Extending a Conceptual Framework for Junior Doctors' Career Decision Making and Rural Careers: Explorers versus Planners and Finding the 'Right Fit'.

Helen Wright,Rebekah Ledingham,Mathew Coleman,David Oldham,Denese Playford,Beatriz Cuesta-Briand,Sarah Moore

doi:10.3390/ijerph17041352

Abstract

This study uses data from a Rural Clinical School of Western Australia (RCSWA) and WA Country Health (WACHS) study on rural work intentions among junior doctors to explore their internal decision-making processes and gain a better understanding of how junior doctors make decisions along their career pathway. This was a qualitative study involving junior doctor participants in postgraduate years (PGY) 1 to 5 undergoing training in Western Australia (WA). Data was collected through semi-structured telephone interviews. Two main themes were identified: career decision-making as an on-going process; and early career doctors’ internal decision-making process, which fell broadly into two groups (‘explorers’ and ‘planners’). Both groups of junior doctors require ongoing personalised career advice, training pathways, and career development opportunities that best “fit” their internal decision-making processes for the purposes of enhancing rural workforce outcomes.

Highlights

Developing a sustainable rural health workforce to ensure equitable access to healthcare professionals and services for rural patients is an international challenge [1]
Most of the Australian evidence on junior doctors’ career choices, consists of quantitative data on current practice location [4,7,8,9,10], and qualitative studies largely focused on the impact of rural training placement [3,11,12] or the identification of factors influencing career decision making [5,6,13]
The narratives of the junior doctors in our study showed that exposure to speciality and rural practice influenced career decision making, solidifying or reshaping professional interests through a process of reassessment of how what they experienced or were witnesses to matched their preferences and perceived attributes

Summary

Introduction

Developing a sustainable rural health workforce to ensure equitable access to healthcare professionals and services for rural patients is an international challenge [1]. No evidence has been published on the exploration of junior doctors’ internal decision-making processes, and there have been calls for more qualitative research to fully understand how medical graduates make choices along the different pathways to rural practice [14]. Pfarrwaller and colleagues [15] developed a conceptual framework of medical students’ primary care career choice. The model consists of two parts: a central part representing students’ internal processing of career choice pathways, and an outer part representing the different systems of influence. The conceptual framework by Pfarrwaller and colleagues— the central part of the model [15]—was used to guide the interpretation of the data, the research team agreed on the main themes. Rigour was enhanced through investigator triangulation, through team member checking, coding validation, peer debriefing [22], and the use of NVivo [23]

Themes

The Role of Exposure

The Explorers

The Planners

Discussion

Conclusions