Factors influencing specialty choice and the effect of recall bias on findings from Irish medical graduates: a cross-sectional, longitudinal study

Abstract

Background Despite being a vital part of medical workforce planning and development, how medical students and graduates choose their career specialty is still not well understood. This study aimed to identify the factors medical graduates consider important influences in their choice of specialty after their first year of practice, and to test the validity of relying on respondent recall to measure changes in specialty choice. Methods The baseline survey was administered online to all final year students in Ireland’s six medical schools. Those who consented to follow-up (n = 483) were surveyed 18 months later (June 2018), during the final month of first year of practice. Results The baseline survey had a 67% (n = 483) response rate. At the follow-up survey, (n = 232, 48% response rate) the top specialty choices were: Medicine, n = 54 (26%); Surgery, n = 34 (16%); General Practice, n = 28 (13%); Anaesthesia, n = 16 (8%) and Paediatrics, n = 14 (7%). Of the 49 respondents (28%) reporting a change of specialty since baseline, 13 (27%) selected the same specialty in both surveys; of the 121 (69%) reporting no change, 22 (18%) selected a different specialty at follow-up. Over 90% of respondents rated as ‘important or ‘very important’: ‘Own aptitude’, ‘Work-life balance’ and ‘What I really want to do’. Over 75% rated as ‘not at all’, or ‘not very important’ ‘Current financial debt’ and ‘Inclinations before medical school’. When adjusted for sex and age, compared with Medicine, General Practice rated as more important: continuity of patient care (RRR 3.20 CI(1.59–6.41), p = 0.001); working hours/conditions (RRR 4.61 CI(1.03–20.60), p = 0.045) and a career that fit their domestic circumstances (RRR 3.19 CI(1.27–8.02), p = 0.014). Those choosing Surgery rated as less important: patient contact (RRR 0.56 CI(0.33–0.95), p = 0.033) and working hours/conditions (RRR 0.55 CI(0.31–0.96), p = 0.035). Conclusions The different demographic and motivational profiles by specialty choice are consistent with other studies suggesting a distinct profile for doctors intending to enter General Practice. In addition, our results suggest longitudinal study designs guard against recall bias and so provide more robust medical workforce models to inform and direct recruitment drives and interventions in future medical workforce planning.

Understanding concepts of generalism and specialism amongst medical students at a research-intensive London medical school

“…Students in Years 1 (junior medical students), 5 and 6 only (senior) were approached to limit survey fatigue and avoid clashes with exam periods in other year groups. This questionnaire (Appendix 1 ) was developed by two of the investigators (MK and VS) on reflection of personal experience (job roles in Medical Education, Clinical Academia and General Medicine) and a knowledge of the literature surrounding associations with certain career choices amongst medical students [ 5 – 7 , 13 , 15 , 16 ]. The questionnaire was delivered via email using the anonymised Qualtrics platform and prompted respondents to complete slider ratings of eighteen job attributes according to whether they applied more to medical generalists or specialists.…”

“…The challenge persists of how to deliver core curriculum coverage and impart an appreciation of the value of generalists and the increasing need for expert generalist care. Researchers have identified several factors that influence medical undergraduates’ and postgraduates’ choice to pursue a generalist career, including lifestyle factors, aspects of patient care, career progression, job opportunities and prestige [ 5 – 7 , 13 , 15 ].…”

Early career experiences of international medical program graduates: An international, longitudinal, mixed-methods study

“…Studying the experiences of IMP graduates can give valuable insights in career preparedness and highlight gaps in their current undergraduate education. Previous research has shown that following these experiences longitudinally through their early career gives the most reliable information on career choice and curriculum evaluation [ 18 , 19 ]. Better insight into graduates’ perceived obstacles and early career experiences will inform curriculum design decisions to help prepare students best for the transition to international clinical practice.…”

A longitudinal study of risk factors associated with white spot disease occurrence in marine shrimp farming in Rayong, Thailand

“…Longitudinal studies can determine the association of risk factors over an extended period. This kind of study can help researchers reduce recall bias, a major error in well-known designs such as ordinary case–control studies ( Lindberg et al, 2017 ; Cronin et al, 2020 ). Likewise, a longitudinal study can help identify all possible changes in factors that may occur over time ( Fitzmaurice, Laird & Ware, 2012 ).…”