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Experience and role models: How medical students describe influences on specialty preference

Lookup NU author(s): Dr Bryan BurfordORCiD, Professor Hugh Alberti, Professor David Kennedy


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Background:Pressures on recruitment to some medical specialties have been increasing, and there are now concerns about gapsin training programmes in specialties which were once easily filled. Interest in the factors which influence medicalstudents and junior doctors’ choice of careers is therefore growing.Recent literature shows that experiences of specialties in clinical practice in later stages of medical school, andduring postgraduate training, can be important, but that personal, domestic and lifestyle factors may in fact havea greater role than clinical aspects in an eventual decision [1, 2].However, the role of early experience during medical school should not be ignored. Quantitative data from ourresearch has found that the expressed interest in different specialties changes in the early years of medical school[3]. Here we will present preliminary analysis of interview data exploring why preferences emerge and change.We have considered the accounts given by medical students in their first two years of study, and considered whatsort of experiences shape their expectations, and their preferences, for career specialisation.Methodology:Qualitative interviews have been carried out with medical students annually since their first year of a five yearprogramme. This paper will describe analysis of interviews in their first two years, in which their exposure to medicalspecialties was limited to university-based teaching, and day visits to hospitals and general practice with somepatient contact.This analysis is based on 33 interviews: 14 in October of Year 1, 10 in May of Year 1, 9 in May of Year 2. The projectis ongoing.Results:Transcripts were first coded in order to identify sections relating to topics including long-term thoughts on medicalcareers, references to specific specialties, comparisons between specialties, and clinical experience relating tospecialty choice.Analysis to develop themes within this dataset is ongoing. Initial observations are that a number of factors influencestudents’ preferences, including experience before medical school, early patient contact in medical school, formalteaching and informal role modelling by clinical teachers. Key points are:• Some students know very little about the potential range of medical careers on entering medical school.Some bring knowledge from home or work experience, but this is limited.• Participants do not have career plans in these early years. While some have preferences for broad areas(GP or hospital, medicine or surgery), all are aware their views may change during medical school.• Teaching can open students' eyes to areas of medicine they have not previously considered or been awareof. Lectures are an effective way of introducing new specialties, if lecturers are enthusiastic and engaging.• Practical, ‘hands on’, opportunities in general practice visits can make GP more appealing than hospitalspecialties where early patient contact may be more limited. Role modelling and encouragement by GPs isimportant. The breadth of cases seen by GPs is a surprise to some.• Personal factors, particularly the desire to have a family life, may conflict with the duration and intensity oftraining. This may be more of an issue for women, and mature students.Discussion:Medical students’ awareness of and attitudes towards career paths is mutable in the early years of medical school.While some may come with preferences – positive or negative – for many the opportunity to find out aboutpotential opportunities is an important element of the first phase of study.Role modelling, and the ways in which clinical opportunities in clinical visits are provided, are an important part ofthis, but lecture-based sessions also provide a ‘shop window’ into clinical specialties. Faculty should be aware notjust of the direct pedagogical impact of their teaching in terms of the formal curriculum, but also how their approachand holistic presentation of a specialty may form early impressions.References:[1] Querido SJ, Vergouw D, Wigersma L, Batenburg RS, De Rond MEJ, Ten Cate OTJ. Dynamics of career choice among students in undergraduate medicalcourses. A BEME systematic review: BEME Guide No. 33, Med Teach. 2016;38:18-29[2] Cleland JA, Johnston PW, Anthony M, Khan N, Scott NW. A survey of factors influencing career preference in new-entrant and exiting medical studentsfrom four UK medical schools. BMC Medical Education 2014; 14: 151[3] Burford B, Alberti H, Kennedy D. Early career intentions of medical students: are we selecting the graduates we need for the 21st century? Education forPrimary Care, 2017; 28:354-355

Publication metadata

Author(s): Burford B, Alberti H, Kennedy DJ

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: Association for the Study of Medical Education Annual Scientific Meeting

Year of Conference: 2018

Pages: 158-158

Online publication date: 11/07/2018

Acceptance date: 02/04/2018

Publisher: Association for the Study of Medical Education