Advances in Health Sciences Education

, Volume 21, Issue 1, pp 79–92 | Cite as

Social dominance theory and medical specialty choice

  • Brice Lepièce
  • Christine Reynaert
  • Philippe van Meerbeeck
  • Valérie Dory
Article

Abstract

Understanding how medical students select their specialty is a fundamental issue for public health and educational policy makers. One of the factors that students take into account is a specialty’s prestige which hinges partly on its focus on technique rather than whole person. We examine the potential of a psychological framework, social dominance theory, to explain why some students, and not others, are drawn to more prestigious, technique-oriented specialties, based on their desire for hierarchy. We conducted a cross-sectional study among medical students at Institution X (N = 359). We examined the link between medical students’ characteristics i.e. social dominance orientation (SDO), gender, age, and their career intention. We also examined level of medical students’ SDO at different stages of the curriculum. SDO scores were significantly associated with technique-oriented career intentions (OR 1.56; 95 % CI [1.18, 2.06]; p = 0.001). The effect was independent of gender. Medical students’ SDO scores were significantly higher in later stages of the medical curriculum (F = 6.79; p = 0. 001). SDO is a significant predictor of medical students’ career intention. SDO scores are higher in students during the clinical phase of the curriculum. Medical socialization, involving the internalization of implicit and explicit norms, particularly in hospital settings, is likely to underpin our findings. This theory illuminates consistent findings in the literature on specialty prestige and the influence of medical school on career choice.

Keywords

Career choice Clinical clerkship Education, medical, undergraduate Hierarchy Medical students Prestige Social dominance 

References

  1. Apker, J., & Eggly, S. (2004). Communicating professional identity in medical socialization: Considering the ideological discourse of morning report. Qualitative Health Research, 14, 411–429.CrossRefGoogle Scholar
  2. Bennett, K. L., & Phillips, J. P. (2010). Finding, recruiting, and sustaining the future primary care physician workforce: A new theoretical model of specialty choice process. Academic Medicine, 85, S81–S88.CrossRefGoogle Scholar
  3. Bland, C. J., Meurer, L. N., & Maldonado, G. (1995). Determinants of primary care specialty choice: A non-statistical meta-analysis of the literature. Academic Medicine, 70, 620–641.CrossRefGoogle Scholar
  4. Block, S. D., Clark-Chiarelli, N., Peters, A. S., & Singer, J. D. (1996). Academia’s chilly climate for primary care. Journal of the American Medical Association, 276, 677–682.CrossRefGoogle Scholar
  5. Borges, N. J., & Gibson, D. D. (2005). Personality patterns of physicians in person-oriented and technique-oriented specialties. Journal of Vocational Behavior, 67, 4–20.CrossRefGoogle Scholar
  6. Borges, N. J., & Osmon, W. R. (2001). Personality and medical specialty choice: Technique orientation versus people orientation. Journal of Vocational Behavior, 58, 22–35.CrossRefGoogle Scholar
  7. Burack, J. H., Irby, D. M., Carline, J. D., Ambrozy, D. M., Ellsbury, K. E., & Stritter, F. T. (1997). A study of medical students’ specialty-choice pathways: Trying on possible selves. Academic Medicine, 72, 534–541.CrossRefGoogle Scholar
  8. Chazal, S., & Guimond, S. (2003). La théorie de la dominance sociale et les choix d’orientation scolaire et de rôles sociaux des filles et des garçons. L’orientation scolaire et professionnelle, 32, 595–616.CrossRefGoogle Scholar
  9. Cheng, J. T., Tracy, J. L., & Henrich, J. (2010). Pride, personality, and the evolutionary foundations of human social status. Evolution and Human Behavior, 31, 334–347.CrossRefGoogle Scholar
  10. Connelly, M. T., Sullivan, A. M., Peters, A. S., Clark-Chiarelli, N., Zotov, N., Martin, N., et al. (2003). Variation in predictors of primary care career choice by year and stage of training: A national survey. Journal of General Internal Medicine, 18, 159–169.CrossRefGoogle Scholar
  11. Costello, K., & Hodson, G. (2010). Exploring the roots of dehumanization: The role of animal–human similarity in promoting immigrant humanization. Group Processes and Intergroup Relations, 13, 3–22.CrossRefGoogle Scholar
  12. Coulehan, J., & Williams, P. C. (2001). Vanquishing virtue: The impact of medical education. Academic Medicine, 76, 598–605.Google Scholar
  13. Creed, P. A., Searle, J., & Rogers, M. E. (2010). Medical specialty prestige and lifestyle preferences for medical students. Social Science and Medicine, 71, 1084–1088.CrossRefGoogle Scholar
  14. Dambrun, M., Kamiejski, R., Haddadi, N., & Duarte, S. (2009). Why does social dominance orientation decrease with university exposure to the social sciences? The impact of institutional socialization and the mediating role of “geneticism”. European Journal of Social Psychology, 39, 88–100.Google Scholar
  15. Davis, B. E., Nelson, D. B., Sahler, O. J. Z., McCurdy, F. A., Goldberg, R., & Greenberg, L. W. (2001). Do clerkship experiences affect medical students’ attitudes toward chronically ill patients? Academic Medicine, 76, 815–820.Google Scholar
  16. Davis-Floyd, R. (2001). The technocratic, humanistic, and holistic paradigms of childbirth. International Journal of Gynecology and Obstetrics, 75, S5–S23.CrossRefGoogle Scholar
  17. Davis-Floyd, R., & St-John, G. (1998). From doctor to healer: The transformative journey. New Brunswick: Rutgers University Press.Google Scholar
  18. De Oliveira, P., Guimond, S., & Dambrun, M. (2012). Power and legitimizing ideologies in hierarchy-enhancing vs hierarchy-attenuating environments. Political Psychology, 33, 867–885.CrossRefGoogle Scholar
  19. Dopelt, K., Yahav, Z., Urkin, J., Bachner, Y., & Davidovitch, N. (2014). The social role of the faculties of medicine: Physicians’ perception of the dominant orientation of their medical studies and social involvement. Harefuah, 153(87–91), 126.Google Scholar
  20. Duarte, S., Dambrun, M., & Guimond, S. (2004). La dominance sociale et les «mythes légitimisateurs»: Validation française de l’échelle d’orientation à la dominance sociale. Revue Internationale de Psychologie Sociale, 17, 97–126.Google Scholar
  21. Ekehammar, B. O., Akrami, N., Gylje, M., & Zakrisson, I. (2004). What matters most to prejudice: Big five personality, social dominance orientation, or right-wing authoritarianism? European Journal of Personality, 18, 463–482.CrossRefGoogle Scholar
  22. Geist, P., & Dreyer, J. (1993). The demise of dialogue: A critique of medical encounter ideology. Western Journal of Communication, 57, 233–246.CrossRefGoogle Scholar
  23. Gorenflo, D., Ruffin, M., & Sheets, K. (1994). A multivariate model for specialty preference by medical students. Journal of Family Practice, 39, 570–576.Google Scholar
  24. Griffith III, C. H., & Wilson, J. F. (2001). The loss of student idealism in the 3rd-year clinical clerkships. Evaluation and the Health Professions, 24, 61–71.Google Scholar
  25. Guimond, S. (2000). Group socialization and prejudice: The social transmission of intergroup attitudes and beliefs. European Journal of Social Psychology, 30, 335–354.CrossRefGoogle Scholar
  26. Guimond, S., Dambrun, M., Michinov, N., & Duarte, S. (2003). Does social dominance generate prejudice? Integrating individual and contextual determinants of intergroup cognitions. Journal of Personality and Social Psychology, 84, 697–721.CrossRefGoogle Scholar
  27. Haley, H., & Sidanius, J. (2005). Person-organization congruence and the maintenance of group-based social hierarchy: A social dominance perspective. Group Processes and Intergroup Relations, 8, 187–203.CrossRefGoogle Scholar
  28. Hinze, S. W. (1999). Gender and the body of medicine or at least some body parts: (Re)constructing the prestige hierarchy of medical specialties. Sociological Quarterly, 40, 217–239.CrossRefGoogle Scholar
  29. Hojat, M., Vergare, M. J., Maxwell, K., Brainard, G., Herrine, S. K., Isenberg, G. A., et al. (2009). The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Academic Medicine, 84, 1182–1191.Google Scholar
  30. Hosmer, D., & Lemeshow, S. (2000). Applied logistic regression (2nd ed.). New York: Wiley.Google Scholar
  31. Jetten, J., & Iyer, A. (2010). Different meanings of the social dominance orientation concept: Predicting political attitudes over time. British Journal of Social Psychology, 49, 385–404.CrossRefGoogle Scholar
  32. Jordan, J., Brown, J. B., & Russell, G. (2003). Choosing family medicine. What influences medical students? Canadian Family Physician, 49, 1131–1137.Google Scholar
  33. Lawson, S. R., & Hoban, J. D. (2003). Predicting career decisions in primary care medicine: A theoretical analysis. The Journal of Continuing Education in the Health Professions, 23, 68–80.CrossRefGoogle Scholar
  34. Lempp, H., & Seale, C. (2004). The hidden curriculum in undergraduate medical education: Qualitative study of medical students’ perceptions of teaching. British Medical Journal, 329, 770–773.CrossRefGoogle Scholar
  35. Malhi, G. S., Parker, G. B., Parker, K., Carr, V. J., Kirkby, K. C., Yellowlees, P., et al. (2003). Attitudes toward psychiatry among students entering medical school. Acta Psychiatrica Scandinavica, 107, 424–429.CrossRefGoogle Scholar
  36. Manuel, R. S., Borges, N. J., & Jones, B. J. (2009). Person-oriented versus technique-oriented specialties: early preferences and eventual choice. Medical Education Online, 14, 4.CrossRefGoogle Scholar
  37. Norredam, M., & Album, D. (2007). Prestige and its significance for medical specialties and diseases. Scandinavian Journal of Public Health, 35, 655–661.CrossRefGoogle Scholar
  38. Pratto, F., Liu, J. H., Levin, S., Sidanius, J., Shih, M., Bachrach, H., et al. (2000). Social dominance orientation and the legitimization of inequality across cultures. Journal of Cross-Cultural Psychology, 31, 369–409.CrossRefGoogle Scholar
  39. Pratto, F., Sidanius, J., Stallworth, L. M., & Malle, B. F. (1994). Social dominance orientation: A personality variable predicting social and political attitudes. Journal of Personality and Social Psychology, 67, 741–763.CrossRefGoogle Scholar
  40. Reed, V. A., Jernstedt, G. C., & Reber, E. S. (2001). Understanding and improving medical student specialty choice: A synthesis of the literature using decision theory as a referent. Teaching and Learning in Medicine, 13, 117–129.CrossRefGoogle Scholar
  41. Rosoff, S. M., & Leone, M. C. (1991). The public prestige of medical specialties: Overviews and undercurrents. Social Science and Medicine, 32, 321–326.CrossRefGoogle Scholar
  42. Scott, I., Gowans, M., Wright, B., Brenneis, F., Banner, S., & Boone, J. (2011). Determinants of choosing a career in family medicine. Canadian Medical Association Journal, 183, E1–E8.CrossRefGoogle Scholar
  43. Senf, J. H., Campos-Outcalt, D., & Kutob, R. (2003). Factors related to the choice of family medicine: A reassessment and literature review. The Journal of the American Board of Family Practice, 16, 502–512.CrossRefGoogle Scholar
  44. Sidanius, J., Kteily, N., Sheehy-Skeffington, J., Ho, A. K., Sibley, C., & Duriez, B. (2013). You’re inferior and not worth our concern: The interface between empathy and social dominance orientation. Journal of Personality, 81, 313–323.Google Scholar
  45. Sidanius, J., & Pratto, F. (2001). Social dominance: An intergroup theory of social hierarchy and oppression. New York: Cambirdge University Press.Google Scholar
  46. Thornton, J., & Esposto, F. (2003). How important are economic factors in choice of medical specialty? Health Economics, 12, 67–73.CrossRefGoogle Scholar
  47. Wear, D. (1997). Professional development of medical students: Problems and promises. Academic Medicine, 72, 1056–1062.CrossRefGoogle Scholar
  48. Whitley, J. (1999). Right-wing authoritarianism, social dominance orientation, and prejudice. Journal of Personality and Social Psychology, 77, 126–134.CrossRefGoogle Scholar
  49. Wong, A., & Trollope-Kumar, K. (2014). Reflections: An inquiry into medical students’ professional identity formation. Medical Education, 48, 489–501.CrossRefGoogle Scholar
  50. Wright, B., Scott, I., Woloschuk, W., & Brenneis, F. (2004). Career choice of new medical students at three Canadian universities: Family medicine versus specialty medicine. CMAJ, 170, 1920–1924.CrossRefGoogle Scholar
  51. Wright, S., Wong, A., & Newill, C. (1997). The impact of role models on medical students. Journal of General Internal Medicine, 12, 53–56.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Brice Lepièce
    • 1
  • Christine Reynaert
    • 1
  • Philippe van Meerbeeck
    • 1
  • Valérie Dory
    • 2
  1. 1.Institute of Health and Society (IRSS)Université catholique de LouvainBrusselsBelgium
  2. 2.Faculty of Medicine, Centre for Medical EducationMcGill UniversityMontréalCanada

Personalised recommendations