Choosing a specialty

The recent changes in UK postgraduate medical training were partly designed to help medical students and recent graduates with their career choices. The aims have been to broaden early experience and to design core training programmes. However, the uncertainties produced by these changes, the difficulties surrounding applications and selection processes, and worries about job availability have increased anxiety among medical students. Ranking of students in the selection processes has raised interest in marks, created worries about the comparability of assessments, and increased competitiveness.

Undergraduate medical programmes aim to produce graduates capable of training in any branch of the profession, although intercalated degrees and student selected components may allow them to explore more specialised non-core interests. Some students enter medical school with a strong idea of their eventual career path. These ideas may have come from personal or family experiences of illness or role models or from the media. Such preferences often develop before students have much knowledge or experience of the range of fields available in medicine.

Several studies have looked at the career choices of students during training and recently after graduation. These have shown variation with time and among countries. The postgraduate training changes and the predicted availability of jobs, together with changes in the demographics of the student population, with more female students in many countries and older graduate entrants, may change career choices and further complicate workforce planning.

Changing your mind

Not surprisingly, choices of potential careers do seem to change during a student’s time at medical school, and in the first few years after training. These changes may be influenced by positive or negative role models.¹ Choices during medical school do not necessarily match job availability. Surgery tends to be more popular as a prospective career choice, and general practice, the destination of 40-50% of graduates, is chosen less often at undergraduate level. In 2002 71% of UK graduates regarded their career choice as definite or probable, although twice as many chose surgery and half as many chose general practice compared with the likely places available in training and as final career posts.² These disparities were greater for male graduates. Few studies have examined whether intended career choices soon after graduation are followed. One study that looked at UK doctors 27 years after graduation showed that 59% of doctors were in their career choice expressed in their first year after graduation.³ Not surprisingly 70% of doctors were in their chosen specialty three years after graduation, and 78% in their fifth year. The chances of being in their chosen specialty were higher for doctors who selected general practice.

In other countries the disparities of choices and availability may be even greater. In a recent study from Jordan surgery was the choice of 65% of second year medical students, but only 38% chose surgery by the final year.⁴ Surgery was more often chosen by men; obstetrics and gynaecology was the most common choice for women; and overall less than 2% of students chose family medicine. Men were most likely to be influenced by the perceived reputation and income of their prospective careers. Similarly in Japan, where family medicine is less developed and students have less exposure, this is not a common choice at undergraduate level.¹

Changes in medical school intake with more women and more graduates will change the picture. Students who enter medical school as graduates are more likely to choose general practice, the differences from non-graduates are more marked for men and increase in the first three years after graduation. This may be related to the attraction of the shorter training period for older students. In contrast, students who take an intercalated bachelor of science are less likely to choose general practice, even after exclusion of schools with compulsory bachelors degrees.⁵

Personality tests

Several articles have explored the question of matching skills, aptitudes, or psychological type to help in choosing a career.⁶ Personality tests, such as the Myers-Briggs type indicator, show differences between doctors in different specialties.⁷ However, the overall differences between specialties tend to be small compared with the variation in personality type within the specialty, and little or no information is available to link these measures to success within careers. Using these characteristics to inform career choice might also maintain inappropriate or outmoded stereotypes, such as the bombastic surgeon or the quiet pathologist. Tests of professional preference and personal attributes, such as Sci59, which is available free to BMA members for one year, may be more useful, not in indicating a definite career path but in giving students or graduates insight into careers and their own preferences.⁸

The influences on choice of career and the effects of change in students’ profiles, undergraduate curriculums, and postgraduate training structures are important areas for evaluation and research.

It is important to provide information about, and exposure to, different specialties in medical school to encourage students to reflect on these opportunities and on their own aptitudes and goals. In the United Kingdom the increased emphasis on provision of career advice at medical school and in the recently founded foundation schools is likely to be helpful and meets a need expressed by recent graduates. ^{9 10} The recent and future changes in training structure and work patterns increase the importance of such expertise because this may not reside with consultants established in their specialties and with memories of their own training. However, such consultants constitute important role models. They owe it to their students and trainees to help them with their choices and this means they need to keep up to date in this area, just as they do in their clinical activity.

Competing interests: None declared.

Provenance and peer review: Commissioned; externally peer reviewed.

See “Spoilt for choice” (BMJ Careers http://careers.bmj.com/careers/advice/view-article.html?id=3084)

1. Saigal P, Takemura Y, Nishiue T, Fetters MD. Factors considered by medical students when formulating their specialty preferences in Japan: findings from a qualitative study. BMC Med Educ 2007;7:31.
2. Lambert TW, Goldacre MJ, Turner G. Career choices of United Kingdom medical graduates of 2002: questionnaire survey. Med Educ 2006;40:514-21.
3. Taylor K, Lambert T, Goldacre MJ. Career destinations, job satisfaction and views of the UK medical qualifiers of 1977. J Roy Soc Med 2008;101:191-200.
4. Khader Y, Al-Zoubi D, Amarin Z, Alkafagei A, Khasawneh M, Burgan S, et al. Factors affecting medical students in formulating their specialty preferences in Jordan. BMC Med Educ 2008;8:32.
5. Goldacre MJ, Davidson JM, Lambert TW. Career preferences of graduate and non-graduate entrants to medical schools in the UK. Med Educ 2007;41:349-61.
6. Borges NJ, Savickas MI. Personality and medical specialty choice: a literature review and integration. J Career Assess 2002;10:362-80.
7. Myers Briggs I, McCaulley MH, Quenk NL, Hammer AL. MBTI manual (a guide to the development and use of the Myers Briggs type indicator). 3rd edition. Mountain View, CA: Consulting Psychologists Press, 1998.
8. Gale R, Grant J. Sci45: the development of a specialty choice inventory. Med Educ 2002;36:659-66.
9. Elton C, Reid J. The roads to success. A practical apprach to career planning for medical students, foundation trainees (and their supervisors). London: Postgraduate Deanery for Kent, Surrey, and Sussex, 2007.
10. Lambert TW, Goldacre MJ. Views of doctors in training on the importance and availability of career advice in UK medicine. Med Educ 2007;41:460-6.

      

 Printable version     Download PDF    E-mail this to a friend    Respond to this article    Request Permissions