Querido Sophie, De Rond Marlies, Wigersma Lode, van den Broek Sjoukje, Ten Cate Olle
Central Board for Specialty training in Elderly Care Medicine in the Netherlands (SOON), P.O. Box 19025, 3501 DA Utrecht, The Netherlands.
Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands.
Med Sci Educ. 2019 Oct 28;30(1):163-171. doi: 10.1007/s40670-019-00832-z. eCollection 2020 Mar.
Medical trainees make career choices in the final year of medical school or after graduation, if they do not continue with residency directly. Most Dutch medical students are trained in vertically integrated (VI) curricula, with early clinical experience and a gradual increase in clinical responsibilities. Students in such curricula have been reported to make career choices at an earlier stage than graduates from more traditionally designed curricula. Many Dutch graduates build further clinical experience after graduation as physicians-not-in-training (PNITs) before beginning residency. We explored how students make career choices and whether pre-residency clinical responsibilities influence this choice.
A qualitative study with a phenomenology approach was used. The authors conducted a longitudinal interview study of medical students with two intervals over a 2-year period. The interview questions covered how trainees establish career preferences and which factors affect preference and choice over time.
Experiencing clinical responsibility was a key factor for career preference during all interview rounds. Being a PNIT who makes diagnostic and therapeutic decisions, have their own patients and have significant patient care responsibilities creates opportunities to build an image of a future context of employment. Some participants mentioned that their experience of having full responsibility as a PNIT was pivotal in a career preference change.
Clinical responsibility as a student or a PNIT appears to be important for career preference and choice. The experience of responsibility as a medical doctor forces trainees to reflect on personal needs and to consider which career preference fits best.
医学生在医学院最后一年或毕业后（如果他们不直接继续住院医师培训）做出职业选择。大多数荷兰医学生接受的是纵向整合（VI）课程培训，有早期临床经验且临床职责逐渐增加。据报道，此类课程的学生比接受更传统设计课程培训的毕业生更早做出职业选择。许多荷兰毕业生在毕业之后作为非住院医师医生（PNITs）积累更多临床经验，然后才开始住院医师培训。我们探究了学生如何做出职业选择，以及住院前的临床职责是否会影响这一选择。
采用现象学方法进行定性研究。作者对医学生进行了一项为期两年、分两个阶段的纵向访谈研究。访谈问题涵盖了实习生如何确立职业偏好，以及随着时间推移哪些因素会影响偏好和选择。
在所有访谈阶段，体验临床职责都是职业偏好的关键因素。作为一名能够做出诊断和治疗决策、拥有自己的患者并承担重大患者护理责任的非住院医师医生，会创造机会构建未来工作环境的形象。一些参与者提到，他们作为非住院医师医生承担全部责任的经历在职业偏好转变中起了关键作用。
作为学生或非住院医师医生时的临床职责似乎对职业偏好和选择很重要。作为医生承担责任的经历迫使实习生反思个人需求，并考虑哪种职业偏好最适合。
