Wright Bruce, Scott Ian, Woloschuk Wayne, Brenneis Fraser, Bradley Joelle
Department of Family Medicine, University of Calgary, Calgary, Alta.
CMAJ. 2004 Jun 22;170(13):1920-4. doi: 10.1503/cmaj.1031111.
Over the last 10 years the number of medical students choosing family medicine as a career has steadily declined. Studies have demonstrated that career preference at the time that students begin medical school may be significantly associated with their ultimate career choice. We sought to identify the career preferences students have at entry to medical school and the factors related to family medicine as a first-choice career option.
A questionnaire was administered to students entering medical school programs at the time of entry at the University of Calgary (programs beginning in 2001 and 2002), University of British Columbia (2001 and 2002) and University of Alberta (2002). Students were asked to indicate their top 3 career choices and to rank the importance of 25 variables with respect to their career choice. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbach's alpha coefficients; biserial correlations between the factors and career choice were also calculated. A logistic regression was performed using career choice (family v. other) as the criterion variable and the factors plus demographic characteristics as predictor variables.
Of 583 students, 519 (89%) completed the questionnaire. Only 20% of the respondents identified family medicine as their first career option, and about half ranked family medicine in their top 3 choices. Factor analysis produced 5 factors (medical lifestyle, societal orientation, prestige, hospital orientation and varied scope of practice) that explained 52% of the variance in responses. The 5 factors demonstrated acceptable internal consistency and correlated in the expected direction with the choice of family medicine. Logistic regression revealed that students who identified family medicine as their first choice tended to be older, to be concerned about medical lifestyle and to have lived in smaller communities at the time of completing high school; they were also less likely to be hospital oriented. Moreover, students who chose family medicine were much more likely to demonstrate a societal orientation and to desire a varied scope of practice.
Several factors appear to drive students toward family medicine, most notably having a societal orientation and a desire for a varied scope of practice. If the factors that influence medical students to choose family medicine can be identified accurately, then it may be possible to use such a model to change medical school admission policies so that the number of students choosing to enter family medicine can be increased.
在过去10年里，选择家庭医学作为职业的医学生数量稳步下降。研究表明，学生进入医学院时的职业偏好可能与其最终的职业选择显著相关。我们试图确定学生进入医学院时的职业偏好以及与家庭医学作为首选职业选择相关的因素。
对卡尔加里大学（2001年和2002年开始的课程）、英属哥伦比亚大学（2001年和2002年）和阿尔伯塔大学（2002年）医学院入学的学生在入学时进行问卷调查。要求学生指出他们的前3个职业选择，并对25个变量在其职业选择中的重要性进行排序。对这些变量进行因子分析。使用克朗巴赫α系数估计因子得分的可靠性；还计算了因子与职业选择之间的双列相关。以职业选择（家庭医学与其他）作为标准变量，以这些因素和人口统计学特征作为预测变量进行逻辑回归分析。
583名学生中，519名（89%）完成了问卷。只有20%的受访者将家庭医学作为他们的第一职业选择，约一半的人将家庭医学排在前3个选择之中。因子分析产生了5个因子（医学生活方式、社会导向、声望、医院导向和多样化的执业范围），解释了52%的回答方差。这5个因子显示出可接受的内部一致性，并在预期方向上与家庭医学的选择相关。逻辑回归分析显示，将家庭医学作为第一选择的学生往往年龄较大，关注医学生活方式，高中毕业后生活在较小的社区；他们也不太倾向于以医院为导向。此外，选择家庭医学的学生更有可能表现出社会导向，并希望有多样化的执业范围。
有几个因素似乎促使学生选择家庭医学，最显著的是具有社会导向和对多样化执业范围的渴望。如果能够准确识别影响医学生选择家庭医学的因素，那么或许可以利用这样一个模型来改变医学院的招生政策，从而增加选择进入家庭医学领域的学生数量。
