The specialty choices of graduates from Brighton and Sussex Medical School: a longitudinal cohort study

Katherine Woolf,Melanie Newport,Caroline Elton

doi:10.1186/s12909-015-0328-z

Abstract

BackgroundSince 2007 junior doctors in the UK have had to make major career decisions at a point when previously many had not yet chosen a specialty. This study examined when doctors in this new system make specialty choices, which factors influence choices, and whether doctors who choose a specialty they were interested in at medical school are more confident in their choice than those doctors whose interests change post-graduation.MethodsTwo cohorts of students in their penultimate year at one medical school (n = 227/239) were asked which specialty interested them as a career. Two years later, 210/227 were sent a questionnaire measuring actual specialty chosen, confidence, influence of perceptions of the specialty and experiences on choice, satisfaction with medicine, personality, self-efficacy, and demographics. Medical school and post-graduation choices in the same category were deemed ‘stable’. Predictors of stability, and of not having chosen a specialty, were calculated using bootstrapped logistic regression. Differences between specialties on questionnaire factors were analysed.Results50% responded (n = 105/277; 44% of the 239 Year 4 students). 65% specialty choices were ‘stable’. Factors univariately associated with stability were specialty chosen, having enjoyed the specialty at medical school or since starting work, having first considered the specialty earlier. A regression found doctors who chose psychiatry were more likely to have changed choice than those who chose general practice. Confidence in the choice was not associated with stability. Those who chose general practice valued lifestyle factors. A psychiatry choice was associated with needing a job and using one’s intellect to help others. The decision to choose surgical training tended to be made early. Not having applied for specialty training was associated with being lower on agreeableness and conscientiousness.ConclusionMedical school experiences are important in specialty choice but experiences post-graduation remain significant, particularly in some specialties (psychiatry in our sample). Career guidance is important at medical school and should be continued post-graduation, with senior clinicians supported in advising juniors. Careers advice in the first year post-graduation may be particularly important, especially for specialties which have difficulty recruiting or are poorly represented at medical school.

Highlights

Since 2007 junior doctors in the United Kingdom (UK) have had to make major career decisions at a point when previously many had not yet chosen a specialty
Selfefficacy was not related to confidence. This longitudinal study found that when considering groups of specialties, two thirds of Brighton and Sussex Medical School (BSMS) graduates had a Foundation Year 2 specialty choice that had been stable since Year 4 of medical school
Many graduates in our sample had a good idea of broad type of specialty they would like to enter while still at medical school, and rated medical school experiences as highly influential

Summary

Introduction

Since 2007 junior doctors in the UK have had to make major career decisions at a point when previously many had not yet chosen a specialty. The Independent Inquiry into Modernising Medical Careers conducted by Sir John Tooke (‘The Tooke Report’) [2] was set up to investigate some of MMC’s initial difficulties. It found that many junior doctors felt that the FY2 year was too early to decide on a specialty, as they may not have been exposed to many by that point. The Tooke Report recommends medical schools play a greater role in preparing students for career decisions. A study at Liverpool medical school found that about 20% of final year medical students did not know what specialty to choose [4]

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