Cronin Frances M, Clarke Nicholas, Hendrick Louise, Conroy Ronan, Brugha Ruairi
Royal College of Surgeons in Ireland, Dublin 2, Ireland.
School of Psychology, Dublin City University, Glasnevin, Dublin 9, Ireland.
BMC Med Educ. 2020 Dec 2;20(1):485. doi: 10.1186/s12909-020-02405-w.
Despite being a vital part of medical workforce planning and development, how medical students and graduates choose their career specialty is still not well understood. This study aimed to identify the factors medical graduates consider important influences in their choice of specialty after their first year of practice, and to test the validity of relying on respondent recall to measure changes in specialty choice.
The baseline survey was administered online to all final year students in Ireland's six medical schools. Those who consented to follow-up (n = 483) were surveyed 18 months later (June 2018), during the final month of first year of practice.
The baseline survey had a 67% (n = 483) response rate. At the follow-up survey, (n = 232, 48% response rate) the top specialty choices were: Medicine, n = 54 (26%); Surgery, n = 34 (16%); General Practice, n = 28 (13%); Anaesthesia, n = 16 (8%) and Paediatrics, n = 14 (7%). Of the 49 respondents (28%) reporting a change of specialty since baseline, 13 (27%) selected the same specialty in both surveys; of the 121 (69%) reporting no change, 22 (18%) selected a different specialty at follow-up. Over 90% of respondents rated as 'important or 'very important': 'Own aptitude', 'Work-life balance' and 'What I really want to do'. Over 75% rated as 'not at all', or 'not very important' 'Current financial debt' and 'Inclinations before medical school'. When adjusted for sex and age, compared with Medicine, General Practice rated as more important: continuity of patient care (RRR 3.20 CI(1.59-6.41), p = 0.001); working hours/conditions (RRR 4.61 CI(1.03-20.60), p = 0.045) and a career that fit their domestic circumstances (RRR 3.19 CI(1.27-8.02), p = 0.014). Those choosing Surgery rated as less important: patient contact (RRR 0.56 CI(0.33-0.95), p = 0.033) and working hours/conditions (RRR 0.55 CI(0.31-0.96), p = 0.035).
The different demographic and motivational profiles by specialty choice are consistent with other studies suggesting a distinct profile for doctors intending to enter General Practice. In addition, our results suggest longitudinal study designs guard against recall bias and so provide more robust medical workforce models to inform and direct recruitment drives and interventions in future medical workforce planning.
尽管医学生和毕业生如何选择职业专业是医学劳动力规划与发展的重要组成部分，但目前仍未得到充分理解。本研究旨在确定医学毕业生在实习第一年之后认为对其专业选择有重要影响的因素，并检验依靠受访者回忆来衡量专业选择变化的有效性。
对爱尔兰六所医学院的所有最后一年学生进行在线基线调查。那些同意接受随访的学生（n = 483）在18个月后（2018年6月），即实习第一年的最后一个月接受了调查。
基线调查的回复率为67%（n = 483）。在随访调查中（n = 232，回复率48%），最受欢迎的专业选择是：医学，n = 54（26%）；外科，n = 34（16%）；全科医学，n = 28（13%）；麻醉学，n = 16（8%）；儿科学，n = 14（7%）。在49名（28%）自基线以来报告专业发生变化的受访者中，13名（27%）在两次调查中选择了相同的专业；在121名（69%）报告未发生变化的受访者中，22名（18%）在随访时选择了不同的专业。超过90%的受访者将“自身能力”“工作与生活的平衡”和“我真正想做的事情”评为“重要”或“非常重要”。超过75%的受访者将“当前的经济债务”和“医学院之前的倾向”评为“一点也不重要”或“不太重要”。在对性别和年龄进行调整后，与医学专业相比，全科医学专业认为以下方面更为重要：患者护理的连续性（相对风险比3.20，置信区间（1.59 - 6.41），p = 0.001）；工作时间/条件（相对风险比4.61，置信区间（1.03 - 20.60），p = 0.045）以及适合其家庭情况的职业（相对风险比3.19，置信区间（1.27 - 8.02），p = 0.014）。选择外科专业的受访者认为以下方面不太重要：与患者的接触（相对风险比0.56，置信区间（0.33 - 0.95），p = 0.033）和工作时间/条件（相对风险比0.55，置信区间（0.31 - 0.96），p = 0.035）。
不同专业选择的人口统计学和动机特征与其他研究一致，表明有意进入全科医学领域的医生具有独特的特征。此外，我们的结果表明纵向研究设计可防止回忆偏差，因此能提供更可靠的医学劳动力模型，为未来医学劳动力规划中的招聘活动和干预措施提供信息并指导方向。
