Department of Medicine (NEP), Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4712, USA.
Acad Med. 2011 Feb;86(2):194-200. doi: 10.1097/ACM.0b013e3182045ee5.
Medical students' career choices affect health care. To understand how to increase the number of students who choose careers in internal medicine (IM), students who seriously considered IM but chose another field ("Switchers") and those who rejected IM ("Never Considered") were compared with those who chose IM ("Choosers").
Fourth-year medical students from 11 U.S. institutions were surveyed about demographics, medical school educational experiences, and aspects of the specialty of IM. Univariate analysis and multivariate logistic regression models examined associations between student characteristics and classification as Switchers, Choosers, and Never Considered.
A total of 1,177 students completed the survey (82% response rate). There were 274 (23%) Choosers, 398 (34%) Switchers, and 499 (43%) Never Considered. The authors' models explained over 80% of variance in these three career choice classification groups. For most responses, an increasingly favorable gradient from Never Considered to Choosers was observed. Multivariate analysis revealed six items that were associated with higher probability of choosing IM: types of patients internists see, timing of career decision, interest groups, intellectual challenge, satisfaction among internists, and the core IM clerkship.
Several potentially modifiable educational experiences and aspects of IM distinguished Switchers from the other two groups. The percentage of variance explained by group suggests that these findings identify important underpinnings of career decisions. These items also suggest ways that educational experiences and aspects of the specialty could be redesigned by academicians and policy makers to improve the attractiveness of IM careers.
医学生的职业选择会影响医疗保健。为了了解如何增加选择内科（IM）职业的学生人数，将认真考虑过 IM 但选择了其他领域的学生（“Switchers”）和拒绝 IM 的学生（“Never Considered”）与选择 IM 的学生（“Choosers”）进行了比较。
从 11 家美国机构的四年级医学生那里调查了人口统计学、医学院教育经历以及内科专业的各个方面。单变量分析和多变量逻辑回归模型检查了学生特征与 Switchers、Choosers 和 Never Considered 分类之间的关联。
共有 1177 名学生完成了调查（82%的回复率）。其中 274 名（23%）为 Choosers，398 名（34%）为 Switchers，499 名（43%）为 Never Considered。作者的模型解释了这三个职业选择分类群体 80%以上的差异。对于大多数回答，从 Never Considered 到 Choosers 观察到越来越有利的梯度。多变量分析显示了与选择 IM 更高概率相关的六个项目：内科医生看到的患者类型、职业决策的时间、利益集团、智力挑战、内科医生的满意度以及内科核心实习。
一些潜在可修改的教育经验和内科的各个方面将 Switchers 与其他两组区分开来。组内方差的百分比表明，这些发现确定了职业决策的重要基础。这些项目还表明，教育经验和专业的各个方面可以由学者和政策制定者重新设计，以提高 IM 职业的吸引力。
