Survey of the career experience and postgraduate training of the 1965 and 1970 graduates of the Scottish university medical schools

A survey of the career experience and postgraduate training of the 1965 and 1970 graduates of the Scottish university medical schools was carried out in 1975. The duration of training for the specialties of medicine and surgery and for obstetrics and gynaecology was in general longer than for anaesthetics, psychiatry and radiology; the implications of varying periods of training for postgraduate education are discussed. Attention is drawn to a number of factors which influenced career choice. The 1970 graduates who became principals spent longer in training for general practice than those of 1965. Some married women with children had difficulty in finding suitable part-time work; this may be a serious problem for those seeking accreditation of higher specialist training and for training for general practice. It was estimated that, of the British nationals, about 11% of the 1965 and 8% of the 1970 graduates had emigrated. General practice was the discipline most commonly chosen by doctors working overseas.     

Graduate and mature entrants to medicine: changes in career intentions

Fifty-nine students who had previously taken degrees or commenced careers in subjects other than medicine entered the Cambridge Clinical Course in its first 5 years of operation, commencing in 1976. A questionnaire was used to ascertain their original career plans when entering medical education, their career plans in 1981, and the reasons for any changes. Graduates originally planning careers in general practice and teaching or research maintained their intentions, but some of those who had favoured hospital clinical work changed their minds in favour of general practice. General practice was also the most common choice amongst those students who were earlier unsure as to what branch of medicine they would enter. Of students changing their career intentions, half indicated that disenchantment with hospital medicine was a prime reason for the change.     

Career preferences of the 1984 medical graduates of Sri Lanka

A total of 196 graduates from the four medical schools in Sri Lanka responded to a postal questionnaire on their career preferences and factors influencing the choice of specialty. Medicine (38%), surgery (21%), paediatrics (15%) and obstetrics (12%) were the most popular choices. 'Service' specialties such as anaesthesia (1.5%), pathology (1.5%) and radiology (1%) were strikingly less attractive. Community medicine (2%) and general practice (2%) were similarly unattractive; medical administration (0.5%) was the least popular choice. In the choice of a career, opportunity for direct contact with patients (59%) was the most important determinant when compared to financial reward (12%), social prestige (10%) and fixed hours of work (12%). Research prospects (6%) and teaching opportunity (5%) were relatively unimportant considerations. The graduates preferred employment in the state health service (65%) to teaching in the clinical departments of medical schools (26%) and full-time private practice (7%). Pre- and paraclinical departments of medical schools attracted only 2% of the graduates. A total of 80% of the graduates wished to practise in the capital city or a major provincial city, while 10% chose to seek employment overseas. These results will be useful in planning undergraduate and postgraduate education, and in designing policies to attract manpower to the scarcity and high priority disciplines, so that the imbalances encountered would be minimal in the future.     

Choosing a career in general practice: the influence of medical schools

Summary. This paper reviews the literature on career choice to investigate the undergraduate influences on the preference of Australian graduates for a career in general practice. Although isolation of influencing factors is difficult, admission criteria and undergraduate curricula may influence career preference. As the institutional environment of medical schools is weighted towards scientific research and specialized medicine, medical students may be socialized into choosing non-generalist careers. Medical schools should consider broadening selection criteria and curriculum exposure to produce graduates with a broad range of career interests.     

Career choices of United Kingdom medical graduates of 2002: questionnaire survey

OBJECTIVES: To report the specialty choices of UK medical graduates of 2002, and to compare their choices with those of qualifiers in previous years and with the profile of career grade doctors in different specialties in England. METHODS: We carried out a postal questionnaire survey in the UK and drew comparisons with official data for numbers of specialists. RESULTS: The response rate was 65.3% (2778/4257). A total of 22.7% of the medical graduates of 2002 (28.1% of women, 14.5% of men) expressed a preference for a longterm career in general practice, compared with 25.3% of 1999 and 2000 graduates combined. A total of 31.1% of men and 11.9% of women chose surgical specialties; 0.7% of men and 3.4% of women chose obstetrics and gynaecology; 3.4% of men and 7.9% of women chose paediatrics. There was a large mismatch between the percentage choosing each specialty group and the percentage of senior National Health Service doctors working in the same specialty group. In all, 71% of graduates regarded their career choice as definite or probable and 80% definitely or probably intended to pursue a longterm career in medicine in the UK, compared with 75% of qualifiers in 1999 and 2000. CONCLUSIONS: Career choices for general practice remain low: only 1 in 4 women and 1 in 7 men now choose general practice at this career stage. Very few men choose obstetrics and gynaecology, despite a recent increase in training opportunities. There is no evidence of an increase, compared with recent previous cohorts, in the percentage of junior doctors who do not want a longterm career in British medicine.     

Career preference enquiry among Queen's University medical undergraduates and graduates: a follow-up

Questionnaires were distributed in 1979 to fourth-and final-year students and to doctors who graduated in 1977 in the second leg of a longitudinal career preference enquiry at Queen's University medical school. Replies were obtained from 98.5 and 92.3% respectively of the undergraduates and from 74.1% of the graduates. While approximately half fourth- and final-year were consistent with their first preference made two years previously for broad fields of practice, less than a quarter of fourth- and a third of final-year were consistent in their preference of specialty. The proportion of Ulster-born students intending to remain rose by 20%. All 103 graduate respondents were working except two. Almost half either did not intend to continue in their present discipline or were undecided. Forty-five per cent were practising the specialty they had elected as final year students indicating that stability of career choice was greater between final year and SHO grading than between fourth and final year. More respondents in anaesthetics and surgery than in any other specialty were consistent in their choice. Eighty-eight per cent of the Ulster-born respondents were resident here at the time of completing the questionnaire. Sixty per cent intended to practise here ultimately, an increase of 15% on 1977.     

Medical school entrance and career plans of Malaysian medical students

This study investigates the reasons for entry to medicine and the career perspectives of phase III medical students of the Universiti Sains Malaysia (USM). The majority of the students were Malays from low socio-economic backgrounds who entered medical school after completing a 2–year matriculation course. An interest in medicine and helping people were the two main stated reasons for entry to medical school. A group of students wishing to work in private practice was identified. In comparison to the rest of the study body, students in the group were: not well prepared to enter medical school; dissatisfied with the course; and subject to family influences. A desire for monetary gain motivated their choice of medicine as a career. Overall, 13% of the students wished to change career because they were dissatisfied with their experience of medicine as undergraduates.
The study did not find a significant difference in career intentions between female and male medical students. However, women were less likely to seek entrance into private practice or pursue formal postgraduate education. The choice of surgery as a career was confined to men. About 90% of the students had already decided on their future specialty. Four well-established specialties were their most popular choices. The gender of the students had no significant influences of the decision to continue into postgraduate education. The proportion of female students who wished to marry doctors was significantly higher than for male students.     

Are professional attitudes related to gender and medical specialty?

OBJECTIVES: The importance of professional attitudes in medical care has long been recognized; however, medical training has not stressed attitude development until recently. In previous studies among medical students, we found that gender and specialty preference are important factors in attitudes. In this study, patient-centredness of trainees in general practice and surgery and of final-year clerks preferring one of these specialties was assessed in one medical school in The Netherlands. The effect of gender, specialty and training level on attitude was investigated. DESIGN: In 1995, attitudes of 37 general practice trainees, 31 surgery trainees and 120 clerks were measured anonymously using questionnaires containing the Doctor-Patient Scale. This attitude scale measures patient-centredness vs. doctor-centredness. Response rates were 78%, 58% and 84%, respectively. SETTING: University of Utrecht. SUBJECTS: Medical students. RESULTS: Attitudes were related to specialty. General practice trainees showed more patient-centredness than surgery trainees. In accordance with previous findings among younger students, no differences were found between final-year clerks and vocational trainees. In contrast to previous studies, gender was not related to patient-centredness. CONCLUSIONS: Professional attitudes, in particular patient-centredness, seem to be related to specialty preference in the final year of graduate medical training and specialty as a career choice. It remains unclear whether professional socialization reinforces existing attitudes or whether existing attitudes result in specialty preference.     

Early medical career choices and eventual careers

The revised structure of hospital specialist training being introduced in the United Kingdom means that a doctor wanting a career in a hospital specialty will need to be confident that his or her early career choice, made within 3 years of qualification, is realistic. Using data from a longitudinal study of the 1983 cohort of UK medical graduates, the early career choices made by over 2000 doctors were compared with their employment 11 years after qualification. At year 11 65% of the doctors were working within the first choice they had expressed towards the end of their pre-registration year, and 79% were employed in their year 3 first choice. There was, however, important variation within this general picture: lower predictive value was associated with choices made by women; choices for hospital mainstreams rather than for general practice; and choices that were less than definite. The recent drop in popularity of general practice as a career choice of new graduates in the UK, and the steady increase in the proportion of women graduates, mean that the predictive value of the career choices of recent graduates may prove to be lower than that of the 1983 cohort.     

Career preference and choice of practice locations by Saudi medical students

Summary. The identification of career preference and intended practice location of medical students may provide a useful contribution to the projections and distribution of doctors across different specialties in the country. Information for this study was obtained from a survey of medical students in the final years at King Saud University College of Medicine in Saudi Arabia. This included demographic characteristics, career choice, training location, qualification in view and intended practice locations. The majority (61.2%) intended to specialize and subsequently practise in the major disciplines of medicine, surgery, paediatrics and obstetrics. Twenty-eight per cent were not sure of their future career choice. Only a few (3.5%) chose primary care and none chose pathology or anaesthesia. More men chose medicine, paediatrics and surgery, but more women chose obstetrics and primary care. The majority (81.2%) would like to have foreign certificates, but all the Saudis would subsequently practice in Saudi Arabia and mainly in large cities. The implications of this career pattern and practise locations are discussed with recommendations for health planners and medical schools.     

Variation by medical school in career choices of UK graduates of 1999 and 2000

OBJECTIVE: To report on how newly qualified doctors' specialty choices, and factors that influenced them, varied by medical school. DESIGN: Postal questionnaires. SETTING: United Kingdom. SUBJECTS: All doctors who graduated in the UK in 1999 and 2000. MAIN OUTCOME MEASURES: Choices of eventual career expressed 1 year after graduating, and factors influencing their choices. RESULTS: There were some significant differences between medical schools in the career choices made by their graduates. For example, the percentage of respondents who expressed the choice of general practice was significantly low among graduates of Oxford and Cambridge and high among graduates of Birmingham and Leicester. There was also significant variation between medical schools in choices for hospital medical and surgical specialties. There were significant differences, too, between medical schools in the extent to which career choices had been strongly influenced by graduates' inclinations before starting medical school and by their experience of their chosen specialty, particular teachers and departments at medical school. As well as the differences, however, there were also many similarities between the schools in graduates' career choices. DISCUSSION: Medical schools currently provide students with a broad training suited to any subsequent choice of specialty. We suggest that the similarities between schools in the career choices made by graduates are generally more striking than the differences. We raise the question of whether there should be any specialisation by individual schools to train students for careers in particular branches of medical practice.     

An assessment of the Doctorate of Medicine (Internal Medicine), University of the West Indies

The outcome is described of 48 entrants to a postgraduate degree course (DM) in Internal Medicine established at the University of the West Indies in 1974. Contact by postal questionnaire was established in 96% of 26 graduates and 82% of 22 non-graduates. 22 of 25 DM graduate responders have remained in the Caribbean, working in six Caribbean territories. All graduate responders developed a subspecialty interest. The graduates' primary employers are the University (9) and the Government (12). However, failure to graduate did not necessarily preclude qualification as consultant physician (7 of 18 responders). Major difficulties with the DM programme included: (1) in practice, lack of recognition by contributing territories of individual DM (Internal Medicine) graduates; (2) incomplete regional coverage; (3) lack of adequate funding for the programme; (4) an inadequate research training input; and (5) difficulties with seniority for staff who trained in Jamaica to go to work in another territory. All these problems have solutions. Overall, the international recognition of the new degree programme has been satisfactory and the graduates' own assessment of the training was complimentary. At last a system has been devised that enables postgraduates to train as internal medicine specialists in the Caribbean to practise effectively within the Caribbean health system.     

Predictive validity of the medical specialty preference inventory

The medical specialty preference inventory (MSPI) was developed to provide information about specialty preferences to medical students facing the question of specialty choice prior to their entry into graduate medical education. The predictive validity of the MSPI was tested using the six MSPI specialty preference scores of each of 385 students from five U.S. medical schools to predict a specialty. The first-year graduate programme the student obtained was used as the criterion measure for determining accuracy of the prediction. A prediction was made for one of the six specialties for which preference scores are provided on the MSPI. Of the 385 predictions, 198 (51%) were accurate. Compared to a conservative chance expectancy level of 17% (1 out of 6) accuracy, the 51% accuracy level indicates that the MSPI has substantial predictive validity. Considerable variation existed among the five schools on a number of variables.     

The careers of men graduates from the Royal Free Hospital School of Medicine, London

The survey records the data supplied by the 290 respondents to a questionnaire sent out to the first 390 male graduates of the Royal Free Hospital School of Medicine who qualified during the 20 year period after the school became co-educational in 1948. As might have been expected, there was a preponderance of students from homes in Greater London and South East England. Whilst an equal entry of male and female students was felt desirable the achievement of this objective was slow, since selection was based on merit and the male applicants in the first few years seemed less well qualified for the medical training. During the period of the survey half of the entry was at the premedical stage and the average age for starting preclinical studies was 20.0 years—a little higher than that (18.9) recorded in the ASME survey for the 1966 entry to medical schools. A slightly higher number of Royal Free men took higher degrees and diplomas than did the women. On the number available it appeared that a higher percentage of Royal Free men took MRCP as compared with women or Birmingham graduates. The DA and DCH qualifications were more favoured by women than men. Three times as many men worked in, and twice as many lived in London as in South East England, a situation that was the reverse of that for Royal Free women. There was no evidence to show that the men preferred to do career training in London and then move out. A greater number of Royal Free men and women were doing hospital work rather than general practice, in contrast with Birmingham graduates, although it would seem likely from the expressed career preferences that a considerable number of the Royal Free men would eventually take up general practice. A much greater number of Royal Free men than Birmingham graduates were practising surgery. Medicine and obstetrics were more favoured by Royal Free men than women or Birmingham doctors. The Royal Free women favoured anaesthetics, paediatrics, pathology and physical medicine as specialities as compared with the men. Of the respondents 5.4% were practising psychiatry as compared with 5.1% of Royal Free women and 4.4% and 4.3% of Birmingham graduates and those in the ASME survey, respectively. The survey showed that the respondents considered themselves to require training until about 6 years after qualification, 43.7% thought this was best done in a hospital post. In the majority of cases a definite career decision was made by Royal Free men within 3–5 years after qualification. About equal numbers chose hospital work with continuing patient responsibility and general practice as first choice for their career, though the numbers of Royal Free men with the preference for general practice was not in agreement with the number actually doing this type of work. For the location of the work there was a marked aversion to large provincial communities, London, South and South West England being favoured. Of the respondents, 14.5% had taken permanent appointments abroad and 13% had made arrangements to do so. The view quoted by Kilgour (1971) that financial benefit was not the strongest motivation for emigration was confirmed in the survey.     

A community pre-registration year: the continuation of a community-oriented medical school curriculum

A voluntary community-based preregistration year (internship) was created for graduates of a community-oriented medical school in Beersheva, Israel. Graduates were placed in community clinics which had been upgraded to meet the needs of the programme through provision of on-site laboratory facilities and specialist consultation, and placement of social workers and health education personnel in the clinics. The graduates participated in a weekly postgraduate education programme directed to their specific needs. There was a high degree of satisfaction with the programme among the trainees, the clinic team members and the patients. Relatively few of the trainees indicated a desire to pursue careers entirely devoted to primary care, despite their positive evaluation of the pre-registration experience. Though this might have been explained by problems encountered in the programme, such as the lack of adequate on-site supervision and lack of support from the health service providers, external factors such as a general move of graduates towards more lucrative subspecialties and the relative lack of status of family practice were probably the more significant reasons. Increasing focus on the internship year, in addition to the undergraduate and residency periods, is needed to help direct medical education to ambulatory settings.     

Attitudes of the 1984 medical graduates of Sri Lanka to anaesthesia

A total of 196 intern medical officers who had graduated from the four medical schools in Sri Lanka in 1984 indicated their attitudes towards anaesthesia as a medical specialty in response to a postal questionnaire. Eighty per cent of the graduates considered anaesthesia to be an established specialty in Sri Lanka, while 17% felt that the specialty had limited clinical application. A total of 62% of the graduates were not aware, prior to their entry to medical school, that anaesthesia was related to medical practice. All the graduates indicated that the intra-operative role of the anaesthetist was on a par with that of the surgeon, but 40% felt that the pre- and post-operative roles were of a secondary nature. Overall, 42% considered that an anaesthetist acts as an assistant to the surgeon. The graduates were of the opinion that only 35% of the patients undergoing surgery were appreciative of the services rendered by an anaesthetist. Fifty per cent of the graduates considered exposure to the specialty in the undergraduate curriculum as inadequate. Anaesthesia was chosen as the first career preference by 1.5%. The dominant reasons for not selecting anaesthesia as a career specialty were: minimal patient contact and patient recognition (62%), and lack of recognition of the specialty by society (54%). Anaesthetists in Sri Lanka are challenged to alter the perceptions associated with the specialty, which are probably a result of chronic staff shortages restricting practice to the confines of operating theatres.     

Career preferences of graduate and non-graduate entrants to medical schools in the UK

OBJECTIVE: Recent UK policy has been to increase substantially the number of graduate entrants to medical schools. Our aim was to study whether graduate and non-graduate entrants have different long-term career preferences. METHODS: We conducted postal questionnaire surveys of medical qualifiers from all UK medical schools in 1999, 2000 and 2002, surveyed 1 year after qualification, and qualifiers of 1999 and 2000, surveyed 3 years after qualification. RESULTS: By Year 3 after qualification, general practice was the choice of 33% of men graduate entrants and 21% of men non-graduates ( = 12.5, P < 0.001) and of 43% of women graduates and 38% of women non-graduates ( = 1.6, P = 0.2). Surgery was a much less popular choice for men graduate entrants than for men non-graduates; but similar percentages of women graduate and non-graduate entrants chose surgery. A lower percentage of graduate entrants than of non-graduates favoured paediatrics. Other differences between graduates and non-graduates were generally small. General practice was the preferred career for a much lower percentage of those who took an intercalated degree while at medical school, than of those who did not. CONCLUSIONS: Increasing graduate entry to medical school is likely to increase the percentage of doctors who want to become general practitioners, but only modestly so. It may also lead to a decline in the percentages choosing surgery and paediatrics. Otherwise, at least on the current criteria used for selecting students, increasing graduate entry will probably not make much difference to the percentage of newly qualified doctors seeking careers in different branches of practice.     

Influences on choice of surgery as a career: a study of consecutive cohorts in a medical school

AIM: To examine the differential impact of person-based and programme-related features on graduates' dichotomous choice between surgical or non-surgical field specialties for first-year residency. METHODS: A 10-year cohort study was conducted, following 578 students (55.4% male) who graduated from a university medical school during 1994-2003. Data were collected as follows: at the beginning of medical studies, on career preference and learning frame; during medical studies, on academic achievement, cross-year peer tutoring and selective clinical traineeship, and at graduation, on the first-year residency selected. Contingency and logistic regression analyses were performed, with graduates grouped by the dichotomous choice of surgery or not. RESULTS: Overall, 23% of graduates selected a first-year residency in surgery. Seven time-steady features related to this choice: male sex, high self-confidence, option of surgery at admission, active learning style, preference for surgery after Year 1, peer tutoring on clinical surgery, and selective training in clinical surgery. Logistic regression analysis, including all features, predicted 87.1% of the graduates' choices. Male sex, updated preference, peer tutoring and selective training were the most significant predictors in the pathway to choice. DISCUSSION: The relative roles of person-based and programme-related factors in the choice process are discussed. The findings suggest that for most students the choice of surgery derives from a temporal summation of influences that encompass entry and post-entry factors blended in variable patterns. It is likely that sex-unbiased peer tutoring and selective training supported the students' search process for personal compatibility with specialty-related domains of content and process.     

A community-based learning experience for medical students

A programme in which medical students are attached to Children's Institutions for one year is described. The students' role embraces a medical and psychosocial component in which students conduct clinics, screening programmes and health education as well as develop relationships with individuals and groups of children. This experiential learning programme enables medical students to obtain an understanding of children's needs and work through their own feelings which are aroused when confronted with children who have been deprived and abused.     

A school of community paediatrics

Medical graduates need a new kind of instruction in the health care of children. The practice of general practitioners, clinical medical officers and paediatricians can be improved by it. The nature of a school, created for this purpose, its teaching programme, its first year of operation and its possible future are described.