Characteristic profiles among students and junior doctors with specific career preferences

BMC Medical Education

Ichiro Kai⁶  Miyako Takahashi¹  Junji Otaki⁵  Linda Snell²  Kunimasa Morio³  Yuko Takeda⁴ 

[1] National Cancer Center, Tokyo, Japan;McGill University Faculty of Medicine, Montreal, Quebec, Canada;Mie University School of Medicine, Tsu, Mie, Japan;King’s College London School of Medicine, London, UK;Hokkaido University School of Medicine, Sapporo, Hokkaido, Japan;University of Tokyo, Tokyo, Japan

关键词: Junior doctor;    Medical student;    Career choice;   

Others  :  1138755
DOI  :  10.1186/1472-6920-13-125

 received in 2013-01-26, accepted in 2013-09-06,  发布年份 2013

【 摘 要 】

Background

Factors influencing specialty choice have been studied in an attempt to find incentives to enhance the workforce in certain specialties. The notion of “controllable lifestyle (CL) specialties,” defined by work hours and income, is gaining in popularity. As a result, many reports advocate providing a ‘lifestyle-friendly’ work environment to attract medical graduates. However, little has been documented about the priority in choosing specialties across the diverse career opportunities.

This nationwide study was conducted in Japan with the aim of identifying factors that influence specialty choice. It looked for characteristic profiles among senior students and junior doctors who were choosing between different specialties.

Methods

We conducted a survey of 4^th and 6^th (final)-year medical students and foundation year doctors, using a questionnaire enquiring about their specialty preference and to what extent their decision was influenced by a set of given criteria. The results were subjected to a factor analysis. After identifying factors, we analysed a subset of responses from 6^th year students and junior doctors who identified a single specialty as their future career, to calculate a z-score (standard score) of each factor and then we plotted the scores on a cobweb chart to visualise characteristic profiles.

Results

Factor analysis yielded 5 factors that influence career preference. Fifteen specialties were sorted into 4 groups based on the factor with the highest z-score: “fulfilling life with job security” (radiology, ophthalmology, anaesthesiology, dermatology and psychiatry), “bioscientific orientation” (internal medicine subspecialties, surgery, obstetrics and gynaecology, emergency medicine, urology, and neurosurgery), and “personal reasons” (paediatrics and orthopaedics). Two other factors were “advice from others” and “educational experience”. General medicine / family medicine and otolaryngology were categorized as “intermediate” group because of similar degree of influence from 5 factors.

Conclusion

What is valued in deciding a career varies between specialties. Emphasis on lifestyle issues, albeit important, might dissuade students and junior doctors who are more interested in bioscientific aspects of the specialty or have strong personal reasons to pursue the career choice. In order to secure balanced workforce across the specialties, enrolling students with varied background and beliefs should be considered in the student selection process.

【 授权许可】

   
2013 Takeda et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Wright B, et al.: Career choice of new medical students at three Canadian universities: family medicine versus specialty medicine. CMAJ 2004, 170(13):1920-1924.
• [2]Ohtaki J, et al.: Specialty choice and understanding of primary care among Japanese medical students. Med Educ 1996, 30(5):378-384.
• [3]Kassebaum DG, Szenas PL, Schuchert MK: Determinants of the generalist career intentions of 1995 graduating medical students. Acad Med 1996, 71(2):198-209.
• [4]Lambert EM, Holmboe ES: The relationship between specialty choice and gender of U.S. medical students, 1990-2003. Acad Med 2005, 80(9):797-802.
• [5]Wigney T, Parker G: Factors encouraging medical students to a career in psychiatry: qualitative analysis. Aust N Z J Psychiatry 2008, 42(6):520-525.
• [6]Kassebaum DG, Szenas PL: Relationship between indebtedness and the specialty choices of graduating medical students. Acad Med 1992, 67(10):700-707.
• [7]Kibbe MR, et al.: Effect of educational debt on career and quality of life among academic surgeons. Ann Surg 2009, 249(2):342-348.
• [8]DeZee KJ, et al.: Effect of financial remuneration on specialty choice of fourth-year U.S. medical students. Acad Med 2011, 86(2):187-193.
• [9]Vanasse A, et al.: Attractiveness of family medicine for medical students: influence of research and debt. Can Fam Physician 2011, 57(6):e216-e227.
• [10]Greysen SR, Chen C, Mullan F: A history of medical student debt: observations and implications for the future of medical education. Acad Med 2011, 86(7):840-845.
• [11]Newton DA, Grayson MS, Thompson LF: The variable influence of lifestyle and income on medical students’ career specialty choices: data from two U.S. medical schools, 1998-2004. Acad Med 2005, 80(9):809-814.
• [12]Grayson MS, Newton DA, Thompson LF: Payback time: the associations of debt and income with medical student career choice. Med Educ 2012, 46(10):983-991.
• [13]Schwartz RW, et al.: The controllable lifestyle factor and students’ attitudes about specialty selection. Acad Med 1990, 65(3):207-210.
• [14]Gorenflo DW, Ruffin MT, Sheets KJ: A multivariate model for specialty preference by medical students. J Fam Pract 1994, 39(6):570-576.
• [15]Murdoch MM, et al.: Evaluating the psychometric properties of a scale to measure medical students’ career-related values. Acad Med 2001, 76(2):157-165.
• [16]Hauer KE, et al.: Factors associated with medical students’ career choices regarding internal medicine. JAMA 2008, 300(10):1154-1164.
• [17]Scott IM, et al.: Choosing a career in surgery: factors that influence Canadian medical students’ interest in pursuing a surgical career. Can J Surg 2008, 51(5):371-377.
• [18]Schwartz MD, et al.: Medical student interest in internal medicine. Initial report of the society of general internal medicine interest group survey on factors influencing career choice in internal medicine. Ann Intern Med 1991, 114(1):6-15.
• [19]Ciechanowski PS, et al.: Using relationship styles based on attachment theory to improve understanding of specialty choice in medicine. BMC Med Educ 2006, 6:3. BioMed Central Full Text
• [20]Petrides KV, McManus IC: Mapping medical careers: questionnaire assessment of career preferences in medical school applicants and final-year students. BMC Med Educ 2004, 4:18. BioMed Central Full Text
• [21]Schwartz RW, et al.: Controllable lifestyle: a new factor in career choice by medical students. Acad Med 1989, 64(10):606-609.
• [22]Patel MS, Katz JT, Volpp KG: Match rates into higher-income, controllable lifestyle specialties for students from highly ranked, research-based medical schools compared with other applicants. J Grad Med Educ 2010, 2(3):360-365.
• [23]Dorsey ER, Jarjoura D, Rutecki GW: Influence of controllable lifestyle on recent trends in specialty choice by US medical students. JAMA 2003, 290(9):1173-1178.
• [24]Dorsey ER, Jarjoura D, Rutecki GW: The influence of controllable lifestyle and sex on the specialty choices of graduating U.S. medical students, 1996-2003. Acad Med 2005, 80(9):791-796.
• [25]Boyd JS, et al.: Emergency medicine career choice: a profile of factors and influences from the Association of American Medical Colleges (AAMC) graduation questionnaires. Acad Emerg Med 2009, 16(6):544-549.
• [26]Schwartz RW, et al.: Career change: in quest of a controllable lifestyle. J Surg Res 1989, 47(3):189-192.
• [27]van der Horst K, et al.: Residents’ reasons for specialty choice: influence of gender, time, patient and career. Med Educ 2010, 44(6):595-602.
• [28]Barbieri RL: EasyROAD-high road or path of least resistance? OBG Management 2004, 16(December):8-9.
• [29]Hauer KE, et al.: Internal medicine clerkship directors’ perceptions about student interest in internal medicine careers. J Gen Intern Med 2008, 23(7):1101-1104.
• [30]Cleland J, et al.: Associations between medical school and career preferences in Year 1 medical students in Scotland. Med Educ 2012, 46(5):473-484.
• [31]Bland CJ, Meurer LN, Maldonado G: Determinants of primary care specialty choice: a non-statistical meta-analysis of the literature. Acad Med 1995, 70(7):620-641.
• [32]Chen DC, et al.: Characterizing changes in student empathy throughout medical school. Med Teach 2012, 34(4):305-311.
• [33]Schwartz MD, et al.: Changes in medical students’ views of internal medicine careers from 1990 to 2007. Arch Intern Med 2011, 171(8):744-749.
• [34]Palmeri M, et al.: Economic impact of a primary care career: a harsh reality for medical students and the nation. Acad Med 2010, 85(11):1692-1697.
• [35]Sommers BD, Bindman AB: New physicians, the affordable care act, and the changing practice of medicine. JAMA 2012, 307(16):1697-1698.
• [36]Tanne JH: Income and job satisfaction fall among US doctors. BMJ 2012, 344:e3109.
• [37]UK Medical Careers Research Group: Cohort studies of doctors’ careers. [cited 2012 8 August]; Available from: http://www.uhce.ox.ac.uk/ukmcrg/ webcite
• [38]Lambert TW, Goldacre MJ, Turner G: Career choices of United Kingdom medical graduates of 2002: questionnaire survey. Med Educ 2006, 40(6):514-521.
• [39]Svirko E, Goldacre MJ, Lambert T: Career choices of the United Kingdom medical graduates of 2005, 2008 and 2009: questionnaire surveys. Med Teach 2013, 35(5):365-375.
• [40]Goldacre MJ, Lambert TW, Laxton L: Career choices made for the hospital medical specialties by graduates from UK medical schools, 1974-2005. Clin Med 2009, 9(1):42-48.
• [41]Lambert TW, Goldacre MJ, Bron AJ: Career choices for ophthalmology made by newly qualified doctors in the United Kingdom, 1974-2005. BMC Ophthalmol 2008, 8:3. BioMed Central Full Text
• [42]Goldacre MJ, et al.: Early career choices and successful career progression in surgery in the UK: prospective cohort studies. BMC Surg 2010, 10:32. BioMed Central Full Text
• [43]Turner G, et al.: Career choices for paediatrics: national surveys of graduates of 1974-2002 from UK medical schools. Child Care Health Dev 2007, 33(3):340-346.
• [44]Goldacre MJ, Lambert TW: Stability and change in career choices of junior doctors: postal questionnaire surveys of the United Kingdom qualifiers of 1993. Med Educ 2000, 34(9):700-707.
• [45]Goldacre MJ, Laxton L, Lambert TW: Medical graduates’ early career choices of specialty and their eventual specialty destinations: UK prospective cohort studies. BMJ 2010, 341:c3199.
• [46]Goldacre MJ, Goldacre R, Lambert TW: Doctors who considered but did not pursue specific clinical specialties as careers: questionnaire surveys. J R Soc Med 2012, 105(4):166-176.
• [47]Barzansky B: Commentary: Research on specialty choice: the challenge is in the details. Educ Health (Abingdon) 2000, 13(2):197-200.
• [48]Goldacre M, Davidson J, Lambert T: The junior doctor exodus. BMJ Careers20 October 2010. http://careers.bmj.com/careers/advice/view-article.html?id=20001543 webcite
• [49]Davidson JM, et al.: UK senior doctors’ career destinations, job satisfaction, and future intentions: questionnaire survey. BMJ 2002, 325(7366):685-6.
• [50]Simon SR, et al.: Views of managed care–a survey of students, residents, faculty, and deans at medical schools in the United States. N Engl J Med 1999, 340(12):928-36.
• [51]Whitcomb ME, Cohen JJ: The future of primary care medicine. N Engl J Med 2004, 351(7):710-2.
• [52]Lee TH, et al.: Perspective roundtable: redesigning primary care. N Engl J Med 2008, 359(20):e24.
• [53]Henderson E, Berlin A, Fuller J: Attitude of medical students towards general practice and general practitioners. Br J Gen Pract 2002, 52(478):359-63.
• [54]Sobral DT: Selective training and cross-year clinical tutoring as educational influences on generalist career choice. Educ Health (Abingdon) 2001, 14(2):295-303.
• [55]Avan BI, et al.: Factors influencing the selection of surgical specialty among Pakistani medical graduates. J Postgrad Med 2003, 49(3):197-200. discussion 201
• [56]Chang PY, et al.: Factors influencing medical students’ choice of specialty. J Formos Med Assoc 2006, 105(6):489-96.
• [57]Koike S, et al.: Postgraduate training and career choices: an analysis of the National Physicians Survey in Japan. Med Educ 2010, 44(3):289-97.
• [58]Yasunaga H: The catastrophic collapse of morale among hospital physicians in Japan. Risk Manag Healthc Policy 2008, 1:1-6.
• [59]Fishbein M: A behavior theory approach to the relations between belief about an object and the attitude toward the object. In Readings in attitude theory and measurement. Edited by Fishbein M. New York: John Wiley and Sons, Inc; 1967:389-400.
• [60]Montano DE, et al.: A survey of fourth-year medical students’ decisions regarding family practice as a career. J Med Educ 1988, 63(11):830-8.
• [61]Chandarana PC, Loncke M, Conlon P: Factors influencing medical students’ intentions to choose psychiatry as a career. Can J Psychiatry 1989, 34(5):425-9.
• [62]Montano DE, Kasprzyk D: Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. In Health behavior and health education. Edited by Glanz K, Rimer BK, Viswanath K. Wiley: Sab Francisco; 2008:67-96.
• [63]Okamoto H, et al.: An occupational health study of emergency physicians in Japan: health assessment by immune variables (CD4, CD8, CD56, and NK cell activity) at the beginning of work. J Occup Health 2008, 50(2):136-46.