1. Why Medical Students Change Career Preferences: An Exploratory Study
struggling specialties
Medical school experiences heavily influence specialty choice, both directly and indirectly (look at variation in numbers joining each specialty)
Less is known about what specifically involved in changes career preferences
Majority of studies on the subject are survey methodology
Amit Singh & Hugh Alberti (Newcastle University)

2. Aim
To explore the changing career preferences of students during medical school, in order to develop a better understanding of medical career decision making

3. Methodology Phenomenological methodology Semi-structured interviews
Thematic Analysis

4. Sample No. Specialty Preference on Medical School Entry
Current Specialty Preference
Gender 1
Psychiatry
Palliative Care F 2
A&E
Surgery (Plastics) M 3
Pathology
Gastroenterology 4
Paediatrics
A&E or Surgery (Orthopaedics) 5
Obs & Gynae GP 6
Surgery (Cardiothoracic)
Paediatrics or GP 7
Cardiology

5. Findings 1A - Influence of Clinical Teachers
Theme 3. Belonging & Fitting In
Theme 1. Influence of Medical School
1A - Influence of Clinical Teachers
1B - Influence of Curriculum & Placements
Theme 2. Perceived Suitability to Specialty
2A - Enthusiasm and Priorities
2B - Personal Characteristics
2C - Perceptions of Specialty Characteristics

6. Theme 1 – Influence of Medical School
1A - Influence of Clinical Teachers “I just thought the way he interacted with them and knew everything about them, I just thought he was the kind of doctor I’d like to be” (Participant 4, Paediatrics → A&E/Surgery) “I guess it’s like when you have a teacher that you don’t really like as much, therefore you don’t like the subject as much” (Participant 1, Psychiatry → Palliative Care) 1B - Influence of the Curriculum “I think that’s [lack of anatomy teaching] is a potential weakness and why [this medical school] doesn’t share out many surgeons because I don’t feel I would be prepared for a surgical position” (Participant 7, Surgery (Cardiothoracic) → Cardiology)

7. Theme 2 – Perceived Suitability to Specialty
2A – Enthusiasm & Innate Interest “Every single time I woke up and went to my paediatric placement, I had a massive smile on my face, like I was really excited, I really enjoyed it” (Participant 6, Surgery → Paediatrics) 2B – Personal Characteristics “It’s to do with my personality, I like interacting and building relationships with patients. Maybe I’ve been through a transition as a person, but I very much value actually getting to know a patient” (Participant 7, Surgery (Cardiothoracic) → Cardiology) 2C – Perceptions of Specialty Characteristics “I guess it’s just maturing through medical school because you realise ‘what kind of specialty do you want to do? Do you want something that’ll mean you’ve not got great social hours and you may be called to work any time” (Participant 2, A&E → Surgery (Plastics)

8. Theme 3 – Belonging & Fitting in
“I just felt like they were my people… for me it’s a priority to make sure that patients are happy and it’s nice to share that opinion and passion with other people working at the same place” (Participant 1, Psychiatry → Palliative Care) “The experience I’ve had with doctors is the single biggest factor [in changing preference]. I would say I can see myself being a GP but I can’t see myself being an O&G doctor now having seen what I’ve seen.” (Participant 5, Obs and Gynae → GP) “Gastro was the one where I was like ‘yes I love this’ and I just felt at home” (Participant 3, Pathology → Gastroenterology)

9. Key Findings Findings found within existing literature
Medical school experiences were the strongest influence
Curriculum content and focus can cause preferences to change
Clinicians can the best or worst advertisement for their specialties
Negative comments impact preferences
Personality is a key factor
Competition and financial incentives are not considered strong influences
Novel findings
Enthusiasm for a specialty is not permanent and can fade
Personalities were described to ‘evolve’
Participants define ‘variety’ uniquely; all considered their specialty to be varied
All participants felt like they belonged in their preference of specialty; they could all envisage themselves in the role
This feeling of belonging a strong influence in changing career preferences

10. Implications
Medical schools need to be aware of the power their curriculum holds, as it will affect career destinations
Clinicians should take more responsibility for trying to attract students to their specialties and be aware of the influence they hold
A zero tolerance policy of specialty undermining should be adopted
Better career advice should be given by medical schools to allow students to become better informed about career pathways
Future research could include:
Why and how personalities and enthusiasms change over time
A large scale prospective study on how stable early career preferences are and how well they match to career destinations

11. Any questions?
Thanks for listening!

12. Strengths & Limitations
Qualitative data is sparse on the subject
Interviews allowed for richer data
Varied preferences in sample
Transparent in research process
Being a medical student
Limitations
Inexperienced researcher
Recall bias
Small data set from 1 medical school
Gender ratio
Evolving interview schedule