Data on gender and race/ethnicity for the sample of 942 students are shown in Table . The prevalence of specialty intentions at freshman orientation, ward orientation, and during the senior year are displayed in Figure . Pediatrics and surgery were the most popular initial choices, followed by family medicine. By ward orientation, the numbers choosing pediatrics had declined sharply, and it remained a less popular choice during senior year. Among the other PC specialties, the general pattern was one of slight change. In contrast, nearly all non-PC specialty choices were more common with time. One fifth of students were undecided on a specialty choice until senior year, when the number then dropped to 1%, and urology was chosen by 1% or fewer at all times points (not displayed).
Description of the Sample of 942 U.S. Medical Students (Senior Year, 2003)
Figure 1 Medical students’ (n=942) intended specialty choices over the course of medical school, percentages shown (time point 1 = freshman orientation, 2 = ward orientation, 3 = senior year). Pediatric subspecialty was not queried at (more ...)
Table displays the patterns of specialty choice over the course of medical school. As mentioned previously, the most common specialty choices among freshman students were pediatrics (185, 20%) and surgery (165, 18%). A similar proportion reported being undecided on a specialty choice (176, 19%). The majority of students changed their specialty choices, either by ward orientation or senior year. For example, only 15% initially interested in pediatrics were interested consistently in that field across all 3 surveys, 11% switched to another choice at ward orientation and reverted to pediatrics during senior year, 10% later chose a pediatric subspecialty, 44% switched to a non-pediatric, non-PC choice, and the remaining 20% switched to another PC specialty. The specialties in which students were most likely to maintain their initial interest included emergency medicine (37%), psychiatry (33%), obstetrics/gynecology (25%), surgery (24%), and family medicine (23%). Regardless of the initial specialty interest, when changing to another specialty by senior year, a non-PC specialty was the most likely new choice. Among the 176 students who were “undecided” when starting medical school, 71% were interested in pursuing a non-PC specialty by senior year. Whereas Figure refers to overall numbers with interest in the noted specialties, not the pattern for individuals, Table indicates that relatively few individuals starting with an interest in GIM remained interested, but other individuals became interested in PC over the course of medical school.
Table shows patterns of specialty choice when specialties were categorized in the more general terms of PC (including GIM), non-PC, and undecided based on specialty interest in freshman year. The most common patterns over the 3 time points were those consistent in choice (i.e., PC at all 3 time points or non-PC at all 3 time points) and those switching from PC to non-PC. Only 30% of those initially interested in PC remained interested at all 3 time points, and an additional 17% chose a non-PC specialty or were undecided at ward orientation but reverted to a PC specialty by senior year. In contrast, 68% of those initially interested in non-PC remained in a non-PC specialty across all 3 surveys, and an additional 16% settled by senior year on a non-PC specialty. Of those initially undecided, 40% remained undecided at ward orientation, and <1% remained undecided by senior year. At freshman orientation, 418 students (44%) were interested in pursuing PC, compared to 298 (32%) by senior year. About half of those changing from an initial choice of PC had done so by ward orientation (107/220).
Because the reputation of some schools for concentrating on either PC or specialties may attract students wanting to go into those respective areas, school-specific patterns were examined. The basic pattern of choice (changing from PC to specialties being much greater than the opposite) was roughly similar for all the schools in the sample: PC being an initial choice for roughly half (school range, 43–72%, median 57%), with large proportions making non-PC choices by senior year (school range, 31–82%, median 53%). Conversely, little movement out of non-PC specialty choices was observed in any school (school range for change to PC, 0–38%, median 14%).
Among females starting in a non-PC specialty, 73% remained in that category as seniors, compared to 90% of males (p
.008). (Note that this is slightly different from the 68% of all students initially interested in non-PC who remained in a non-PC specialty across all 3 surveys
mentioned above.) The percentages of females interested in PC at each of the 3 time points were 57%, 41%, and 44%, respectively, compared to 34%, 17%, and 21%, respectively, for males. The differences between genders were significant at all time points (all p
Basic descriptive data on importance of having a high-prestige career and interest in prevention are shown in Table . There was no significant association between consistency of specialty category (i.e., the same category choice at all 3 times versus some change) and prevention interest (p
.05). Male students were more likely than female students (48% versus 36%, p
.005) to report prestige as being important to them. Students indicating interest in a non-PC specialty were more likely to state a desire to have a high-prestige career than those interested in a PC specialty (48% versus 31%, p
.002). Specifically, ≥50% of students intending to specialize in a medical subspecialty, surgery, or anesthesiology/pathology/radiology reported that having a high-prestige career was important to them. Fewer of those pursuing family medicine (18%), general pediatrics (30%), or GIM (40%) stated that prestige was important.