Pfarrwaller Eva, Maisonneuve Hubert, Laurent Camille, Abbiati Milena, Sommer Johanna, Baroffio Anne, Haller Dagmar M
University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
University College of General Medicine, Faculty of Medicine, University Claude Bernard Lyon 1, Lyon, France.
J Gen Intern Med. 2024 Jul;39(9):1544-1555. doi: 10.1007/s11606-023-08567-9. Epub 2023 Dec 15.
Increasing primary care's attractiveness as a career choice is an important task of socially accountable medical schools. Research has broadly studied influences on medical students' career choice. However, a deeper understanding of the processes behind career decision-making could support medical schools in their efforts to promote primary care careers.
To explore the dynamics of career choice during medical school with a focus on primary care, based on a previously developed conceptual framework.
Qualitative study using a phenomenological, inductive-deductive approach DESIGN AND PARTICIPANTS: Individual interviews were conducted from May 2019 to January 2020 with 14 first-year postgraduate trainee physicians, graduates of the Faculty of Medicine in Geneva, Switzerland, purposively sampled based on their interest in primary care during undergraduate studies. The interview guide was developed to elicit narratives about career-related decision-making. Two authors coded the transcripts. Thematic analysis alternated with data collection until thematic saturation was reached. Emerging themes were discussed and refined within the research team.
Two main themes emerged: (1) developing professional identity, expressed as a changing professional image from unprecise and idealistic to concrete and realistic; priorities changed from content-based to lifestyle-based preferences; (2) individual trajectories of career-related decision-making, determined by different stages of refining professional interests; students navigated this process by employing various strategies, ranging from active exploration to passive behaviors.
This study's narrative approach illustrates the dynamic nature of career choice and refines elements of a conceptual framework previously developed by the authors. Its findings underline the importance of exploration, for which personal experiences and observations of physicians' work are crucial. To advance efforts to make primary care a more attractive career, students must be sufficiently exposed to primary care in a safe and individualized environment and should be supported in all stages of their career choice process.
提高初级保健作为职业选择的吸引力是具有社会责任感的医学院校的一项重要任务。研究广泛探讨了影响医学生职业选择的因素。然而，深入了解职业决策背后的过程有助于医学院校推动初级保健职业发展。
基于先前开发的概念框架，探讨医学院校期间以初级保健为重点的职业选择动态。
采用现象学、归纳-演绎方法的定性研究
2019年5月至2020年1月，对14名一年级研究生实习医生进行了个人访谈，他们均为瑞士日内瓦医学院的毕业生，根据其本科期间对初级保健的兴趣进行了有目的的抽样。访谈指南旨在引出与职业相关决策的叙述。两名作者对访谈记录进行编码。主题分析与数据收集交替进行，直至达到主题饱和。研究团队对新出现的主题进行了讨论和完善。
出现了两个主要主题：（1）形成职业身份，表现为职业形象从不精确和理想化转变为具体和现实；优先事项从基于内容的偏好转变为基于生活方式的偏好；（2）职业相关决策的个人轨迹，由职业兴趣细化的不同阶段决定；学生通过采用从积极探索到被动行为等各种策略来应对这一过程。
本研究的叙述方法说明了职业选择的动态性质，并完善了作者先前开发的概念框架的要素。其研究结果强调了探索的重要性，个人经历和对医生工作的观察对此至关重要。为推进使初级保健成为更具吸引力职业的努力，必须让学生在安全和个性化的环境中充分接触初级保健，并在其职业选择过程的各个阶段给予支持。
