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Wednesday, May 14, 2008

Speciality Choice of Medical Students, Impact of Clerkship

I wanted to be a psychiatrist before I went to Med School. Fascinated by the work of Jung and especially Freud, psychiatry seemed the ultimate goal for Med School. Encountered these pioneers while reading literature and a new goal was formulated. Before that my hart was set on social geography, thank god I changed my mind.Other factors such as the encounter with people out of the ordinary during my earlier years most certainly did help my career choice but I found out after finishing Med School during residency in psychiatry.

During Med School I only once doubted my choice. It was during my clerkship of internal medicine. The head of the department, it was hematology, seemed to appreciate my interest in patients and internal medicine. He asked me to apply for a residency in Internal Medicine. Shortly thereafter he was diagnosed with oat cell tumor, lung cancer and died within 6 months and that was the end of my uncertainty about my specialty after med school.

Factors that are associated with choice of specialty based on earlier research are:

  • Work content and willingness to work with chronically ill patients as important determinants of choosing a career in general practice.

  • Students who sought surgical training attached greater importance to prestige and career opportunities.

  • Increased awareness of a specialty and clinical experiences during clerkships are associated with shifts in preferences and eventual specialty choice.

  • General practice clerkships encourage students to pursue further training in this specialty

  • Women are more likely to prefer part-time work and opportunities to combine work and personal life and they choose a career in community based areas and social medicine

  • Men are typically more attracted by technical challenges, prestige and learning potential and they prefer hospital-based specialties

What did this research do?
They carried out a longitudinal cohort study to collect data on career preferences and attitudes towards future careers among 3 cohorts of students before and after clerkships in surgery (n = 200), internal medicine (n = 277) and general practice (n = 184).

And what did they find?

  • Students were encouraged by the clerkship to consider a future career in the specialty of the rotation. Many students saw their ideas regarding a specialty, whether positive or negative, reinforced during the clerkship and, as a result, did not alter their preferences.

  • Relatively more male than female students preferred a career in surgery, and more female than male students preferred a career in general practice.

  • Men opted more for surgery and women for general practice.

  • Experiences in primary care settings promote an interest in general practice and show it to have advantages that were not considered or known of beforehand.

  • Gender differences regarding career choice appear to be not only based on typical male and female choices but to be a combination of attitudinal factors, such as type of preferred patients and work (technology oriented work and emergency situations versus chronic patients and palliative care) and lifestyle preferences (part-time work or career and income orientation).

Overall what can be learned from this research is that students choose a specialty
on the basis of the work content experienced during a clerkship. The results also show that it is the content of the work that matters. So clinical teachers, the clerkship is the time to promote your specialty.

My clerkship for psychiatry was not representative of psychiatry as I know it today. It was a clerkship at a medium stay care facility in a state hospital. My first encounter with real work in psychiatry was emergency psychiatry and I loved it and stayed for 2 years. Residency in a University Hospital did the rest. Still love my job.
Maiorova, T., Stevens, F., Scherpbier, A., van der Zee, J. (2008). The impact of clerkships on students̢۪ specialty preferences: what do undergraduates learn for their profession?. Medical Education, 42(6), 554-562. DOI: 10.1111/j.1365-2923.2008.03008.x


Aqua said...

You can tell you still love your job. I bet you have many, many patients who feel lucky you made the choice to be a psychiatrist.

Dr. Shock said...

Now you made me blush....
Dr Shock

Anonymous said...

I am sure you love your job and you are a great write too!
I am new to psychiatry blog. I would really appreciate if you could read the following post.
I wrote it almost 6 months back.I am totally fine now.It was just a case pf post partum depression but I kinda used the sublimation technique and wrote not so rhymy poems instead.
Check it out!