Journal of General Internal Medicine

, Volume 23, Issue 7, pp 1095–1100 | Cite as

Changes in U.S. Medical Students’ Specialty Interests over the Course of Medical School

  • Michael T. Compton
  • Erica Frank
  • Lisa Elon
  • Jennifer Carrera
Original Article

Abstract

Background

Studies have examined factors affecting medical students’ specialty choice, but little research exists on stability of these specialty interests.

Objective

To describe patterns of change in specialty interests during medical school and examine associations between specialty change patterns and gender, desire for a high-prestige career, and interest in prevention.

Design

Medical students (Class of 2003) at 15 representative US schools were invited to complete surveys during freshman orientation, entry to wards, and senior year.

Participants

This analysis used data from 942 students who completed all 3 surveys.

Measurements

In addition to a number of other items, students were asked to choose the 1 specialty they were most interested in pursuing.

Results

The most common specialty choices among freshman students were pediatrics (20%) and surgery (18%); least common choices were psychiatry and preventive medicine (1% each). General internal medicine was the initial specialty choice for 8%. Most students changed their specialty choices, regardless of initial interest. Only 30% of those initially interested in primary care (PC) remained interested at all 3 time points, compared to 68% of those initially interested in non-PC. Female versus male students were more commonly interested in PC at all 3 time points. Senior students interested in non-PC specialties were more likely to desire a high-prestige career (48%) than those interested in PC (31%).

Conclusions

Medical students may benefit from more intensive introduction to some specialties earlier in pre-medical and medical education. In addition, increasing the prestige of PC fields may shape the physician workforce.

KEY WORDS

medical students changes in specialty choices prestige 

References

  1. 1.
    Weissman SH, Haynes RA, Killian CD, Robinowitz C. A model to determine the influence of medical school on students’ career choices: psychiatry, a case study. Acad Med. 1994;69:58–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Sierles FS, Dinwiddie SH, Patroi D, Atre-Vaidya N, Schrift MJ, Woodard JL. Factors affecting medical student career choice of psychiatry from 1991–2001. Acad Psychiatry. 2003;27:260–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Rosenthal MP, Rabinowitz HK, Diamond JJ, Markham FW. Medical students’ specialty choice and the need for primary care. Prim Care. 1996;23:155–67.PubMedGoogle Scholar
  4. 4.
    Cochran A, Melby S, Neumayer LA. An internet-based survey of factors influencing medical student selection of a general surgery career. Am J Surg. 2005;189:742–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Sanfey HA, Saalwachter-Schulman A, Nyhof-Young JM, Eidelson B, Mann BD. Influences on medical student career choice: gender or generation? Arch Surg. 2006;141:1086–94.CrossRefPubMedGoogle Scholar
  6. 6.
    Pamies RJ, Lawrence LE, Helm EG, Strayhorn G. The effects of certain student and institutional characteristics on minority medical student specialty choice. J Nat Med Assoc. 1994;86:136–40.Google Scholar
  7. 7.
    Newton DA, Grayson MS, Whitley TW. What predicts medical student career choice? J Gen Intern Med. 1998;13:200–3.CrossRefPubMedGoogle Scholar
  8. 8.
    Barshes NR, Vavra AK, Miller A, Brunicardi FC, Goss JA, Sweeney JF. General surgery as a career: a contemporary review of factors central to medical student specialty choice. J Am Coll Surg. 2004;1999:792–9.CrossRefGoogle Scholar
  9. 9.
    Kassebaum DG, Szenas PL. Factors influencing the specialty choices of 1993 medical school graduates. Acad Med. 1994;69:164–70.Google Scholar
  10. 10.
    Ruhnke GW. Physician supply and the shifting paradigm of medical student choice. JAMA. 1997;277:70–1.CrossRefPubMedGoogle Scholar
  11. 11.
    Tonkin P. Effect of rising medical student debt on residency specialty selection at the University of Minnesota. Minn Med. 2006;89:46–9.PubMedGoogle Scholar
  12. 12.
    Novielli K, Hojat M, Park PK, et al. Change of interest in surgery during medical school: a comparison of men and women. Acad Med. 2001;76:S58–61.CrossRefPubMedGoogle Scholar
  13. 13.
    Stoll M. The Best Medical Schools. 2000 Edition. New York, NY: Princeton Review Publishing; 1999.Google Scholar
  14. 14.
    Association of American Medical Colleges. Applicant age at anticipated matriculation, 1992–2001. http://www.aamc.org/data/facts/archive/famg112001a.htm. Accessed 26 February 2008.
  15. 15.
    Association of American Medical Colleges. Total enrollment by gender and race/ethnicity, 1992–2001. http://www.aamc.org/data/facts/archive/famg82001.htm. Accessed 26 February 2008.
  16. 16.
    Association of American Medical Colleges. Medical schools. http://www.aamc.org/medicalschools.htm. Accessed 26 February 2008.
  17. 17.
    National Institutes of Health. Support to U.S. Medical Schools, Fiscal Year 2000. http://grants.nih.gov/grants/award/rank/medschrank00.txt. Accessed 26 February 2008.
  18. 18.
    Frank E, Carrera JS, Elon L, Hertzberg VS. Basic demographics, health practices, and health status of U.S. medical students. Am J Prev Med. 2006;31:499–505.CrossRefPubMedGoogle Scholar
  19. 19.
    Frank E, Carrera JS, Elon L, Hertzberg VS. Predictors of US medical students’ prevention counseling practices. Prev Med. 2007;44:76–81.CrossRefPubMedGoogle Scholar
  20. 20.
    Henderson SJ, Elon L, Frank E. Self-report of quality of medical student health care. Med Educ. 2007;41:632–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Dillman DA. Mail and Telephone Surveys: The Total Design Method. New York, NY: Wiley; 1978.Google Scholar
  22. 22.
    Shah BV, Barnwell BG, Bieler GS. SUDAAN User’s Manual, Release 8.0: Software for the Statistical Analysis of Correlated Data. Research Triangle Park, NC: Research Triangle Institute; 2001.Google Scholar
  23. 23.
    Markert RJ. Change in specialty choice during medical school. J Fam Pract. 1983;17:295–300.PubMedGoogle Scholar
  24. 24.
    Zeldow PB, Preston RC, Daugherty SR. The decision to enter a medical specialty: timing and stability. Med Educ. 1992;26:327–32.PubMedCrossRefGoogle Scholar
  25. 25.
    Kassebaum DG, Szenas PL. Medical students’ career indecision and specialty rejection: roads not taken. Acad Med. 1995;70:938–43.Google Scholar
  26. 26.
    Babbott D, Baldwin DC, Jolly P, Williams DJ. The stability of early specialty preferences among U.S. medical school graduates in 1983. JAMA. 1988;259:1970–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Bland CJ, Meurer LN, Maldonado G. Determinants of primary care specialty choice: a non-statistical meta-analysis of the literature. Acad Med. 1995;70:620–41.PubMedCrossRefGoogle Scholar
  28. 28.
    Rogers LQ, Fincher RM, Lewis LA. Factors influencing medical students to choose primary care or non-primary care specialties. Acad Med. 1990;65:S47–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Kassler WJ, Wartman SA, Silliman RA. Why medical students choose primary care careers. Acad Med. 1991;66:41–3.CrossRefPubMedGoogle Scholar
  30. 30.
    Fincher RM, Lewis LA, Rogers LO. Classification model that predicts medical students’ choices of primary care or non-primary care specialties. Acad Med. 1992;67:324–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Weinstein P, Gipple C. Some determinants of career choice in the second year of medical school. J Med Educ. 1975;50:194–8.PubMedGoogle Scholar
  32. 32.
    Freed DH. Hospitalists: evolution, evidence, and eventualities. Health Care Manager. 2004;23:238–56.PubMedGoogle Scholar
  33. 33.
    Wachter RM. Reflections: the hospitalist movement a decade later. J Hosp Med. 2006;1:248–52.CrossRefPubMedGoogle Scholar
  34. 34.
    West CP, Popkave C, Schultz HJ, Weinberger SE, Kolars JC. Changes in career decisions of internal medicine residents during training. Ann Int Med. 2006;145:774–9.PubMedGoogle Scholar
  35. 35.
    Jennett PA, Kishinevsky M, Bryant H, Hunter KL. Major changes in medical careers following medical school graduation: when, how often, and why. Acad Med. 1990;65:48–9.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Michael T. Compton
    • 1
    • 2
  • Erica Frank
    • 1
    • 3
  • Lisa Elon
    • 4
  • Jennifer Carrera
    • 4
  1. 1.Department of Family and Preventive MedicineEmory University School of MedicineAtlantaUSA
  2. 2.Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaUSA
  3. 3.Department of Health Care and EpidemiologyUniversity of British ColumbiaVancouverCanada
  4. 4.Department of BiostatisticsRollins School of Public Health, Emory UniversityAtlantaUSA

Personalised recommendations