Abstract
BackgroundMedical schools can contribute to the insufficient primary care physician workforce by influencing students’ career preferences. Primary care career choice evolves between matriculation and graduation and is influenced by several individual and contextual factors. This study explored the longitudinal dynamics of primary care career intentions and the association of students’ motives for becoming doctors with these intentions in a cohort of undergraduate medical students followed over a four-year period.MethodsThe sample consisted of medical students from two classes recruited into a cohort study during their first academic year, and who completed a yearly survey over a four-year period from their third (end of pre-clinical curriculum) to their sixth (before graduation) academic year. Main outcome measures were students’ motives for becoming doctors (ten motives rated on a 6-point scale) and career intentions (categorized into primary care, non-primary care, and undecided). Population-level flows of career intentions were investigated descriptively. Changes in the rating of motives over time were analyzed using Wilcoxon tests. Two generalized linear mixed models were used to estimate which motives were associated with primary care career intentions.ResultsThe sample included 217 students (60% females). Career intentions mainly evolved during clinical training, with smaller changes at the end of pre-clinical training. The proportion of students intending to practice primary care increased over time from 12.8% (year 3) to 24% (year 6). Caring for patients was the most highly rated motive for becoming a doctor. The importance of the motives cure diseases, saving lives, and vocation decreased over time. Primary care career intentions were positively associated with the motives altruism and private practice, and negatively associated with the motives prestige, academic interest and cure diseases.ConclusionOur study indicates that career intentions are not fixed and change mainly during clinical training, supporting the influence of clinical experiences on career-related choices. The impact of students’ motives on primary care career choice suggests strategies to increase the attractivity of this career, such as reinforcing students’ altruistic values and increasing the academic recognition of primary care.
Highlights
Medical schools can contribute to the insufficient primary care physician workforce by influencing students’ career preferences
Dynamics of primary care career intentions The proportion of students intending to practice primary care steadily increased from 12.8% (N = 24) in year 3 to 24% (N = 45) in year 6
Association between students’ motives to become doctors and their primary care career intentions In the first model (Table 1), comparing primary care to non-primary care career intentions, we found that a higher importance rating of the motives private practice and altruism increased the probability of primary care career intentions, whereas the ratings of prestige, academic interest and cure diseases were negatively related to primary care career intentions
Summary
Medical schools can contribute to the insufficient primary care physician workforce by influencing students’ career preferences. This study explored the longitudinal dynamics of primary care career intentions and the association of students’ motives for becoming doctors with these intentions in a cohort of undergraduate medical students followed over a four-year period. Definition of primary care The term “primary care” refers to the provision of integrated, accessible health care services to the whole population, serving as first point of contact in the healthcare system and addressing most health care needs [6, 7] This definition is universal, the type of physicians practicing primary care (in terms of postgraduate specialization) differs between countries. In Switzerland, there is no specific primary care specialization: general internists and pediatricians working in private practice are considered PCPs [8]
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