Determinants of the generalist career intentions of 1995 graduating medical students

Abstract

Using national databases of the Association of American Medical College, the authors employed logistic regression analysis to show the relative predictive influences of selected demographic, structural, attitudinal, and educational variables on the specialty careers choices of 1995 U.S. medical school graduates. Plans to pursue certification in family practice or an unspecified generalist career could be predicted with moderate success, while choices of general internal medicine and general pediatrics could not. The intentions of the 1995 graduates to pursue generalist specialty, were significantly associated with demographic factors such as female gender, older student age, and rural hometown; early interest in the generalist specialties; attitudes favoring helping people over seeking opportunities for leadership, intellectual challenge, or research; the presence of a department of family medicine in the medical school; and ambulatory care experiences in the third and fourth years. In the multiple-regression models used in this study, a number of factors widely touted as important to the cultivation of generalism were not significant predictors of generalist decisions; an institutional mission statement expressly addressing the cultivation of generalist careers; giving admission preferences to applicants who vowed an interest in generalism; public (versus private) school sponsorship; discrete organization units for general internal medical or general pediatrics; the proportion of institutional faculty in the general specialty of medicine and pediatrics; the level of educational debt; the students; clinical experiences in the first and second years of medical school. The authors acknowledge the danger of inferring causal relationships from analyses of this kind, and described how the power of previous associations--e.g., that between a required third-year clerkship in family medicine and graduates' family practice career choices--may be weakened when the independent variable spreads across institutional cultures that at present are less conductive to primary care. The findings of this analysis add to the evidence that generalist career intentions are largely carried on the tide of students' interests and experiences in family medicine and ambulatory primary care. In terms of the predictive values of the input variable in this study, career decisions for the other two generalist specialties--general internal medicine and general pediatrics--were essentially a crapshoot, either because the tactics to promote interest in these fields were ineffective (or confounded), or because the efforts were underdeveloped. Moreover, the statistical models of this study employed quantifiable variables that can be discerned and manipulated to guide the result, whereas medical students tend to identify less tangible elements as more powerful factors influencing their career choices. The results sharpen the strategic focus, but must be combined with those of other, descriptive analysis for a more complete understanding of graduating...

Factors Related to the Choice of Family Medicine: A Reassessment and Literature Review

“…23 All 3 of these studies had relatively high quality scores, so that the results of one are not clearly more sound than the others.…”

“…25 Studies using multivariate analysis also had conflicting results; one did not find that age predicted plans for a family medicine career, 22 the other found a linear positive relationship between age and a plan for a family medicine career. 23 Although these results are mixed, it would seem that older age is at least weakly related to a choice of family medicine.…”

Évaluation préliminaire d'un stage d'externat expérimental en médecine générale à la faculté de médecine de Tours

“…L'influence d'un stage en médecine générale à l'égard du choix d'exercice de cette discipline, que ce soit en confortant ou en remettant en cause les orientations des étudiants, a été étudiée dans le cadre de plusieurs études consacrées au recensement des principaux déterminants pour le choix de la méde-cine générale comme spécialité [2,12] . L'expérience d'un stage en médecine générale, avant le choix dé-finitif de la filière, au même titre que l'existence d'un département de médecine générale au sein de la faculté [13] , semble être l'un des déterminants [2,3] les plus importants, au regard des perceptions anticipées qu'il permet concernant la qualité de vie, la satisfaction au travail, la relation avec les patients, le suivi au long cours, la diversité de l'activité. Ce stage permet d'exposer les étudiants à un « modèle de rôle » supplémentaire, complétant ceux que jouent les chefs de service hospitaliers auprès des externes, ce qui est aussi un facteur important dans le choix [2] .…”

¿Qué determina la elección de una Especialidad en Medicina?

“…Kassebaum et al 27 , a través del análisis por regresión logística de la información obtenida de bases de datos de la Asociación de Colegios Médicos Americanos, estudiaron las intenciones de los graduados en 1995 en EEUU para seguir carreras generalistas. En particular, los factores que se asociaban positivamente con la elección de medicina de familia eran el sexo femenino, una edad mayor o igual a 28 años, un origen rural y la presencia de un departamento de medicina de familia.…”