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What determines medical students’ career preference for general practice residency training?: a multicenter survey in Japan

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      Abstract

      BackgroundFew 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.MethodsFrom 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.ResultsA 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.ConclusionsOur 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.

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      Career choice of new medical students at three Canadian universities: family medicine versus specialty medicine.

      Over the last 10 years the number of medical students choosing family medicine as a career has steadily declined. Studies have demonstrated that career preference at the time that students begin medical school may be significantly associated with their ultimate career choice. We sought to identify the career preferences students have at entry to medical school and the factors related to family medicine as a first-choice career option. A questionnaire was administered to students entering medical school programs at the time of entry at the University of Calgary (programs beginning in 2001 and 2002), University of British Columbia (2001 and 2002) and University of Alberta (2002). Students were asked to indicate their top 3 career choices and to rank the importance of 25 variables with respect to their career choice. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbach's alpha coefficients; biserial correlations between the factors and career choice were also calculated. A logistic regression was performed using career choice (family v. other) as the criterion variable and the factors plus demographic characteristics as predictor variables. Of 583 students, 519 (89%) completed the questionnaire. Only 20% of the respondents identified family medicine as their first career option, and about half ranked family medicine in their top 3 choices. Factor analysis produced 5 factors (medical lifestyle, societal orientation, prestige, hospital orientation and varied scope of practice) that explained 52% of the variance in responses. The 5 factors demonstrated acceptable internal consistency and correlated in the expected direction with the choice of family medicine. Logistic regression revealed that students who identified family medicine as their first choice tended to be older, to be concerned about medical lifestyle and to have lived in smaller communities at the time of completing high school; they were also less likely to be hospital oriented. Moreover, students who chose family medicine were much more likely to demonstrate a societal orientation and to desire a varied scope of practice. Several factors appear to drive students toward family medicine, most notably having a societal orientation and a desire for a varied scope of practice. If the factors that influence medical students to choose family medicine can be identified accurately, then it may be possible to use such a model to change medical school admission policies so that the number of students choosing to enter family medicine can be increased.
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        Factors related to the choice of family medicine: a reassessment and literature review.

        Recent decreases in the number of students entering family medicine has prompted reconsideration of what is known about the factors affecting specialty choice. Thirty-six articles on family medicine specialty choice published since 1993 were reviewed and rated for quality. Rural background related positively and parents' socioeconomic status relates negatively to choice of family medicine. Career intentions at entry to medical school predict specialty choice. Students who believe primary care is important, have low income expectations, and do not plan a research career are more likely to choose family medicine. The school characteristic related to choice of family medicine is public ownership. Large programs to increase numbers entering primary care seem effective. Required family medicine time in clinical years is related to higher numbers selecting family medicine. Faculty role models serve both as positive and negative influences. Students rejecting family medicine are concerned about prestige, low income, and breadth of knowledge required. Students planning on a career in a disadvantaged or rural area are more likely to enter family medicine. Multiple factors are consistently shown to be related to the choice of the specialty of family medicine.
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          Determinants of primary care specialty choice: a non-statistical meta-analysis of the literature.

          This paper analyzes and synthesizes the literature on primary care specialty choice from 1987 through 1993. To improve the validity and usefulness of the conclusions drawn from the literature, the authors developed a model of medical student specialty choice to guide the synthesis, and used only high-quality research (a final total of 73 articles). They found that students predominantly enter medical school with a preference for primary care careers, but that this preference diminishes over time (particularly over the clinical clerkship years). Student characteristics associated with primary care career choice are: being female, older, and married; having a broad undergraduate background; having non-physician parents; having relatively low income expectations; being interested in diverse patients and health problems; and having less interest in prestige, high technology, and surgery. Other traits, such as value orientation, personality, or life situation, yet to be reliably measured, may actually be responsible for some of these associations. Two curricular experiences are associated with increases in the numbers of students choosing primary care: required family practice clerkships and longitudinal primary care experiences. Overall, the number of required weeks in family practice shows the strongest association. Students are influenced by the cultures of the institutions in which they train, and an important factor in this influence is the relative representation of academically credible, full-time primary care faculty within each institution's governance and everyday operation. In turn, the institutional culture and faculty composition are largely determined by each school's mission and funding sources--explaining, perhaps, the strong and consistent association frequently found between public schools and a greater output of primary care physicians. Factors that do not influence primary care specialty choice include early exposure to family practice faculty or to family practitioners in their own clinics, having a high family medicine faculty-to-student ratio, and student debt level, unless exceptionally high. Also, students view a lack of understanding of the specialties as a major impediment to their career decisions, and it appears they acquire distorted images of the primary care specialties as they learn within major academic settings. Strikingly few schools produce a majority of primary care graduates who enter family practice, general internal medicine, or general practice residencies or who actually practice as generalists. Even specially designed tracks seldom produce more than 60% primary care graduates. Twelve recommendations for strategies to increase the proportion of primary care physicians are provided.
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            Author and article information

            Affiliations
            [1 ]ISNI 0000 0001 2151 536X, GRID grid.26999.3d, Department of General Internal Medicine, , Kawasaki Municipal Tama Hospital/St. Marianna University School of Medicine, ; 1-30-37 Shukugawara, Kawasaki, Kanagawa 214-8525 Japan
            [2 ]ISNI 0000 0004 0372 555X, GRID grid.260026.0, Department of Family Medicine, , Mie University School of Medicine, ; 2-174 Edobashi, Tsu-shi, Mie 514-8507 Japan
            [3 ]Family Practice Center of Okayama, 292-1 Toyosawa, Katsuta-gun, Nagi-cho, Okayama 708-1323 Japan
            [4 ]Iwakura Station Tahara Clinic, 291-1 Chuzaiji, Iwakura, Sakyo-ku, Kyoto-shi, Kyoto 606-0021 Japan
            [5 ]Thank You All, Family Clinic Hiratsuka, 215-3 Okazaki, Hiratsuka-shi, Kanagawa 259-1212 Japan
            [6 ]ISNI 0000 0004 0372 555X, GRID grid.260026.0, Department of Education and Research in Family and Community Medicine, , Mie University Graduate School of Medicine, ; 2-174 Edobashi, Tsu-shi, Mie 514-8507 Japan
            [7 ]ISNI 0000 0001 2151 536X, GRID grid.26999.3d, International Research Center for Medical Education, Graduate School of Medicine, , The University of Tokyo, ; 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
            Contributors
            ORCID: http://orcid.org/0000-0002-1387-0588, iekenya0321@gmail.com
            chimunii@gmail.com
            masao.tahara@gmail.com
            komiyama.manabu@gmail.com
            ichikawa-s@clin.medic.mie-u.ac.jp
            yousuke@clin.medic.mie-u.ac.jp
            onishi-hirotaka@umin.ac.jp
            Journal
            Asia Pac Fam Med
            Asia Pac Fam Med
            Asia Pacific Family Medicine
            BioMed Central (London )
            1444-1683
            1447-056X
            27 January 2018
            27 January 2018
            2018
            : 17
            5787259
            39
            10.1186/s12930-018-0039-9
            © The Author(s) 2018

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

            Funding
            Funded by: The Japan Primary Care Association
            Award ID: 26-01-001
            Award Recipient :
            Categories
            Research
            Custom metadata
            © The Author(s) 2018

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