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1.  Attitudes and perceptions of medical students about family medicine in Spain: protocol for a cross-sectional survey 
BMJ Open  2011;1(2):e000231.
Despite the fact that family medicine (FM) has become established as a specialty in the past 25 years, this has not been reflected in the inclusion of the specialty in the majority of medical schools in Spain. Almost 40% of the students will work in primary care but, in spite of this, most universities do not have an assessed placement as such. There are only specific practice periods in health centres or some student-selected components with little weight in the overall curricula.
To evaluate the attitudes and perceptions of medical students about FM in the health system and their perception about the need for specific training in FM at the undergraduate level. To explore change over time of these attitudes and perceptions and to examine potential predictive factors for change. Finally, we will review what teaching activity in FM is offered across the Spanish schools of medicine.
Descriptive cross-sectional survey. Each one of the different analyses will consist of two surveys: one for all the students in the first, third and fifth year of medical school in all the Spanish schools of medicine asking about their knowledge, perceptions and attitudes in relation to primary care and FM. There will be an additional survey for the coordinating faculty of the study in each university about the educational activities related to FM that are carried out in their centres. The repetition of the study every 2 years will allow for an analysis of the evolution of the cohort of students until they receive their degree and the potential predictive factors.
This study will provide useful information for strategic planning decisions, content and educational methodology in medical schools in Spain and elsewhere. It will also help to evaluate the influence of the ongoing changes in FM, locally and at the European level, on the attitudes and perceptions of the students towards FM in Spain.
Article summary
Article focus
There is a need to explore further the reasons for which students choose a specific specialty for training and future practice. This protocol outlines the design of a cross-sectional survey to evaluate attitudes and perceptions of medical students about family medicine.
The project will assess the potential impact of medical school teaching on the final profiles of students, both in perceptions and expectations and in the choice of specialty.
Key messages
This is a protocol of a multicentre survey that will take place in Spanish medical schools. The study includes a survey for students and one for the coordinators of family medicine in each centre.
The repetition of the student survey every 2 years will allow for an analysis of the evolution of student cohorts until the end of their studies.
The results of this study will provide valuable information for curriculum development related to family medicine in the different schools of medicine and will help to prioritise those activities that are likely to be most effective for promoting this specialty.
Strengths and limitations of this study
The research team for this study includes coordinating faculty from 22 of the 27 universities throughout Spain. The study will be repeated every 2 years and will explore change over time of the issues addressed.
The principal limitations of this study are related to its design, of observational nature. The results observed will serve as hypotheses generating and cannot be regarded as definitive. Finally, the fact that the survey will be anonymous will impede the evaluation, at an individual level, of change over time.
PMCID: PMC3278481  PMID: 22189348
2.  A Cross-sectional Measurement of Medical Student Empathy 
Journal of General Internal Medicine  2007;22(10):1434-1438.
Empathy is important in the physician–patient relationship. Prior studies have suggested that physician empathy may decline with clinical training.
To measure and examine student empathy across medical school years.
Design and Participants
A cross-sectional study of students at Boston University School of Medicine in 2006. Incoming students plus each class near the end of the academic year were surveyed.
The Jefferson Scale of Physician Empathy–Student Version (JSPE-S), a validated 20-item self-administered questionnaire with a total score ranging from 20 to 140. JSPE-S scores were controlled for potential confounders such as gender, age, anticipated financial debt upon graduation, and future career interest.
658 students participated in the study (81.4% of the school population). The first-year medical student class had the highest empathy scores (118.5), whereas the fourth-year class had the lowest empathy scores (106.6). Measured empathy differed between second- and third-year classes (118.2 vs 112.7, P < .001), corresponding to the first year of clinical training. Empathy appears to increase from the incoming to the first-year class (115.5 vs 118.5, P = .02). Students preferring people-oriented specialties had higher empathy scores than students preferring technology-oriented specialties (114.6 vs 111.4, P = .002). Female students were more likely than male students to choose people-oriented specialties (51.5 vs 26.9%, P < .001). Females had higher JSPE-S scores than males (116.5 vs 112.1, P < .001). Age and debt did not affect empathy scores.
Empathy scores of students in the preclinical years were higher than in the clinical years. Efforts are needed to determine whether differences in empathy scores among the classes are cohort effects or represent changes occurring in the course of medical education. Future research is needed to confirm whether clinical training impacts empathy negatively, and, if so, whether interventions can be designed to mitigate this impact.
PMCID: PMC2305857  PMID: 17653807
empathy; medical student education; physician attitudes
3.  Association of Medical Students' Reports of Interactions with the Pharmaceutical and Medical Device Industries and Medical School Policies and Characteristics: A Cross-Sectional Study 
PLoS Medicine  2014;11(10):e1001743.
Aaron Kesselheim and colleagues compared US medical students' survey responses regarding pharmaceutical company interactions with the schools' AMSA PharmFree scorecard and Institute on Medicine as a Profession's (IMAP) scores.
Please see later in the article for the Editors' Summary
Professional societies use metrics to evaluate medical schools' policies regarding interactions of students and faculty with the pharmaceutical and medical device industries. We compared these metrics and determined which US medical schools' industry interaction policies were associated with student behaviors.
Methods and Findings
Using survey responses from a national sample of 1,610 US medical students, we compared their reported industry interactions with their schools' American Medical Student Association (AMSA) PharmFree Scorecard and average Institute on Medicine as a Profession (IMAP) Conflicts of Interest Policy Database score. We used hierarchical logistic regression models to determine the association between policies and students' gift acceptance, interactions with marketing representatives, and perceived adequacy of faculty–industry separation. We adjusted for year in training, medical school size, and level of US National Institutes of Health (NIH) funding. We used LASSO regression models to identify specific policies associated with the outcomes. We found that IMAP and AMSA scores had similar median values (1.75 [interquartile range 1.50–2.00] versus 1.77 [1.50–2.18], adjusted to compare scores on the same scale). Scores on AMSA and IMAP shared policy dimensions were not closely correlated (gift policies, r = 0.28, 95% CI 0.11–0.44; marketing representative access policies, r = 0.51, 95% CI 0.36–0.63). Students from schools with the most stringent industry interaction policies were less likely to report receiving gifts (AMSA score, odds ratio [OR]: 0.37, 95% CI 0.19–0.72; IMAP score, OR 0.45, 95% CI 0.19–1.04) and less likely to interact with marketing representatives (AMSA score, OR 0.33, 95% CI 0.15–0.69; IMAP score, OR 0.37, 95% CI 0.14–0.95) than students from schools with the lowest ranked policy scores. The association became nonsignificant when fully adjusted for NIH funding level, whereas adjusting for year of education, size of school, and publicly versus privately funded school did not alter the association. Policies limiting gifts, meals, and speaking bureaus were associated with students reporting having not received gifts and having not interacted with marketing representatives. Policy dimensions reflecting the regulation of industry involvement in educational activities (e.g., continuing medical education, travel compensation, and scholarships) were associated with perceived separation between faculty and industry. The study is limited by potential for recall bias and the cross-sectional nature of the survey, as school curricula and industry interaction policies may have changed since the time of the survey administration and study analysis.
As medical schools review policies regulating medical students' industry interactions, limitations on receipt of gifts and meals and participation of faculty in speaking bureaus should be emphasized, and policy makers should pay greater attention to less research-intensive institutions.
Please see later in the article for the Editors' Summary
Editors' Summary
Making and selling prescription drugs and medical devices is big business. To promote their products, pharmaceutical and medical device companies build relationships with physicians by providing information on new drugs, by organizing educational meetings and sponsored events, and by giving gifts. Financial relationships begin early in physicians' careers, with companies providing textbooks and other gifts to first-year medical students. In medical school settings, manufacturers may help to inform trainees and physicians about developments in health care, but they also create the potential for harm to patients and health care systems. These interactions may, for example, reduce trainees' and trained physicians' skepticism about potentially misleading promotional claims and may encourage physicians to prescribe new medications, which are often more expensive than similar unbranded (generic) drugs and more likely to be recalled for safety reasons than older drugs. To address these and other concerns about the potential career-long effects of interactions between medical trainees and industry, many teaching hospitals and medical schools have introduced policies to limit such interactions. The development of these policies has been supported by expert professional groups and medical societies, some of which have created scales to evaluate the strength of the implemented industry interaction policies.
Why Was This Study Done?
The impact of policies designed to limit interactions between students and industry on student behavior is unclear, and it is not known which aspects of the policies are most predictive of student behavior. This information is needed to ensure that the policies are working and to identify ways to improve them. Here, the researchers investigate which medical school characteristics and which aspects of industry interaction policies are most predictive of students' reported behaviors and beliefs by comparing information collected in a national survey of US medical students with the strength of their schools' industry interaction policies measured on two scales—the American Medical Student Association (AMSA) PharmFree Scorecard and the Institute on Medicine as a Profession (IMAP) Conflicts of Interest Policy Database.
What Did the Researchers Do and Find?
The researchers compared information about reported gift acceptance, interactions with marketing representatives, and the perceived adequacy of faculty–industry separation collected from 1,610 medical students at 121 US medical schools with AMSA and IMAP scores for the schools evaluated a year earlier. Students at schools with the highest ranked interaction policies based on the AMSA score were 63% less likely to accept gifts as students at the lowest ranked schools. Students at the highest ranked schools based on the IMAP score were about half as likely to accept gifts as students at the lowest ranked schools, although this finding was not statistically significant (it could be a chance finding). Similarly, students at the highest ranked schools were 70% less likely to interact with sales representatives as students at the lowest ranked schools. These associations became statistically nonsignificant after controlling for the amount of research funding each school received from the US National Institutes of Health (NIH). Policies limiting gifts, meals, and being a part of speaking bureaus (where companies pay speakers to present information about the drugs for dinners and other events) were associated with students' reports of receiving no gifts and of non-interaction with sales representatives. Finally, policies regulating industry involvement in educational activities were associated with the perceived separation between faculty and industry, which was regarded as adequate by most of the students at schools with such policies.
What Do These Findings Mean?
These findings suggest that policies designed to limit industry interactions with medical students need to address multiple aspects of these interactions to achieve changes in the behavior and attitudes of trainees, but that policies limiting gifts, meals, and speaking bureaus may be particularly important. These findings also suggest that the level of NIH funding plays an important role in students' self-reported behaviors and their perceptions of industry, possibly because institutions with greater NIH funding have the resources needed to implement effective policies. The accuracy of these findings may be limited by recall bias (students may have reported their experiences inaccurately), and by the possibility that industry interaction policies may have changed in the year that elapsed between policy grading and the student survey. Nevertheless, these findings suggest that limitations on gifts should be emphasized when academic medical centers refine their policies on interactions between medical students and industry and that particular attention should be paid to the design and implementation of policies that regulate industry interactions in institutions with lower levels of NIH funding.
Additional Information
Please access these websites via the online version of this summary at
The UK General Medical Council provides guidance on financial and commercial arrangements and conflicts of interest as part of its good medical practice document, which describes what is required of all registered doctors in the UK
Information about the American Medical Student Association (AMSA) Just Medicine campaign (formerly the PharmFree campaign) and about the AMSA Scorecard is available
Information about the Institute on Medicine as a Profession (IMAP) and about its Conflicts of Interest Policy Database is also available
“Understanding and Responding to Pharmaceutical Promotion: A Practical Guide” is a manual prepared by Health Action International and the World Health Organization that medical schools can use to train students how to recognize and respond to pharmaceutical promotion
The US Institute of Medicine's report “Conflict of Interest in Medical Research, Education, and Practice” recommends steps to identify, limit, and manage conflicts of interest
The ALOSA Foundation provides evidence-based, non-industry-funded education about treating common conditions and using prescription drugs
PMCID: PMC4196737  PMID: 25314155
4.  A survey of factors influencing career preference in new-entrant and exiting medical students from four UK medical schools 
BMC Medical Education  2014;14:151.
Workforce planning is a central issue for service provision and has consequences for medical education. Much work has been examined the career intentions, career preferences and career destinations of UK medical graduates but there is little published about medical students career intentions. How soon do medical students formulate careers intentions? How much do these intentions and preferences change during medical school? If they do change, what are the determining factors? Our aim was to compare medical students’ career preferences upon entry into and exit from undergraduate medical degree programmes.
This was a cross-sectional questionnaire survey. Two cohorts [2009–10, 2010–11] of first and final year medical students at the four Scottish graduating medical schools took part in career preference questionnaire surveys. Questions were asked about demographic factors, career preferences and influencing factors.
The response rate was 80.9% [2682/3285]. Significant differences were found across the four schools, most obviously in terms of student origin [Scotland, rest of UK or overseas], age group, and specialty preferences in Year 1 and Year 5. Year 1 and Year 5 students’ specialty preferences also differed within each school and, while there were some common patterns, each medical school had a different profile of students’ career preferences on exit. When the analysis was adjusted for demographic and job-related preferences, specialty preferences differed by gender, and wish for work-life balance and intellectual satisfaction.
This is the first multi-centre study exploring students’ career preferences and preference influences upon entry into and exit from undergraduate medical degree programmes. We found various factors influenced career preference, confirming prior findings. What this study adds is that, while acknowledging student intake differs by medical school, medical school itself seems to influence career preference. Comparisons across medical school populations must therefore control for differences in input [the students] as well as context and process [the medical school] when looking at output [e.g., performance]. A robust, longitudinal study is required to explore how medical students’ career preferences change as they progress through medical school and training to understand the influence of the learning environment on training choice and outcomes.
PMCID: PMC4131477  PMID: 25056270
5.  Specialty choice in times of economic crisis: a cross-sectional survey of Spanish medical students 
BMJ Open  2013;3(2):e002051.
To investigate the determinants of specialty choice among graduating medical students in Spain, a country that entered into a severe, ongoing economic crisis in 2008.
Since 2008, the percentage of Spanish medical school graduates electing Family and Community Medicine (FCM) has experienced a reversal after more than a decade of decline.
A nationwide cross-sectional survey conducted online in April 2011.
We invited all students in their final year before graduation from each of Spain's 27 public and private medical schools to participate.
Main outcome measures
Respondents’ preferred specialty in relation to their perceptions of: (1) the probability of obtaining employment; (2) lifestyle and work hours; (3) recognition by patients; (4) prestige among colleagues; (5) opportunity for professional development; (6) annual remuneration and (7) the proportion of the physician's compensation from private practice.
978 medical students (25% of the nationwide population of students in their final year) participated. Perceived job availability had the largest impact on specialty preference. Each 10% increment in the probability of obtaining employment increased the odds of preferring a specialty by 33.7% (95% CI 27.2% to 40.5%). Job availability was four times as important as compensation from private practice in determining specialty choice (95% CI 1.7 to 6.8). We observed considerable heterogeneity in the influence of lifestyle and work hours, with students who preferred such specialties as Cardiovascular Surgery and Obstetrics and Gynaecology valuing longer rather than shorter workdays.
In the midst of an ongoing economic crisis, job availability has assumed critical importance as a determinant of specialty preference among Spanish medical students. In view of the shortage of practitioners of FCM, public policies that take advantage of the enhanced perceived job availability of FCM may help steer medical school graduates into this specialty.
PMCID: PMC3586052  PMID: 23408072
Medical Education & Training; Primary Care
6.  Medical Students' Exposure to and Attitudes about the Pharmaceutical Industry: A Systematic Review 
PLoS Medicine  2011;8(5):e1001037.
A systematic review of published studies reveals that undergraduate medical students may experience substantial exposure to pharmaceutical marketing, and that this contact may be associated with positive attitudes about marketing.
The relationship between health professionals and the pharmaceutical industry has become a source of controversy. Physicians' attitudes towards the industry can form early in their careers, but little is known about this key stage of development.
Methods and Findings
We performed a systematic review reported according to PRISMA guidelines to determine the frequency and nature of medical students' exposure to the drug industry, as well as students' attitudes concerning pharmaceutical policy issues. We searched MEDLINE, EMBASE, Web of Science, and ERIC from the earliest available dates through May 2010, as well as bibliographies of selected studies. We sought original studies that reported quantitative or qualitative data about medical students' exposure to pharmaceutical marketing, their attitudes about marketing practices, relationships with industry, and related pharmaceutical policy issues. Studies were separated, where possible, into those that addressed preclinical versus clinical training, and were quality rated using a standard methodology. Thirty-two studies met inclusion criteria. We found that 40%–100% of medical students reported interacting with the pharmaceutical industry. A substantial proportion of students (13%–69%) were reported as believing that gifts from industry influence prescribing. Eight studies reported a correlation between frequency of contact and favorable attitudes toward industry interactions. Students were more approving of gifts to physicians or medical students than to government officials. Certain attitudes appeared to change during medical school, though a time trend was not performed; for example, clinical students (53%–71%) were more likely than preclinical students (29%–62%) to report that promotional information helps educate about new drugs.
Undergraduate medical education provides substantial contact with pharmaceutical marketing, and the extent of such contact is associated with positive attitudes about marketing and skepticism about negative implications of these interactions. These results support future research into the association between exposure and attitudes, as well as any modifiable factors that contribute to attitudinal changes during medical education.
Please see later in the article for the Editors' Summary
Editors' Summary
The complex relationship between health professionals and the pharmaceutical industry has long been a subject of discussion among physicians and policymakers. There is a growing body of evidence that suggests that physicians' interactions with pharmaceutical sales representatives may influence clinical decision making in a way that is not always in the best interests of individual patients, for example, encouraging the use of expensive treatments that have no therapeutic advantage over less costly alternatives. The pharmaceutical industry often uses physician education as a marketing tool, as in the case of Continuing Medical Education courses that are designed to drive prescribing practices.
One reason that physicians may be particularly susceptible to pharmaceutical industry marketing messages is that doctors' attitudes towards the pharmaceutical industry may form early in their careers. The socialization effect of professional schooling is strong, and plays a lasting role in shaping views and behaviors.
Why Was This Study Done?
Recently, particularly in the US, some medical schools have limited students' and faculties' contact with industry, but some have argued that these restrictions are detrimental to students' education. Given the controversy over the pharmaceutical industry's role in undergraduate medical training, consolidating current knowledge in this area may be useful for setting priorities for changes to educational practices. In this study, the researchers systematically examined studies of pharmaceutical industry interactions with medical students and whether such interactions influenced students' views on related topics.
What Did the Researchers Do and Find?
The researchers did a comprehensive literature search using appropriate search terms for all relevant quantitative and qualitative studies published before June 2010. Using strict inclusion criteria, the researchers then selected 48 articles (from 1,603 abstracts) for full review and identified 32 eligible for analysis—giving a total of approximately 9,850 medical students studying at 76 medical schools or hospitals.
Most students had some form of interaction with the pharmaceutical industry but contact increased in the clinical years, with up to 90% of all clinical students receiving some form of educational material. The highest level of exposure occurred in the US. In most studies, the majority of students in their clinical training years found it ethically permissible for medical students to accept gifts from drug manufacturers, while a smaller percentage of preclinical students reported such attitudes. Students justified their entitlement to gifts by citing financial hardship or by asserting that most other students accepted gifts. In addition, although most students believed that education from industry sources is biased, students variably reported that information obtained from industry sources was useful and a valuable part of their education.
Almost two-thirds of students reported that they were immune to bias induced by promotion, gifts, or interactions with sales representatives but also reported that fellow medical students or doctors are influenced by such encounters. Eight studies reported a relationship between exposure to the pharmaceutical industry and positive attitudes about industry interactions and marketing strategies (although not all included supportive statistical data). Finally, student opinions were split on whether physician–industry interactions should be regulated by medical schools or the government.
What Do These Findings Mean?
This analysis shows that students are frequently exposed to pharmaceutical marketing, even in the preclinical years, and that the extent of students' contact with industry is generally associated with positive attitudes about marketing and skepticism towards any negative implications of interactions with industry. Therefore, strategies to educate students about interactions with the pharmaceutical industry should directly address widely held misconceptions about the effects of marketing and other biases that can emerge from industry interactions. But education alone may be insufficient. Institutional policies, such as rules regulating industry interactions, can play an important role in shaping students' attitudes, and interventions that decrease students' contact with industry and eliminate gifts may have a positive effect on building the skills that evidence-based medical practice requires. These changes can help cultivate strong professional values and instill in students a respect for scientific principles and critical evidence review that will later inform clinical decision-making and prescribing practices.
Additional Information
Please access these Web sites via the online version of this summary at
Further information about the influence of the pharmaceutical industry on doctors and medical students can be found at the American Medical Students Association PharmFree campaign and PharmFree Scorecard, Medsin-UKs PharmAware campaign, the nonprofit organization Healthy Skepticism, and the Web site of No Free Lunch.
PMCID: PMC3101205  PMID: 21629685
7.  Factors influencing medical students’ choice of family medicine 
Canadian Family Physician  2012;58(11):e649-e657.
To identify factors that influence medical students’ choice of family medicine versus another specialty and to analyze influential factors by urban versus rural background of students.
Cross-sectional questionnaire survey conducted in 2010.
University of Alberta in Edmonton.
A total of 118 first-, 120 second-, and 107 third-year medical students.
Main outcome measures
Twenty-two factors influencing preferred career choice, type of community lived in (rural vs urban), and student age and sex.
Overall, 283 (82.0%) students responded to the survey. Those who preferred family medicine rather than another specialty as a career option were older (≥ 25 years) (69.6% vs 40.9%, P < .001), female (69.6% vs 39.3%, P < .001), and had previously lived in rural locations (< 25 000 population) (46.8% vs 23.9%, P < .001). Four factors were significantly associated with students preferring family medicine compared with any other specialty: emphasis on continuity of care (87.3 vs 45.3%, P < .001); length of residency (73.4% vs 25.9%, P < .001); influence of family, friends, or community (67.1% vs 50.2%, P = .011); and preference for working in a rural community (41.8% vs 10.9%, P < .001). For students with urban backgrounds, the preference for family medicine was more strongly influenced by the opportunity to deal with a variety of medical problems; current debt load; and family, friends, or community than for those with rural backgrounds. Practice location preferences also differed between students from rural and urban backgrounds.
Medical students who prefer family medicine as a career choice appear to be influenced by a different set of factors than those who prefer other specialties. Being female; being older; having previously lived in a rural location; placing importance on continuity of care; desire for a shorter residency; and influence of family, friends, or community are associated with medical students preferring family medicine. Some differences in factors influencing career choice exist between medical students from rural versus urban backgrounds. To increase the supply of family physicians, medical schools might consider introducing elements into the admissions process and the medical curriculum that encourage family medicine as a career choice.
PMCID: PMC3498039  PMID: 23152472
8.  The temporal decline of idealism in two cohorts of medical students at one institution 
BMC Medical Education  2014;14:58.
A number of studies have indicated that students lose idealistic motivations over the course of medical education, with some identifying the initiation of this decline as occurring as early as the second year of the traditional US curricula. This study builds on prior work testing the hypothesis that a decline in medical student idealism is detectable in the first two years of medical school.
The original study sought to identify differences in survey responses between first-year (MS1) and second-year (MS2) medical students at the beginning and end of academic year 2010, on three proxies for idealism. The current study extends that work by administering the same survey items to the same student cohorts at the end of their third and fourth years (MS3 and MS4), respectively. Survey topics included questions on: (a) motivations for pursuing a medical career; (b) specialty choice; and (c) attitudes toward primary care. Principle component analysis was used to extract linear composite variables (LCVs) from responses to each group of questions. Linear regression was then used to test the effect of the six cohort/time-points on each composite variable, controlling for demographic characteristics.
Idealism in medicine decreased (β = -.113, p < .001) while emphasis on employment and job security increased (β = .146, p < .001) as motivators of pursuing a career in medicine at each medical school stage and time period. Students were more likely to be motivated by student debt over interest in content in specialty choice (β = .077, p = .004) across medical school stages. Negative attitudes towards primary care were most sensitive to MS group and time effects. Both negative/antagonistic views (β = .142, p < .001) and negative/sympathetic views (β = .091, p < .001) of primary care increased over each stage.
Our results provide further evidence that declines in medical student idealism may occur as early as the second year of medical education. Additionally, as students make choices in their medical careers, such as specialty choice or consideration of primary care, the influences of job security, student debt and social status increasingly outweigh idealistic motivations.
PMCID: PMC3994310  PMID: 24655727
Career choice; Idealism; Students; Medical; Surveys
9.  Empathy in senior year and first year medical students: a cross-sectional study 
BMC Medical Education  2011;11:52.
The importance of fostering the development of empathy in undergraduate students is continuously emphasized in international recommendations for medical education. Paradoxically, some studies in the North-American context using self-reported measures have found that empathy declines during undergraduate medical training. Empathy is also known to be gender dependent- (highest for female medical students) and related to specialty preference - (higher in patient-oriented than technology-oriented specialties). This factor has not been studied in Portuguese medical schools.
This is a cross-sectional study of undergraduate medical students on self-rated measures of empathy collected at entrance and at the conclusion of the medical degree, and on the association of empathy measures with gender and specialty preferences in one medical school in Portugal. Empathy was assessed using the Portuguese adaptation of the Jefferson Scale of Physician Empathy-students version (JSPE-spv) among three cohorts of undergraduate medical students in the first (N = 356) and last (N = 120) year. The construct validity of JSPE-spv was cross-validated with Principal Component Analysis and Confirmatory Factor Analysis. Reliability was assessed using Cronbach' Alpha. Global JSPE-spv score differences were examined by year of medical school, gender and specialty preferences (people-oriented vs technology-oriented specialties).
The empathy scores of students in the final year were higher as compared to first year students (F (1,387) = 19.33, p < .001, ɳ2p = 0.48; π = 0.99). Female students had higher empathy scores than male students (F (1,387) = 8.82, p < .01, ɳ 2p = 0.23; π = 0.84). Significant differences in empathy were not found between the students who prefer people-oriented specialties compared to those who favor the technology-oriented specialties (F (1,387) = 2.44, p = .12, ɳ 2p = 0.06; π = 0.06).
This cross-sectional study in one medical school in Portugal showed that the empathy measures of senior year students were higher than the scores of freshmen. A longitudinal cohort study is needed to test variations in students' empathy measures throughout medical school.
PMCID: PMC3163625  PMID: 21801365
10.  Advanced Topics in Emergency Medicine: Curriculum Development and Initial Evaluation 
Emergency medicine (EM) is a young specialty and only recently has a recommended medical student curriculum been developed. Currently, many schools do not require students to complete a mandatory clerkship in EM, and if one is required, it is typically an overview of the specialty.
We developed a 10-month longitudinal elective to teach subject matter and skills in EM to fourth-year medical students interested in the specialty. Our goal was producing EM residents with the knowledge and skills to excel at the onset of their residency. We hoped to prove that students participating in this rigorous 10-month longitudinal EM elective would feel well prepared for residency.
We studied the program with an end-of-the-year, Internet-based, comprehensive course evaluation completed by each participant of the first 2 years of the course. Graduates rated each of the course components by using a 5-point Likert format from “strongly disagree” to “strongly agree,” either in terms of whether the component was beneficial to them or whether the course expectations were appropriate, or their perceptions related to the course.
Graduates of this elective have reported feeling well prepared to start residency. The resident-led teaching shifts, Advanced Pediatric Life Support certification, Grand Rounds presentations, Advanced Cardiovascular Life Support proficiency testing, and ultrasound component, were found to be beneficial by all students.
Our faculty believes that participating students will be better prepared for an EM residency than those students just completing a 1-month clerkship. Our data, although limited, lead us to believe that a longitudinal, immersion-type experience assists fourth-year medical students in preparation for residency.
PMCID: PMC3236174  PMID: 22224157
11.  The specialty choices of graduates from Brighton and Sussex Medical School: a longitudinal cohort study 
BMC Medical Education  2015;15:46.
Since 2007 junior doctors in the UK have had to make major career decisions at a point when previously many had not yet chosen a specialty. This study examined when doctors in this new system make specialty choices, which factors influence choices, and whether doctors who choose a specialty they were interested in at medical school are more confident in their choice than those doctors whose interests change post-graduation.
Two cohorts of students in their penultimate year at one medical school (n = 227/239) were asked which specialty interested them as a career. Two years later, 210/227 were sent a questionnaire measuring actual specialty chosen, confidence, influence of perceptions of the specialty and experiences on choice, satisfaction with medicine, personality, self-efficacy, and demographics. Medical school and post-graduation choices in the same category were deemed ‘stable’. Predictors of stability, and of not having chosen a specialty, were calculated using bootstrapped logistic regression. Differences between specialties on questionnaire factors were analysed.
50% responded (n = 105/277; 44% of the 239 Year 4 students). 65% specialty choices were ‘stable’. Factors univariately associated with stability were specialty chosen, having enjoyed the specialty at medical school or since starting work, having first considered the specialty earlier. A regression found doctors who chose psychiatry were more likely to have changed choice than those who chose general practice. Confidence in the choice was not associated with stability. Those who chose general practice valued lifestyle factors. A psychiatry choice was associated with needing a job and using one’s intellect to help others. The decision to choose surgical training tended to be made early. Not having applied for specialty training was associated with being lower on agreeableness and conscientiousness.
Medical school experiences are important in specialty choice but experiences post-graduation remain significant, particularly in some specialties (psychiatry in our sample). Career guidance is important at medical school and should be continued post-graduation, with senior clinicians supported in advising juniors. Careers advice in the first year post-graduation may be particularly important, especially for specialties which have difficulty recruiting or are poorly represented at medical school.
PMCID: PMC4365809  PMID: 25889968
Careers; Specialty choice; Longitudinal; Experience
12.  Career choices among medical students in Bangladesh 
Information regarding career choices of medical students is important to plan human resources for health, design need-based educational programs, and ensure equitable and quality health care services in a country.
The aim of the study is to identify career choices, nature of career, intended practice locations, and reasons for career choices of Bangladesh medical students.
First-, third-, and fifth-year students of Bangladesh Medical College and Uttara Adhunik Medical College completed a self-report questionnaire on career choices, nature of career, intended practice locations, and reasons for career choices. The students were requested to choose three long-term choices from the given specialties.
A total of 132 students responded (46 males and 86 females) and response rate was 75%. The popular choices (first choice) among males and females were medical specialty, surgical specialty, obstetrics and gynecology, and general practice. For first, second, and third choices altogether, male students chose surgical specialties and female students preferred medical specialties. The leading reasons for selecting a specialty were personal interest and wide job opportunity. More than 67% of respondents wanted to join private services and about 90% chose major cities as practice locations. About 43% of respondents expressed willingness to practice medicine in Bangladesh, whereas 51% of total respondents wanted to practice abroad.
Majority of students intended to specialize in established clinical specialties and subsequently practice in major cities, and more than half wanted to immigrate to other countries. Basic medical subjects and service-oriented (lifestyle-related) and preventive/social medical specialties were found to be less attractive. If this pattern continues, Bangladesh will suffer a chronic shortage of health personnel in certain specialties and in rural areas.
Reorientation of health care and medical education is needed along with policy settings to attract doctors to the scarcity and high-priority disciplines so that imbalances encountered would be minimal in future.
PMCID: PMC3661246  PMID: 23745076
career choices; medical students; Bangladesh
13.  Choosing a career in surgery: factors that influence Canadian medical students' interest in pursuing a surgical career 
Canadian Journal of Surgery  2008;51(5):371-377.
Interest in both general surgery and surgical subspecialties has been declining among Canadian medical students. Studies have shown that a student's desire to practise surgery is largely determined before entry into medical school. As part of a larger study of students' career preferences throughout medical school, we sought to identify the level of interest in surgical careers and the factors that influence a student's interest in pursuing a surgical career.
We surveyed students from 18 different classes at Canadian medical schools at the commencement of their studies between 2001 and 2004. We asked the students to list their top career choices and the degree to which a series of variables influenced their choices. We also collected demographic data. We performed a factor analysis on the variables.
Of 2420 surveys distributed, 2168 (89.6%) were completed. A total of 21.0% of respondents named a surgical specialty as their first choice of career. We found that male students were more likely to express interest in a surgical specialty than female students, who were more likely to express interest in either family medicine or a medical specialty. Compared with students interested in a career in family medicine, those interested in a surgical or medical specialty were younger, more likely to be single and more likely to be influenced by prestige when making their career choices. Students interested in a career in surgery were less influenced by medical lifestyle and a varied scope of practice, less likely to demonstrate a social orientation and more likely to be hospital-oriented than students interested in either family medicine or a medical specialty. Male students interested in a career in surgery were more hospital-oriented and less likely to demonstrate a social orientation than female students interested in surgical careers.
We identified 5 factors and a number of demographic variables associated with a student's interest in a surgical career.
PMCID: PMC2556546  PMID: 18841235
14.  Few gender differences in specialty preferences and motivational factors: a cross-sectional Swedish study on last-year medical students 
BMC Medical Education  2013;13:39.
Today, women constitute about half of medical students in several Western societies, yet women physicians are still underrepresented in surgical specialties and clustered in other branches of medicine. Gender segregation in specialty preference has been found already in medical school. It is important to study the career preferences of our future physicians, as they will influence the maintenance of an adequate supply of physicians in all specialties and the future provision of health care. American and British studies dominate the area of gender and medical careers whereas Swedish studies on medical students’ reasons for specialty preference are scarce. The aim of this study is to investigate and compare Swedish male and female medical students’ specialty preferences and the motives behind them.
Between 2006 and 2009, all last-year medical students at Umea University, Sweden (N = 421), were invited to answer a questionnaire about their future career and family plans. They were asked about their specialty preference and how they rated the impact that the motivational factors had for their choice. The response rate was 89% (N = 372); 58% were women (N = 215) and 42% were men (N = 157). Logistic regression was used to evaluate the independent impact of each motivational factor for specialty preference.
On the whole, male and female last-year students opted for similar specialties. Men and women had an almost identical ranking order of the motivational factors. When analyzed separately, male and female students showed both similarities and differences in the motivational factors that were associated with their specialty preference. A majority of the women and a good third of the men intended to work part-time. The motivational factor combining work with family correlated with number of working hours for women, but not for men.
The gender similarities in the medical students’ specialty preferences are striking and contrast with research from other Western countries where male and female students show more differences in career aspirations. These similarities should be seized by the health care system in order to counteract the horizontal gender segregation in the physician workforce of today.
PMCID: PMC3599519  PMID: 23497262
15.  The medical schools outcomes database project: Australian medical student characteristics 
BMC Medical Education  2014;14:180.
Global medical workforce requirements highlight the need for effective workforce planning, with the overall aims being to alleviate doctor shortages and prevent maldistribution. The Medical Schools Outcomes Database and Longitudinal Tracking (MSOD) Project provides a foundation for evaluating outcomes of medical education programs against specified workforce objectives (including rural and areas of workforce needs), assisting in medical workforce planning, and provision of a national research resource. This paper describes the methodology and baseline results for the MSOD project.
The MSOD Project is a prospective longitudinal multiple-cohort study. The project invites all commencing and completing Australian medical students to complete short questionnaires. Participants are then asked to participate in four follow-up surveys at 1, 3, 5 and 8 years after graduation.
Since 2005, 30,635 responses for medical students (22,126 commencing students and 8,509 completing students) in Australia have been collected. To date, overall eligible cohort response rates are 91% for commencing students, and 83% for completing students. Eighty three percent of completing medical student respondents had also completed a commencing questionnaire.
Approximately 80% of medical students at Australian medical schools are Australian citizens. Australian medical schools have only small proportions of Indigenous students. One third of medical students speak a language other than English at home.The top three vocational choices for commencing medical students were surgery, paediatrics and child health and general practice. The top three vocational choices for completing students were surgery, adult medicine/ physician, and general practice. Overall, 75.7% of medical students changed their first career preference from commencement to exit from medical school.
Most commencing and completing medical students wish to have their future medical practice in capital cities or in major urban centers. Only 8.1% of commencing students and 4.6% of completing students stated an intention to have their future medical practice in smaller towns and small communities.
The MSOD longitudinal project is now an established national resource that is beginning to generate significant research outputs, along with providing key information for workforce planning and policy makers. The project has now expanded to enrol New Zealand medical students.
PMCID: PMC4156614  PMID: 25169797
Medical education; Medical workforce; Health; Medical student; Medical doctors; Longitudinal; Medicine; Methodology; Interns; Internship
16.  Why medical students switch careers 
Canadian Family Physician  2007;53(1):94-95.
To determine why students switch their career choices during the preclinical years of medical school.
Two questionnaires were administered: the first at the beginning of medical school and the second about 3 years later just before students entered clinical clerkship.
University of British Columbia, University of Alberta, University of Toronto, University of Ottawa, Queen’s University, University of Western Ontario, University of Calgary, and McMaster University.
Entering cohorts from 10 medical school classes at 8 Canadian medical schools.
Proportion of students who switched career choices and factors that influenced students to switch.
Among the 845 eligible respondents to the second survey, 19.6% (166 students) had switched between categories of family medicine and specialties, with a net increase of 1.2% (10 students) to family medicine. Most students who switched career choices had already considered their new careers as options when they entered medical school. Seven factors influenced switching career choices; 6 of these (medical lifestyle, encouragement, positive clinical exposure, economics or politics, competence or skills, and ease of residency entry) had significantly different effects on students who switched to family medicine than on students who switched out of family medicine. The seventh factor was discouragement by a physician.
Seven factors appear to affect students who switch careers. Two of these factors, economics or politics and ease of residency entry, have not been previously described in the literature. This study provides specific information on why students change their minds about careers before they get to the clinical years of medical training.
PMCID: PMC1952562  PMID: 17872616
17.  Specialty preferences among medical students in a Kenyan university 
Specialty distribution in Kenya continues to exhibit gender disparities despite the increasing number of female medical students graduating each year. This study aimed at assessing specialty preferences and factors influencing these choices among male and female medical students in Kenya.
Four hundred and fifty medical students, from first to fifth year of study at the University of Nairobi, were each issued a self-administered questionnaire designed to assess their specialty preferences and factors influencing these choices. The specialty preferences were compared with the actual distribution of specialists in Kenya. Data collected were analyzed using Statistical Package for Social Sciences.
Three hundred and eighty five (85.6%) questionnaires were completed. Surgery had the highest preference rate followed by pediatrics, internal medicine and obstetrics and gynecology. Significantly more males preferred surgery than females who mainly selected pediatrics (p<0.001). There was an increased likelihood of female students choosing controllable lifestyle specialties. These preferences mirrored the actual distribution of specialists in Kenya. Male students significantly considered prestige in a specialty (p=0.006), while their female counterparts mostly considered ease of raising a family and gender distribution in the specialty (p<0.001).
Gender-based similarities and differences exist in factors influencing specialty preferences among Kenyan medical students. These factors may explain the observed specialist doctor distribution in the country.
PMCID: PMC3032620  PMID: 21293745
Specialty; Gender; Career; Medical study; Kenya
18.  The role of curriculum in influencing students to select generalist training: A 21-year longitudinal study 
To determine if specific curricula or backgrounds influence selection of generalist careers, the curricular choices of graduates of Mount Sinai School of Medicine between 1970 and 1990 were reviewed based on admission category. Students were divided into three groups: Group 1, those who started their first year of training at the School of Medicine; Group 2, those accepted with advanced standing into their third year of training from the Sophie Davis School of Biomedical Education, a five-year program developed to select and produce students likely to enter primary care fields; and Group 3, those accepted with advanced standing into the third year who spent the first two years at a foreign medical school. All three groups took the identical last two years of clinical training at the School of Medicine. There were no significant differences with respect to initial choice of generalist training programs among all three groups, with 46% of the total cohort selecting generalist training. Of those students who chose generalist programs, 58% in Group 1,51% in Group 2, and 41% in Group 3 remained in these fields rather than progressing to fellowship training. This difference was significant only with respect to Group 3. However, when an analysis was performed among those students providing only primary care as compared to only specialty care, there were no significant differences. Analysis by gender revealed women to be more likely to select generalist fields and remain in these fields without taking specialty training (P<.0001). Differentiating characteristics with respect to choosing generalist fields were not related to either Part I or Part II scores on National Board Examinations or selection to AOA. However, with respect to those specific specialties considered quite competitive (general surgery, obstetrics and gynecology, and ophthalmology), total test scores on Part I and Part II were significantly higher than those of all other students. The analysis indicated that, despite the diverse characteristics of students entering the third year at the School of Medicine, no one group produced a statistically greater proportion of generalists positions than any other, and academic performance while in medical school did not have a significant influence on whether a student entered a generalist field.
PMCID: PMC3456709  PMID: 10091195
19.  Factors affecting medical students in formulating their specialty preferences in Jordan 
In recent years there has been a growing appreciation of the issues of career preference in medicine as it may affect student learning and academic performance. However, no such studies have been undertaken in medical schools in Jordan. Therefore, we carried out this study to investigate the career preferences of medical students at Jordan University of Science and Technology and determine factors that might influence their career decisions.
A cross-sectional questionnaire-based survey was carried out among second, fourth and sixth year medical students at the Jordan University of Science and Technology, Irbid, Jordan during the academic year 2006/2007. A total of 440 students answered the questionnaire which covered demographic characteristics, specialty preferences, and the factors that influenced these career preferences. Possible influences were selected on the basis of a literature review and discussions with groups of medical students and physicians. Students were asked to consider 14 specialty options and select the most preferred career preference.
The most preferred specialty expressed by male students was surgery, followed by internal medicine and orthopaedics, while the specialty most preferred by female students was obstetrics and gynaecology, followed by pediatrics and surgery. Students showed little interest in orthopedics, ophthalmology, and dermatology. While 3.1% of females expressed interest in anesthesiology, no male students did. Other specialties were less attractive to most students.
Intellectual content of the specialty and the individual's competencies were the most influential on their preference of specialty. Other influential factors were the "reputation of the specialty", "anticipated income", and "focus on urgent care".
Surgery, internal medicine, pediatrics, and obstetrics and gynaecology were the most preferred specialty preferences of medical students at Jordan University of Science and Technology.
PMCID: PMC2423351  PMID: 18501004
20.  Medical specialty considerations by medical students early in their clinical experience 
Specialty selection by medical students determines the future composition of the physician workforce. Selection of career specialties begins in earnest during the clinical rotations with exposure to the clinical and intellectual environments of various specialties. Career specialty selection is followed by choosing a residency program. This is the period where insight into the decision process might help healthcare leaders ascertain whether, when, and how to intervene and attempt to influence students' decisions. The criteria students consider important in selecting a specialty and a residency program during the early phases of their clinical rotations were examined.
Questionnaires distributed to fifth-year medical students at two Israeli medical schools.
229 of 275 (83%) questionnaires were returned. 80% of the students had considered specialties; 62% considered one specialty, 25% two, the remainder 3-5 specialties. Students took a long-range view; 55% considered working conditions after residency more important than those during residency, another 42% considered both equally important. More than two-thirds wanted an interesting and challenging bedside specialty affording control over lifestyle and providing a reasonable relationship between salary and lifestyle. Men were more interested in well-remunerated procedure-oriented specialties that allowed for private practice. Most students rated as important selecting a challenging and interesting residency program characterized by good relationships between staff members, with positive treatment by the institution, and that provided much teaching. More women wanted short residencies with few on-calls and limited hours. More men rated as important residencies affording much responsibility for making clinical decisions and providing research opportunities. More than 50% of the students considered it important that their residency be in a leading department, and in a large university medical center. Only 5% considered it important to do their residency in the country's peripheral areas, while 30% reported interest in a residency in the country's center.
The fifth year of a six-year medical school is an opportune time to provide students with information and guidance on the various specialties and selecting a residency program as they begin to solidify their perceptions and ideas about the various specialties. This study serves as an impetus to medical educators and healthcare leaders to become interested in students' career selection.
PMCID: PMC3424828  PMID: 22913658
Medical students; medical specialties; specialty selection; residency; healthcare system; physician workforce
21.  Preparing medical students for obstetrics and gynecology milestone level one: a description of a pilot curriculum 
Medical Education Online  2014;19:10.3402/meo.v19.25746.
The implementation of the Accreditation Council for Graduate Medical Education (ACGME) Milestones in the field of obstetrics and gynecology has arrived with Milestones Level One defined as the level expected of an incoming first-year resident.
We designed, implemented, and evaluated a 4-week elective for fourth-year medical school students, which utilized a multimodal approach to teaching and assessing the Milestones Level One competencies.
The 78-hour curriculum utilized traditional didactic lectures, flipped classroom active learning sessions, a simulated paging curriculum, simulation training, embalmed cadaver anatomical dissections, and fresh-frozen cadaver operative procedures. We performed an assessment of student knowledge and surgical skills before and after completion of the course. Students also received feedback on their assessment and management of eight simulated paging scenarios. Students completed course content satisfaction surveys at the completion of each of the 4 weeks.
Students demonstrated improvement in knowledge and surgical skills at the completion of the course. Paging confidence trended toward improvement at the completion of the course. Student satisfaction was high for all of the course content, and the active learning components of the curriculum (flipped classroom, simulation, and anatomy sessions) had higher scores than the traditional didactics in all six categories of our student satisfaction survey.
This pilot study demonstrates a practical approach for preparing fourth-year medical students for the expectations of Milestones Level One in obstetrics and gynecology. This curriculum can serve as a framework as medical schools and specific specialties work to meet the first steps of the ACGME's Next Accreditation System.
PMCID: PMC4246035  PMID: 25430640
ACGME Milestones; flipped classroom; active learning
22.  Clerkship in primary care: a cross-sectional study about expectations and experiences of undergraduates in medicine 
Introduction: With the amendment of the medical licensure act (Approbationsordnung) in 2012, a four-week clerkship in primary care (FHV) became mandatory. We investigated the expectations with which students begin the FHV, which criteria are relevant in selecting the location for the FHV, and the experiences the students had during the FHV.
Method: In a cross-sectional study, all third-year students at both medical schools in Saxony-Anhalt were surveyed in 2013 about their expectations and experiences regarding the FHV. This is the last cohort for which the FHV is optional. Questions were asked about 29 items addressing six topics (personal information, selection of FHV location, selection of FHV medical practice, expectations, experiences, and specialty selection).
Results: Out of a student body of 446, responses were received from N=424 (response rate 95.1%; of which 61.8% female). Of these students, 71 (16.7%) had completed the FHV and 70 (16.5%) were planning to; another 267 students (63%) had not (yet) planned to participate in an FHV. Where a student’s parents lived, personal recommendations of a particular medical practice and the attractiveness of the region were the most important criteria for selecting the clerkship site. After completing the FHV, the learning objectives reflected themselves in the experiences of the students in a similar order and significance as in the expectations of students who planned or had not (as of yet) planned to complete the FHV. A relevant influence of the FHV confirming the choice to specialize in general practice or outpatient care was not indicated by those who had completed the FHV.
Conclusion: After location and practice, the FHV is selected according to personal criteria and in connection with prioritized learning objectives. From the students’ perspective, the most frequently named learning objectives are also identified as acquired experience after completing the FHV. However, the FHV does not have a reinforcing effect on the selection of general practice as a specialty.
PMCID: PMC4259063  PMID: 25489344
general practice; lerkship; primary care; expectation; experiences
23.  Basic life support knowledge of healthcare students and professionals in the Qassim University 
To evaluate the knowledge of basic life support (BLS) among students and health providers in Medicine, Pharmacy, Dentistry, and Allied Health Science Colleges at Qassim University.
A cross sectional study was performed using an online BLS survey that was completed by 139 individuals.
Ninety-three responders were medical students, 7 were medical interns, 6 were dental students, 7 were pharmacy students, 11 were medical science students and 15 were clinical practitioners. No responder scored 100% on the BLS survey. Only two out of the 139 responders (1.4%) scored 90–99%. Both of these individuals were fifth year medical students. Six responders (4.3%) scored 80–89%. Of these, 5 were fifth year medical students, and one was fourth-year medical student. Eleven responders (7.9%) scored 70–79%. Of these, eight were fifth year medical students, two were medical interns and one was a pharmacist. Twenty-three responders (16.5%) scored 60–69%. Of these, 11 were fifth year medical students, 1 was a fourth-year medical student, 3 were medical interns, 2 were medical science students, 1 was a dentistry student, and 5 were pharmacists. Twenty-eight responders (20.1%) scored 50–59%. Of these, 11 were fifth year medical students, 3 were fourth-year medical students, 1 was a third-year medical student, 1 was a second-year medical student, 2 were first-year medical students, 1 was a pharmacy student, 3 were dental students, 1 was a allied health science student, 2 were doctors, and 3 were pharmacists. The remaining 69 responders (49.6%) scored less than 50%.
Knowledge of BLS among medicine, pharmacy, dentistry, and allied health science students and health providers at Qassim University is poor and needs to be improved. We suggest that inclusion of a BLS course in the undergraduate curriculum with regular reassessment would increase awareness and application of this valuable life-saving skill set.
PMCID: PMC4166986  PMID: 25246881
24.  Intercalated degrees, learning styles, and career preferences: prospective longitudinal study of UK medical students 
BMJ : British Medical Journal  1999;319(7209):542-546.
To assess the effects of taking an intercalated degree (BSc) on the study habits and learning styles of medical students and on their interest in a career in medical research.
Longitudinal questionnaire study of medical students at application to medical school and in their final year.
All UK medical schools.
6901 medical school applicants for admission in 1991 were studied in the autumn of 1990. 3333 entered medical school in 1991 or 1992, and 2695 who were due to qualify in 1996 or 1997 were studied 3 months before the end of their clinical course. Response rates were 92% for applicants and 56% for final year students.
Main outcome measures
Study habits (surface, deep, and strategic learning style) and interest in different medical careers, including medical research. Identical questions were used at time of application and in final year.
Students who had taken an intercalated degree had higher deep and strategic learning scores than at application to medical school. Those with highest degree classes had higher strategic and deep learning scores and lower surface learning scores. Students taking intercalated degrees showed greater interest in careers in medical research and laboratory medicine and less interest in general practice than their peers. The effects of the course on interest in medical research and learning styles were independent. The effect of the intercalated degree was greatest in schools where relatively few students took intercalated degrees.
Intercalated degrees result in a greater interest in research careers and higher deep and strategic learning scores. However, the effects are much reduced in schools where most students intercalate a degree. Introduction of intercalated degrees for all medical students without sufficient resources may not therefore achieve its expected effects.
Key messagesAlthough intercalated degrees are well established, little is known about their effect on medical studentsIn this longitudinal study final year students who had taken intercalated degree were more interested in medical research, and had higher deep and strategic learning style scores than other studentsThe effects of the intercalated degree were dose dependent, being greatest in those gaining a first class degreeThe effects of the intercalated degree were greatest in medical schools where a relatively small proportion of medical students took the degree.Differences between medical schools are most easily explained by resource dilution
PMCID: PMC28204  PMID: 10463892
25.  Perceptions of Medical Students About Family Medicine in Ghana 
Ghana Medical Journal  2013;47(4):178-184.
To determine the perceptions of medical students in Ghana about family medicine with regard to knowledge and relevance as well as specialty preferences.
A descriptive study.
The study was conducted on first clinical year students of the University of Ghana Medical School (first group of students introduced to the specialty of family medicine) in July 2008, using structured questionnaire. Data was analyzed by descriptive statistics.
Main outcome measures
The respondents' awareness of family medicine, their views on the relevance of family medicine and their specialty preferences.
Level of awareness of the specialty was high among the students (88.0%, [95% CI 80.2–93.6]). Information from friends and relations was the major source of awareness (29.5%, CI 20.2–40.3). Majority of the students perceived that family physicians are capable of providing total health care for 85–95% of their clients (54.4%, CI 44.1–64.5) and also reduce overall cost of health care (79.8%, CI 70.5–87.2). However, only 2.4% (CI 0.4–7.6) were considering postgraduate training in family medicine. The major factor for specialty choice was personal interest (75.6%, CI 65.9–83.6) and the main reason for not choosing family medicine was inadequate understanding of the specialty (79.3%, CI 69.5–87.0).
There is high level of awareness of family medicine among medical students in Ghana however very few students want to choose it as a specialty because of inadequate understanding of the specialty.
PMCID: PMC3961854  PMID: 24669023
Family medicine; perceptions; medical students; postgraduate; residency

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