Intracurricular Factors Influencing Medical Students' Specialty Choice: A Systematic Review

Overview

Journal Adv Med Educ Pract

Publisher Dove Medical Press

Specialty Medical Education

Date 2024 Dec 2

PMID 39620065

Authors

Birte Schoon

Thomas Kotter

Affiliations

Soon will be listed here.

Abstract

Background: Medical school graduates are faced with the difficult decision of choosing a specialty training program. Understanding the decision criteria as well as the intracurricular factors-which have been studied less frequently and thus lack clarity-may help to prevent an impending shortage of certain specialists and to ensure the recruitment of young doctors into supposedly less popular specialties. Evidence-based changes to the medical curriculum are needed to support the balanced development of health care systems with demand-driven staffing of all specialties, especially in the outpatient sector and in rural areas. The aim of this systematic review was to identify the intracurricular factors that influence medical students' choice of specialty that have been described in the international literature.

Methods: A systematic review was conducted by searching Medline. After applying the inclusion and exclusion criteria to the 2537 primary results and 19 hits from an additional manual search, data were extracted from 334 studies. In addition, a quality assessment of all included studies was performed.

Results: A total of 14 influencing factors were identified from the reviewed literature, of which "clinical-practical experience", "clinical role models", and "voluntary offerings" were mentioned most frequently. We sorted the factors into four main categories: "Teaching"; "Teaching environment, influence and interaction"; "Curriculum"; and "Voluntary work". The studies were highly heterogeneous regarding research methods and the quality of reporting.

Conclusion: Involving students in the planning and structuring of clinical phases, active feedback, voluntary offerings, seminars/simulations, and involvement in the clinical team can increase a specialty preference. Conversely, discrimination, prejudice and poor quality of teaching and clinical exposure may act as a deterrent. It is necessary to sensitize medical staff regarding their role and influence in the decision-making process. Further prospective and qualitative research is needed to address this issue adequately.

References

Williamson M, Gormley A, Bills J, Farry P . The new rural health curriculum at Dunedin School of Medicine: how has it influenced the attitudes of medical students to a career in rural general practice?. N Z Med J. 2003; 116(1179):U537. View

Moldovan F, Gligor A, Moldovan L, Bataga T . The Impact of the COVID-19 Pandemic on the Orthopedic Residents: A Pan-Romanian Survey. Int J Environ Res Public Health. 2022; 19(15). PMC: 9368229. DOI: 10.3390/ijerph19159176. View

Hays R . Choosing a career in general practice: the influence of medical schools. Med Educ. 1993; 27(3):254-8. DOI: 10.1111/j.1365-2923.1993.tb00265.x. View

Talbot J, Ward A . Alternative Curricular Options in Rural Networks (ACORNS): impact of early rural clinical exposure in the University of West Australia medical course. Aust J Rural Health. 2000; 8(1):17-21. DOI: 10.1046/j.1440-1584.2000.81237.x. View

Ek E, Ek E, Mackay S . Undergraduate experience of surgical teaching and its influence and its influence on career choice. ANZ J Surg. 2005; 75(8):713-8. DOI: 10.1111/j.1445-2197.2005.03500.x. View

Holm-Petersen C, Vinge S, Hansen J, Gyrd-Hansen D . The impact of contact with psychiatry on senior medical students' attitudes toward psychiatry. Acta Psychiatr Scand. 2007; 116(4):308-11. DOI: 10.1111/j.1600-0447.2007.01036.x. View

Werwick K, Spura A, Gottschalk M, Meyer F, Walcher F, Konig S . [Creating Enthusiasm for Surgery - Perceptions of the Impact of Undergraduate Practical Education (Clerkship) for Occupational Choices]. Zentralbl Chir. 2017; 142(6):550-559. DOI: 10.1055/s-0043-114732. View

Kraft M, Sayfie A, Klein K, Gruppen L, Quint L . Introducing First-Year Medical Students to Radiology: Implementation and Impact. Acad Radiol. 2019; 25(6):780-788. DOI: 10.1016/j.acra.2018.02.002. View

Wimsatt L, Cooke J, Biggs W, Heidelbaugh J . Institution-Specific Factors Associated With Family Medicine Residency Match Rates. Teach Learn Med. 2016; 28(3):269-78. DOI: 10.1080/10401334.2016.1159565. View

10.

Lau T, Zamani D, Lee E, Asli K, Gill J, Brager N . Factors affecting recruitment into psychiatry: a canadian experience. Acad Psychiatry. 2015; 39(3):246-52. PMC: 4422873. DOI: 10.1007/s40596-014-0269-6. View

11.

Manassis K, Katz M, Lofchy J, Wiesenthal S . Choosing a career in psychiatry: influential factors within a medical school program. Acad Psychiatry. 2006; 30(4):325-9. DOI: 10.1176/appi.ap.30.4.325. View

12.

Rehman A, Rehman T, Shaikh M, Yasmin H, Asif A, Kafil H . Pakistani medical students' specialty preference and the influencing factors. J Pak Med Assoc. 2011; 61(7):713-8. View

13.

Pianosi K, Bethune C, Hurley K . Medical student career choice: a qualitative study of fourth-year medical students at Memorial University, Newfoundland. CMAJ Open. 2016; 4(2):E147-52. PMC: 4933642. DOI: 10.9778/cmajo.20150103. View

14.

Parekh R, Jones M, Singh S, Yuan J, Chan S, Mediratta S . Medical students' experience of the hidden curriculum around primary care careers: a qualitative exploration of reflective diaries. BMJ Open. 2021; 11(7):e049825. PMC: 8323369. DOI: 10.1136/bmjopen-2021-049825. View

15.

Wright S, Wong A, Newill C . The impact of role models on medical students. J Gen Intern Med. 1997; 12(1):53-6. PMC: 1497058. DOI: 10.1046/j.1525-1497.1997.12109.x. View

16.

Deutsch T, Lippmann S, Frese T, Sandholzer H . Who wants to become a general practitioner? Student and curriculum factors associated with choosing a GP career--a multivariable analysis with particular consideration of practice-orientated GP courses. Scand J Prim Health Care. 2015; 33(1):47-53. PMC: 4377739. DOI: 10.3109/02813432.2015.1020661. View

17.

Ford J . Influence of a problem-based learning curriculum on the selection of pathology as a career: evidence from the Canadian match of 1993-2004. Hum Pathol. 2005; 36(6):600-4. DOI: 10.1016/j.humpath.2005.04.003. View

18.

Singh A, Alberti H . Why UK medical students change career preferences: an interview study. Perspect Med Educ. 2020; 10(1):41-49. PMC: 7809071. DOI: 10.1007/s40037-020-00636-7. View

19.

Joiner A, Mahmood S, Dearman S, Maddicott S . Foundation trainees and changes in career intentions. Australas Psychiatry. 2017; 26(1):98-101. DOI: 10.1177/1039856217737882. View

20.

Barber S, Brettell R, Perera-Salazar R, Greenhalgh T, Harrington R . UK medical students' attitudes towards their future careers and general practice: a cross-sectional survey and qualitative analysis of an Oxford cohort. BMC Med Educ. 2018; 18(1):160. PMC: 6030758. DOI: 10.1186/s12909-018-1197-z. View