Specialty Selection Research Articles

Medical student hand preference, perceived dexterity, and impact of handedness on training

BackgroundThe ubiquity of right-handed instruments and a predominance of right-handed surgical faculty present a challenge to left-handed trainees. Little is known about hand preference and its impact on specialty selection. We sought to evaluate hand preference, perceived dexterity, and impact of handedness on training among medical students. Materials and methodsA survey was distributed to third and fourth year medical students. Hand preference was queried for various activities. A Likert scale was used to assess perceived dexterity and impact of handedness on training. Fisher's exact test was used to compare groups. ResultsOf those queried, 131 (37%) responded. Handedness was defined by writing preference: right (80%), left (18%), other (2%). Left-handed students were more likely to perceive themselves to be ambidextrous (50% versus 15%; P < 0.001) and prefer their contralateral hand for at least one other activity (50% versus 4%; P < 0.001). Left-handed students were significantly more likely to report that handedness affected their specialty selection (33% versus 10%; P < 0.01) and training (58% versus 6%; P < 0.001). In addition, they reported that they would benefit from additional training with right-handed instruments (61% versus 31%; P < 0.01), availability of left-handed instruments (63% versus 8%; P < 0.001), and trainers who adapted to their handedness (70% versus 14%; P < 0.001). ConclusionsLeft-handed medical students reported greater ambidexterity and adverse impact of handedness on training. These results provide a contemporary snapshot of hand preference in medical students and an argument for improving and adapting surgical training for left-handed individuals.

Technical flaws in multiple-choice questions in the access exam to medical specialties ("examen MIR") in Spain (2009-2013).

BackgroundThe main factor that determines the selection of a medical specialty in Spain after obtaining a medical degree is the MIR (“médico interno residente”, internal medical resident) exam. This exam consists of 235 multiple-choice questions with five options, some of which include images provided in a separate booklet. The aim of this study was to analyze the technical quality of the multiple-choice questions included in the MIR exam over the last five years.MethodsAll the questions included in the exams from 2009 to 2013 were analyzed. We studied the proportion of questions including clinical vignettes, the number of items related to an image and the presence of technical flaws in the questions. For the analysis of technical flaws, we adapted the National Board of Medical Examiners (NBME) guidelines. We looked for 18 different issues included in the manual, grouped into two categories: issues related to testwiseness and issues related to irrelevant difficulties.ResultsThe final number of questions analyzed was 1,143. The percentage of items based on clinical vignettes increased from 50 % in 2009 to 56-58 % in the following years (2010–2013). The percentage of items based on an image increased progressively from 10 % in 2009 to 15 % in 2012 and 2013.The percentage of items with at least one technical flaw varied between 68 and 72 %. We observed a decrease in the percentage of items with flaws related to testwiseness, from 30 % in 2009 to 20 % in 2012 and 2013. While most of these issues decreased dramatically or even disappeared (such as the imbalance in the correct option numbers), the presence of non-plausible options remained frequent.With regard to technical flaws related to irrelevant difficulties, no improvement was observed; this is especially true with respect to negative stem questions and “hinged” questions.ConclusionThe formal quality of the MIR exam items has improved over the last five years with regard to testwiseness. A more detailed revision of the items submitted, checking systematically for the presence of technical flaws, could improve the validity and discriminatory power of the exam, without increasing its difficulty.

Influence of Course in Medical Ethics and Law on Career Plans of Medical Students

Background: The significant increase in medical disputes and lawsuits in recent years in Taiwan has severely affected behavior and ecology in medical practice. For this reason, we designed integrated courses on ethics and law and conducted a questionnaire-based career plan study to understand whether these issues influence their specialty selection process. Method: We randomly selected sixth-year medical students that rotated to our hospital to take an integrated course on medical ethics, laws and regulations, and problem-based learning. The students completed the same questionnaire before and after the course. We used a five-point Likert scale for agreement. In addition to calculating the proportion of agreement, we used paired t-tests in the question items before and after the course at a 0.05 level of significance. A qualitative analysis was also made. Results: This study included 98 medical students, 65 of whom were male, and 33 were female. In terms of reasons for studying medicine, the question item with the highest agreement proportion was I chose to study medicine because being a doctor will enable me to lead a stable life; in terms of career plans, it was I will choose my specialty based on my personal aspirations and interests. On agreement scale, significant increases were presented in I will choose my specialty based on my personal aspirations and interests and I will choose my specialty based on my sense of accomplishment. However, a significant reduction was found in I will choose my specialty based on quality-of-life considerations. Qualitative analysis indicated that the students learnt that acquiring good communication skills and fulfilling the obligation to obtain informed consent are the fundamental means of preventing medical disputes. Conclusion: After completing the course, medical students put greater emphasis on personal aptitude, interests, and sense of accomplishment, and less on quality-of-life in choosing a specialty.

MEDICAL GRADUATES?

A universal challenge faced by developing countries these days is the inequitabledistribution of health professionals, which compromises the capacity of the health system todeliver efficient and effective health care. Availability of reliable data on medical graduatesis important for health planning and development of policies and plans dealing with healthworkforce labour market. Objectives: To determine the proportion of medical graduates whoremained affiliated with the profession three to six years after graduation from a private medicalschool, To find out the specialty selection and practice location of these graduates, and todetermine the association between their gender and affiliation with the profession. Methods:A cross-sectional study was undertaken at the Lahore Medical &amp; Dental College from March toMay 2014 selecting graduates through convenience sampling. The graduates were contactedthrough e-mail, Facebook and telephone. After obtaining voluntary informed consent fromthe respondents, a pre-tested structured questionnaire was used to collect information.Thedata was recorded and analysed using the statistical package for social sciences version 16.0.Chi-square test is used to test statistical significance between respondent’s gender and theiraffiliation with the medical profession at p &lt; 0.05. Results: A large proportion 98(88%) ofmedical graduates remained affiliated with the profession. Those who didn’t pursue it were allfemales (p &lt; 0.05). Majority 86(88%) were located in Pakistan. A greater proportion worked inthe tertiary health care facilities 65(94%). The popular specialty being pursued was medicine24(24%). Conclusion: Female medical graduates should be provided opportunities for parttime work.Medical schools should provide early and prolonged exposure of students to primaryhealth care facilities, in order to increase their uptake of rural postings.

Abstract No. 386 - Gender specific preferences influencing interventional radiology specialty selection for medical students

In the upcoming years, interventional radiology will be transitioning from a fellowship to a residency program. In 2012-2013, only 15% of interventional radiology fellows were women. The purpose of our study is to evaluate gender specific preferences that may influence medical student specialty selection for residency, in particular interventional radiology. An online survey was distributed via email to assess gender specific preferences that influence specialty selection for medical students. The survey drew parallels to prior investigations looking at similar factors in comparable fields such as interventional cardiology. This survey also inquired about educational exposure to diagnostic radiology and interventional radiology during the medical school. Participation was elicited from medical schools in the Tri-state area on a voluntary basis. Statistical analysis was performed using fisher exact test with p value of < 0.05 set for significance. 106 medical students answered the distributed survey. Of those 58% (n=61) of responders were females and 42% (n=45) were males. 56% of males are considering Interventional Radiology as future specialty, as opposed to 21% of females (p=0.01). The top five deterring factors for females in terms of specialty selection were radiation exposure, extended work hours, call responsibilities, length of career and male predominance. Specifically the two significant deterring factors for females were call responsibilities and male predominance (p=0.02). Interventional radiology exposure was similar between males and females and less than that diagnostic radiology. However, males were also more likely to be part of an IR interest group in their medical school than females (p=0.003). Radiation exposure is still the number one factor that deter medical students from selecting interventional radiology as a career. Interestingly the factors that distinctly deter females rather than males from this field are the call responsibilities and current male dominance in the field.

Abstract W P423: Women Perceive Differences in Stroke Prevention Care Based on their Primary Care Physician’s Specialty

BACKGROUND: Women have higher lifetime risk of stroke than men. Many women rely solely on their Ob/Gyn as their PCP; however, there are no data on women’s perceptions of stroke prevention (SP) care by their Ob/Gyn. OBJECTIVES: to explore (1) women’s perceptions of SP based on their PCP’s specialty; (2) if ethnicity or age influenced women’s selection of PCP specialty; and (3) women’s awareness of stroke prevalence and preferences for which type of PCP address their stroke risk factors. METHODS: We administered surveys to 224 women at Ob/Gyn (n = 132) and PCP (n = 94) clinics in Brooklyn, NY. Surveys consisted of 16 questions on patient demographics, awareness of stroke prevalence, stroke risk factors, specialties of physicians they regularly visit, preferences for SP and SP care received. Kruskall-Wallis and Mann-Whitney tests were used to compare ordinal variables. Fisher’s exact test was used for categorical variables. RESULTS: We found a difference (p &lt; 0.0001) in the mean age (but not in other demographic variables) of women who only visited an Ob/Gyn (30.0yrs±6.0) compared with those who visited an Ob/Gyn and another PCP (44.2±15.9) and those who visited at least one non-Ob/Gyn PCP (55.7±17.7). Women recalled: BP measurement by Ob/Gyn in 75% vs. 95% by other PCP (p&lt;0.001); cholesterol measurement by Ob/Gyn 24% vs. other PCP 59% (p&lt;0.0001); diabetes screening (p = 0.17) and weight measurement (p = 1.0) were similar. Awareness of stroke prevalence differed (p = 0.04) among women visiting only an Ob/Gyn (mean 0.5±0.7 correct answers), women visiting Ob/Gyn and at least one other PCP (1.0±0.8) and women visiting only a non-Ob/Gyn PCP (1.2±0.8). Women reported a greater preference for addressing SP with their non-Ob/Gyn PCP (73%) vs. their Ob/Gyn (2%) vs. no preference (26%). CONCLUSIONS: Ob/Gyn are perceived to provide less SP care than non-Ob/Gyn PCP. However, most women would prefer to address SP with their non-Ob/Gyn PCP. Women who visit only an Ob/Gyn and no other PCP were younger and less aware of stroke prevalence than women who visited other PCP. This surrogate approach to actual SP care evaluation suggests a need for assessing Ob/Gyn practices in SP.

Determinants of specialty choice of resident doctors; Case study- among resident doctors in Nigeria

This study examined medical specialty selection by Nigerian resident doctors using a marketing research approach to determine the selection criteria and the role of perceptions, expected remuneration, and job placement prospects of various specialties in the selection process. Data were from the Community of residents from April 2014 to July 2014. The cohort included 200 residents, but only 171 had complete information. Data were obtained from a cross section of resident doctors in the Lagos State University Teaching Hospital and at the 2014 Ordinary General Meeting of the National Association of Resident Doctors(NARD) where representatives from over 50 Teaching hospitals in Nigeria attended. Using a client behaviour model as a framework, a tripartite questionnaire was designed and administered to residents to deduce information on their knowledge about and interests in various specialties, their opinions of sixteen specialties, and the criteria they used in specialty selection. A total of 171 (85.5%) questionnaires were returned. ln many instances, consistency between selection criteria and perceptions of a specialty were accompanied by interest in pursuing the specialty. Job security, job availability on completion of programme, duration of training and qualifying examinations were highly correlated with p value < 0.05. Results of the Principal Component Analysis show two components (with Eigen values greater than one) explaining 65.3% of the total variance. The first component had placement and training and practice related variables loaded on it while the second component was loaded with job security and financial remuneration related variables. Using marketing research concepts for medical specialty selection (Weissmanet al 2012) stipulates that choice of speciality is influenced by criteria and perception. This study shows that job security expected financial remuneration, and examination requirements for qualification are major determinants of the choice of speciality for residents.

Clerkship in primary care: a cross-sectional study about expectations and experiences of undergraduates in medicine.

Introduction: With the amendment of the medical licensure act (Approbationsordnung) in 2012, a four-week clerkship in primary care (FHV) became mandatory. We investigated the expectations with which students begin the FHV, which criteria are relevant in selecting the location for the FHV, and the experiences the students had during the FHV.Method: In a cross-sectional study, all third-year students at both medical schools in Saxony-Anhalt were surveyed in 2013 about their expectations and experiences regarding the FHV. This is the last cohort for which the FHV is optional. Questions were asked about 29 items addressing six topics (personal information, selection of FHV location, selection of FHV medical practice, expectations, experiences, and specialty selection).Results: Out of a student body of 446, responses were received from N=424 (response rate 95.1%; of which 61.8% female). Of these students, 71 (16.7%) had completed the FHV and 70 (16.5%) were planning to; another 267 students (63%) had not (yet) planned to participate in an FHV. Where a student’s parents lived, personal recommendations of a particular medical practice and the attractiveness of the region were the most important criteria for selecting the clerkship site. After completing the FHV, the learning objectives reflected themselves in the experiences of the students in a similar order and significance as in the expectations of students who planned or had not (as of yet) planned to complete the FHV. A relevant influence of the FHV confirming the choice to specialize in general practice or outpatient care was not indicated by those who had completed the FHV.Conclusion: After location and practice, the FHV is selected according to personal criteria and in connection with prioritized learning objectives. From the students’ perspective, the most frequently named learning objectives are also identified as acquired experience after completing the FHV. However, the FHV does not have a reinforcing effect on the selection of general practice as a specialty.

Role models play the greatest role - a qualitative study on reasons for choosing postgraduate training at a university hospital.

Objective: Why physicians choose a certain specialty at a university hospital for their postgraduate training is incompletely understood. Our aim was to identify factors that led physicians from different generations to opt for postgraduate training in a specialty with high or low patient contact at a university hospital. Methods: We conducted 14 semi-structured interviews with residents and attending physicians from the departments of Internal Medicine (high patient contact) and Laboratory Medicine (low patient contact) at the University Hospital Hamburg-Eppendorf, Germany. We used template analysis to code the interview transcripts and iteratively reduced and displayed the data. Initial codes and concepts were shaped into categories until agreement on the final template was reached.Results: We identified five main categories of factors that influenced postgraduate specialty selection. Role models with a civilized code of behavior and expertise in their specialty had had the greatest influence on participants’ choice of a specialty across generations. Electives and a doctoral thesis project had also influenced participants’ decisions, mainly because of meeting a role model in their supervisor. Patient contact and intellectual challenges were identified as contributing factors in the selection of a specialty with high patient contact. As reasons for selecting a university hospital for postgraduate education four categories were identified: the possibility to participate in scientific research, a broad spectrum of activities, personal contacts and future career opportunities.Conclusions: The professional attitudes of teachers as role models were identified as having the greatest influence on postgraduate education choices. Besides other actions to attract students to certain specialties for their postgraduate education, the aspect of being perceived as a role model while teaching requires particular attention when preparing medical faculty for undergraduate medical teaching.

Medical student mentorship in radiation oncology at a single academic institution: A 10-year analysis

PurposeMentorship has been identified by medical students, residents, and faculty as an important component of specialty selection and research productivity in radiation oncology. This study quantitatively analyzes the impact of a mentorship program in radiation oncology targeted to medical students at our institution. Methods and materialsWe performed a retrospective review of 76 current or former medical students who were mentored by faculty radiation oncologists at our institution between 2004 and 2013. Data were collected from the medical school’s Office of Student Affairs and from internal departmental records. Mentees were organized by mentorship tracks, which included a clinical track and a research track. For each track, data were compiled and analyzed for student specialty selection, and Fisher exact tests were used to determine the relative significance of exposure to clinical, research, or both tracks on student likelihood of pursuing residency in radiation oncology relative to other specialties. We further tracked the research productivity of mentees in the program, as determined by the number publications that were coauthored by mentees and mentors each year. ResultsThe absolute number of mentees has grown each year, with a total of 76 mentees, including 58 alumni, at the end of 2013. Mentees in the program have produced a total of 53 manuscripts, given 75 presentations at national conferences, and received numerous national and internal medical school research awards. Of the 58 alumni, 17 (29.3%) applied to and matched into radiation oncology residencies. Alumni of both the research and the clinical track were 5.76 (P < .01) times more likely to enter a radiation oncology residency program than the average single-track alumnus. ConclusionsMentorship in medical school is an important factor in the development of future radiation oncologists. These results demonstrate the positive impact mentorship has on specialty selection and research productivity.

The personality of emergency nurses: is it unique?

With ever increasing demands on emergency services it is necessary to consider how to enhance the recruitment and retention of emergency nurses in public hospitals. Personality is known to influence occupational choice, yet there is a lack of research exploring how personality may influence the workforce decisions of emergency nurses. A standardised personality test instrument, the NEO™-PI-3, was used in a survey design inclusive of demographic questions to measure personality characteristics. Data were collected from 72 emergency nurses working at an Australian Emergency Department between July and October 2012. The personality scores of emergency nurses were compared against general population norms in each of five personality domains and their 30 associated facets. Participants scored higher than population norms in the domains of Extraversion (p < .001), Openness to experience (p < .001) and Agreeableness (p = .001), and in twelve facets, including excitement-seeking (p < .001) and competence (p = .003). The personality profile of this sample of emergency nurses is different to the population norm. Assessment of personality and knowledge of its influence on specialty selection may assist in improving retention and recruitment in emergency nursing.

Düzce Üniversitesi Tıp Fakültesi 5. ve 6. sınıf Öğrencilerinin Branş Tercihleri ve Tıpta Uzmanlık Sınavı'na Bakışlarının İncelenmesi

Objective: In this study, it was aimed that analyzing career choices of Students of Medical Faculty and their opinions regarding Medical Specialty Selection Examination. Methods: At 2012-2013 education terms, 101 medical students from Duzce University participated in this cross sectional study. 58 (57,4%) of them were at 5th grade and 43 (42,6%) of the participants were at 6th grade. Career Choices, affecting factors, training course satisfaction, some demographic factors (age, gender, grade, type of high school graduated from), thoughts regarding to Medical Specialty Selection Exam and foreign language examination scores were questioned via the questionnaire based survey. Results: 41(40.6%) of the 101 participants who filled up the questionnaire based survey were male, 60(59.4%) of them were female. Their mean age was 23.6±0.9 years and most of them (n=50; 49.5%) had graduated from Anatolian High Schools. It is reported that top 5 training course according to student satisfaction as follows Emergency Medicine (n=16; 15,8%), Dermatology (n=16; 15.8%), Cardiology (n=11; 10.9%), Brain Surgery (n=9; 8.9%) and Pediatrics (n=7; 6.9%) (p<0.0001). It is also reported that top 5 areas according to the choices on Medical Specialty Selection Examination are as follows; Otolaryngology (n=11; 10.9%), Dermatology (n=9; 8.9%), Internal Medicine (n=8; %7.9), Plastic Surgery (n=8; 7.9%) and Psychiatry (n=8; 7.9%) (p<0.0001). If we compare male and female students, male students prefer sports medicine (n=5; 12.2%), whereas female students prefer Otolaryngology (n=9; 15.0%) in the first rank of their choices. Conclusion: It is reported that regarding to Medical Specialty Selection Examination choices; in addition to gender differences, “impacts on family and private life and properties of academic career” are also the most affecting factors

Motivations and Demographics of I-6 and Traditional 5+2 Cardiothoracic Surgery Resident Applicants: Insights From an Academic Training Program

The introduction of the integrated 6-year cardiothoracic surgery residency (I-6) has changed the training paradigm for future cardiothoracic surgeons. Increased interest in these programs emphasizes the need for an understanding of the applicant pool and of their differences from the traditional trainee (5+2). National trends (National Resident Matching Program data), objective (Electronic Residency Application Services documents, United States Medical Licensing Examination [USMLE] scores, transcripts) and subjective metrics (interviews, personal statements, and recommendation letters) were evaluated for invited applicants for I-6 and 5+2 positions in 2010, 2011, and 2012. Demographics and motivations for specialty selection were determined. Statistical analyses were performed with Student's t test for continuous variables and Fisher's exact test for categoric variables. The number of applicants completing the match for I-6 positions each year was as follows: 2010, 74 (49 United States [US]); 2011, 74 (53 US); 2012, 80 (59 US). The number completing the match for 5+2 positions was as follows: 2010, 93 (67 US); 2011, 87 (55 US); 2012, 90 (63 US). For I-6 positions we interviewed 9 candidates in 2010, 17 in 2011, and 16 in 2012; for the 5+2 program we interviewed 14 candidates in 2010, 17 in 2011, and 13 in 2012. Both groups had a similar percentage of female applicants, number of US medical graduates, additional degrees, and membership in Alpha Omega Alpha. The I-6 applicants were younger (mean age, 27.4 years), were less likely to take time off for research (43.5% vs 72.7%), were less published, and had higher surgery clinical honors and USMLE scores. The 5+2 applicants were less likely to have done a cardiothoracic medical school rotation and had done senior-level rotations on general thoracic during residency; yet, only 29.5% had done a senior level cardiac rotation. The most frequently cited motivation was a clinical encounter during a cardiothoracic rotation for both (94.9% I-6 applicants, 88.6% 5+2 applicants). The I-6 applicants had more interest in minimally invasive techniques. There were no differences in the influence of a mentor or a desire for an academic career. Institutional strategies to increase medical student and general surgery resident exposure to cardiothoracic surgery clinically will optimize our ability to attract and train the best candidates in our specialty.

Relationship between personality traits and choosing a medical specialty.

The recent imbalance in the labor market structure of medical specialists can cause problems in access to care, and result in lower quality and increased costs of medical care. The labor market structure of medical specialists requires discussion in relation to specialty selection and personality traits. This study examined the relationship between personality traits and specialist selection among medical students. This study used the Edwards Personal Preference Schedule and a customized questionnaire. The participants were 358 medical students of the College of Medicine at Chang Gung University. Medical students scored the highest in Intraception and the lowest in Deference. Women scored significantly higher compared to men for Intraception, Succorance, and Change, whereas men scored significantly higher than women for Dominance and Heterosexuality. Medical students who have family or friends who are also physicians scored higher in Affiliation and lower in Deference than other medical students. Medical students who did not participate in extracurricular activities scored higher in Aggression than those who did. Fourth-year medical students scored significantly higher in Succorance than 7(th)-year medical students. A significant difference was found among medical students of different specialties regarding Exhibition, Autonomy, Intraception, Succorance, and Nurturance. Surgery students scored significantly higher in Exhibition than general medicine students. Students who chose a specialty scored higher in Autonomy than general medicine students. General medicine students scored higher in Intraception and Succorance than surgery students. The results of this study can be used as a frame of reference in the field of medical education or in the formulation of governmental policies regarding physician human resource management.

Gender differences in the learning and teaching of surgery: a literature review.

ObjectivesTo explore evidence concerning gender differences in teaching and learning in surgery to guide future initiatives.MethodsThis systematic review was conducted searching in the following electronic databases: MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, Scopus and PubMed. All studies related to gender differences in surgical education, teaching or learning of surgery at an undergraduate level were included. Data was extracted and critically appraised. Gender differences in learning, teaching, skills acquisition, perceptions and attitudes, interest on surgery, personality and factors influencing interest in surgical careers were differentiated.ResultsThere is an underrepresentation of women in surgical academia, due to lack of role models and gender awareness. It is not clear whether or not gender itself is a factor that affects the learning of surgical tasks. Female students pursuing a surgical career had experienced sexual harassment and gender discrimination that can have an effect on the professional identity formation and specialty choice. There are differences in personality among female and male students interested in surgery. Gender is a determining factor to choose surgery, with a consistent lower proportion of women compared interested in pursuing a surgical career. Mentoring and personality fit are important in medical student’s specialty selection. Female students are more likely to be discouraged from pursuing a surgical career by a lack of female role models.ConclusionsBias against women in surgery still exists. There is a lack of studies that investigate the role of women in the teaching of surgery.

The FacharztDuell: innovative career counselling in medicine.

Objective: The selection of a future medical specialty is a challenge all medical students face during the course of their studies. Students can choose from more than sixty specialties after graduation. There is usually no structured career counselling program available at German medical faculties. So far only little data on acceptance, formats and effects of different career counselling programs are available.The aim of this study is to describe an innovative format of career counselling for medical students including its evaluation of acceptance and its possible influence on medical specialty preferences. Methods: The need for career counselling became evident after the analysis of mentor-mentee conversations held within the mentoring program of our medical faculty, an online-based survey, an ad-hoc focus group and a pilot event. Panel discussions as an interactive format of presenting related medical specialties were developed and hence held four times under the name “FacharztDuell”. Students evaluated all events separately with a questionnaire and changes in medical specialty choice preferences were documented using an Audience-Response-System (ARS). The FacharztDuell is organized regularly and supported by faculty teaching funds. Results: Among the student body FacharztDuell was well accepted (an average of 300 participants/event) and rated (average grade of 1.8 (SD= 0.7, 1=very good, 6=unsatisfactory, n=424). On average, 77.8% of the participating students considered the FacharztDuell to be a decision support for their future selection of a specialty. Up to 12% of the students changed their medical specialty choice preference throughout the event. Conclusion: FacharztDuell was well accepted by medical students of all semesters and seems to be supportive for their selection of a future medical specialty. However, longitudinal studies are necessary to better understand the decision making process of medical students along their career path.The FacharztDuell is easily transferrable to other faculties with respect to organization, staff and technical resources.

Perceptions of Greek medical students regarding medical profession and the specialty selection process during the economic crisis years

PurposeTo assess the beliefs and preferences of 6th year Greek medical students, regarding medical profession and the specialty selection process, in the years of financial crisis. SettingDemocritus University of Thrace, Medical School, Alexandroupolis, Greece. Material and methodsA custom questionnaire based on former similar studies was developed and administered to senior medical students. Further to demographics, the questionnaire gathered information on perceptions and trends regarding medical profession, the specialty and residency selection processes. Total question scores were summed for comparisons among questions. Mean scores and standard deviations were calculated for comparisons between student groups. Results111 students responded successfully to the instrument. “Helping patients” and the “scientific basis of medicine” were the fundamental reasons for choosing the medical profession. Compared to women, male students placed greater importance on the “financial allowances” (men: 3.73±1.03, women: 3.05±1.30, p=0.01). Regarding the selection criteria for a certain specialty, “challenging specialty” and “bedside specialty”, were the main influence factors. Men more strongly preferred a specialty that could “financially support their desired lifestyle” (men: 3.93±0.88, women: 3.41±1.30, p=0.02). Concerning selection criteria of a residency program, students chose a “well structured” program at a “recognized hospital/department”. Regarding the country of preference for their residency, 86% planned to continue abroad, primarily in Germany and the United Kingdom. ConclusionGreek medical students perceive the medical profession and the specialty process in a similar way like their colleagues form Western countries. However, the vast majority identify that migration to another country is the most promising alternative choice for their medical career.

The Influence of Medical Liability Premiums on Obstetrics and Gynecology Specialty Selection

INTRODUCTION: The objective of this study was to determine if statewide malpractice premiums correlate with rates of selection of obstetrics–gynecology specialty by U.S. medical graduates during the years 2001–2005. METHODS: Longitudinal cohort study involving U.S. medical graduates applying through the Electronic Residency Application System. All applicants to obstetrics and gynecology residency programs from 2001 to 2005 were identified and pooled by medical school. State medical liability premium data were abstracted from national survey data. Correlation of the proportion of students matching into obstetrics–gynecology to mean state liability premium was analyzed on a state-by-state level, then by annualized premium tercile, and overall median national liability premium. RESULTS: A total of 82,709 graduates from 122 schools in 45 states were identified, of whom 4,926 matched into obstetrics–gynecology. During the study period, the median liability premium in the United States increased from $40,093 to $74,447. The state-by-state analysis revealed a poor correlation between the obstetrics–gynecology selection rate and medical liability premium (R2=0.06). Categorical analysis by annualized premium tercile revealed a statistically significant relationship between malpractice premium tercile and obstetrics–gynecology selection frequency (lower tercile: premium=$35,228, selection frequency=6.92%; middle tercile: premium=$55,150, selection frequency=6.30%; upper tercile: premium=$89,930, selection frequency=5.47%; P<.001). The overall U.S. analysis similarly revealed a statistically significant relationship between premiums and selection of obstetrics–gynecology (R2=0.80, P=.04). CONCLUSIONS: Increasing state medical liability premiums were inversely correlated to decreased selection rates of obstetrics–gynecology as a career by U.S. medical graduates during the most recent period of medical malpractice crisis.

Addressing the nation's physician workforce needs: The Society of General Internal Medicine (SGIM) recommendations on graduate medical education reform.

The Graduate Medical Education (GME) system in the United States (US) has garnered worldwide respect, graduating over 25,000 new physicians from over 8,000 residency and fellowship programs annually. GME is the portal of entry to medical practice and licensure in the US, and the pathway through which resident physicians develop the competence to practice independently and further develop their career plans. The number and specialty distribution of available GME positions shapes the overall composition of our national workforce; however, GME is failing to provide appropriate programs that support the delivery of our society's system of healthcare. This paper, prepared by the Health Policy Education Subcommittee of the Society of General Internal Medicine (SGIM) and unanimously endorsed by SGIM's Council, outlines a set of recommendations on how to reform the GME system to best prepare a physician workforce that can provide high quality, high value, population-based, and patient-centered health care, aligned with the dynamic needs of our nation's healthcare delivery system. These recommendations include: accurate workforce needs assessment, broadened GME funding sources, increased transparency of the use of GME dollars, and implementation of incentives to increase the accountability of GME-funded programs for the preparation and specialty selection of their program graduates.

Academic Achievement and Primary Care Specialty Selection of Volunteers at a Student-Run Free Clinic

Background: Previous studies have reached conflicting conclusions about the associations between service and academic achievement and service and primary care specialty choice. Purposes: This study examines the associations between service at a student-run clinic and academic achievement and primary care specialty choice. Methods: Retrospective review of medical student service and statistical analysis of grade point average (GPA), Step 1 and Step 2 Clinical Knowledge (CK) scores, and specialty choice were conducted, as approved by our Institutional Review Board. Results: Volunteers, compared to nonvolunteers, had higher GPA (3.59 ± 0.33 vs. 3.40 ± 0.39, p < .001), Step 1 (229 ± 19 vs. 220 ± 21, p < .001), and Step 2 CK (240 ± 18 vs. 230 ± 21, p < .001) scores, but did not pursue primary care specialties at a significantly higher percentage (52% vs. 51%, χ2 = .051, p = .82). Conclusions: Further exploration of the associations between service and academic achievement and primary care specialty choice is warranted.