Who wants to become a general practitioner? Student and curriculum factors associated with choosing a GP career - a multivariable analysis with particular consideration of practice-orientated GP courses

Figures & data

Table I. Description of the optional undergraduate general practice courses examined in this study.

Study section	Optional courses
Pre-clinical study section (years 1 and 2)	Pre-clinical elective “general practice”  • Aim: motivation for general practice via acquisition of clinical skills and early patient contact  • Form: introduction/preparatory course (14 TU^1) + practical training (one-to-one) in an associated GP's office^2 (11 TU) + debriefing/oral exam (3 TU)
Clinical study section (years 3–5)	Clinical elective “general practice”  • Aim: motivation for general practice via acquisition of clinical skills (adapted to the advanced level of education) and experiences in general practice  • Form: preparatory course (6 TU) + practical training (one-to-one) in an associated GP's office (21 TU)
	Clerkship in general practice
	• Duration: 4 weeks  • Full-time experience in the GP setting  • Optional organizational support by the Department of Primary Care
Final (clinical) year (year 6)	Clinical rotation in general practice  • Duration: 4 months  • Content structured by the Department of Primary Care (defined catalogue of learning objectives)  • One-to-one training by specifically trained GP  • Supervision of students and GP tutors

Notes: ¹TU = teaching unit (= 45 minutes). ²The Department of Primary Care of Leipzig Medical School collaborates with a large number of associated, specifically qualified GPs.

Table II. Sample characteristics.

Variable	Valid (n)	n (%)^1
Age [mean ± SD]	659	27.9 ± 2.5
Female gender	659	441 (66.9)
In a relationship	658	463 (70.4)
Has children	658	127 (19.3)
At least one parent with higher education degree	658	521 (79.2)
Being a physician's child	659	201 (30.5)
Family or friends in general practice during schooldays/years of study	657	172 (26.2)
Mainly grew up in …	653
… big city		231 (35.4)
… small town		246 (37.7)
… rural area		176 (27.0)

Note: ¹Unless otherwise indicated.

Table III. Multivariable binary logistic regression analyses predicting GP career choice, n = 648 (valid data for all included variables).

Variable	Model 1^1		Model 2^2
	(Pseudo-R²Nagelkerke = 0.362)		(Pseudo-R²Nagelkerke = 0.234)		(Pseudo-R²Nagelkerke = 0.350)		(Pseudo-R²Nagelkerke = 0.486)
	OR (95% CI)	p	OR (95% CI)	p	OR (95% CI)	p	OR (95% CI)	p
Participation (vs. no participation) in …
… pre-clinical elective course in general practice (pre-clinical study section)			2.2 (1.2–4.0)	0.011	2.1 (1.1–4.0)	0.022	2.6 (1.3–5.3)	0.006
… clinical elective course in general practice (clinical study section)			1.8 (0.7–4.8)	0.234	1.7 (0.6–4.4)	0.318	1.4 (0.5–4.2)	0.536
… four-week clerkship in general practice (clinical study section)			3.8 (2.2–6.8)	< 0.001	2.4 (1.3–4.4)	0.005	2.6 (1.3–5.0)	0.005
… four-month clinical rotation in general practice (final year)			7.5 (3.7–15.2)	< 0.001	7.3 (3.4–15.7)	< 0.001	10.7 (4.3–26.7)	< 0.001
Age ≥ 25 years at the time of the mandatory two-week general practice clerkship (vs. ≤ 24 years)	2.4 (1.3–4.3)	0.004			2.6 (1.5–4.7)	0.001	3.0 (1.6–5.7)	0.001
Family or friends in general practice during schooldays/years of study (vs. not)	2.0 (1.1–3.5)	0.016			2.1 (1.2–3.7)	0.012	2.3 (1.2–4.3)	0.010
Consideration of general practice as a career option at study entry (preferred or possible option) (vs. no option)	5.5 (2.7–11.0)	< 0.001			5.6 (2.8–11.3)	< 0.001	3.6 (1.7–7.7)	0.001
Preference for later work in a rural or small-town area (vs. not)	2.3 (1.3–3.9)	0.004					2.5 (1.4–4.6)	0.004
Personal (job-related) importance of … (five-point Likert-scale from 1 = unimportant to 5 = very important)
… broad spectrum of patients	1.6 (1.1–2.3)	0.026					2.1 (1.3–3.4)	0.001
… long-term doctor–patient relationships	2.7 (1.9–3.8)	< 0.001					2.6 (1.8–3.8)	< 0.001

Notes: ¹Model 1 was the result of the purposeful selection of covariates process (see paragraph “Statistical analysis”) considering the influence of variables frequently found to be relevant in earlier studies (excluding curricular experiences). The following variables were taken into consideration within the model-building process: age, gender, having a partner, having children, being a physician's child, regional background, family or friends in general practice during schooldays/years of study, at least one parent with higher education degree, preference for later work in a rural or small-town area, consideration of general practice as a career option at study entry, and the seven variables addressing job-related value orientations presented in Table IV. ²Model 2 examines the independent association of the four optional undergraduate general practice experiences (see Table I) with GP career choice adjusted for the variables shown to be relevant in Model 1. To uncover possibly meaningful changes, variables were included in three steps: undergraduate general practice courses, complemented by the definitely unalterable variables of Model 1, complemented by the variables of Model 1 that may have altered over time.

Table IV. Job-related value orientations: Comparisons based on career choice and gender.

Personal (job-related) importance of … (five-point Likert-scale from 1 = unimportant to 5 = very important)		All	Future GPs	Other		Female	Male
	n	Mean ± SD	Mean ± SD	Mean ± SD	p^1	Mean ± SD	Mean ± SD	p^1
… variety of everyday tasks	658	4.3 ± 0.6	4.5 ± 0.6	4.3 ± 0.6	0.007	4.3 ± 0.6	4.3 ± 0.6	0.539
… broad spectrum of patients	659	3.9 ± 0.8	4.2 ± 0.7	3.8 ± 0.8	< 0.001	3.9 ± 0.8	3.8 ± 0.8	0.032
… high income	658	3.5 ± 0.8	3.4 ± 0.9	3.5 ± 0.8	0.147	3.4 ± 0.8	3.6 ± 0.8	0.065
… prestige	654	2.7 ± 0.9	2.5 ± 0.9	2.7 ± 0.9	0.176	2.6 ± 0.9	2.8 ± 0.9	0.001
… positive work–life balance	657	4.6 ± 0.7	4.7 ± 0.5	4.5 ± 0.7	0.124	4.6 ± 0.6	4.4 ± 0.8	< 0.001
… involvement in research	656	2.6 ± 1.1	2.3 ± 1.0	2.6 ± 1.1	0.011	2.4 ± 1.0	2.9 ± 1.2	< 0.001
… long-term doctor–patient relationships	659	3.3 ± 1.0	4.2 ± 0.8	3.2 ± 1.0	< 0.001	3.4 ± 1.0	3.2 ± 1.0	< 0.001

Note: ¹Mann–Whitney U-test.