Ie Kenya, Murata Akiko, Tahara Masao, Komiyama Manabu, Ichikawa Shuhei, Takemura Yousuke C, Onishi Hirotaka
1Department of General Internal Medicine, Kawasaki Municipal Tama Hospital/St. Marianna University School of Medicine, 1-30-37 Shukugawara, Kawasaki, Kanagawa 214-8525 Japan.
2Department of Family Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu-shi, Mie 514-8507 Japan.
Asia Pac Fam Med. 2018 Jan 27;17:2. doi: 10.1186/s12930-018-0039-9. eCollection 2018.
Few studies have systematically explored factors affecting medical students' general practice career choice. We conducted a nationwide multicenter survey (Japan MEdical Career of Students: JMECS) to examine factors associated with students' general practice career aspirations in Japan, where it has been decided that general practice will be officially acknowledged as a new discipline.
From April to December 2015, we distributed a 21-item questionnaire to final year medical students in 17 medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item.
A total of 1264 responses were included in the analyses. The top three specialty choice were internal medicine: 833 (65.9%), general practice: 408 (32.3%), and pediatrics: 372 (29.4%). Among demographic factors, "plan to inherit other's practice" positively associated with choosing general practice, whereas "having physician parent" had negative correlation. After controlling for potential confounders, students who ranked the following items as highly important were more likely to choose general practice: "clinical diagnostic reasoning (adjusted odds ratio (aOR): 1.65, 95% CI 1.40-1.94)", "community-oriented practice (aOR: 1.33, 95% CI 1.13-1.57)", and" involvement in preventive medicine (aOR: 1.18, 95% CI 1.01-1.38)". On the contrary, "acute care rather than chronic care", "mastering advanced procedures", and "depth rather than breadth of practice" were less likely to be associated with general practice aspiration.
Our nationwide multicenter survey found several features associated with general practice career aspirations: clinical diagnostic reasoning; community-oriented practice; and preventive medicine. These results can be fundamental to future research and the development of recruitment strategies.
很少有研究系统地探讨影响医学生选择全科医学职业的因素。我们开展了一项全国性多中心调查（日本医学生职业调查：JMECS），以研究在日本与医学生全科医学职业抱负相关的因素，日本已决定将全科医学正式确认为一门新学科。
2015年4月至12月，我们向17所医学院校的医学专业最后一年学生发放了一份包含21个条目的问卷。该调查询问了学生从19个专业领域中选出的前三个职业偏好、他们的人口统计学信息以及职业优先事项。采用多变量逻辑回归来确定每个条目的影响。
分析共纳入1264份回复。前三个专业选择分别是内科：833人（65.9%）、全科医学：408人（32.3%）、儿科：372人（29.4%）。在人口统计学因素中，“计划继承他人诊所”与选择全科医学呈正相关，而“父母是医生”则呈负相关。在控制潜在混杂因素后，将以下项目列为非常重要的学生更有可能选择全科医学：“临床诊断推理（调整优势比（aOR）：1.65，95%置信区间1.40 - 1.94）”、“以社区为导向的实践（aOR：1.33，95%置信区间1.13 - 1.57）”以及“参与预防医学（aOR：1.18，95%置信区间1.01 - 1.38）”。相反，“急性病护理而非慢性病护理”、“掌握先进操作”以及“实践的深度而非广度”与选择全科医学职业抱负的关联较小。
我们的全国性多中心调查发现了一些与全科医学职业抱负相关的特征：临床诊断推理；以社区为导向的实践；以及预防医学。这些结果可能是未来研究和制定招聘策略的基础。
