Volume 5, Issue 1 , Pages 11-15, January 2012
What undergraduate factors influence medical students when making their choice of postgraduate career?
Article Outline
- Summary
- Introduction
- Methods
- Results
- Discussion
- Conclusion
- Conflict of interest
- Appendix A.
- References
- Copyright
Summary
Objectives
To determine what factors final year medical students consider when deciding upon their future post graduate career and to what extent each factor influences their decision.
Methods
150 final year medical students were asked to complete an anonymous questionnaire relating to factors relating to their future career choice. Students were asked to rate each factor according to the level of importance or influence it exerted when choosing a post graduate career. A simple visual analogue scale from 1 to 10 was utilised with 10 being most influential.
Results
The most significant factors influencing final year medical students in their career choice were clinical mentors and specialty themed PBL cases with scores of 6.8 and 6.5 out of a maximum of 10. Clinical exposure exerted the weakest influence with a mean score of 2.5.
Conclusion
Various factors influence the future career choice of final year medical students to a differing extent. In order to promote Urology as a favourable career choice in this cohort, a concerted and coherent effort should be made at national level to engage medical students and promote the specialty.
Keyword: Training
Introduction
Medical students are less likely than ever before to choose Urology as a future career option with the number of final year students considering a career in Urology declining from 25% to just under 10% in the last 5 years ([1], [2], Pearce and Sinclair, unpublished data). In many of the 25 medical schools in the UK, it is possible to graduate and enter foundation training without any clinical exposure to Urology or a Urological Surgeon, indeed a recent European survey involving over 400 participants across 34 countries found that 25% of medical graduates had no exposure to Urology [3].
Methods
All 5th year medical students at Manchester Medical School were invited to a series of lectures based around common urological issues. Students were asked to declare and comment on their level of urological exposure and whether they had considered a postgraduate career in Urology.
They were also asked to rate a series of factors thought to influence their choice of postgraduate career. Each factor was rated on a visual analogue scale from 1 to 10 with a higher score indicating a greater influence (Appendix A).
Lifestyle was not specifically addressed in this study as this has been assessed on many previous occasions and it was felt that this was included in the reputation of a specialty as a whole.
The data collected were analysed utilising basic spreadsheet functions to determine the mean score for each influencing factor.
Results
A total of 150 completed questionnaires were returned. All factors were scored by the students and each factor received scores throughout the full range of 1–10.
The presence of a clinical mentor was rated by students to be the single most influencing factor when deciding their postgraduate career path (mean 6.8) with over a third of respondents scoring this as either 9 or 10 out of a maximum of 10, whilst only 31 students (20%) gave this factor a score of less than 5.
Specialty themed problem based learning (PBL) was the second most influential factor with a mean of 6.5, 30% rating it as 9 or 10 and only 25% of students rating it less than 5.
The only two factors with a mean and median score less than 5 were specialty themed projects (mean 3.9) and clinical exposure (mean 2.5). Only 6 students (4%) felt that clinical exposure to a specialty warranted a score of 9 or 10 whilst 129 (86%) gave this a score of less than 5.
The mean and median figures for each factor are summarised in Table 1.
Table 1. Factors influencing medical students choice of future career.
| Influencing factor | Mean score | Median score |
|---|---|---|
| Lectures | 5.2 | 5 |
| Specialty themed PBL | 6.5 | 7 |
| Specialty curriculum | 5.3 | 5 |
| Projects | 3.9 | 3 |
| Clinical exposure | 2.5 | 2 |
| Clinical mentor | 6.8 | 8 |
| Personal mentor | 5.6 | 6 |
| Specialty reputation | 5.3 | 5 |
31 students (30%) offered free text in the space provided, of these almost a third cited lifestyle as the reason for choosing a particular career with others citing various other factors such as “…watching Scrubs”, “Specialist society activity” and even “lifelong interest”.
Interestingly, only one student mentioned a career fair as being an influential factor.
Discussion
This survey from a single final year in a single medical school offers us great insight into those issues and factors undergraduate medical students take into account when deciding upon their future postgraduate career. In an era when career paths are decided upon earlier and earlier, this allows specialties to re-think their strategy regarding medical students in an attempt to attract the most able candidates.
In a recent survey across all years of medical students (n
=282) in a single medical college in India, Kumar and Dhaliwal [4] found that 55% of their respondents cited lifestyle as a significantly influencing factor. Similar results have been reported from Greece [5] and in New Zealand where lifestyle was one of the top three reasons cited for career choice [6]. These findings have been supported elsewhere across the globe.
In this survey only 29% claimed this to be of influence. A broader survey of 115 students in five medical schools choosing to enter surgery in Germany found that work life balance and lifestyle was only weakly influential in career selection with a mean score of 46/100 [7]. The discrepancy between our survey and these other surveys may be explained by the fact that this was not a pointed question but rather relied on free text, and hence may not have been entered on the form.
Whilst our survey did not address the issue of gender differences, this is clearly important with respect to lifestyle and was found to be the key deterrent preventing female students electing to follow a surgical career [8], [9], [10], [11].
In our survey, the presence of a clinical mentor was rated as the greatest influencing factor with 80% of students giving this a score of 5 or more. This correlates well with Mwachaka and Mbugua who found that 66% and 68% of male and female students respectively stated that personal role models were a significant factor in their career choice [12]. Such findings are not unusual and role models such as those providing either clinical or personal mentorship have been highlighted as significantly influential factors in determining future career choice in several previous studies [13], [14], [15], [16].
This is not universal however, in 2010 Mendalawi reported that only 7.5% of final year medical students surveyed in Bhagdad felt that role models influenced their choice of career. Such wide variation may be explained by cultural differences or indeed the recent turmoil in Iraq (the survey was conducted in 2008). Personal interest (30%) and higher income (29%) were the two most influential factors [17]. A similar survey performed in the Lebanon declared the presence of role models to be one of the least influential reasons for deciding upon career path [18].
Pikoulis et al. also reported that clinical exposure was felt to be significantly influential by only 29% of 93 students [5], which correlates with our findings that this is a weak influence when deciding career pathways.
The availability or otherwise of a specialty themed undergraduate curriculum is best considered on the basis of our survey to be a moderately influencing factor but this is at odds with other findings, in particular Stefanidis et al. who reported that 92% of 4th year medical students (n=94) felt this to be of significant value, although this also included practical skills in addition to knowledge recommendations [9].
Educational experiences such as PBL and themed lectures were moderately to highly influential in our survey, findings consistent with the literature. Hauer et al. found this to be one of the top three influencing factors in a web based survey of over 1000 students [19].
One factor which this study failed to address was that of intellectual and academic challenge which in other studies has repeatedly been cited as a significant influential factor, if not the prime reason for postgraduate specialty choice [10], [15], [18], [20], [21], [22], [23].
Monetary aspects were not included in this survey for purposes of brevity but previous studies have also suggested that this carries significant influence [17], [24], [25], [26], [27] and in the current climate of rising university tuition fees, this may play an increasing role in determining the postgraduate career path of medical graduates in the UK.
An alternative view to the entire concept is that career pathways are dictated by postgraduate rather than undergraduate experiences. Watmough et al. reported exactly this finding in 2007 although there is good reason to believe that regardless of its validity, the very fact that decisions regarding career pathways must be made earlier rather than later, renders this less relevant in the current era [28]. It may, however, account in part for the current trend of approximately a quarter of all core surgical trainees changing specialties.
Conclusion
It is clear from this snapshot survey that various factors influence final year medical students in their choice of postgraduate career to a differing degree. It would seem sensible, if not necessary, to utilise this information to formulate a broader survey of medical students from across the UK and to utilise findings to mould a national policy, endorsed by BAUS, to engage more with medical students to ensure the specialty is considered more widely as a postgraduate career choice. If outstanding candidates are to be continued to be recruited into the specialty, BAUS must engage with medical schools and students throughout the country to both broaden and enhance its profile with the Urological Surgeons of tomorrow. Urologists should be encouraged to adopt the roles of greatest influence, to become personal and clinical mentors and to deliver PBL sessions and lectures. A BAUS endorsed curriculum with recommended educational objectives including guidance on practical procedures should also be developed as this is an influencing factor and previous work (Pearce and Sinclair, unpublished data) has indicated that this would be well received by the student body.
Conflict of interest
The authors declare that there are no conflicts of interest.
Appendix A.
Medical graduates are now expected to decide upon their career path at an earlier stage than ever before.
It would be of great help to us in delivering urological undergraduate teaching if you would answer the following questions relating to those aspects of the undergraduate curriculum and their potential influence on your chosen career path.
Please score the following influencing factors in order of their importance when considering your potential postgraduate career with 10 being the most influential factor and 1 being the least influential.
| 1. | Exposure to a clinical firm |  |
| 2. | Specialty themed PBL cases | |
| 3. | Specialty themed lectures | |
| 4. | SSC Project | |
| 5. | SSM Project options | |
| 6. | Academic/Portfolio Supervisor | |
| 7. | Personal mentor | |
| 8. | Specialty reputation | |
| 9. | Specialty themed undergraduate curriculum | |
| 10. | Other: Please state | |
References
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PII: S1875-9742(11)00182-0
doi:10.1016/j.bjmsu.2011.10.004
© 2011 British Association of Urological Surgeons. Published by Elsevier Inc. All rights reserved.
Volume 5, Issue 1 , Pages 11-15, January 2012
