Specialty Selection Research Articles

Criteria of medical students for the selection of their future clinical specialisation: a cross-sectional survey at the Medical Faculty of Rostock.

Objective: Despite the increase in the number of graduates in Human Medicine, it has been predicted that there will not only be a shortage of doctors, but also a shortage of specialists in Germany for the years to come. At the same time there are only a few studies on the factors that influence medical students in their decision to select a specialty. Against this background, a study was conducted at the Medical Faculty in Rostock, to investigate the criteria for deciding on a later field of specialty.Methods: Conducting focus groups of four to seven participants of each year of study, criteria were determined which seemed relevant to the students during their selection of their specialty field. The interviews were transcribed and the answers of the participants classified in super categories. With the data obtained a questionnaire was prepared and sent electronically to all students of Human Medicine. Via exploratory factor analysis important criteria and their correlations were determined.Results: A total of 421 students took part in the questionnaire (31.4% return) and indicated their own clinical experience, but also patient contact and work-life-balance as important criteria for a future selection of specialty field. 44.8% of the participants had already made their choice of specialty at the time of the query, and this for the most part took place in the clinical study phase and most often for the subjects Internal Medicine (15.3%), General Medicine (14.2%), Pediatrics (12.0%) and Surgery (11.5%). For those students who already had made a decision, the size and complexity of the field as well as the opportunity to be able to build relationships with patients, were decisive for selection. Those still undecided indicated that for their choice of specialty family friendliness of the field, leisure time and esteem from others were important.Conclusions: Our results show that the personal clinical experience can be a decisive influential factor for future specialty selection. Early contact with the different disciplines could therefore be structured as an aid to help in the decision making, in order to break down any apprehensions and to stop a pending deficiency in specialists.

A comparison of temperament and character among psychiatry, internal medicine, and surgery residents at Iran University of Medical Sciences in the academic year 2013-2014.

Background: This study was conducted to compare temperament and character among psychiatry residents, internal medicine, and surgery residents in hospitals affiliated to Iran University of Medical Sciences in the academic year 2013–2014. Methods: This cross sectional analytical study was conducted on 201 residents using the non-probability method of convenience sampling. Cloninger’s 125-item Temperament and Character Inventory (TCI) and Maslach’s Burnout Inventory (MBI) were distributed among all the residents in their morning session. Once the questionnaires were completed and submitted, the data were analyzed in SPSS 16. The frequency of different personality traits was analyzed among the selected residents. Results: A total of 49.8% of the respondents were female (n=100) and 50.2% were male (n=101). The results of data analysis showed more novelty seeking, reward dependence, and harm avoidance and less persistence (33.93, p=0.006; 9.00, p=0.056; 32.55, p=0.021; and 2.48, p=0.028, respectively) in psychiatry residents than in surgery residents (31.97, 7.87, 30.74, and 3.12 respectively). Reward dependence was more frequent in internal medicine residents than in surgery residents (9.44 and 7.87 respectively, p=0.002). The self-directedness score was lower in psychiatry residents than in internal medicine residents (p=0.761) and higher than in surgery residents (17.96, 18.30, and 17.57 respectively, p=0.824). The cooperativeness and self-transcendence scores were higher in psychiatry residents than in internal medicine (p=0.943, p=0.199, respectively) and surgery residents (p=0.105, p=0.069 respectively). Conclusion: The different dimensions of personality varied between the surgery, internal medicine, and psychiatry residents. Particularly, this study did not show statistically significant differences in dimensions of character (cooperativeness, self-directedness, and self-transcendence) among surgery, internal medicine, and psychiatry residents. The selection of medical specialties based on character traits significantly contributes to more effective treatment of patients and higher satisfaction of the residents.

Analysis of the selection of IT specialties by graduates in Ternopil

Analysis of the selection of IT specialties by graduates in Ternopil

Race and Gender in the Obstetrics and Gynecology Clerkship: A Mixed Methods Assessment

OBJECTIVE: To assess perceptions of the obstetrics and gynecology (OBGYN) clerkship and to observe if either race or gender informs selection of specialty. METHODS: A prospective cross-sectional study was performed among third and fourth year medical students from February-June 2018. Respondents completed an anonymous and confidential online survey examining their perceptions of the field, the clinical clerkship itself and the potential influence of race and gender during the clerkship. Qualitative responses were coded in an iterative process to evaluate for specific themes. Categorical variables were analyzed using the χ2 test. A p-value of less than 0.05 was considered statistically significant. RESULTS: 123 out of 229 (53.7%) medical students responded to the survey. Students were more likely to consider OBGYN as a career choice upon completion of the clerkship compared to before (44.9% vs 31.7%, p=0.03). Eleven percent (11%) of respondents reported race personally affecting their clerkship experience whereas 66% identified gender to be a personal influencer on clerkship experience. Male and under-represented minority (URM) students delineated more negative clinical interactions along with fewer meaningful educational experiences on the clerkship due to a perceived lack of cultural inclusivity. The lack of both racial and gender diversity of faculty, residents and ancillary staff was perceived as fostering an environment of discomfort due to displays of both unconscious and conscious bias. CONCLUSION: Male and URM medical students have disparate experiences on the OBGYN clerkship as compared those who are female or white, with the racial/gender composition of the clinical environment being contributory.

Factors associated with specialty choice in Chinese medical students and residents: an exploratory cross-sectional study

BackgroundSpecialty maldistribution stemming from a lack of preference for certain specialties can substantially impact a country's health-care system. Promoting primary care or addressing the shortages of certain specialties needs a better understanding of the underlying motives that might encourage or discourage medical students to choose certain specialties. We aimed to explore the predominant factors that influence specialty choice in China's medical students and physicians through a nationwide survey. MethodsFrom 2016 to 2017, an electronic survey was distributed to medical students and physicians across all seven administrative regions of China. We used validated instruments including the Job Contentment Questionnaire, the Professionalism Assessment Scale, the Chronic Fatigue Syndrome Symptom Inventory, the Maslach Burnout Inventory, the General Health Questionnaire (Chinese version), and a modified Center for Epidemiologic Studies Depression Scale. Ethical approval was obtained by the institutional review board of the principal investigator's institution. Findings2549 respondents from 85 medical schools and hospitals filled out the questionnaire. The most influential factors in determining specialty selection were quality of training (N=901 [35·3%], mean 3·8 [SD 1·1]), autonomy (876 [34·4%], 3·9 [1·1]), and social commitment (760 [29·8%], 3·7 [1·1]). By contrast, the least influential factors were salary, length of residency, and academic experience. Selection of quality of training and autonomy were positively associated with professional development and inversely associated with negative health outcomes. With the exception of salary, negative associations were found between all specialty choice factors (ie, comprehensibility, role models, family influence, specialty prestige, work–life balance, research opportunities, social commitment, variety of medical problems, and work style) and nearly all health burden variables. InterpretationFocusing on ensuring autonomy in medical practice, enhancing the quality of training, and correcting outdated remuneration mechanisms might be the best way to ensure a proper balance of physicians across medical specialties. FundingRepublic of China Ministry of Science and Technology (MOST 105-2629-S-010-001).

Fundamental Curriculum Change with 1-Year Pre-Clerkship Phase and Effect on Stress Associated with Residency Specialty Selection.

Vanderbilt University School of Medicine recently changed from 2 pre-clerkship years (Traditional curriculum) to a 1.5-year pre-clerkship phase for one class (Hybrid curriculum) to a 1-year pre-clerkship phase (Curriculum 2.0). This study investigated the relationship between shortened pre-clerkship training and stress associated with selecting a residency field. The surveyed graduating medical student population included one cohort from the Traditional and Hybrid curricula, and the first two cohorts from Curriculum 2.0. The authors modeled recollected stress levels using a Zero-Inflated Linear Mixed Model with additional covariate and random effects adjustments. Specialty decision-related stress levels increased in the Hybrid curriculum by 10.208 points [p = 0.0115, 95% CI 2.293, 18.122] on a 0-100 point scale. Curriculum 2.0 students had an insignificant increase in stress of 4.062 points [p = 0.304, 95% CI - 3.690, 11.814] relative to the Traditional curriculum. Time since starting medical school and time when a specialty was chosen were the largest factors associated with stress. While this study only evaluated a single facet of the potential downstream effects of curricular change, these data should inspire confidence for reform efforts as a significant increase in specialty decision-related stress present in Hybrid curriculum resolved in both cohorts of Curriculum 2.0.

Propagating the “SEAD”: Exploring the Value of an Overnight Call Shift in the Surgical Exploration and Discovery (SEAD) Program

Attrition of general surgery residents highlights a need to support well-informed specialty selection. This study evaluated preclerkship medical students' perception of overnight call shifts in surgical career exploration. A mixed-methods design was used, involving entry and postcall shift surveys and focus groups. Survey data characterized the population and call shift, guided focus group segmentation by baseline interest in surgery, and provided context for interpretation of qualitative data. Focus groups were transcribed and analyzed with a phenomenological approach using thematic analysis. Call shifts took place at the University of Toronto's Sunnybrook Health Sciences Centre and St. Michael's Hospital, 2 Level 1 trauma centers in Toronto, Canada. Twenty-five first-year medical students participating in the Surgical Exploration and Discovery program. Sixty-four percent (n = 16) of the participants were male. Students in the high interest group (n = 9) had more prior operating room exposure than students in the moderate (n = 12) and low (n = 4) interest groups (p = 0.039). Most students valued participating in a call shift; 80% (n = 20) rated the experience "positive" or "very positive." Thematic analysis yielded 2 categories of themes: (1) Valuable aspects of the experience, including being part of a team, mentorship, understanding the clerk's role, dispelling misconceptions, trial of working overnight, and influencing interest in a surgical career; and (2) Determinants of an enjoyable experience, including resident engagement and number of traumas. An overnight call shift experience was valuable to preclerkship medical students regardless of baseline interest in surgery. While it only influenced a few students' specialty preferences, exposure facilitated a better understanding of a unique component of surgical careers and provided valuable mentorship. These findings support implementing calls shifts in other curricular or extracurricular programs to make the experience more widely available and enable earlier, informed career decision-making.

The popularity of neurology in Spain: an analysis of specialty selection

IntroductionNeurology is one of the medical specialties offered each year to residency training candidates. This project analyses the data associated with candidates choosing neurology residency programmes in recent years. MethodsData related to specialty selection were obtained from official reports by the Spanish Ministry of Health, Social Services, and Equality. Information was collected on several characteristics of teaching centres: availability of stroke units, endovascular intervention, national reference clinics for neurology, specific on-call shifts for neurology residents, and links with medical schools or national research networks. ResultsThe median selection list position of candidates selecting neurology training has been higher year on year; neurology was among the 4 most popular residency programmes in 2016. Potential residents were mainly female, Spanish, and had good academic results. The median number of hospitals with higher numbers of beds, endovascular intervention, stroke units, and national reference clinics for neurology is significantly lower. This is also true when centres are analysed by presence of specific on-call shifts for neurology residents and association with medical schools or national research networks. The centres selected by candidates with the highest median selection list position in 2012-2016 were the Clínico San Carlos, 12 de Octubre, and Vall d’Hebron university hospitals. ConclusionsNeurology has gradually improved in residency selection choices and is now one of the 4 most popular options. Potential residents prefer larger centres which are more demanding in terms of patient care and which perform more research activity.

Correlating the Length of Medical School Clerkship and OB/GYN Specialty Selection [14H

INTRODUCTION: Third year medical school clerkships provide students an opportunity to see specialties first hand and observe mentors in the field. Shorter clerkships have the potential to negatively affect their decision on specialty selection. We sought to describe clerkship length at US medical schools with OB/GYN clerkships and correlate this to the OB/GYN residency match rate in 2017. METHODS: This was an observational cohort study of US allopathic medical schools with OB/GYN clerkships. Medical school websites were reviewed and clerkship coordinators contacted when necessary to determine clerkship length. The 2017 GME Track Resident Survey was utilized to determine medical schools for first-year residents. Mean number of programs and students matching into OB/GYN were reported with standard deviations. RESULTS: 147 US allopathic medical schools were identified and complete clerkship information was available for 137. The majority of medical schools provided a 5-6 week clerkship (n = 101; 73.7%) followed by 7-8 weeks (n = 28; 20.4%) and 4 weeks (n = 8; 5.8%). Residency Survey data was available for 94.8% of first year residents. Four-week, 5-6 week and 7-8 week clerkships were associated with a 3.96% (SD 0.88), 4.77 (SD 2.38) and 5.19 (2.21) match rate into OB/GYN respectively. CONCLUSION: The majority of US allopathic medical schools provide a 6-week OB/GYN clerkship experience. There was an increase in the percentage of medical students entering OB/GYN based on clerkship length that was not statistically significant. As medical schools undergo curriculum change, it is important that adequate exposure to the specialty be provided.

Role of Debt and Loan Forgiveness/Repayment Programs in Osteopathic Medical Graduates' Plans to Enter Primary Care.

Osteopathic medicine emphasizes partnering with patients to help them attain or maintain health. This philosophy encourages physicians to practice primary care and a mission of improving community health. However, there is currently a shortage of primary care physicians in many areas of the United States. To determine whether intended practice patterns of recent graduates of colleges of osteopathic medicine favor primary care and whether practice patterns correlate with medical education debt. Responses were analyzed from the American Association of Colleges of Osteopathic Medicine survey of pending medical school graduates from 2007 through 2016 regarding indebtedness and specialty selection. The percentage of graduating osteopathic medical students who chose a primary care specialty increased from 28.1% (676 students) in 2007 to 33.2% (1377 students) in 2016. Among graduates, those above the 75th percentile of debt had a general move toward more non-primary care positions, with a value of 74.4% in 2007 and 79.9% in 2016. Graduates below the 25th percentile had a gradual increase in primary care representation, moving from 24.6% in 2007 to 29.4% in 2016. In 2007, graduates with a loan forgiveness/repayment program were more likely to choose primary care over graduates without such a program (OR, 0.681 [95% CI, 0.505-0.920]; P=.02). Analysis of subsequent years showed a declining OR with increasing significance. Results of this analysis indicated that increased educational debt loan directly influenced physician practice choice. Graduates with high debt burden were more likely to enter primary care fields and use loan forgiveness/repayment programs. Graduates with high debt burden who did not use loan forgiveness/repayment programs were more likely to enter non-primary care specialty fields, with this trend increasing as mean medical school debt increased. This association has implications for policies that could affect choice of primary care. However, further research is needed to fully understand the primary care choice by graduates of colleges of osteopathic medicine.

Investigating the Relationship between Personality Dimensions in Selecting a Field Specialty for Medical Students of Mashhad University of Medical Sciences

Introduction: selecting a specialty is one of the most difficult decision of medical practitioners, and this selection depends on personal factors, such as motives and dimensions of personality traits. Therefore, this study investigates relation between of dimensions of Personality traits on selecting the specialty for Medical Students of Mashhad University of Medical SciencesMethods: This cross-sectional study was conducted on 243 medical students of Mashhad University of Medical Sciences in 2016. Data were obtained from two demographics questionnaires and 125-item questionnaire of personality assessment according to Cloninger theory and TCI test. The association among 7 dimensions of personality traits in four groups including surgery-general, internal medicine, diagnostic and psychiatric specialties was assessed by applying SPSS software and Kruskal-Wallis and Mann-Whitney tests. In this study, a= 0.05 was considered as significance level. Results: There was a significant difference between men and women in reward dependency, harm avoidance and self-directedness (p <0.05).women had a higher mean in terms of reward dependence and harm avoidance, however, lower mean regarding the self-directedness dimension. There were significant differences regarding personality dimensions, harm avoidance, persistence and self-directedness among specialties (p <0.05), so that harm avoidance, persistence and self-directedness had the highest mean in psychiatric specialty, surgery-general specialty and diagnostic specialty, respectively. Conclusion: Considering that personality patterns in specialties can be different, thus, awareness of the association between personality traits and the selection of specialty can help students, managers and planners in the future.

Problematic issues of vocational guidance and professional selection of candidates for service in the agencies of the National Police of Ukraine

The author of the article has presented the results of the analysis of national approaches to the implementation of vocational guidance work among young people for the selection of police specialties. On this basis the author has singled out problematic issues in each of the vocational guidance areas (professional information, professional counseling, professional selection and professional adaptation).&#x0D; A number of general problems of vocational guidance among young people has been considered. The author has emphasized the general and special shortcomings in the organization and conduction of vocational guidance in regard to professional choice in general and professions related to the service in the units of the National Police of Ukraine, in particular. The general shortcomings include both the peculiarities of the organization of vocational guidance (lack of a unified system of vocational guidance work, insufficient level of interaction between the participants in the process of vocational guidance, lack of an individual, differentiated and phased approach to each individual while implementing professional choice, etc.) and its content component (low level of awareness of children, parents and teachers regarding the existing social professional inquiry; improper attention to the motivational component of the profession selection, etc.). The special shortcomings include the following: lack of awareness among young people about the peculiarities of different specialties (an investigator, an employee of operational units, a district police officer, etc.); lack of opportunity to try themselves in different types of law enforcement activities within the framework of interaction, for example, between district police station, educational institution, school and parents; insufficient use of media opportunities to adequately cover various aspects of police activities.&#x0D; The author has emphasized the necessity of creating an effective strategy of vocational guidance and qualitative selection procedure, referral and enrollment of young people to higher educational institutions with specific learning conditions.

The Rising Physicians Program: A Novel Approach for Mentoring Medical Students.

The transition to medical school is a particularly challenging time for new students as they are faced with significant academic responsibilities. Moreover, for many students at the Uniformed Services University they are adjusting to being on active duty in the military. Mentoring has been considered a way to help with the transition and professional development. Prior to 2015, there was no formal mentoring program for new students at the Uniformed Services University. In order to address the demands and challenges facing matriculating medical students, the Rising Physicians Program was created. This student initiated program enabled pre-clerkship medical students to connect with residents at the Walter Reed National Military Medical Center via a secure database with resident profiles. Residents were recruited and voluntarily agreed to serve as mentors. Students were then able to access the database and reach out to mentors based on their specific goals. The program was introduced to students during orientation and student participation was completely voluntary. A survey was designed using best survey practices and sent to the 175 students participating in the program for the 2015 academic (class of 2019) year to determine participation and characteristics of the program. Sixty-four percent (112/175) of the students from the class of 2019 participated in the post-implementation survey. Fifteen percent of the class (26/175) reported participating in the voluntary mentoring program. The three most commonly used communication methods with mentors in precedence were in-person, e-mail, and text messages. The majority of the students found their interactions in this program were beneficial and did not get in the way of their academic performance. The most common topics of discussion were academics (20%), mentor's past experience (22%), military lifestyle (7%), medical school pathways (23%), and specialty selections (23%). Limitations of the program included a lack of U.S. Air Force mentors and mentors within certain residency specialties. The Rising Physician Program provides a near-peer mentoring model for new medical students. Students preferred to communicate with their mentors in person, but the flexibility of communication appears to be important. New students have a variety of academic and professional development concerns that could partially be addressed through mentoring by residents.

Attitudes Of Final Year Dental Students Towards Postgraduate Specialization

Objective: The aim of this study was to understand the preferences of final year dentistry students in postgraduate specialization and explore the factors which influence them in making decisions regarding their future in pursuing postgraduate studies. Methodology: A cross-sectional survey was carried out between August 2017- January 2018 at four dental colleges across Karachi, including, three private sector and one public sector institution. A multiple choice, closed-ended questionnaire consisting of 8 statements was prepared and distributed among all the final year BDS students. 225 used and 200 student responses were recorded. Data was analyzed using SPSS version 23 and Chi Square was applied to achieve the results. Results: 81% of the respondents were females. 79% were in the age range of 22-23years. 63% age of students had parents that came from a professional background. 75% of the total respondents wanted to pursue postgraduate studies. The link between the age of the student, gender and the willingness to pursue postgraduate studies was found to be insignificant whereas with parental profession, it was significant (p value=0.016). 60% students believed that they had received enough specialty exposure and encouragement from their institutions to be able to decide on their postgraduate plans. The first choice of specialty for 28% students was Oral Surgery followed by Orthodontics and Endodontics for 22% respondents. The second choice of specialty for the students was Operative Dentistry for 30% of the students followed by 17% who preferred Orthodontics. The rest were divided among the other subjects. 36% of the students cited their aptitude for a specific field as the most common factor for affecting their decision on specialization. 28% cited job status/ prospects and financial reasons as the factor most likely to influence their decision on specialization. Conclusion: According to the study, there was no significant association between the age, gender and the preferences of the student towards postgraduate specialization. However, parental occupation was bound to play a role. The choices of the students as regards specialty selection and influencing factors are varied. As the trend towards postgraduate specialization in dentistry is gaining momentum, it is imperative to research this area more for better planning and allowing students to make informed decisions.

The Incentives Affecting the Selection of Future Specialty of Medical Interns

Background: The dramatic increase in the number of general practitioners and their limited job situations has increased the desire to continue studies in specialized fields. However, different fields are not desired in the same way. Therefore, to plan for the guidance of general practitioners towards fields needed for the society, understanding the motives for choosing a field is necessary. The present study is aimed to investigate the incentives affecting the selection of specialty field in the students of medicine of Mashhad University of Medical Sciences. Methods: This cross-sectional study was conducted on 243 interns. In this study, the medical school graduation questionnaire was used. After collecting the data, they were first coded into fields and then in four groups of surgery, internal medicine, diagnostics medicine, and psychiatry and analyzed using SPSS software version 19 and Chi-square and Mann-Whitney tests. Results: In this study, the five most popular fields were radiology, cardiovascular, ophthalmology, pathology, and dermatology, respectively. Fields with the least interest were infectious diseases, oncology and internal medicine. There was a significant difference between the desired field and sex (p = 0.003). Among factors affecting the choice of specialty, good income had the highest mean, which was significantly different between men and women (p = 0.011). Conclusion: Currently, it seems that students are more concerned with issues such as income and the ease of study than they are concerned with their interests and academic qualities and competencies.

Comparing Perceptions of Pathology as a Medical Specialty Between Canadian Pathologists and Pre-Clinical Medical Students

Medical student specialty selection is complex and multifactorial. Pathology is often not selected as a primary career choice, despite its importance to patient care. Previous studies identified negative pathologist stereotypes and pathologist “invisibility” as potential reasons for this. Our objective was to better understand students’ perceptions of pathologists and how these contrast to the reality of practicing pathologists. Medical students at Western University and Canadian pathologists participated in online surveys. Descriptive and mean comparisons were used to understand whether their perceptions were similar or different. Students found pathology interesting and clinically relevant. They felt that pathologists appeared more satisfied with their careers than other doctors, yet only one student intended to pursue a career in pathology. Although their estimation of pathologist workload was accurate, they did not understand what pathologists did on a daily basis and overestimated the time pathologists spent examining deceased persons. Although medical students see the value and benefits of pathology, it is not an attractive career option, perhaps in part due to lack of understanding. To maintain adequate staffing in pathology departments, misconceptions need to be addressed and schools should consider actively seeking applicants who may be interested in a diagnostic specialty.

Gender-based analysis of factors affecting junior medical students\u2019 career selection: addressing the shortage of surgical workforce in Rwanda

BackgroundThere is a strong need for expanding surgical workforce in low- and middle-income countries. However, the number of medical students selecting surgical careers is not sufficient to meet this need. In Rwanda, there is an additional gender gap in speciality selection. Our study aims to understand the early variables involved in junior medical students’ preference of specialisation with a focus on gender disparities.MethodsWe performed a cross-sectional survey of medical students during their clinical rotation years at the University of Rwanda. Demographics, specialisation preference, and factors involved in that preference were obtained using questionnaires and analysed using descriptive statistics and odds ratios.ResultsOne hundred eighty-one respondents participated in the study (49.2% response rate) with a female-to-male ratio of 1 to 2.5. Surgery was the preferred speciality for 46.9% of male participants, and obstetrics/gynaecology for 29.4% of females. The main selection criteria for those who had already decided on surgery as a career included intellectual challenge (60.0%), interaction with residents (52.7%), and core clerkship experience (41.8%) for male participants and interaction with residents (57.1%), intellectual challenge (52.4%), and core clerkship experience (52.4%) for female participants. Females were more likely than males to join surgery based on perceived research opportunities (OR 2.7, p = 0.04). Male participants were more likely than their female participants to drop selection of surgery as a speciality when an adverse interaction with a resident was encountered (OR 0.26, p = 0.03).ConclusionThis study provides insight into factors that guide Rwandan junior medical students’ speciality preference. Medical students are more likely to consider surgical careers when exposed to positive clerkship experiences that provide intellectual challenges, as well as focused mentorship that facilitates effective research opportunities. Ultimately, creating a comprehensive curriculum that supports students’ preferences may help encourage their selection of surgical careers.

UK nationals who received their medical degrees abroad: selection into, and subsequent performance in postgraduate training: a national data linkage study

ObjectivesTo compare the likelihood of success at selection into specialty training for doctors who were UK nationals but obtained their primary medical qualification (PMQ) from outside the UK (‘UK overseas...

Unpacking the dark variance of differential attainment on examinations in overseas graduates.

Differential performance in postgraduate examinations between home medical graduates and those who qualified outside their country of practice is well recognised. This difference is especially marked in the practical component of the UK Membership of the Royal College of General Practitioners (MRCGP) examination. The potential causes of such disparities are not well understood. Data were available for 1874 international medical graduates who applied for general practice (GP) specialty training in the UK in 2008-2012. The primary outcome was performance in the Clinical Skills Assessment (CSA) OSCE component of the MRCGP. The main predictors were performance on a situational judgement test (SJT) and clinical problem-solving test (CPST), a test of applied clinical knowledge, used in the selection for GP training. Data relating to demographic characteristics and English language fluency were also available. To better understand the relationship between the predictors, the selection measures and the outcome, a series of univariable and multivariable models were developed and tested, concluding with a structural equationmodel to explore causality. The CSA rating was more strongly predicted by SJT scores (standardised beta, 0.26) than by performance on the CPST (standardised beta, 0.17). There was a relationship between English language fluency and CSA score that was mainly mediated via SJT performance. These findings demonstrate that performance on an SJT predicts performance in a high-fidelity clinical simulation (the CSA) in international medical graduates. Although the constructs tested by SJTs are debated, and are likely to vary across settings, culturally appropriate knowledge of interpersonal competence is likely to be evaluated. Improving the confidence of doctors in this area through targeted educational interventions, rather than focusing on increased clinical knowledge, is likely to be more effective at reducing disparities observed in postgraduate examination performance. Thus, there are important implications for the design of specialty selection and licensing assessments globally.

The Stability of Factors Influencing the Choice of Medical Specialty Among Medical Students and Postgraduate Radiology Trainees

ObjectiveTo investigate whether general psychological motivating factors that guide career selection of a medical specialty differ over the course of medical school and to compare differences in motivating factors among students choosing “controllable” lifestyle specialties, students choosing “uncontrollable” lifestyle specialties, and a cohort of radiology residents. Materials and MethodsAn anonymous survey was distributed to first- through fourth-year medical students and radiology residents at a single institution. Participants were asked to select their top three of seven factors that most influenced their choice of medical specialty. Fourth-year students were asked to designate the specialty to which they had applied. ResultsThe survey was distributed to 259 students and 47 radiology residents with a response rate of 93.8% (243 of 259) and 95.7% (45 of 47), respectively. The top three factors indicated by medical students were finding the daily work fulfilling, work–life balance, and interest in the subject. These top three factors were common to all medical student classes and did not differ between students choosing “controllable” versus “uncontrollable” fields. The factors uncommonly selected were similar personality to others in the field, attending income, competitiveness or prestige, and job market conditions. For radiology residents, the top three motivating factors were the same as for medical students. ConclusionThree out of seven motivating factors were universally important to trainees, regardless of their stage of medical training or their selection of a controllable versus uncontrollable lifestyle specialty. These data suggest the variety of career choices made by students may not derive from differing underlying values.