lifestyle and the ability to work limited hours Yet, students not interested in FM more often perceived FM as being a boring specialty and less often perceived it as providing a reasonable income to lifestyle ratio. Additionally, students not interested in FM rated the selection criteria, academic opportunities and a prestigious specialty, more highly than did students interested in FM. However, they perceived FM as neither being prestigious nor as affording academic opportunities

Conclusion

This study enriches our understanding of the younger generation's attitudes towards FM and thus provides administrators, department chairs and residency program directors with objective information regarding selection criteria and the students’ perceptions of FM. We identified the disconnect between the selection criteria profiles and the perceptions of FM of students not inclined to pursue a residency in FM. This allowed for recommendations on how to possibly make FM more attractive to some of these students.