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BCMJ 49 Vol9 Articles Factors Influencing
BCMJ 49 Vol9 Articles Factors Influencing
Lee, PhD, Yvette Leung, MD, Bruce Fleming, MD, Elena Vikis, MD,
Eric M. Yoshida, MD, MHSc
40% of Canadian medical school grad- ical students, residents, and physi- 327 survey packages distributed and
uates made family medicine their first cians. 118 completed and returned. Of the 118
choice in 1982. By 1996, the propor- respondents, 29.7% (35/118) were
tion had declined to 32% and by 2005 medical students, 37.3% (44/118) were
to only 28%. 1 Similar trends were The study population included medical internal medicine or general surgery
Study population
observed in the United States, where students, internal medicine and gener- residents, and 33% (39/118) were
there was decreasing interest in prima- al surgery residents, and physicians physicians. The response rate was
ry care and increasing interest in sub- currently practising in British Colum- 25.0% (35/140) for the medical stu-
specialties. 2-4 bia. A total of 327 individuals received dents, 93.6% (44/47) for the residents,
As medical science and technology the survey package: 140 third-year Uni- and 27.9% (39/140) for the physicians.
have become more sophisticated, the versity of British Columbia medical Of the respondents 54.2% were male.
university spotlight has been focused students, 36 internal medicine resi- The demographic characteristics of all
on subspecialties. Consequently, dents, 11 general surgery residents, and respondents is shown in Table 1 .
many medical students appear to find 140 physicians randomly selected
primary care less appealing than other from the College of Physicians and
specialties. What further complicates Surgeons of British Columbia physi-
Factors influencing
the problem is the reimbursement gap cian directory. Respondents were asked to rank seven
career choices
between the generalists and the spe- factors that influenced their career
cialists. choices. “Personal interests” was
Given the declining interests in Between April and July 2005, survey ranked first among all the respondents,
Survey procedures
primary care, an understanding of the materials were mailed to the medical followed by “previous positive experi-
factors that influence career choices students and physicians in practice, ence,” “personal reasons,” and “job
made by medical students, residents, and distributed to the residents (who opportunities.” Selection factors that
and physicians is essential. Although might not have a permanent address) at were considered less important were
many variables (e.g., level of educa- their academic half days. “influence from a mentor,” “lifestyle
tional debt, mentorship experiences, The survey packages were com- and financial rewards,” and “geograph-
income prospects, lifestyle) have been pleted anonymously and participation ical location.” The career choices and
investigated in previous studies, 5-7 lit- in the study was entirely voluntary. A selection factors for the medical stu-
tle research has been done to compare cover letter sent with the survey pack- dents, residents, and physicians were
the relative importance of different fac- age explained that completion and further analyzed separately. A summa-
tors affecting career choice, and the fac- return of the material implied consent ry of these findings is shown in
tors that have the greatest influence to participate. Completed forms and Table 2 .
thus remain unclear. The purpose of questionnaires were returned by fax or
the study described here was to identi- mail, and were destroyed after data Medical students. Family medicine
fy the different factors and the relative analysis. The study was reviewed and was selected as the top choice for a
importance of each in career selection approved by the Behavioural Research future career by 28.6% of students,
in order to gain some insight into what Ethics Board of the University of while 22.9% expressed interest in in -
might enhance interest in primary care British Columbia. ternal medicine, and 8.6% were in-
as a career choice. terested in surgical specialties. The re-
maining 37.1% of students were
Chi-square analysis was used to deter- interested in other specialties, such as
Analysis
A one-page questionnaire was designed mine the frequency count variables. anesthesia, emergency medicine,
Methods
to identify the factors influencing The mean and median of the ranking pathology, pediatrics, public health,
career choice (see Appendix A and variables were computed and reported. psychiatry, radiology, and radiation
Appendix B). Respondents were asked Becau s e t h e s u b g ro u p s i zes oncology (one student did not answer,
to provide demographic data and to were small, the nonparametric Mann- so percentages do not total 100%).
rank the factors that influenced their Whitney U test was applied to the Students ranked “personal inter-
residency choice. The factors present- ranking variables.
ests” as the most important factor in- rewards.” Factors that were considered cording to those who were and were
fluencing their residency selection. relatively less influential were “future not interested in family medicine and
This was followed by “previous posi- job opportunities,” “geographical loca- compared their career choice factors,
tive clerkship experience,” “personal tions,” and “influence from a mentor.” there were significant differences for
reasons,” and “lifestyle and financial When we grouped the students ac - certain variables. Students who were
interested in family medicine ranked
“personal reasons” (P = .0329) and job
opportunities (P = .0051) higher than
Table 1. Demographic characteristics of 118 respondents.
tant factors.
Female 20 (57.1%) 21 (47.7%) 13 (33.3%)
—
5-year age group
— location.”
Graduate from
significant.
— —
11–15 8 (20.5%)
— —
16–20 2 ( 5.1%)
Personal reasons 4.0 (3.8) 4.0 (4.3) 4.0 (4.0) 4.0 (4.1)
43.5%, found their mentors “some- resident respondents (38/44) expressed some key factors that influenced the
what helpful” or “pretty helpful” (one their interests in a mentorship pro- career choices made by medical stu-
student did not answer, so percentages gram in the future. dents, residents, and practising physi-
do not total 100%). cians. “Personal interests” and “previ-
In terms of mentor influence on Physicians. Of the 39 physician re- ous positive clerkship experience”
residency choice, only 13% of the stu- spondents, 16 had had mentors during were the two most important factors
dents found their mentors had a “strong their residency. Among those who had for the students, residents, and physi-
influence” on their career choices. mentors, 8 were strongly influenced cians when selecting their specialty,
“General guidance” was the most by their mentors when choosing their while “lifestyle and financial rewards”
important benefit students expected careers. and “geographical location” did not
from their mentors, followed by “ca- As a physician and mentor, pro- attain significance as predictors of a
reer counseling” and “professional viding “general guidance” to the men- career choice. It was somewhat sur-
support.” Providing “emotional sup- tees was perceived as most important, prising to see that “lifestyle and finan-
port” and “assistance on research pro- followed by “career counseling,” “pro- cial rewards” had minimal influence
jects” was considered less important. fessional support,” “emotional support,” on the career choices since previous
When asked whether they would be and “assistance on research projects.” studies 9,10 have shown that the odd
interested in a mentorship program in While 97.1% of student respon- ratios for selecting a residency other
the future, the majority of student dents and 86.4% of resident respon- than primary care increased as the con-
respondents (34/35) expressed interest. dents were interested in a mentorship cern about student indebtedness
program, only 69.3% of physicians increased. Moreover, comments in the
Residents. Among the 44 responding were interested, a statistically signifi- Vancouver media have suggested that
residents, 20 had mentors prior to res- cant difference (P = .0079). the decline in physician interest in pri-
idency; however, this number dropped mary care, especially family medicine,
significantly during residency, to 11. is in part due to income disparity
When the residents were analyzed by There were several limitations to this between primary care physicians and
Study limitations
speciality, 36% of internal medicine study. The sample size was small and specialists. 11,12
and 73% of surgery residents had men- the participant rate was low. The study The results of this study regarding
tors during medical school. During res- relied on the respondents to self-report mentorship were also somewhat sur-
idency, only 27% of internal medicine what influenced their career choices and prising. Other studies have reported
residents and 18% of surgery residents these responses, especially in that role models or mentors influence
had mentors. the case of residents and physicians, a medical student’s selection of resi-
Among those residents who had would be subject to recall or nondisclo- dency. 7,13 In our study, both the resi-
mentors prior to residency, only 15% sure bias. Furthermore, this study dents and physicians ranked “influence
found their mentors had a “strong looked at only seven career-choice selec- from a mentor” third, after “personal
influence” on their residency choices. tion factors; other factors such as mar- interests” and “previous positive clerk-
For those residents who currently had ital status, level of educational debt, ship experiences.” However, when
mentors, 27.3% found their mentors and desire to work with people, were asked about mentors specifically, very
“very helpful,” 27.3% “somewhat not considered. Lastly, the study sam- few respondents felt that mentors did
helpful,” and 45.5% found them “pret- ple was drawn from students, residents, not provide any influence. In fact, the
ty helpful.” and physicians from a single Canadian perceived value of mentors appeared to
“Career counseling” was ranked as province and may not be generalizable be greatest among the practising
the most important benefit residents to other provinces and countries. To physicians. This is in contrast to the
expected from their mentors, followed better understand the career-choice responses of medical students, who
perceived that having a mentor did not a predictor for later generalist prac-
have any significant influence on res- tice. 14,15 Therefore, selecting medical
family medicine: What influences med-
possible this finding may be due to the mary care might be helpful.
49:1131-1137.
looked only at third-year medical stu- will require substantial effort. Various
What predicts medical student career
65.7% of these students had mentors. sure to primary care during training,
203.
It may also be possible that students selecting students who express inter-
7. Wright S, Wong A, Newill C. The impact
tend to meet their mentors after they ests in primary care, and improving
of role models on medical students. J
have decided on a career path, and that satisfaction among family physicians
Gen Intern Med 1997;12:53-56.
ceived only long after the mentorship pursue a career in primary care. How-
Which primary care specialty? Factors
has been completed and not immedi- ever, all these will require a coordinat-
that relate to a choice of family medicine,
be of great benefit, even if those stu- and academics. Although this study
Med 2004;36:123-130.
dent respondents with mentors do not provides some insight, studies that
9. Kiker BF, Zeh M. Relative income expec-
appreciate this right away. Another involve multiple centres and a larger
tations, expected malpractice premium
possibility is that the difference in the sample are still needed to provide bet-
costs, and other determinants of physi-
4. Rank the following factors that influenced your choice of residency program:
(1 = most important; 7 = least important; please use each number only ONCE)
___ Personal interests
___ Personal reasons (e.g. family, friends, etc.)
___ Geographical location
___ Previous positive clerkship experience
___ Influence from a mentor
___ Lifestyle and financial rewards
___ Future job opportunities in that field
8. Rank the following areas that you expect to benefit from the mentor:
(1 = most important; 5 = least important; please use each number only ONCE)
___ General guidance
___ Career counseling
___ Assistance & support surrounding professional issues
___ Emotional support surrounding personal or non-work related issues
___ Assistance on research project
*Medical students received this questionnaire, while practising physicians received the questionnaire in Appendix B. Residents received a questionnaire
similar to this one, except it gathered information on the medical school graduated from, current speciality, and year of residency.
6. Rank the following factors that had motivated you to choose the current specialty:
(1 = most important; 7 = least important; please use each number only ONCE)
___ Personal interests
___ Personal reasons (family, friends, etc.)
___ Geographical location
___ Previous positive clerkship or rotation experience
___ Influence from a mentor
___ Lifestyle and financial rewards
___ Future job opportunities in that field
8. Looking back, would you feel you could have benefited from having a mentor?
Yes No
(Skip Question #9, go to Question #10)
10. Are you interested in mentoring a medical student or resident or fellow in the future?
Yes No
11. If answered “Yes” in the above question, please rank the following that you feel a good mentor should offer to
the mentee: (1 = most important; 5 = least important)
Please use each number only ONCE
___ General guidance
___ Career counseling
___ Assistance & support surrounding professional issues
___ Emotional support surrounding personal or non-work related issues
___ Assistance on research project