Dear Sir
Health human resource planning of physicians is determined by a number of factors including, in many jurisdictions, the career preference of future providers. Students choose their careers against a backdrop of societal influences, medical school influences, medical practice influences and the mechanism in place for choosing or assigning post-graduate training positions.
In 2003 we carried out 8 focus groups and 4 individual interviews with 33 students at the University of British Columbia and the University of Calgary, two medical schools in Western Canada at the midpoint of their medical studies (prior to their clinical experiences) to understand the factors affecting medical student career choice in the pre-clinical years.
Students identified pre-medical experience and medical school experiences (in both the clinical and non-clinical realms), their perceived fit with their desired career (including current life stage and/or circumstances) and the residency application procedure as key elements of their career decision making process. Many students reported elements of the residency application process itself as significant barriers to their future career aspirations. These barriers included: the short time period available for clinical electives at their school prior to the residency match, the timing of those electives in relation to the residency match, the types of elective choices and experiences available to them as well as their perceived likelihood of successfully matching to a particular residency.
Students reported two specific conflicts that arose from their interaction with the residency application process: conflicts between personal and professional needs and conflicts between making strategic choices or declarations to others and being honest. Students also highlighted the dynamic nature of the decision making process and their uncertainty around these decisions during the pre-clinical years.
In response to this study, we would suggest that medical educators provide information on the factors associated with career choice, offer opportunities for students to receive information around the residency application process and opportunities for students to explore their own perceptions around the residency application process. Normalising the dynamic uncertain nature of the career decision making process would also be helpful to students. It is clear from our study that students are actively engaged in the career decision making process early in their medical education and these actions could support students in their career decisions.
Ian Scott, MD
Department of Family Practice
University of British Columbia
Suite 300
5950 University Boulevard
Vancouver, Canada V6T 1Z3
email: [email protected]
Bruce Wright MD
Department of Family Medicine
University of Calgary, Canada
Pamela Brett-MacLean PhD (C) and Fraser Brenneis MD
Department of Family Medicine
University of Alberta, Canada