Factors associated with medical students' career choices regarding internal medicine
Factors associated with medical students' career choices regarding internal medicine
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DOI：
10.1001/jama.300.10.1154
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发表时间：
2008-09-10
影响因子：
120.7
通讯作者：
Schwartz, Mark D.
中科院分区：
文献类型：
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作者：
Hauer, Karen E.;Durning, Steven J.;Schwartz, Mark D.
随着人口老龄化和医学生对内科(IM)职业的兴趣下降(尤其是普通IM，这是为老年人服务的主要专业)，预计美国医生劳动力将出现短缺。影响医学生对IM职业选择的因素尚不清楚。目的描述医学生关于IM的职业决策，并确定与此决策相关的可修改因素。设计、设置和参与者于2007年春季对美国11所医学院的1177名四年级医学生(回复率82%)进行了基于网络的横断面调查。主要结果指标包括人口统计学、债务、教育经历和选择或考虑IM职业的人数。通过因子分析评估对职业选择的影响。结果1177名被调查者中，274人(23.2%)计划从事IM职业，其中24人(2.0%)计划从事IM职业。只有228人(19.4%)回答说，他们的核心IM助理工作让一般IM职业看起来更有吸引力，而574人(48.8%)回答说，这让次级IM职业更有吸引力。影响IM职业选择的三个因素：IM的教育经历、IM患者护理的性质和生活方式。如果学生是男性(优势比[OR]1.75；95%可信区间[CI]，1.20-2.56)，就读私立学校(OR，1.88；95%CI，1.26-2.83)，对他们在IM的教育经历印象良好(OR，4.57；95%CI，3.01-6.93)，报告对照顾IM患者的好感(OR，8.72；95%CI，6.03~12.62)，或对内科医生的生活方式有良好印象(OR，2.00；95%CI，1.39~2.87)。结论医学生重视IM实习期间的教学，但对IM作为职业表示严重保留。那些对内科医生照顾的病人、IM实践环境和内科医生的生活方式有更好印象的学生更有可能从事IM职业。
Context Shortfalls in the US physician workforce are anticipated as the population ages and medical students' interest in careers in internal medicine ( IM) has declined ( particularly general IM, the primary specialty serving older adults). The factors influencing current students' career choices regarding IM are unclear.Objectives To describe medical students' career decision making regarding IM and to identify modifiable factors related to this decision making.Design, Setting, and Participants Web- based cross- sectional survey of 1177 fourth- year medical students ( 82% response rate) at 11 US medical schools in spring 2007.Main Outcome Measures Demographics, debt, educational experiences, and number who chose or considered IM careers were measured. Factor analysis was performed to assess influences on career chosen. Logistic regression analysis was conducted to assess independent association of variables with IM career choice.Results Of 1177 respondents, 274 ( 23.2%) planned careers in IM, including 24 ( 2.0%) in general IM. Only 228 ( 19.4%) responded that their core IM clerkship made a career in general IM seem more attractive, whereas 574 ( 48.8%) responded that it made a career in subspecialty IM more attractive. Three factors influenced career choice regarding IM: educational experiences in IM, the nature of patient care in IM, and lifestyle. Students were more likely to pursue careers in IM if they were male ( odds ratio [ OR] 1.75; 95% confidence interval [ CI], 1.20- 2.56), were attending a private school ( OR, 1.88; 95% CI, 1.26- 2.83), were favorably impressed with their educational experience in IM ( OR, 4.57; 95% CI, 3.01- 6.93), reported favorable feelings about caring for IM patients ( OR, 8.72; 95% CI, 6.03- 12.62), or reported a favorable impression of internists' lifestyle ( OR, 2.00; 95% CI, 1.39- 2.87).Conclusions Medical students valued the teaching during IM clerkships but expressed serious reservations about IM as a career. Students who reported more favorable impressions of the patients cared for by internists, the IM practice environment, and internists' lifestyle were more likely to pursue a career in IM.