Schoon Birte, Kötter Thomas
Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, SH, Germany.
Adv Med Educ Pract. 2024 Nov 23;15:1127-1140. doi: 10.2147/AMEP.S491008. eCollection 2024.
Medical school graduates are faced with the difficult decision of choosing a specialty training program. Understanding the decision criteria as well as the intracurricular factors-which have been studied less frequently and thus lack clarity-may help to prevent an impending shortage of certain specialists and to ensure the recruitment of young doctors into supposedly less popular specialties. Evidence-based changes to the medical curriculum are needed to support the balanced development of health care systems with demand-driven staffing of all specialties, especially in the outpatient sector and in rural areas. The aim of this systematic review was to identify the intracurricular factors that influence medical students' choice of specialty that have been described in the international literature.
A systematic review was conducted by searching Medline. After applying the inclusion and exclusion criteria to the 2537 primary results and 19 hits from an additional manual search, data were extracted from 334 studies. In addition, a quality assessment of all included studies was performed.
A total of 14 influencing factors were identified from the reviewed literature, of which "clinical-practical experience", "clinical role models", and "voluntary offerings" were mentioned most frequently. We sorted the factors into four main categories: "Teaching"; "Teaching environment, influence and interaction"; "Curriculum"; and "Voluntary work". The studies were highly heterogeneous regarding research methods and the quality of reporting.
Involving students in the planning and structuring of clinical phases, active feedback, voluntary offerings, seminars/simulations, and involvement in the clinical team can increase a specialty preference. Conversely, discrimination, prejudice and poor quality of teaching and clinical exposure may act as a deterrent. It is necessary to sensitize medical staff regarding their role and influence in the decision-making process. Further prospective and qualitative research is needed to address this issue adequately.
医学院毕业生面临着选择专业培训项目这一艰难决定。了解决策标准以及课程内因素（这些因素研究较少，因而不够明晰），可能有助于防止某些专科医生即将出现的短缺情况，并确保年轻医生被招募到本应不太热门的专科领域。需要对医学课程进行循证变革，以支持医疗保健系统的均衡发展，实现各专科按需配备人员，尤其是在门诊部门和农村地区。本系统评价的目的是确定国际文献中描述的影响医学生专业选择的课程内因素。
通过检索Medline进行系统评价。在对2537条初步结果和另外手动检索得到的19条结果应用纳入和排除标准后，从334项研究中提取数据。此外，对所有纳入研究进行了质量评估。
从纳入综述的文献中总共确定了14个影响因素，其中“临床实践经验”“临床榜样”和“志愿活动”被提及的频率最高。我们将这些因素分为四大类：“教学”；“教学环境、影响和互动”；“课程”；以及“志愿工作”。这些研究在研究方法和报告质量方面高度异质性。
让学生参与临床阶段的规划和组织、积极反馈、志愿活动、研讨会/模拟以及参与临床团队，可以增加对某一专科的偏好。相反，歧视、偏见以及教学和临床实习质量差可能会起到威慑作用。有必要让医务人员意识到他们在决策过程中的作用和影响。需要进一步开展前瞻性和定性研究，以充分解决这一问题。
