How do medical schools influence their students’ career choices? A realist evaluation

ABSTRACT

Introduction

The career choices of medical graduates vary widely between medical schools in the UK and elsewhere and are generally not well matched with societal needs. Research has found that experiences in medical school including formal, informal and hidden curricula are important influences. We conducted a realist evaluation of how and why these various social conditions in medical school influence career thinking.

Methods

We interviewed junior doctors at the point of applying for speciality training. We selected purposively for a range of career choices. Participants were asked to describe points during their medical training when they had considered career options and how their thinking had been influenced by their context. Interview transcripts were coded for context-mechanism-outcome (CMO) configurations to test initial theories of how career decisions are made.

Results

A total of 26 junior doctors from 12 UK medical schools participated. We found 14 recurring CMO configurations in the data which explained influences on career choice occurring during medical school.

Discussion

Our initial theories about career decision-making were refined as follows: It involves a process of testing for fit of potential careers. This process is asymmetric with multiple experiences needed before deciding a career fits (‘easing in’) but sometimes only a single negative experience needed for a choice to be ruled out. Developing a preference for a speciality aligns with Person-Environment-Fit decision theories. Ruling out a potential career can however be a less thought-through process than rationality-based decision theories would suggest. Testing for fit is facilitated by longer and more authentic undergraduate placements, allocation of and successful completion of tasks, being treated as part of the team and enthusiastic role models. Informal career guidance is more influential than formal. We suggest some implications for medical school programmes.

KEYWORDS:

• Career choice
• medical school
• undergraduate medical curriculum
• realist evaluation
• decision theory

Acknowledgments

Dr Helen Thursby who conducted interviews, Dr Stu McBain and Prof Simon Gay who advised on the initial design of the study

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

AT conducted some of the interviews, led data analysis and wrote the initial draft of the manuscript as a masters dissertation. JL led the research team which devised the study and were awarded the research grant and revised the manuscript into this paper. All authors contributed to initial programme theory, did coding, discussed modifications of the programme theory and edited drafts of the paper

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10872981.2024.2320459

Additional information

Funding

This work was supported by an ASME/GMC Excellent Education Award Grant 2015.