Integrated Medical Education Resources: 120824P

Written and prepared by Professor Omar Hasan Kasule Sr.

GENERAL FACTORS OF CAREER CHOICE

Personal interest: Many factors, some unknown and unrecognized, play a role in the career choice decision. A study with disturbing findings showed that student career choice was not guided by previous experience or knowledge of the area meaning that trust of expressed choices should be taken with caution[1]. On entry into medical school the students are idealists wanting to study medicine for intellectual and personal fulfillment, getting community respect, financial security as well as admiration for the doctor as a committed, smart, decisive leader with interpersonal skills[2]. As they progress through their studies to eventually choose their careers, their choices are driven by more pragmatic considerations. Lifestyle and earning potential were rated higher than research opportunities in career selection[3]. 'Personal interest' was rated by 80% of students as important in influencing their choice, followed by stability (58%), reputation of the specialty (56%) and lifestyle (55%)[4]. Career choices change and evolve with time. A UK prospective study showed that one quarter of post graduates were working in specialties other than what they chose at the start of their training[5].

Public interest: Career choices do not always match the needs of the country they tend to reflect student priorities. Graduates of a medical college in 1982 Bombay either went abroad (one quarter) and 90 percent of those who stayed in India went into private practice where they were satisfied with their career[6]. Career intentions of medical students in Sub Saharan Africa were not aligned to local health priorities[7]. A Canadian study showed a mismatch between student career preferences on entry into medical school and the needs of the different specialties[8].

Academic interest: US medical schools offered more research tenured tracks than educational or clinical tracks[9]. The proportion of US students planning full time clinical practice careers is decreasing[10]. Mistreatment in medical school turned students off academic careers[11]. Factors influencing choosing an academic career in hematology were presenting and publishing research, mentorship, intellect, and practice type. Those choosing a non-academic career were more concerned with lifestyle.[12].

Effect of prior exposure to the discipline: Dutch medical students who attended periods of training in a US academic center had a high chance of developing academic careers[13]. The nature of clerkship influenced specialty choice[14]. A sub-medicine internship did not affect students’ application to join internal medicine[15]. Clinical exposure was an important factor in choosing family medicine[16]. Preceptors have an impact on student career choices the impact being larger the longer the duration of contact[17]. Students from small colleges had more hands on experience and felt more confident at internship[18].

Professional success: Selection of an appropriate career, based on existing student attributes, ensures professional success and career satisfaction. A 10-year longitudinal study identified academic achievement as a predictor of professional competence, copying styles predicted career satisfaction, and levels of anxiety and depression predicted future quality of life. Professional stress was not predictable[19].

Career guidance: Career choice is neither easy nor straightforward and a lot if career guidance/counseling is needed. Medical students experience anxiety and depression due to external pressures to succeed in a medical career[20]. This anxiety may be positive when it spurs them to work and succeed and may be negative when it paralyzes their effort out of fear of failing. College based career advisory programs were more effective than one-to-one faculty advising about careers[21]. Fourth year medical students were satisfied with career advisory services at the college[22]. A UK study showed that students delayed career choices especially general practice however those from poorer areas has early career intentions[23].

Other factors: A US study showed that postgraduate experience was more important than undergraduate clinical attachments in determining career choices[24]. New Zealand data showed no relation between career choice and size if the secondary school or town of origin[25].

CHOICE OF PUBLIC AND PRIMARY HEALTH CARE DISCIPLINES

Public health: The proportion of students ending up in public health careers is higher than the proportion who expressed interest during medical school an indication that there are other factors operating in public health career choices[26].

General practice: A national survey in France showed low interest in general practice and increasing feminization of the profession[27]. Choice of general practice tracks were influenced by: 'Patient orientation'[28]. Older students in New Zealand differed from direct entry from school in a higher proportion taking up general practice as a specialty[29].

Primary care: Financial pressures after graduation were a disincentive for choosing a career in primary care[30]. Factors of choice of primary care were: interest in underserved populations, relationships with patients, scope of practice, and role models important in their career choice. Salary and competitiveness were "not at all" important.[31]. International health electives influenced choice of a career in primary health care and public health[32].

Community medicine: Canadian students had poor understanding of community medicine and had several misconceptions: irrelevant to clinical practice, no exclusive specialty, poor understanding of its role [33]

Family medicine: Students know income by specialty quite early in their career and their knowledge that family medicine has low income acted as a disincentive[34].

Geriatrics: Positive attitude to the elderly and female gender determined choice of geriatrics in Singapore[35] [36].

Rural practice: Factors that predicted rural practice for graduates of an American medical college were: growing up rural, planning rural practice, and planning family medicine [37]. A special program in Australia encouraged students to choose rural practice[38]. A longer rural clerkship increased choice of a rural career[39]. Clinical attachments encouraged US students to choose rural careers[40]. Medical students in Malawi from small towns and rural areas tended to work in rural areas[41].

CHOICE OF SURGICAL DISCIPLINES

Surgery: An international study revealed variation by country in favoring a surgical career with males preferring surgery more than females[42]. Some countries experiencing a decline while others experienced an increase[43] in surgical interest. Greek students had a low interest for surgical[44]. Malawian students preferred surgical disciplines over others with choice of specific surgical sub disciplines depending on the influence of the mentor[45]. Surgical demonstrations encouraged choice of surgical careers[46]. Canadian students choosing careers in surgery were: male, younger age, single, influenced by prestige, and hospital oriented[47]. Exposure was the most important factor making medical students choose a career in plastic surgery[48]. Brief exposure to a hand surgeon influenced student career preferences[49]. A study in Ireland showed that males preferred surgical disciplines while females preferred care disciplines of pediatrics and geriatrics[50]. An Irish study showed that three factors determined specialty choice among students: Future employment, career opportunities and intellectual challenge. Job prestige was addition factor for those interested in a surgical career. Lifestyle factors made surgery unpopular among women.[51]. Student choice of an orthopedic career was made prior to medical school, contact with faculty, clinical rotations, and anticipated income played a small role[52]. Exposure of students to endovascular surgery simulation increased student interest in this career path[53] [54]. Medical school and residency experiences determined choice of an academic neuro surgery career[55] [56]. Clerkship in surgery and a mentor predicted choice of a career in general surgery[57]. Being female and desiring a narrow scope of practice were factors favoring choice of an obstetric career[58].

CHOICE OF MEDICAL DISCIPLINES

Pediatrics: Support of medical students to undertake pediatric research motivated them to choose a career in pediatrics and especially in academic pediatrics[59]. Students in pediatric clerkships needed advice about career choice in addition to the clerkship experience[60].

Internal medicine (IM): Factors that influenced student choice of internal medicine were: educational experiences in IM, the nature of patient care in IM, and lifestyle. Students were more likely to pursue careers in IM if they were of male gender, attended a private school, had favorable impression with their educational experience in IM, had favorable feelings about caring for IM patients or reported a favorable impression of internists' lifestyle[61].

Psychiatry: Student choice of psychiatry as a career choice was affected by an undergraduate education in the arts, having close family or friends practicing medicine, having worked voluntarily with people with mental illness, and lower hospital orientation[62] A promotional DVD increased students’ interest in psychiatry[63]. A study in Serbia found mixed reactions to psychiatry as a career among medical students: Those who liked psychiatry considered it an interesting and challenging job (especially intellectually) and were less interested in its prestige and financial reward. Those who did not like psychiatry saw it as lacking a scientific foundation, clinically inefficient, intense emotional involvement, and stressful.[64]. Despite a small number of practicing psychiatrists few Pakistani students showed interest in the discipline[65].

OTHER DISCIPLINES

Emergency medicine: Students interested in emergency medicine had some attributes: hospital orientation, medical lifestyle, and less social orientation[66]. Lifestyle and length of residency were found to be factors of students choosing emergency medicine[67] [68].

Radiology: Use of medical students to triage images after hours influenced their career choices[69].

Anatomy: Nigerian students showed low preference for anatomy as a career choice[70].

REFERENCES