Martha S. Grayson

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

Benefits and Costs to Community-Based Physicians Teaching Primary Care to Medical Students

The purpose of this study was to determine the benefits and costs to community-based primary care physicians teaching medical students in their offices. Survey data were collected from 185 preceptors between 1990 and 1996. Respondents reported increases in their enjoyment of the practice of medicine (82%), time spent reviewing clinical medicine (66%), desire to keep up with recent developments in medicine (49%), and patients’ perception of their stature (44%). However, 61% reported a decrease in the number of patients seen when a student was present. We conclude that despite the costs associated with teaching medical students in their offices, preceptors derived many benefits.

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 a First-year Primary Care Experience on Residency Choice*

110 906 vs

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

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.

Incorporating the fourth year of medical school into an internal medicine residency: Effect of an accelerated program on performance outcomes and career choice

We designed a retrospective cohort study of first-year medical students to assess the impact of a community-based primary care course, Introduction to Primary Care (IPC), on residency choice. In the group that took IPC (n=282), 48.2% entered generalist residencies (internal medicine, pediatrics, family medicine, or medicine/pediatrics), compared to 38.2% in the group that wanted IPC (n=398) and 39.6% in the group that did not want IPC (n=245). Controlling for gender, students who took IPC had a 40% higher odds of selecting a generalist residency than those who wanted to take IPC (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.04 to 1.95). There was no difference between those who wanted IPC and those who did not (OR, 1.08; CI, 0.78 to 1.52). The community-based primary care experience was positively associated with students’ selection of generalist residencies.

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

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.

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

Background: To counter declining student interest in general internal medicine, New York Medical College and Saint Vincents Catholic Medical Centers of New York implemented an experimental accelerated internal medicine curriculum that was provisionally approved by the American Board of Internal Medicine. Description: This accelerated program allowed selected 4th-year medical students to obtain credit for their 1st year of an internal medicine residency while completing requirements for the MD degree. Evaluation: Career and performance outcomes for trainees in the accelerated and traditional internal medicine residency programs were compared for 6 classes of graduates. There were no statistically significant differences between the 2 groups in mean scores on the Intern Clinical Evaluation Exercise, standardized in-service exam, monthly attending evaluations, or in Board pass rates. However, graduates of the accelerated program were more likely to be in general internal medicine practice on completion of residency. Conclusions: The accelerated program successfully increased the number of trainees entering generalist practice a year earlier, and maintained academic standards.

Comparing the teaching of physical diagnosis in a primary care setting and a hospital setting

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.