Career Preferences of First-year Students at Canadian Medical Schools, 1966-67 to 1968-69

The principal findings of this study of the career preferences of first-year Canadian medical students were:Over 70% of the first-year students expressed a preference for specialty practice, with only 20% oriented towards practice as a family practitioner.There were considerable differences between the medical schools in the proportion of medical students preferring general practice, ranging from less than 10% at McGill to nearly 33% at Queen''s.Nearly one-third of the students stated that they preferred primarily salaried practice. These students were largely those who preferred specialty practice or a career in an area such as public health or research.Nearly 70% of the students looked for a career with part-time teaching, while 8% preferred a full-time teaching career.Only 1% preferred a full-time research career although 90% expected to have at least some research involvement.Students from smaller communities were more likely to express a preference for general practice than those from large urban areas.Men and women had similar practice preferences in terms of general practice and clinical specialty, but significantly more women than men preferred a career in salaried practice. Significantly fewer women expressed a preference for major involvement in either teaching or research.     

Career and parenting satisfaction among medical students,residents and physician teachers at a Canadian medical school

BACKGROUND: Studies of career and parenting satisfaction have focused separately on medical students, residents and practising physicians. The objective of this study was to compare satisfaction across a spectrum of stages of medical career. METHODS: A survey of incoming medical students, current medical students, residents and physician teachers at the University of Saskatchewan was conducted in the spring of 1997. Response rates were 77% (43/56), 81% (177/218), 65% (134/206) and 39% (215/554) respectively. Factors assessed in the stepwise regression analysis were the effect of sex, parenting and level of training on the likelihood of recommending parenting to medical students or residents, and on parenting dissatisfaction, job dissatisfaction, career dissatisfaction and the importance of flexibility within the college program to accommodate family obligations. RESULTS: More male than female physician teachers had partners (92% v. 81%, p < 0.01) and were parents (94% v. 72%, p < 0.01). Female physician teachers spent equal hours per week at work compared with their male counterparts (mean 52 and 58 hours respectively) and more than double the weekly time on family and household work (36 v. 14 hours, p < 0.01). Physician teachers were the most likely respondents to recommend parenting to residents and their peers. Residents were the most dissatisfied with their parenting time. At all career stages women were less likely than men to recommend parenting, were more dissatisfied with the amount of time spent as parents and were more likely to regard flexibility within the college program as beneficial. There were no sex-related differences in job dissatisfaction and career dissatisfaction. However, married women were more dissatisfied with their jobs than were married men. Job dissatisfaction was greatest among medical students, and career dissatisfaction was greatest among residents. INTERPRETATION: The optimal timing of parenthood appears to be upon completion of medical training. Women were less likely to recommend parenting, less satisfied with the time available for parenting and more likely to value flexibility within the college program to accommodate family needs. These differences did not translate into women experiencing more job or career dissatisfaction.     

Student perceptions of mistreatment and harassment during medical school. A survey of ten United States schools.

Senior students at 10 medical schools in the United States responded to a questionnaire that asked how often, if ever, they perceived themselves being mistreated or harassed during the course of their medical education. Results show that perceived mistreatment most often took the form of public humiliation (86.7%), although someone else taking credit for one''s work (53.5%), being threatened with unfair grades (34.8%), and threatened with physical harm (26.4%) were also reported. Students also reported high rates of sexual harassment (55%) and pervasive negative comments about entering a career in medicine (91%). Residents and attending physicians were cited most frequently as sources of this mistreatment. With the exception of more reports of sexual harassment from women students, perceived mistreatment did not differ significantly across variables such as age, sex, religion, marital status, or having a physician parent. Scores from the 10 schools also did not vary significantly, although the presence of a larger percentage of women in the class appeared to increase overall reports of mistreatment from both sexes.     

Perceptions of family medicine and career choice among first year medical students: a cross-sectional survey in a Turkish medical school

Public attitudes to family medicine in Turkey have lagged behind its rapid academic development. The effect of undergraduate training in primary care on medical students' attitudes to family medicine has not been assessed. Objectives of this study were to assess the attitudes of first year medical students at Uludag University School of Medicine in Bursa, Turkey to family medicine and to determine their career aspirations. The study was a survey of the first year medical class in 2003-2004. The response rate was 95% (248/261 students). Students were positive about their choice of medicine as a career but had negative opinions of general practice. Female students were more positive in this respect. Initial preference was for specialization in fields other than general practice with little knowledge of the academic specialty of family medicine. Greater undergraduate exposure to family medicine is needed in order to increase knowledge of the field and influence student career choices.     

Dentistry as a prospective career choice in india

Career choice is a complex decision in a student''s life. The opportunity to participate in dental education in many countries, especially in the developing ones, is limited to a small percentage of the community. There is a wide range of options for students to choose as a career in general family, gender, personal interest; outcome expectancies can affect the decision in choosing it. Many studies showed that many individuals find themselves in occupations not really knowing why they made that particular decision. The changing nature of the dental workforce and the need to retain the services of future members has made it important to understand why current dental students have chosen dentistry as their career. However, the choice of dentistry becomes forceful at times by peer pressure, cultural thrust or inability to procure medicine. It is of interest to evaluate dentistry as a prospective career choice in India. The participants answered a questionnaire based online survey and the results were collected and analysed statistically. Analyses of data from the survey shows that majority (36.72%) of students had chosen dentistry as a career choice having missed entry or selection into medicine.     

Challenges and advice for MD/PhD applicants who are underrepresented in medicine

The importance of diversity is self-evident in medicine and medical research. Not only does diversity result in more impactful scientific work, but diverse teams of researchers and clinicians are necessary to address health disparities and improve the health of underserved communities. MD/PhD programs serve an important role in training physician-scientists, so it is critical to ensure that MD/PhD students represent diverse backgrounds and experiences. Groups who are underrepresented in medicine and the biomedical sciences include individuals from certain racial and ethnic backgrounds, individuals with disabilities, individuals from disadvantaged backgrounds, and women. However, underrepresented students are routinely discouraged from applying to MD/PhD programs due to a range of factors. These factors include the significant cost of applying, which can be prohibitive for many students, the paucity of diverse mentors who share common experiences, as well as applicants’ perceptions that there is inadequate support and inclusion from within MD/PhD programs. By providing advice to students who are underrepresented in medicine and describing steps programs can take to recruit and support minority applicants, we hope to encourage more students to consider the MD/PhD career path that will yield a more productive and equitable scientific and medical community.     

Patients' Attitudes to Medical Students in General Practice

259 consecutive adult patients were interviewed regarding their attitudes to the presence of medical students at consultation, at examination, and at home visits. Few patients declared reluctance to discussing physical illness and smoking or drinking problems in the student''s presence, but many had appreciable inhibitions about discussing almost every other common component of consultation. Over half of the younger women interviewed would prefer students not to be present at physical or pelvic examination.Neither age nor social class showed significant association with declared preference, but previous contact with students did not decrease inhibitions among patients. Only 15% of respondents said that they would be more upset by the presence of two students rather than one.     

Career and practice profiles of Alberta medical graduates (1973-85) practising in Alberta.

This collaborative study examined the career choices and practice locations of the 940 (58%) of the Alberta medical students graduating between 1973 and 1985 who remained in Alberta. Of the 686 practising graduates slightly less than two-thirds were in family/general practice; the remainder were in a specialty. More women (76%) than men (60%) had chosen family/general medicine. The women graduates spent about 10 hours less a week on patient care than their male colleagues. Personal and professional factors were cited most often as determinants of practice location. Approximately 20% of the practising graduates chose to locate in small towns or rural areas. Accessibility to consultants and opportunities for continuing medical education were reported as vital prerequisites for more physicians to move to smaller Alberta centres. These findings provide a starting point for studies designed to determine how Alberta medical school graduates are contributing to patient care within the province.     

Careers of medical women.

In autumn 1977 91% of the women who had graduated from United Kingdom medical schools in 1949-51 (early cohort) and 1965 (late cohort) were practising medicine. Over the first 12 years after qualification the late cohort was marginally more active in medicine and had more members in career and training posts than the early cohort. On the survey date 1 October 1977 (26-28 years after qualification) the participation index of the early cohort was 0.73 and of the late cohort (12 years) 0.65. Both cohorts show the bimodal career pattern characteristic of British women''s occupational experience.     

Mapping the factors that influence the career specialty preferences by the undergraduate medical students

It is often perceived that undergraduate medical students do not select their career specialty until they are graduated. This study aimed to probe the preferences of undergraduate medical students about their career specialty and the factors influencing their choices. A self-administered questionnaire was distributed to 3rd through 5th year undergraduate medical students to record their choices of specialties and to identify the factors that influence their career selection. Out of 220 respondents, 29 (13.2%) students selected General Surgery, 24 (10.9%) Pediatrics, and 18 (8.2%) Internal Medicine as their career specialties; whereas 24 (10.9%) students were not able to select a major specialty. The least popular specialties were Gynecology and Obstetrics, Oncology, Histopathology, Orthopedics, Genetics, Psychology, each selected by one student. One hundred and seventeen (53.1%) thought their selected specialty ‘matched their capabilities’ and 82 (37.2%) perceived their selection as “innovative field in medicine”. Career advice by friends and families and the desire to serve academic institutions could not influence career selection. Career preferences by medical students result from the interplay of a range of factors. General Surgery, Pediatrics and Internal Medicine were the most preferred specialties. The professional grooming programs to target specialties matching the trainees’ capabilities and the specialties with state-of-the-art innovative technologies attract medical undergraduate students. The attained knowledge is vitally important for the policy makers in modifying the existing framework that can cater the popular and favored specialties.     

Sexual Behaviour and Contraceptive Practice of Unmarried Female Undergraduates at Aberdeen University

After the sixth week of the spring term of 1971 the unmarried female undergraduates at Aberdeen University were sent a postal questionnaire about their sexual behaviour and contraceptive practice and 1,552 (90%) replied. Of these, 684 (44%) had experienced intercourse, 486 in the six-week period preceding the study, of whom 46% had had it more than six times in this period. It was found that 86% of the relationships were with fiancés or steady partners.Only half of the experienced and a quarter of the inexperienced girls thought that contraceptive advice and materials were adequately available. Contraceptives had not been used by 53% of the students on the first occasion that they had intercourse. In the previous six-week period 192 girls had intercourse without using a contraceptive -39% of those having sexual relations. The use of contraceptives increased with the frequency of intercourse and the stability of the relationship. During the previous six weeks 30% of those having intercourse were on the pill, 38% used the sheath, and 26% relied on the safe period or withdrawal as their most frequent method of contraception.Sixty-five girls had been pregnant in the past, six were pregnant at the time of the survey, and 49 thought that they might be.The uncertainty and difficulty that are experienced in obtaining contraceptives and the large number of occasions on which they are not used are discussed. Moral and pragmatic aspects of promoting a more effective use are examined and better publicity for the family planning clinics that already exist is urged.     

Determinants of choosing a career in family medicine

Background

Student choice is an important determinant of the distribution of specialties of practising physicians in many countries. Understanding characteristics at entry into medical school that are associated with the choice of residency in family medicine can assist medical schools in admitting an appropriate mix of students to serve the health care needs of their regions.

Methods

From 2002 to 2004, we collected data from students in 15 classes at 8 of 16 Canadian medical schools at entry. Surveys included questions on career choice, attitudes to practice and socio-demographic characteristics. We followed students prospectively with these data linked to their residency choice. We used multiple logistic regression analysis to identify entry characteristics that predicted a student’s ultimate career choice in family medicine.

Results

Of 1941 eligible students in the participating classes, 1542 (79.4%) contributed data to the final analyses. The following 11 entry variables predicted whether a student named family medicine as his or her top residency choice: being older, being engaged or in a long-term relationship, not having parents with postgraduate university education nor having family or close friends practicing medicine, having undertaken voluntary work in a developing nation, not volunteering with elderly people, desire for varied scope of practice, a societal orientation, a lower interest in research, desire for short postgraduate training, and lower preference for medical versus social problems.

Interpretation

Demographic and attitudinal characteristics at entry into medical school predicted whether students chose a career in family medicine.The number of physicians per capita in both Canada and the United States has declined, and this decline is expected to continue. Canada has already experienced a drop of 5.1% in the physician-to-population ratio from a peak in 2000, and in the United States a shortage of up to 200 000 physicians, or 20% of the needed workforce, is predicted to occur by 2025.^1,2 Combined with a growing elderly population and decreasing physician-hours,^3,4 this reduction in the physician-to-population ratio is expected to have implications for the health care systems of both countries. Therefore, health resource planners likely will be looking to expand the role of primary care, and of family medicine in particular.^5–8 To support such an expansion, a commensurate increase in the numbers of domestically trained family physicians will be required. But with as few as 25% (in 2003)⁹ of Canadian medical graduates choosing family medicine as their top career choice in the residency match, it is unlikely the health care system will be able to supply adequate numbers of primary care physicians.In most countries, the number and the distribution of specialties of physicians are determined by numerous factors, including government policies, training opportunities, immigration and emigration of providers, sex and age distribution of providers, and remuneration incentives and disincentives.^10–17 In many medical systems, the career interests of students also have a substantial steering effect on the distribution and number of available physicians.^18,19The purpose of this study was to follow a large cohort of Canadian medical students from school entry through exit to examine how their career aspirations changed over time and to identify, using multiple logistic regression analysis, the variables at entry into medical school that predict a career choice of family medicine at graduation.     

Family planning/contraception

It is the position of the Canadian Medical Association (CMA) that family planning advice and assistance should be readily available to all residents of Canada. This is viewed as a responsibility of practising physicians that is to be shared with other health and educational agencies. CMA has recommended the establishment of facilities in addition to physicians'' offices for the dissemination of advice on family planning. These facilities should be developed in consultation with and under the supervision of the medical profession. CMA believes induced abortion should not be an alternative to contraception as a method of responsible family planning. In the event of an unwanted pregnancy, full counselling services should be provided. Within the context of preventive medicine, CMA supports the development of educational programs in family living and the promotion of sex education in the school system by knowledgeable persons sensitive to the needs of students.     

Scientists want more children

Scholars partly attribute the low number of women in academic science to the impact of the science career on family life. Yet, the picture of how men and women in science--at different points in the career trajectory--compare in their perceptions of this impact is incomplete. In particular, we know little about the perceptions and experiences of junior and senior scientists at top universities, institutions that have a disproportionate influence on science, science policy, and the next generation of scientists. Here we show that having fewer children than wished as a result of the science career affects the life satisfaction of science faculty and indirectly affects career satisfaction, and that young scientists (graduate students and postdoctoral fellows) who have had fewer children than wished are more likely to plan to exit science entirely. We also show that the impact of science on family life is not just a woman's problem; the effect on life satisfaction of having fewer children than desired is more pronounced for male than female faculty, with life satisfaction strongly related to career satisfaction. And, in contrast to other research, gender differences among graduate students and postdoctoral fellows disappear. Family factors impede talented young scientists of both sexes from persisting to research positions in academic science. In an era when the global competitiveness of US science is at risk, it is concerning that a significant proportion of men and women trained in the select few spots available at top US research universities are considering leaving science and that such desires to leave are related to the impact of the science career on family life. Results from our study may inform university family leave policies for science departments as well as mentoring programs in the sciences.     

Weep for Adonais

A 1995 motor-vehicle crash brought a tragic end to the promising medical career of Michael Agapitos, a specialist in physical medicine and rehabilitation who graduated from the University of Ottawa in 1982. The death of the popular young Ottawa physician and the subsequent court case involving the driver of the other vehicle have had a major impact on the victim''s family and patients, Nicole Baer reports.     

EDWIN L. BRUCK,M.D

The progressive fall in the status and numbers of general practitioners has produced a dangerous void in the field of comprehensive medical care. The Millis Commission and other national study committees have recommended that family practice be made a board-certified specialty in order to restore the status and numbers of family physicians. The scope of family practice that is envisioned, however, would be so restricted in depth as to raise serious doubts that sufficient medical graduates would be attracted to careers in this new specialty. Better training in broadly-based general or family practice—rather than a specialty board, per se—is the only realistic way to elevate status and attract more medical students to this field.     

Contraceptives,counselling, and pregnancy in women with sickle cell disease.

Sickle cell disease is listed in the manufacturers'' data sheets in the United Kingdom as a contraindication to the use of most combined contraceptive pills; the result is confused advice on family planning to a group of women who are at substantial risk from both planned and unplanned pregnancy. A study in north London on the use of contraceptives by women with sickle cell disease indicates that the use of combined oral contraceptives is common. Although medical staff usually advised against pregnancy, such advice was almost always ignored. Over half of the women surveyed had some knowledge about antenatal diagnosis. Family planning advice should be an integral part of the care of women with sickle cell disease. In the absence of specific data to the contrary all methods of contraception may be considered, although with appropriate caution.     

The psychological and social effects of myocardial infarction on wives.

Eighty-two wives of men suffering a first myocardial infarction were interviewed while their husbands were in hospital, and again two months and a year after they went home. The wives had substantial and persistent psychological symptoms, and the husbands'' illness had continuing effects on their work, leisure and social activities, and family life and marriage, their psychosocial disability being comparable to that of the patients. Measures of psychosocial adjustment before the illness and the quality of the marriage and of family life were good predictors of outcome for the wives. The women had a major role in the patients'' readjustment during convalescence, and their attitudes and behaviour as well as the general quality of family life were important determinants of the rate and extent of the patients'' recovery. The wives of patients with myocardial infarction should have more practical help and advice during the hospital period, and the whole family should be given advice and help throughout the convalescence.     

Attitudes Toward Women Physicians: A Study of 500 Clinic Patients

A questionnaire was administered to 500 clinic patients and their replies about men and women physicians were analyzed. Ninety-six percent stated that the typical doctor is a man, and 78 percent expressed a preference for a male doctor. A significant number of patients said they would be unwilling to discuss certain subjects with a woman doctor or to follow her advice. Women physicians were considered less competent and less experienced than their male counterparts.Attitudes toward women doctors were correlated with patients'' sex, age, ethnicity, occupation, and chief complaint. Most impressive statistically were the negative attitudes of Spanish-speaking patients and the positive responses of obstetrics and gynecology patients and black women patients. Patients who had previously consulted women physicians were more favorable toward them, suggesting that increased exposure may lead to reduced prejudice.