The Significance of Experiencing Clinical Responsibilities for Specialty Career Choice

Sophie Querido,Marlies De Rond,Olle Ten Cate,Lode Wigersma,Sjoukje Van Den Broek

doi:10.1007/s40670-019-00832-z

Abstract

AimMedical trainees make career choices in the final year of medical school or after graduation, if they do not continue with residency directly. Most Dutch medical students are trained in vertically integrated (VI) curricula, with early clinical experience and a gradual increase in clinical responsibilities. Students in such curricula have been reported to make career choices at an earlier stage than graduates from more traditionally designed curricula. Many Dutch graduates build further clinical experience after graduation as physicians-not-in-training (PNITs) before beginning residency. We explored how students make career choices and whether pre-residency clinical responsibilities influence this choice.MethodA qualitative study with a phenomenology approach was used. The authors conducted a longitudinal interview study of medical students with two intervals over a 2-year period. The interview questions covered how trainees establish career preferences and which factors affect preference and choice over time.ResultsExperiencing clinical responsibility was a key factor for career preference during all interview rounds. Being a PNIT who makes diagnostic and therapeutic decisions, have their own patients and have significant patient care responsibilities creates opportunities to build an image of a future context of employment. Some participants mentioned that their experience of having full responsibility as a PNIT was pivotal in a career preference change.ConclusionClinical responsibility as a student or a PNIT appears to be important for career preference and choice. The experience of responsibility as a medical doctor forces trainees to reflect on personal needs and to consider which career preference fits best.

Highlights

Medical trainees need to make an important career choice about a specialty when they face the transition from medical school to residency
We aimed to explore how students from vertically integrated curricula develop career preferences and make their career choice and whether additional preresidency clinical experiences and increased responsibilities influence this choice
We found that pre-residency responsibilities enable medical students to reflect on their career preference in a timely manner

Summary

Introduction

Medical trainees need to make an important career choice about a specialty when they face the transition from medical school to residency. When they feel urged to make this choice depends on the structure and length of medical training in the country [1]. The medical graduate can either do temporary supervised clinical work before residency as a socalled physician-not-in-training, start a PhD trajectory or start residency directly [1,2,3,4,5]. Many of the Dutch medical graduates choose physician-not-in-training work experience in one or more specialties before residency to make a thoughtful specialty decision [5]. In the United Kingdom (UK), all junior doctors have a 2-year foundation training after medical school and choose a

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