Dale A. Newton

What predicts medical student career choice

The literature on medical student career choice has identified several influences that can be categorized as student demographics, medical school characteristics, students’ perceptions of specialty characteristics, and student-held values. A logistic regression model that included demographics, medical school, and student-rated influences as a proxy for perceptions and values was used to determine their relative contribution to student career choice for three consecutive cohorts of senior medical students attending two schools (n=649). This model identified a positive relation between choice of primary care career and both student-rated influences and one student demographic characteristic, but not between career choice and school attended. Variables positively correlated with primary care career choice were related to working with people and marital status. Negatively correlated variables were related to income and prestige.

Payback time: the associations of debt and income with medical student career choice.

Medical Education 2012: 46: 983–991

Pediatric peripheral intravenous access: does nursing experience and competence really make a difference?

Placement of peripheral pediatric intravenous (IV) catheters in infants and children is difficult, even in skilled hands. This large, 2-institution prospective study used real-time independent observations to describe the effect of nurse experience and competence on the length of time and the number of attempts to establish a successful IV placement in the hospitalized child. Data from a convenience sample of 592 evaluable patients and 1135 venipunctures showed that successful IV placements required an average of 2 venipunctures over 28 minutes. Although nurse experience and self-rated competence were correlated with attaining a successful IV placement, time of day, predicted difficulty of the venipuncture, and cooperativeness of the child appeared to be better predictors of success.

Money, Lifestyle, or Values? Why Medical Students Choose Subspecialty Versus General Pediatric Careers

Although there are many published studies on factors associated with medical student career choice, few are specific to pediatric careers, and even fewer address the choice between general and subspecialty pediatric training. Fourth-year medical students surveyed at 2 schools reported their demographics, anticipated future income, the factors influencing their career choice, and their anticipated career. This study included the subset of 337 students planning pediatric careers. Results indicated that marital status, anticipated income, and career values are associated with pediatric career plans. Specifically, married students were more likely than unmarried students to pursue general pediatric careers (P < .01). Compared with students planning subspecialties, those intending to pursue general pediatric careers anticipated lower incomes (

Impact of AOA Status and Perceived Lifestyle on Career Choices of Medical School Graduates

110 906 vs

Measurement Invariance in Careers Research Using IRT to Study Gender Differences in Medical Students' Specialization Decisions

135 984; P < .001) and rated lifestyle, comprehensive patient care, and working with the poor as more important (P < .05) when choosing a career. Students planning subspecialty pediatric careers placed more value (P < .05) on prestige, income, and research opportunities.

Promoting institutional change to encourage primary care: Experiences at New York medical college and East Carolina university school of medicine

ABSTRACTBACKGROUNDBased upon student ratings of such factors as predictable work hours and personal time, medical specialties have been identified as lifestyle friendly, intermediate, or unfriendly. Lifestyle friendly programs may be more desirable, more competitive, and for students elected to the Alpha Omega Alpha (AOA) Honor Medical Society, more attainable.OBJECTIVEThe objective of this study was to evaluate whether AOA students increasingly entered lifestyle friendly residency programs and whether trends in program selection differed between AOA and non-AOA graduates.DESIGNThis retrospective cohort study examined PGY-2 data from the Association of American Medical Colleges and the 12 allopathic schools in the Associated Medical Schools of New York.PARTICIPANTSData on 1987–2006 graduates from participating schools were evaluated.MAIN MEASURESResidency program selection over the 20-year period served as the main outcome measure.KEY RESULTSAOA graduates increasingly entered lifestyle-friendly residencies—from 12.9% in 1987 to 32.6% in 2006 (p < 0.01). There was also a significant decrease in AOA graduates entering lifestyle unfriendly residencies, from 31.6% in 1987 to 12.6% in 2006 (p < 0.01). Selection of lifestyle intermediate residencies among AOA graduates remained fairly stable at an average of 53%. Similar trends were found among non-AOA students. However, within these categories, AOA graduates increasingly selected radiology, dermatology, plastic surgery and orthopedics while non-AOA graduates increasingly selected anesthesiology and neurology.CONCLUSIONSWhile lifestyle factors appear to influence residency program selection, AOA graduates differentially were more likely to either choose or attain certain competitive, lifestyle-friendly specialties. Health care reform should be targeted to improve lifestyle and decrease income disparities for specialties needed to meet health manpower needs.

Primary Care "Provider" and Professional Identity.

The current study demonstrates the use of item response theory (IRT) to conduct measurement invariance analyses in careers research. A self-report survey was used to assess the importance 1,363 fourth-year medical students placed on opportunities to provide comprehensive patient care when choosing a career specialty. IRT analyses supported measurement invariance across gender. Additional analyses indicated that compared with men, women placed significantly greater importance on opportunities to provide comprehensive patient care. This in turn predicted career choice, with women being more likely than men to pursue primary care specialties. This study extends the careers literature both methodologically and substantively. Methodologically, this study exemplifies how and why to use IRT to assess measurement invariance prior to comparing groups on career-related attitudes. Substantively, this study is the first to demonstrate that the importance placed on comprehensive patient care mediates the effect of gender on intentions to pursue primary care specialties.

Response to Walsh and Homer on medical student indebtedness

New York Medical College and East Carolina University School of Medicine significantly changed their curricula and organizational structures in response to The Robert Wood Johnson Foundations Generalist Physician Initiative (GPI). Seven common elements essential to successful institutional change were retrospectively identified at these two markedly different schools. They are (1) using national priorities to promote need for change, (2) establishing internal and external financial support, (3) developing a planning process and organizational structure to effect change, (4) devising an ongoing evaluation strategy, (5) sustaining positive attitudes toward primary care, (6) integrating community-based physicians, and (7) sustaining interest in the GPI. Within this framework, the authors present the GPI objectives at both schools, discuss examples of methods for institutional change and describe successes, failures, and lessons learned. The authors conclude that both schools have significantly increased the number of students choosing primary care careers and note the general perception of improvement in the quality of primary care educational programs, student recruitment, departmental collaboration, and faculty development opportunities. Although these changes have not yet been fully institutionalized, the similarities of the processes described may be of value to others addressing similar issues.

The variable influence of lifestyle and income on medical students' career specialty choices: data from two U.S. medical schools, 1998-2004.

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Pronovost reported receiving grants from the Agency for Healthcare Research and Quality and the US Centers for Disease Control and Prevention; receiving other contracts from Ernst and Young; and receiving personal fees from health systems as speaking honoraria; however, none of these relate to technologies to enhance the physical examination. No other disclosures were reported.