Medical Student Career Choice Research Articles

The Current Status of Medical Student Urological Education in the United States

The current status of urological education in medical schools in the United States was investigated. A questionnaire regarding medical student teaching was sent to the program directors of the 118 urological residency programs in the United States. Of the 118 individuals 95 (81%) completed and returned the questionnaire. Three urology programs were not affiliated with medical schools and had no contact with medical students. In 29 programs (32%) there were no urology faculty lectures in the preclinical years. At 46 schools (50%) there was no urology lecture in the physical diagnosis course. Compared to a decade ago program directors believed that exposure to urology was about the same at 41 schools (45%), increased at 20 (22%) but decreased at 31 (34%). Finally, 60 program directors (65%) stated that it was possible for a student to graduate from the school without any clinical exposure to urology. This survey identifies alarming trends that, if left uncorrected, could adversely affect patient care in the future, particularly as the population of the United States ages. In addition, these trends may jeopardize the number and quality of future urological residency applicants.

Elisabeth Pauline Pickett (1918-): Opening the Door for Women in Urological Oncology

We outline the career of Elisabeth Pauline Pickett (1918-), the first board certified female urologist. The historical literature including personal writings of Pickett and her mentors were reviewed. The factors which determine female medical student career choice as well as a summary of the current status of women in urology were also examined. The groundwork for women in the modern era of urology was forged by Mary E. Childs MacGregor, who also supported and encouraged fellowship training. Inspired by Doctor MacGregor's example, Elisabeth Pickett became the first female general surgeon to complete a fellowship in urological oncology in 1955 under Dr. Willet Whitmore at Memorial Sloan-Kettering, and to be board certified in urology in 1962. Despite the benchmark set by these early pioneers the American Board of Urology currently lists only 324 female board certified urologists, 86 female candidates and 20 board eligible individuals as of the year 2006. Although the number of female graduating medical students in modern times is equivalent to males, there still exists a large discrepancy in the number of women choosing urology and other surgical subspecialties as a career. Elisabeth Pickett demonstrated that it could be done at a time when few thought it possible. However, only a minority of women today continue to pursue fellowship training.

Factors Influencing Surgical Career Choices and Advancement in Ireland and Britain

The aim of this study was to analyze the factors that influence the advancement and the career choices of doctors and medical students. Using the combined databases of the iformix and surgent websites, 450 doctors and medical students were invited to complete an internet-based survey. Surgent (http://www.surgent.ie) and iformix (http://www.iformix.com) are two free internet services administered by the authors. Surgent is a medical educational website, while iformix facilitates the online submission of abstracts to surgical and medical conferences across Britain and Ireland. The combined database of these two websites is approximately 4500 entries. Four hundred and fifty users represented a 10% sample based on an expected 40%-45% response rate. This was anticipated to yield between 180 and 202 respondents, statistically sufficient to analyze the data. A detailed Likert scale assessed the importance of "academic," "clinical," and "lifestyle" factors in determining career choice and progression. Analysis included descriptive statistics and inferential testing. Fifty percent (N = 222) of surveys were returned; 142 men and 78 women. Thirty-seven percent of respondents were Irish, 28% British, and 35% non-European. Fifteen percent were undergraduates, 4% interns, 12% had 2-4 years of clinical experience, while 69% had completed more than 4 years. Fifty-six percent had decided upon a career in general surgery. Overall, the most important factors for career choice were intellectual challenge (95%), academic opportunities (61%), and research opportunities(54%). Doctors with more than 4 years of experience deemed duration of training (p = 0.002), lifestyle during training (p = 0.02), and stress (0.005) as less important factors when considering career choice. Correlation analyses demonstrated that prestige (p = 0.002), patient relationships (p = 0.006), and advice from friends or family (p = 0.01) were more important influencing factors for interns. In terms of career advancement, 66% of non-Europeans considered family contacts important as opposed to 20% of British and 45% of Irish doctors (p < 0.001). In addition, 47% of females felt gender was important for career advancement as opposed to 31% of males (p = 0.01). Academic and clinical factors play an important role in career choice. However, it is clear that lifestyle factors predominate in determining an individual's career decisions in surgery.

Opportunity for sub-specialty recruitment

The importance that undergraduate experience of psychiatry has in shaping the career choices of medical students is highlighted by Eagles et al ( Psychiatric Bulletin , February 2007, 31 , [70–72][1]). However, although some form of psychiatric experience is included in all medical school

Error in Degree and Affiliation in: Influences on Medical Student Career Choice: Gender or Generation?

Error in Degree and Affiliation in: Influences on Medical Student Career Choice: Gender or Generation?

Viewpoint: Developing a Physician Workforce for America???s Disadvantaged

Eliminating health disparities will be difficult as long as many rural and disadvantaged inner-city communities remain medically underserved. The authors argue that the current debate on physician workforce policy has not adequately emphasized medical schools' social mission to educate physicians who will improve health care access and equity; fulfilling that mission means training students who will deliver primary care to underserved people. But fewer medical students are entering primary care specialties and practicing in underserved areas, and students who have the characteristics that make them likely to select such careers are increasingly uncommon among medical school matriculants. Unless there is a dramatic change, the imbalance will only become worse. The authors argue that the epidemiology of medical student career choice is sufficiently understood to permit schools to accept applicants with those characteristics, both demographic and individual, that are known to increase the probability of students caring for populations in need after graduation. Programs that have selected students on the basis of those predictors have been successful in increasing the distribution of doctors to primary care specialties and underserved areas, but these have not been of sufficient scope. The authors present a proposal for prioritizing medical school admissions to favor applicants who, rather than delivering just high grades, will contribute to improving America's health care outcomes.

Who wants to be a surgeon? A study of 300 first year medical students

BackgroundWhile medicine in general is becoming more female-dominated, women are still under-represented in surgery. Opinion is divided as to whether this is due to lifestyle considerations, disinterest or perceived discrimination. It is not clear at what stage these careers decisions are made.Methods300 first year medical students at Guy's King's and St Thomas' School of Medicine (GKT) were asked their view on possible career choices at this stage.ResultsWhile men represented only 38% of the student population, they represented over two-thirds of the students wishing to pursue a career in surgery.Women still opt for general practice and paediatrics.ConclusionSurgery is a disproportionately unpopular career choice of the female first-year medical students of GKT compared to the male students. It appears that the choice is freely made and, at this stage at least, does not represent concerns about compatibility with lifestyle.

Effective Surgical Residents Strongly Influence Medical Students to Pursue Surgical Careers

There is a paucity of data about the influence of surgical residents on the career choices of medical students. We hypothesized that medical students exposed to effective surgical residents would be more likely to pursue careers in surgery. From 1998 to 2003, 108 surgical residents were evaluated by medical students rotating on the third-year clerkship. Residents were scored on a 4-point scale (1 = outstanding to 4 = poor). The career choices of all medical students were also tabulated. We examined 2,632 evaluations on 108 residents. Medical students who eventually pursued surgical residency training were exposed to surgical residents who were more effective clinical teachers, role models, and overall residents. In addition, medical students exposed to the highest-rated residents were more likely to pursue surgical residency training compared with students exposed to the least effective residents (12% versus 4.9%, p = 0.022). These data suggest that surgical residents who are effective educators and mentors influence medical students to pursue surgical careers. Efforts to provide more leadership and teaching workshops to surgical residents may not only create better future surgeon educators, but may also increase the number of students pursuing surgical training.

Influences on Medical Student Career Choice

We hypothesized that increased enrollment of female medical students and different priorities of the current generation of students would be important influences on the declining interest in surgical careers. Students scored statements on surgical careers on 5-point Likert scales regarding agreement and whether these statements encouraged them to pursue a career in surgery. Data were analyzed using the Mann-Whitney U test. Qualitative comments were iteratively coded using a constant comparative method. Nine US medical schools. A Web-based survey on the Association for Surgical Education server was e-mailed to medical students. A total of 1300 of the 1365 respondents stated their sex. The survey asked questions pertaining to surgical life, surgical residency, surgeons as influence, equity, family, and other influences. A total of 680 (52%) of the 1300 respondents were male. Men and women disagreed about whether surgeons lead well-balanced lives (68% and 77%, respectively) and saw this as a deterrent. A total of 35% of women (3% men; P<.001) were discouraged by a lack of female role models. Compared with students unlikely to study surgery, lower percentages of male (74% vs 65%) and female students (85% vs 58%) likely to study surgery agreed that career choice was influenced by their decision to have a family (P=.01 for men, P<.001 for women). Of medical students who agreed that their skill sets were compatible with surgical careers, similar percentages were likely (30% men vs 24% women) and unlikely (49% men vs 54% women) to study surgery. All differences between men and women were less apparent when students likely to study surgery were compared with students unlikely to study surgery. The decision to have a family was a more significant influence for women than men, but family and lifestyle priorities were also important to male students, supporting our hypothesis that generation and gender are both important influences on career choices.

Influences on Medical Student Career Choice—Invited Critique

Influences on Medical Student Career Choice—Invited Critique

Effect of the inpatient general medicine rotation on student pursuit of a generalist career

Entry into general internal medicine (GIM) has declined. The effect of the inpatient general medicine rotation on medical student career choices is uncertain. To assess the effect of student satisfaction with the inpatient general medicine rotation on pursuit of a career in GIM. Multicenter cohort study. Third-year medical students between July 2001 and June 2003. End-of-internal medicine clerkship survey assessed satisfaction with the rotation using a 5-point Likert scale. Pursuit of a career in GIM defined as: (1) response of "Very Likely" or "Certain" to the question "How likely are you to pursue a career in GIM?"; and (2) entry into an internal medicine residency using institutional match data. Four hundred and two of 751 (54%) students responded. Of the student respondents, 307 (75%) matched in the 2 years following their rotations. Twenty-eight percent (87) of those that matched chose an internal medicine residency. Of these, 8% (25/307) were pursuing a career in GIM. Adjusting for site and preclerkship interest, overall satisfaction with the rotation predicted pursuit of a career in GIM (odds ratio [OR] 3.91, P<.001). Although satisfaction with individual items did not predict pursuit of a generalist career, factor analysis revealed 3 components of satisfaction (attending, resident, and teaching). Adjusting for preclerkship interest, 2 factors (attending and teaching) were associated with student pursuit of a career in GIM (P<.01). Increased satisfaction with the inpatient general medicine rotation promotes pursuit of a career in GIM.

Postgraduate medical placements in rural areas: their impact on the rural medical workforce

In 1988, the New South Wales (NSW) Department of Health developed the NSW Rural Resident Medical Officer Cadetship Program (Cadetship Program) to help overcome a junior doctor workforce shortage in rural hospitals. A second aim was to increase recruitment to the rural medical workforce on the basis that positive exposure to rural medicine increases the likelihood of choosing to practice in a rural location. The Cadetship Program offers bonded scholarships which provide financial support for residents of NSW studying medicine during the final 2 years of their medical degree. In return, cadets are contracted to complete 2 of their first 3 postgraduate years in the NSW rural hospital network. NSW Rural Doctors Network has managed the Cadetship Program for the NSW Department of Health since 1993, and carried out an evaluation in 2004. The purpose of this evaluation was to track the career choice and practice location of medical students entering the Cadetship Program before 1999, and to comment on the impact of the Program on the rural medical workforce in NSW to date, and its implications for the future workforce. The career choice and practice locations of 107 medical students who received cadetships between 1989 and 1998 were tracked. Students who did not graduate from medical school (n = 3) or who did not complete their rural service (13) were excluded from the analysis. Career choice was not available for a further nine former cadets and they were also excluded from the analysis. The NSW Rural Doctors Network was the major source of data on career choice and practice location due to its role in administering the Cadetship Program on behalf of the NSW Department of Health. Two brief questionnaires targeting specific groups of cadets were used to fill knowledge gaps about where cadets grew up, what vocational training they undertook, and where they were working in 2004. Where this information was not obtained from cadets first hand, it was sourced from the CD-ROM version of the Medical Directory of Australia. Forty-three percent of cadets entering the Program before 1999 were working in rural locations in 2004 (compared with 20.5% of medical practitioners nationally), 46% had attended primary school in a rural location and 44% chose to specialize in general practice. Career choice was the major determinant of practice location. Having a rural background did not appear to influence practice location; whereas, those specialising in general practice made up 70% of this cohort of cadets working in rural areas. All general practice trainees were in rural locations compared with only two of the 25 trainee specialists, which reflects the availability of accredited training places in rural Australia. The Cadetship Program, which ensures junior doctors work for 2 of their first 3 postgraduate years in a rural allocation centre, is an effective link between medical school and rural practice, particularly rural general practice. Providing vocational training opportunities in rural locations is central to this success, and needs to be considered in efforts to expand the rural specialist workforce, and in ensuring rural health capitalises on the increasing number of medical students moving through the education and training system in the next 4-10 years.

An exploration of when urban background medical students become interested in rural practice

While it is well recognized that rural background medical students are more likely to enter rural practice than urban background, students' research shows that 34% to 67% of rural doctors have urban backgrounds. This article explores the factors influencing urban background medical students' interest in rural practice. The study used a qualitative design employing focus groups and semi-structured interviews. Data were collected at three Australian universities and a national student rural health conference, and the participants were 82 first and final year medical students who participated in focus groups, and 49 who were interviewed individually. Data were analysed using the N6 computer package to manage the data. Forty-three urban background students indicated an interest in rural practice and the data presented in this article relate to this group of students. This article presents an analysis of data from one part of a larger project conducted from 2002 to 2004 investigating medical student career choice. The students' level of interest in rural practice depends on an interaction between student and location factors and other external influences with students seeking to match their needs and interests with locations. Some are 'predisposed' to develop interest in rural practice via their familiarity with rural areas, level of altruism, interest in generalist work, and interest in certain leisure activities. Exposure to rural locations provides knowledge about different places. Students recognize differences between rural locations in relation to the size of town and the remoteness of the town, and they seek specific rural locations which will match their values and interests. Existing social relationships can be enabling or limiting factors in the student's ability to follow through their interest in rural practice and to enter rural practice, and are important in the students finding a match between themselves and an appropriate location. Exposure of urban background students to rural practice and a range of rural locations generates an interest in rural practice among many urban background students. This exposure may increase the number of students who become interested in rural practice and decide to enter rural practice. Further quantitative research is required to test the findings from this exploratory qualitative study.

Professional attitudes and career choices of female medical laboratory technology students and graduates: Experience from Eastern Saudi Arabia

Professional attitudes and career choices of female medical laboratory technology students and graduates: Experience from Eastern Saudi Arabia

General Surgery as Education, Not Specialization

The topic I have chosen for the Presidential Address is controversial. I will present my point of view on the subject, which does not necessarily reflect the opinions of the other members of the Association. General surgery in crisis has been an increasingly repeated topic of discussion, but not many solutions to this discussion has been offered. There is no doubt, however, that general surgery should continue to be used as an effective coordinator of undergraduate surgical teaching, not withstanding departmental fragmentation. Over the years, general surgery has been providing core surgical training for many specialties’ residents. Snow1 has outlined this by saying, “The specialties of surgery, other than general surgery, continue to depend upon the discipline and specialty of general surgery for education, research and clinical practice.” Therefore, the discipline of general surgery has remained as the unifying force in surgery. Along this same line, Organ2 defined general surgery as the “gatekeepers” for surgical education, research, and patient care. Despite these eloquent declarations, general surgery has been losing its appeal as a career choice for students and residents alike, and moreover, it has been scrutinized by its nonsurgical colleagues and the public in general. In the United States, general surgery had its peak level of interest in 1981, when 12.1% of senior medical students selected general surgery as the first choice of specialty.3 In 1989, the interest level dropped to 10%, then down to 8% the following year, and to a low of 6.1% in the 2001 match program. Questionnaires were handed out to the students asking them to make a list of factors that were influential in their decision-making process.3 In the 1990s, students ranked the “type of patient problems encountered” as having the greatest influence in their decision of the specialty they wished to pursue. The second most influential factor was “clerkship” in the area, intellectual content of the specialty, or “challenging diagnostic problems.” The third most influential factor was “example of a physician to the specialty,” which was interpreted to be the “role model” that the student identified to. In the data extracted from the 1978 to 2001 medical student graduate questionnaire, all medical schools reported a large percentage of students (38.8%–57.8%) who were initially attracted to the specialty of general surgery and later changed their minds because of the following lifestyle issues4: unpredictable work hours, demands on time and effort, amount of stress, type of patient problems encountered, and the length of the residency program. In an analysis of contemporary trends in student selection of medical specialties by Bland and Isaacs,5 it was confirmed that perceived threats to lifestyle remained an important factor influencing the career choice of medical students. These issues may be among the most important because half of the medical students today are women, and lifestyle in a surgical program has been viewed as “especially difficult to combine with family life.” Program directors must address these issues in an attempt to attract top students. The surgery clerkship experience is also a major factor for students when deciding on a specialty. Polk6 has observed a 30% decrease in required clerkship experience in medical schools and students’ exposure to surgical sciences because of the shortening of requisite surgical rotations. In a recent Presidential Address, “Surgery, a Noble Profession in a Changing World,” Debas7 concluded that unless these trends are reversed (not only the declining number of students applying for surgical training but also the declining quality of training for those who do apply), “general surgery as specialty is threatened, and a future shortage of general surgeons is inevitable.” In addition, in America, the results of the 2001 general surgery national residency match program revealed an entirely unprecedented 7% unfilled first-year general surgery training positions.8 In an analysis9 of the data from the Canadian Residency Matching Service, the number of applicants listing general surgery as their first choice was 5.68% in 1996 and dropped to 4.25% by 2001. There are no official figures in Europe, but there is a consensus that general surgery is now becoming one of the least competitive surgical specialties. Another crucial deterrent in the pursuit of a career in general surgery may be the length of training period (residency programs of 5 or 6 years). Furthermore, quite often there maybe subsequent extensions to their training programs. It could be said that, in light of the current situation, general surgery has probably lost its personality as a specialty.

MD/MBA Students: An Analysis of Medical Student Career Choice

Background: An increasing number of medical schools are offering dual degree MD/MBA programs. Career choices and factors influencing students to enter these programs provide an indicator of the roles in which dual degree students will serve in health care as well as the future of dual degree programs.Purpose: Using career choice theory as a conceptual framework, career goals and factors influencing decisions to enter dual degree programs were assessed among dual degree medical students.Methods: Students enrolled at dual degree programs at six medical schools were surveyed and interviewed. A control group of traditional medical students was also surveyed.Results: Factors influencing students to seek both medical and business training are varied but are often related to a desire for leadership opportunities, concerns about change in medicine and job security and personal career goals. Most students expect to combine clinical and administrative roles.Conclusions: Students entering these programs do so for a variety of reasons and plan diverse careers. These findings can provide guidance for program development and recruitment for dual degree medical education programs

ALLIANCE FOR CLINICAL EDUCATION (ACE) PROCEEDINGS: Proceedings of the 2002 and 2003 Annual Meetings of the Association of Directors of Medical Student Education in Psychiatry (ADMSEP)

The Association of Directors of Medical Student Education in Psychiatry (ADMSEP) is an organization of approximately 130 members whose mission includes championing excellence in psychiatric education for medical students and fostering the professional development of their psychiatric educators. ADMSEP held its 28th annual meeting in Key Biscayne, Florida, from June 13 to June 15, 2002, and its 29th annual meeting in Jackson Hole, Wyoming, from June 12 to June 14, 2003. s were selected by a subcommittee of the ADMSEP Executive Council based on the quality and originality of the work and its presentation, its suitability to abstract form, and its general interest to readers of Teaching and Learning in Medicine. Authors' e-mail addresses are included for those who wish to discuss studies or collaborate on projects. Several final articles are already in press; their abstracts are not printed here, but the articles are noted in the following paragraph. As these abstracts reflect, the 2002 and 2003 annual meetings focused on issues that are of central concern to clerkship directors, including assessment of and change in curricula, both preclinical and clinical; methods of evaluating students; and resident and faculty development. The quantity and quality of educational research conducted by the ADMSEP membership has been enhanced by the membership's willingness to participate in national surveys to determine the status of the educational programs in our field, and by collaboration across different institutions. In particular, additional presentations from the same study discussed in the Carlson and Clegg abstracts are pending publication in an upcoming issue of Academic Psychiatry (Levine, RE. "Psychiatric Clerkship Usage of the NBME Subject Exam"; Rosenthal R. "Clerkship Length: Assessment and Academic Issues"). Other topics that stimulated interest but are less readily conveyed in an abstract format include national initiatives in medical education across specialties, the ongoing scarcity of resources, and psychiatric educators' responses to the terrorist crisis (2002), a special presentation on writing manuscripts for publication by Academic Psychiatry's editor Laura Roberts, approaches to teaching psychotherapy, and innovative uses of new technology (2003). Sierles's presentation during the 2003 meeting entitled "School-by-School Trends in Medical Student Career Choice of Psychiatry, 1999–2001," has been published in the Winter 2003 issue of Academic Psychiatry.

Economic diversity in medical education: the relationship between students' family income and academic performance, career choice, and student debt.

Providing access to higher education across all income groups is a national priority. This analysis assessed the performance, career choice, and educational indebtedness of medical college students whose educational pursuits were assisted by the provision of financial support. The study looked at designated outcomes (academic performance, specialty choice, accumulated debt) in relation to the independent variable, family (parental) income, of 1,464 students who graduated from Jefferson Medical College between 1992 and 2002. Students were classified into groups of high, moderate, and low income based on their parental income. During the basic science years, the high-income group performed better; however, in the clinical years, performance measures were similar. Those in the high-income group tended to pursue surgery, while those in the low-income group preferred family medicine. The mean of accumulated educational debt was significantly higher for the low-income group. The study provides support for maintaining economic diversity in medical education.

Career choice of new medical students at three Canadian universities: family medicine versus specialty medicine.

Over the last 10 years the number of medical students choosing family medicine as a career has steadily declined. Studies have demonstrated that career preference at the time that students begin medical school may be significantly associated with their ultimate career choice. We sought to identify the career preferences students have at entry to medical school and the factors related to family medicine as a first-choice career option. A questionnaire was administered to students entering medical school programs at the time of entry at the University of Calgary (programs beginning in 2001 and 2002), University of British Columbia (2001 and 2002) and University of Alberta (2002). Students were asked to indicate their top 3 career choices and to rank the importance of 25 variables with respect to their career choice. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbach's alpha coefficients; biserial correlations between the factors and career choice were also calculated. A logistic regression was performed using career choice (family v. other) as the criterion variable and the factors plus demographic characteristics as predictor variables. Of 583 students, 519 (89%) completed the questionnaire. Only 20% of the respondents identified family medicine as their first career option, and about half ranked family medicine in their top 3 choices. Factor analysis produced 5 factors (medical lifestyle, societal orientation, prestige, hospital orientation and varied scope of practice) that explained 52% of the variance in responses. The 5 factors demonstrated acceptable internal consistency and correlated in the expected direction with the choice of family medicine. Logistic regression revealed that students who identified family medicine as their first choice tended to be older, to be concerned about medical lifestyle and to have lived in smaller communities at the time of completing high school; they were also less likely to be hospital oriented. Moreover, students who chose family medicine were much more likely to demonstrate a societal orientation and to desire a varied scope of practice. Several factors appear to drive students toward family medicine, most notably having a societal orientation and a desire for a varied scope of practice. If the factors that influence medical students to choose family medicine can be identified accurately, then it may be possible to use such a model to change medical school admission policies so that the number of students choosing to enter family medicine can be increased.

Factors affecting medical student career choice of psychiatry from 1999 to 2001.

The proportion of students matching into psychiatry (PMP) at each medical school results from a complex interplay between extrinsic (e.g., national trends, geographic region) and intrinsic factors (e.g., the quality of psychiatric education). The goal of the study was to learn the extent to which regional and local extrinsic factors (and one intrinsic factor) influenced PMP at medical schools in the U.S. from 1999 to 2001. The authors obtained data about these factors from deans of student affairs, the National Resident Matching Program (NRMP), American Medical Association (AMA), Association of American Medical Colleges (AAMC), American Psychiatric Association (APA), and Harvard University's HealthSystem Consortium. The best predictor of a school's PMP is the PMP of the prior year for that particular school. Local and regional extrinsic factors were not significantly associated with PMP. There was a modest inverse correlation between PMP and the proportion of international medical graduates (IMGs) in psychiatry residency. The authors infer that intrinsic factors are most important for recruitment, and they make recommendations for addressing these factors.