Understanding medical students’ intercalation decisions to preserve the clinical academic pipeline: a mixed-method survey

Abstract

Introduction: Clinical academics are pivotal in advancing innovations by integrating clinical practice with education and research. The clinical academic workforce in the UK has struggled with a persistent shortage, now reaching a critical point. A recent nationwide decline in medical students opting for intercalated degrees, which provide early research exposure during undergraduate medical education, significantly contributed to the workforce crisis. However, the underlying factors for this recent decline in intercalation remain unclear. This study investigates the factors influencing medical students' decisions to intercalate, focusing on personal motivations, and perceived value in the context of rising living costs and changing national policies. Methods: We utilised a mixed-methods survey to explore the factors influencing medical students' decisions regarding intercalation. Quantitative data from closed-ended questions were analysed using descriptive statistics and chi-square tests to identify associations between variables. Thematic analysis of qualitative data from open-ended questions was conducted using Vroom's expectancy theory as an interpretive lens. Results: A total of 50 students completed the questionnaire. The chi-square test demonstrated a significant association (p = 0.001) between the cost-of-living crisis and the decision to intercalate. The thematic analysis of non-intercalators highlighted the theme of financial burden, including reduced student loans, increased debt, and family financial stress. Conversely, we developed the theme of effective financial strategies and support systems from intercalators. The perception of career benefits significantly influenced intercalation decisions (p < 0.001). Furthermore, a change in policy to remove extra consideration for intercalated degree holders in UK foundation applications significantly affected decisions (p = 0.014). Thematic analysis of non-intercalators identified the lack of perceived career advantage, including a loss of extrinsic motivation and perceived unrecognition. Intercalators cited long-term career benefits, research skills and confidence, portfolio building and networking as their primary motivators. Conclusions: Our study provided new insights into the socioeconomic, policy-related, and motivational differences among students that influence intercalation decisions. Financial constraints and the removal of extra consideration for intercalated degrees in physician training selection were major deterrents, particularly for students from diverse backgrounds. Future research should focus on developing targeted interventions to mitigate challenges and support a diverse and equitable clinical academic workforce.