Specialty preference and attitudes toward the aged.

The relationship between the attitudes and knowledge regarding the aged and specialty preference of undergraduate medical students at three medical schools was studied. No significant differences in attitudes were found when students were classified by class (freshman, sophomore, junior, or senior) or by sex. A significant though weak relationship between class and level of cognitive knowledge was found. Students indicating a preference for family practice as a specialty demonstrated levels of cognitive knowledge which did not differ significantly from all other students. Similarly, attitudes of family practice students did not differ significantly from attitudes expressed by other students. However, when all students expressing a preference for a primary care specialty were compared to students expressing preferences for non-primary care specialties, primary care students had significantly more positive attitudes toward the aged than their peers. Levels of cognitive knowledge did not differ significantly. The data appeared to suggest that students selecting primary care specialties are somewhat more humanistic and empathetically oriented, at least in regard to the aged, than their peers while exhibiting essentially identical levels of cognitive knowledge. The implications of these findings for family practice education are discussed.     

Factors related to the choice of family medicine: a reassessment and literature review

BACKGROUND: Recent decreases in the number of students entering family medicine has prompted reconsideration of what is known about the factors affecting specialty choice. METHODS: Thirty-six articles on family medicine specialty choice published since 1993 were reviewed and rated for quality. RESULTS: Rural background related positively and parents' socioeconomic status relates negatively to choice of family medicine. Career intentions at entry to medical school predict specialty choice. Students who believe primary care is important, have low income expectations, and do not plan a research career are more likely to choose family medicine. The school characteristic related to choice of family medicine is public ownership. Large programs to increase numbers entering primary care seem effective. Required family medicine time in clinical years is related to higher numbers selecting family medicine. Faculty role models serve both as positive and negative influences. Students rejecting family medicine are concerned about prestige, low income, and breadth of knowledge required. Students planning on a career in a disadvantaged or rural area are more likely to enter family medicine. CONCLUSIONS: Multiple factors are consistently shown to be related to the choice of the specialty of family medicine.     

Career preferences and career outcomes of Australian medical students

Students entering three Australian medical schools were followed over a 15-year period to trace both movement into the profession and the longer-term outcomes of early career aspirations. A variety of student entry characteristics are examined together with aspirations, attainments and self-images. The results indicate that women, rather than men, are more likely to enter medical school with aspirations that involve specialty training. As they proceed through medical school, both groups move away from the idea of pursuing specialty training, although women tend to decide earlier than men that specialty practice is not for them. Women students are more likely than men to attain career goals if these involve general practice and less likely to if these involve specialization. The results indicate that although at graduation women medical practitioners have the same career goals and desires as men, if additional training is required women are unlikely to have their aspirations fulfilled.     

Development of an interest in a career in public health during medical school

OBJECTIVES: In The Netherlands, approximately 12% of medical graduates spend their professional life in public health, but it is the authors' belief that few of them become interested in such a career during medical school. The aim of this study was to investigate students' development of interest in a career in a public health specialty during medical school. METHODS: A written questionnaire was completed by students of all years at a Dutch medical school in 2002 (n=1371) and 2003 (n=1293). Students indicated their interest in a career in 37 Dutch medical specialties. Three public health specialties were distinguished and compared with the least popular specialty, the most popular specialty and with the average interest over all specialties. RESULTS: Interest in a career in occupational health and social insurance health was low throughout medical school. However, almost 15% of students indicated a high level of interest in youth health care in the first year of medical school, which is over twice as many as for the average specialty. This percentage decreased dramatically during medical school. At graduation, all three public health specialties had interest figures well below the average. CONCLUSIONS: Students have little interest in careers in public health. However, given that approximately 12% of medical graduates spend their professional life in public health, the factors that influence career preferences should be investigated. Targeted measures may yield more primary career preference in this direction. Reasons for the loss of interest in youth health care need to be investigated.     

Changes in students'' attitudes and values during medicine versus surgery clerkships

A prospective study of students' attitudes and values was conducted during medicine and surgery clerkships over the first clinical year. Students who finished the surgery clerkship first were more cynical and intolerant of ambiguity than the medicine students. Surgery students also felt they lacked self-confidence and had stronger feelings of being victimized. Cynicism and attitudes towards ambiguous situations improved during the medicine clerkship. Feeling victimized was strongly correlated with their problems with self-confidence, with cynicism, and a feeling of having to submit to authority figures. The findings of this study suggest that the clerkship order significantly affects the development of students' attitudes. Students also became more punitive and less confident as the first clinical year progressed. The implications of these changes in attitude on educational planning are discussed.     

The impact of clerkships on students’ specialty preferences: what do undergraduates learn for their profession?

Objective  Clinical experiences and gender have been shown to influence medical students' specialty choices. It remains unclear, however, which aspects of experiences make students favour some specialties and reject others. This study aimed to clarify the effects of clerkships on specialty choice and to identify explanatory factors.
Methods  We carried out a longitudinal cohort study to collect data on career preferences and attitudes towards future careers among 3 cohorts of students before and after clerkships in surgery ( n  = 200), internal medicine ( n  = 277) and general practice ( n  = 184). Regression analyses were performed to identify the determinants of career choice and the role of gender.
Results  Exposure to clinical settings encourages students to opt for a career in the corresponding specialty. Men were more stimulated than women by the general practice clerkship. Gender had no clear role as a predictor of career preference. The major predictor of career choice in all 3 specialties was positive evaluation of work-intrinsic factors. A preference for working with acute patients and technology-oriented work, prestige orientation and insignificance of a controllable lifestyle were determinants of a preference for surgery. Students with a preference for general practice had almost opposite preferences. Those who chose internal medicine favoured a controllable lifestyle.
Discussion  Factors other than gender appear to drive specialty decisions. Work content, type of patients and lifestyle options play major roles. Consequently, along with teaching about the practice of medicine, the matching of specialty preferences with reality is an essential outcome of clerkships.     

Motivation for medical school: the relationship to gender and specialty preferences in a nationwide sample

OBJECTIVES: Motivation for going to medical school and career plans of a 1 year cohort of students entering medical school in Norway (n = 420 response rate: 90%, 54% women, mean age: 22 years) were surveyed by a postal questionnaire the first month after they had started. DESIGN: Motives for choosing medicine were categorized into three indexes: 'people orientated', 'status/security orientated' and 'natural science orientated' motives. SETTING: University of Oslo. SUBJECTS: Medical students. RESULTS: Students picked out which they preferred among 53 specialties. The highest motivational scores were on the 'person orientated' index, female students scoring higher than men. Female students were, however, nearly as highly motivated by status/security and interests in natural science as were men. 'Person orientated' and 'natural science orientated' motives exerted the strongest influence on specialty preferences. Those who preferred family medicine were more person orientated and less natural science orientated, while those who preferred internal medicine were more natural science orientated. Father being a physician did not influence the motivational pattern, but increased the preference for laboratory and internal medicine. Frequently repeated upper secondary school exams for acceptance into medical school were negatively related to natural science motivation, and to increased preference for becoming a surgeon. CONCLUSIONS: In this first month of the curriculum students regarded person oriented motives as the most important for becoming a doctor.     

Prevalence,Risk Factors,Clinical Consequences,and Treatment of Enteral Feed Intolerance During Critical Illness

Background: We aimed to determine the incidence of enteral feed intolerance and factors associated with intolerance and to assess the influence of intolerance on nutrition and clinical outcomes. Methods: We conducted a retrospective analysis of data from an international observational cohort study of nutrition practices among 167 intensive care units (ICUs). Data were collected on nutrition adequacy, ventilator‐free days (VFDs), ICU stay, and 60‐day mortality. Intolerance was defined as interruption of enteral nutrition (EN) due to gastrointestinal (GI) reasons (large gastric residuals, abdominal distension, emesis, diarrhea, or subjective discomfort). Logistic regression was used to determine risk factors for intolerance and their clinical significance. A sensitivity analysis restricted to sites specifying a gastric residual volume ≥200 mL to identify intolerance was also conducted. Results: Data from 1,888 ICU patients were included. The incidence of intolerance was 30.5% and occurred after a median 3 days from EN initiation. Patients remained intolerant for a mean (±SD) duration of 1.9 ± 1.3 days . Intolerance was associated with worse nutrition adequacy vs the tolerant (56% vs 64%, P < .0001), fewer VFDs (2.5 vs 11.2, P < .0001), increased ICU stay (14.4 vs 11.3 days, P < .0001), and increased mortality (30.8% vs 26.2, P = .04). The sensitivity analysis demonstrated that intolerance remained associated with negative outcomes. Although mortality was greater among the intolerant patients, this was not statistically significant. Conclusions: Intolerance occurs frequently during EN in critically ill patients and is associated with poorer nutrition and clinical outcomes.     

Tolerance for ambiguity among medical students: implications for their selection, training and practice

The practice of medicine has always been characterized by uncertainty. Yet, attempts to study tolerance for uncertainty in medicine have been few, and limited to its influence on specialty preferences and test-ordering behavior. In particular, studies have not investigated how the process of socialization into the medical profession affects tolerance for uncertainty. Based on the assumption that uncertainty and ambiguity are related concepts, a modified version of a tolerance for ambiguity scale was used to study Johns Hopkins medical students' (N = 386) tolerance for ambiguity (TFA) through 4 yr of medical school. In addition, using alcoholism as an example of a clinically ambiguous condition, the association between students' tolerance for ambiguity and their perceived role in diagnosing and treating alcoholism was also investigated. Results indicate that tolerance for ambiguity (1) does not change throughout medical school, (2) is lower among men, whites and students who are younger when they begin medical school, (3) is higher among prospective psychiatrists than surgeons, and (4) is lower among students who do not feel responsible for diagnosing and treating alcoholism. These findings suggest that tolerance for ambiguity may, indeed, affect practitioners' career choices and performance and that selection of medical students may be more important than medical training per se in influencing students' tolerance for ambiguity. If medical schools admitted students who possess a high tolerance for ambiguity, quality of care for ambiguous conditions might improve, imbalances in physician supply and practice patterns might be reduced, and the increasing ambiguity in medical practice might be better acknowledge and accepted.     

Associations between medical school and career preferences in Year 1 medical students in Scotland

Medical Education 2012: 46 : 473–484 Objectives Little is known about the relationship between the career preferences of medical students and the medical schools at which they are enrolled. Our aim was to explore this relationship early in students’ medical training. Methods Year 1 (2009–2010) medical students at the five Scottish medical schools were invited to take part in a career preference questionnaire survey. Questions were asked about demographic factors, career preferences and influencing factors. Results The response rate was 87.9% (883/1005). No significant differences were found among medical schools with regard to first‐choice specialty. Surgery (22.5%), medicine (19.0%), general practice (17.6%) and paediatrics (16.1%) were the top career choices. Work–life balance, perceived aptitude and skills, intellectual satisfaction, and amount of patient contact were rated as the most important job‐related factors by most respondents. Few differences were found among schools in terms of the impact of job‐related factors on future career preferences. Students for whom the work–life balance was extremely important (odds ratio [OR] = 0.6) were less likely to prefer surgery. Students for whom the work–life balance (OR = 2.2) and continuity of care (OR = 2.1) were extremely important were more likely to prefer general practice. Conclusions Students’ early career preferences were similar across the five medical schools. These preferences result from the interplay among demographic factors and the perceived characteristics of the various specialties. Maintaining a satisfactory work–life balance is very important to tomorrow’s doctors, and the data hint that this may be breaking down some of the traditional gender differences in specialty choice. Longitudinal work is required to explore whether students’ career preferences change as they progress through medical school and training.     

The learning style of medical students

Recent research indicates that students' learning styles and approaches to study may have a significant bearing on their academic success. A study was undertaken on first-, third- and final-year medical students to analyse their preferred learning styles and approaches to study, using the Lancaster Approaches to Learning Inventory. The results showed that students entering the medical school had preferences which were more similar to science students' than arts students'. The medical students had high scores on reproducing orientation (surface approach) in all years tested. The first-year students had low scores on meaning orientation (deep approach) but the scores from students in later years showed a progressive rise. The implications of these results with regard to selection, teaching and assessment are explored. However, this preliminary study does not allow us to differentiate between the effect of student preference and that of the context and the environment in which they study.     

对903例人群食物不耐受相关症状调查分析

目的对903例人群食物不耐受相关症状及其影响凶素进行分析。方法用酶联免疫方法（ELISA）检测人血清中14种食物过敏原特异性IgG抗体。同时采用食物不耐受检测健康状况评估表收集食物不耐受阳性情况、饮食习惯等方面资料。采用SPSSFORWINDOWS13．0软件对相关资料进行频数分析、卡方检验、Mann—Whitney检验等。以P〈0．05为差异有统计学意义。结果食物不耐受发牛频率前五位依次是：蟹（254例,占28．13％）、蛋清／蛋黄（244例,占27．02％）、牛奶（118例,占13．07％）、大豆（108例,占11．96％）。不同患者可出现1种到8种食物不耐受。食物不耐受者症状出现频率依次为神经系统（55．89％）、消化道（45．69％）、心血管系统症状（15．64％）。脑力劳动者发生食物不耐受低于体力劳动者（P〈0．05）。结论人群对食物不耐受最常见的食物为：蟹、蛋清／蛋黄和牛奶。不耐受的症状可表现在多个系统。多见于体力劳动者。     

Are professional attitudes related to gender and medical specialty?

OBJECTIVES: The importance of professional attitudes in medical care has long been recognized; however, medical training has not stressed attitude development until recently. In previous studies among medical students, we found that gender and specialty preference are important factors in attitudes. In this study, patient-centredness of trainees in general practice and surgery and of final-year clerks preferring one of these specialties was assessed in one medical school in The Netherlands. The effect of gender, specialty and training level on attitude was investigated. DESIGN: In 1995, attitudes of 37 general practice trainees, 31 surgery trainees and 120 clerks were measured anonymously using questionnaires containing the Doctor-Patient Scale. This attitude scale measures patient-centredness vs. doctor-centredness. Response rates were 78%, 58% and 84%, respectively. SETTING: University of Utrecht. SUBJECTS: Medical students. RESULTS: Attitudes were related to specialty. General practice trainees showed more patient-centredness than surgery trainees. In accordance with previous findings among younger students, no differences were found between final-year clerks and vocational trainees. In contrast to previous studies, gender was not related to patient-centredness. CONCLUSIONS: Professional attitudes, in particular patient-centredness, seem to be related to specialty preference in the final year of graduate medical training and specialty as a career choice. It remains unclear whether professional socialization reinforces existing attitudes or whether existing attitudes result in specialty preference.     

The decision to enter a medical specialty: timing and stability

The timing and stability of the decision to enter a medical specialty were examined for one class of medical students. Students were asked to predict specialty choices for themselves on six occasions from orientation day in year 1 to January of the senior year. Choices were compared to actual National Residency Matching Programme results. Forty-five per cent predicted their ultimate specialty choice at orientation, and 69% predicted their ultimate choice by the end of the second year. Specialty choices are made early, and are more stable and accurate than the previous literature has suggested. Variations in timing among the specialties are described, and implications for medical education are discussed.     

The effects of physicians'' training and personality on test ordering for ambulatory patients

We studied records of 351 hypertensive patients cared for by 30 internists in private office practice. We correlated the use of outpatient diagnostic tests with personal characteristics of the prescribing physicians. Doctors trained in medical schools with academic orientations used more tests than other physicians. Patterns of use were not strongly related to the number of years since medical school graduation, or physicians "intolerance of ambiguity" as measured by a standard psychological instrument. These findings suggest that certain types of training may predispose physicians to be high testers.     

Tolerance of ambiguity among MD/MBA students: implications for management potential.

BACKGROUND: Health care is increasingly characterized by uncertainty and turbulence. In an environment of rapid change, flexibility is critical to the success of managers and organizations. Future physician executives must also be open to change and must be able to deal with the uncertainties of management; they must be able to tolerate the ambiguity in management situations. METHOD: This study uses tolerance of ambiguity measures to analyze students at six medical schools offering dual-degree (MD/MBA) programs. Students enrolled in dual-degree programs were assessed and compared with a control group of traditional medical students. RESULTS: MD/MBA students exhibit a higher tolerance of ambiguity than traditional medical students. FINDINGS: As a characteristic associated with leadership ability, tolerance of ambiguity offers a potential indicator of future success as a physician executive. As such, tolerance of ambiguity might be used for selective admissions to medical school and as an indicator of a student's potential to transition between clinical and management functions. As students match personality traits with career choices, those who serve their learning needs must anticipate differences across selected disciplines, roles, and responsibilities.     

Career preference enquiry among Queen's University medical undergraduates and graduates: a follow-up

Questionnaires were distributed in 1979 to fourth-and final-year students and to doctors who graduated in 1977 in the second leg of a longitudinal career preference enquiry at Queen's University medical school. Replies were obtained from 98.5 and 92.3% respectively of the undergraduates and from 74.1% of the graduates. While approximately half fourth- and final-year were consistent with their first preference made two years previously for broad fields of practice, less than a quarter of fourth- and a third of final-year were consistent in their preference of specialty. The proportion of Ulster-born students intending to remain rose by 20%. All 103 graduate respondents were working except two. Almost half either did not intend to continue in their present discipline or were undecided. Forty-five per cent were practising the specialty they had elected as final year students indicating that stability of career choice was greater between final year and SHO grading than between fourth and final year. More respondents in anaesthetics and surgery than in any other specialty were consistent in their choice. Eighty-eight per cent of the Ulster-born respondents were resident here at the time of completing the questionnaire. Sixty per cent intended to practise here ultimately, an increase of 15% on 1977.     

For money or service? a cross-sectional survey of preference for financial versus non-financial rural practice characteristics among ghanaian medical students

Background

Health worker shortage and maldistribution are among the biggest threats to health systems in Africa. New medical graduates are prime targets for recruitment to deprived rural areas. However, little research has been done to determine the influence of workers' background and future plans on their preference for rural practice incentives and characteristics. The purpose of this study was to identify determinants of preference for rural job characteristics among fourth year medical students in Ghana.

Methods

We asked fourth-year Ghanaian medical students to rank the importance of rural practice attributes including salary, infrastructure, management style, and contract length in considering future jobs. We used bivariate and multivariate ordinal logistic regression to estimate the association between attribute valuation and students' socio-demographic background, educational experience, and future career plans.

Results

Of 310 eligible fourth year medical students, complete data was available for 302 students (97%). Students considering emigration ranked salary as more important than students not considering emigration, while students with rural living experience ranked salary as less important than those with no rural experience. Students willing to work in a rural area ranked infrastructure as more important than students who were unwilling, while female students ranked infrastructure as less important than male students. Students who were willing to work in a rural area ranked management style as a more important rural practice attribute than those who were unwilling to work in a rural area. Students studying in Kumasi ranked contract length as more important than those in Accra, while international students ranked contract length as less important than Ghanaian students.

Conclusions

Interventions to improve rural practice conditions are likely to be more persuasive than salary incentives to Ghanaian medical students who are willing to work in rural environments a priori. Policy experiments should test the impact of these interventions on actual uptake by students upon graduation.

     

Interprofessional education in medical school

The opinions of entering medical students regarding interprofessional education (IPE), and their reasons, are described in this article. More female than male students favour IPE, 49 as compared to 25%. Students who endorse IPE give different reasons for their position than students who oppose it. The former group refer to increased communication and respect among health professionals, increased knowledge about mutual roles and function, greater equality among members of the health team and improved patient care. The opposing group fear that IPE would lower the quality of education by increasing class size and slow the pace of instruction to accommodate students with limited scientific backgrounds. Students also protest against having to study irrelevant subjects and acquire irrelevant skills. The opposing group is concerned primarily with IPE's effect on medical students; the group in favour is concerned more with the effect on patients and interprofessional relations. It seems that opinions about IPE are part of a basic attitudinal structure that medical students bring with them when they enter medical school. The implications for IPE in medical school are discussed.     

Influence of Third-Year Clerkships on Medical Student Specialty Preferences

Purpose – The purpose of this study was to investigate influences on third-year medical students' specialty preferences. Method – A survey questionnaire was mailed to third-year medical students at two medical schools. The questionnaire asked students to rate the degree to which various aspects of the third-year curriculum and perceived specialty characteristics influenced their specialty preferences. Results – A total of 214 (70%) of eligible students responded, of whom 46% were female and 57% preferred primary care (PC) specialties. The most frequently cited influential clerkship was internal medicine. Most clerkships (72%) had a positive influence on students' preferences. PC clerkships had more positive influences than non-primary care (NPC) clerkships, especially among PC-oriented students. The most influential aspects of clerkships were faculty and residents, especially in PC clerkships. For both PC- and NPS-oriented students, the diagnostic and patient-related characteristics of their preferred specialties were highly influential. PC-oriented students were more likely to be attracted to prevention and biopsychosocial aspects of specialties, and NPC-oriented students to the opportunity to do procedures and intervene in illnesses. Student gender appeared to have little influence on response patterns, except as a proxy for specialty preference, which, for women, was more likely to be a primary care specialty. Conclusion – These findings suggest that the third-year clerkships, especially at non-university sites, play an important role in specialty choice, and that factors attracting students to PC differ significantly from those attracting students to NPC. This revised version was published online in July 2006 with corrections to the Cover Date.