The stability of early specialty preferences among US medical school graduates in 1983

Medical graduates in 1983 were in preclinical training when the Graduate Medical Education National Advisory Committee forecast a surplus of 70,000 physicians by 1990. Among the problems identified was the nuclear role of medical schools in affecting specialty choices. To understand this role further, the current study determined the stability and evolution of specialty preferences between the time of the Medical College Admission Test and the senior year of medical school. The study included 10,321 US medical school graduates in 1983. Eighty percent changed their specialty preference during this interval, demonstrating the substantial effects that medical schools have on specialty selection. The stability of early preferences ranged from 41% to 1%. Interest in primary care specialties declined among both men and women; interest in specialty care and supporting services increased during this five-year longitudinal study. These findings parallel shifts away from primary care among US medical school graduates in 1978 and 1983.     

Alcohol-use patterns through medical school. A longitudinal study of one class

We describe the patterns of alcohol use of one medical school class assessed repeatedly over time from the first day of medical school to a point several months short of graduation. Although male students consistently drank more than their female counterparts during the preclinical years, the men reduced their alcohol intake during the clinical years to converge on the lower, more consistent intake rates of their female classmates. Over the four years of medical school, 11% of the students met criteria for excessive drinking for at least one six-month period and 18% were identified as alcohol abusers by Research Diagnostic Criteria during the first two years. More than half of the excessive drinkers met abuse criteria, whereas only one third of the alcohol abusers were also excessive drinkers. Alcohol abusers had better first-year grades and better overall scores on the National Board of Medical Examiners, part I, test than their classmates. The implications of these findings for designing and implementing alcoholism intervention/prevention programs in medical schools are discussed herein.     

Trends in evolution of specialty choice. Comparison of US medical school graduates in 1983 and 1987

This study describes the evolution of specialty choices among US medical school seniors in 1983 and 1987. Its purposes were to determine the specialty interests of the 1987 cohort as these 11,264 students proceeded through medical school and to compare their evolving specialty plans with those of the 10,321 US medical school seniors in 1983. As the 1987 cohort advanced through medical school, they became increasingly interested in general and subspecialty internal medicine, psychiatry, obstetrics and gynecology, anesthesia, radiology and rehabilitation medicine and less interested in family practice, general surgery, pathology, and public health. Compared with the 1983 cohort, 1987 seniors were significantly less likely to choose general internal medicine and more likely to choose internal medicine and pediatric subspecialties. Similar proportions of each cohort of seniors chose family practice. Between 1983 and 1987, men's interest in pediatrics, general surgery, and obstetrics and gynecology declined, while their interest in the surgical subspecialties, anesthesia, and rehabilitation medicine increased.     

A longitudinal study of medical specialty choice and certainty level.

Two successive classes of entering medical students at the University of Colorado participated in a longitudinal study on the development of medical specialty choice. Students indicated specialty choices and their degree of certainty about them in the freshman, sophomore, and senior years. Results indicated that students were highly uncertain of their choices at the beginning of medical school but became very certain by graduation. Nearly three-fourths switched specialties between freshman and senior years. In general, there was no relationship between degree of certainty and switching. The exception occurred in family practice. The least specialty switching occurred with internal medicine and the most with psychiatry. Increasing numbers of students chose internal medicine over the four years.     

Trends in career choice by US medical school graduates

Context  Trends in career choice among specialties have varied greatly. Most notable is the recent decrease in the percentage of US medical student graduates choosing a primary care career, which has important implications for the US physician workforce. Objective  To review temporal trends in career choice by graduates of allopathic US medical schools, focusing on US medical doctors entering residencies since 1987. Data Sources  Three databases, the Association of American Medical Colleges Graduation Questionnaire (AAMC GQ), the National Resident Matching Program, and the national Graduate Medical Education census, were used to review temporal trends in the number of US medical doctors entering residencies in primary care, general or subspecialty surgical, and non–primary care and nonsurgical specialties from 1987 to 2002. Data Synthesis  In 1987, 49.2% of all medical school graduates matched to one of the generalist residencies (internal medicine, pediatrics, or family medicine). The percentage of students matching to primary care specialties declined in the early 1990s, peaked at 53.2% in 1998, and declined to 44.2% in 2002. Concurrent with the latter decline, AAMC GQ data showed a decrease in medical student interest in primary care careers (35.6% in 1999 to 21.5% in 2002). The total percentage of US medical doctors matching to general or subspecialty surgical residencies remained stable at 11% to 12% from 1987 to 2002. During this same period, emergency medicine and plastic surgery increased as a match choice, while anesthesiology, pathology, and psychiatry were more variable over time. Conclusions  Distribution of medical students' career choices among specialties varied considerably from 1987 to 2002. The debate will continue regarding the appropriate specialty mix within the physician workforce.      

Factors influencing the choice of specialty of Australian medical graduates

OBJECTIVE: To identify the relative importance of extrinsic determinants of doctors' choice of specialty. DESIGN: A self-administered postal questionnaire. SETTING: Australian vocational training programs. PARTICIPANTS: 4259 Australian medical graduates registered in September 2002 with one of 16 Australian clinical colleges providing vocational training programs. MAIN OUTCOME MEASURES: Choice of specialist vocational training program; extrinsic factors influencing choice of program, and variation by sex, age, marital status and country of birth. RESULTS: In total, 79% of respondents rated "appraisal of own skills and aptitudes" as influential in their choice of specialty followed by "intellectual content of the specialty" (75%). Extrinsic factors rated as most influential were "work culture" (72%), "flexibility of working arrangements" (56%) and "hours of work" (54%). We observed variation across training programs in the importance ascribed to factors influencing choice of specialty, and by sex, age and marital status. Factors of particular importance to women, compared with men, were "appraisal of domestic circumstances" (odds ratio [OR], 1.9), "hours of work" (OR, 1.8) and "opportunity to work flexible hours" (OR, 2.6). Partnered doctors, compared with single doctors, rated "hours of work" and "opportunity to work flexible hours" as more important (OR, 1.3), while "domestic circumstances" was more important to doctors with children than those without children (OR, 1.7). In total, 80% of doctors had chosen their specialty by the end of the third year after graduation. CONCLUSIONS: Experience with discipline-based work cultures and working conditions occurs throughout medical school and the early postgraduate years, and most doctors choose their specialty during these years. It follows that interventions to influence doctors' choice of specialty need to target these critical years.     

医学院校毕业生的追踪调查殚

为了使我们的医学教育更适应当前我国卫生防病工作的需求,培养合格的实用型预防医学本科人才的目的,对一所医学院校近三年毕业的毕业生和其用人单位进行了有关学校专业课程设置、教学方法及能力培养、实践教学、教学管理、对继续教育的需求和用人单位对医学专业毕业生的评价等方面的调查.