Determinants of the generalist career intentions of 1995 graduating medical students
Determinants of the generalist career intentions of 1995 graduating medical students
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DOI：
10.1097/00001888-199602000-00030
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发表时间：
1996-02-01
影响因子：
7.4
通讯作者：
Schuchert, MK
中科院分区：
文献类型：
--
作者：
Kassebaum, DG;Szenas, PL;Schuchert, MK
利用美国医学院协会的国家数据库，作者使用Logistic回归分析，显示了选定的人口、结构、态度和教育变量对1995年美国医学院毕业生专业职业选择的相对预测影响。在家庭实践或未指明的全科医生职业生涯中追求认证的计划可能会取得中等成功，而普通内科和普通儿科的选择则不能。1995届毕业生在没有具体说明个人多面手专业的情况下，追求多面手职业的意图与人口统计因素密切相关，如女性、年龄较大的学生和农村家乡；对多面手专业的早期兴趣；倾向于帮助人们的态度，而不是寻求领导、智力挑战或研究的机会；医学院设有家庭医学系；以及第三和第四年的门诊护理经历。在这项研究中使用的多元回归模型中，一些被广泛吹捧为对培养通才很重要的因素并不是通才决定的显著预测因素：明确阐述通才职业培养的机构使命声明；对发誓对通才感兴趣的申请者给予优先录取；公立(相对于私立)学校赞助；普通内科或普通儿科的离散组织单位；普通内科和儿科学机构教员的比例；教育债务水平；和学生在医学院第一年和第二年的临床经验。作者承认从这类分析中推断因果关系的危险，并描述了当自变量传播到目前不利于初级保健的机构文化时，以前的联系--例如，要求家庭医学三年助理与毕业生家庭执业职业选择之间的联系--的力量可能会被削弱。这一分析的发现进一步证明，通才的职业意图在很大程度上是随着学生对家庭医学和门诊初级保健的兴趣和经验的浪潮而进行的。就这项研究中输入变量的预测值而言，其他两个通才专业-普通内科和普通儿科-的职业决策基本上是一团糟，要么是因为促进对这些领域的兴趣的策略无效(或混乱)，要么是因为努力不发达。此外，这项研究的统计模型使用了可以识别和操纵的可量化变量来指导结果，而医学生倾向于将较不有形的因素识别为更强大的影响他们职业选择的因素。研究结果突出了战略重点，但必须与其他描述性分析相结合，以便更全面地理解毕业生的职业决策。
Using national databases of the Association of American Medical Colleges, the authors employed logistic regression analysis to show the relative predictive influences of selected demographic, structural, attitudinal, and educational variables on the specialty career choices of 1995 U.S. medical school graduates. Plans to pursue certification in family practice or an unspecified generalist career could be predicted with moderate success, while choices of general internal medicine and general pediatrics could not. The intentions of the 1995 graduates to pursue generalist careers, when they did not specify an individual generalist specialty, were significantly associated with demographic factors such as female gender, older student age, and rural hometown; early interest in the generalist specialties; attitudes favoring helping people over seeking opportunities for leadership, intellectual challenge, or research; the presence of a department of family medicine in the medical school; and ambulatory care experiences in the third and fourth years. In the multiple-regression models used in this study, a number of factors widely touted as important to the cultivation of generalism were not significant predictors of generalist decisions: an institutional mission statement expressly addressing the cultivation of generalist careers; giving admission preferences to applicants who vowed an interest in generalism; public (versus private) school sponsorship; discrete organizational units for general internal medicine or general pediatrics; the proportion of institutional faculty in the general specialties of medicine and pediatrics; the level of educational debt; and students' clinical experiences in the first and second years of medical school.The authors acknowledge the dangers of inferring causal relationships from analyses of this kind, and describe how the power of previous associations-e.g., that between a required third-year clerkship in family medicine and graduates' family practice career choices-may be weakened when the independent variable spreads across institutional cultures that at present are less conducive to primary care.The findings of this analysis add to the evidence that generalist career intentions are largely carried on the tide of students' interests and experiences in family medicine and ambulatory primary care. In terms of the predictive values of the input variables in this study, career decisions for the other two generalist specialties-general internal medicine and general pediatrics-were essentially a crap-shoot, either because the tactics to promote interest in these fields were ineffective (or confounded), or because the efforts were underdeveloped. Moreover, the statistical models of this study employed quantifiable variables that can be discerned and manipulated to guide the result, whereas medical students tend to identify less tangible elements as more powerful factors influencing their career choices. The results sharpen the strategic focus, but must be combined with those of other, descriptive analyses for a more complete understanding of graduating students' career decisions.