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      Factors influencing subspecialty choice among medical students: a systematic review and meta-analysis

      systematic-review

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          Abstract

          Objective

          To characterise the contributing factors that affect medical students’ subspecialty choice and to estimate the extent of influence of individual factors on the students’ decision-making process.

          Design

          Systematic review and meta-analysis.

          Methods

          A systematic search of the Cochrane Library, ERIC, Web of Science, CNKI and PubMed databases was conducted for studies published between January 1977 and June 2018. Information concerning study characteristics, influential factors and the extent of their influence (EOI) was extracted independently by two trained investigators. EOI is the percentage level that describes how much each of the factors influenced students’ choice of subspecialty. The recruited medical students include students in medical school, internship, residency training and fellowship, who are about to or have just made a specialty choice. The estimates were pooled using a random-effects meta-analysis model due to the between-study heterogeneity.

          Results

          Data were extracted from 75 studies (882 209 individuals). Overall, the factors influencing medical students’ choice of subspecialty training mainly included academic interests (75.29%), competencies (55.15%), controllable lifestyles or flexible work schedules (53.00%), patient service orientation (50.04%), medical teachers or mentors (46.93%), career opportunities (44.00%), workload or working hours (37.99%), income (34.70%), length of training (32.30%), prestige (31.17%), advice from others (28.24%) and student debt (15.33%), with significant between-study heterogeneity (p<0.0001). Subgroup analyses revealed that the EOI of academic interests was higher in developed countries than that in developing countries (79.66% [95% CI 70.73% to 86.39%] vs 60.41% [95% CI 43.44% to 75.19%]; Q=3.51, p =0.02). The EOI value of prestige was lower in developed countries than that in developing countries (23.96% [95% CI 19.20% to 29.47%] vs 47.65% [95% CI 34.41% to 61.24%]; Q=4.71, p=0.01).

          Conclusions

          This systematic review and meta-analysis provided a quantitative evaluation of the top 12 influencing factors associated with medical students’ choice of subspecialty. Our findings provide the basis for the development of specific, effective strategies to optimise the distribution of physicians among different departments by modifying these influencing factors.

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          Most cited references101

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          Statistical methods for assessing the influence of study characteristics on treatment effects in 'meta-epidemiological' research.

          Biases in systematic reviews and meta-analyses may be examined in 'meta-epidemiological' studies, in which the influence of trial characteristics such as measures of study quality on treatment effect estimates is explored. Published studies to date have analysed data from collections of meta-analyses with binary outcomes, using logistic regression models that assume that there is no between- or within-meta-analysis heterogeneity. Using data from a study of publication bias (39 meta-analyses, 394 published and 88 unpublished trials) and language bias (29 meta-analyses, 297 English language trials and 52 non-English language trials), we compare results from logistic regression models, with and without robust standard errors to allow for clustering on meta-analysis, with results using a 'meta-meta-analytic' approach that can allow for between- and within-meta-analysis heterogeneity. We also consider how to allow for the confounding effects of different trial characteristics. We show that both within- and between meta-analysis heterogeneity may be of importance in the analysis of meta-epidemiological studies, and that confounding exists between the effects of publication status and trial quality. Copyright 2002 John Wiley & Sons, Ltd.
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            Imbalance in the health workforce

            Imbalance in the health workforce is a major concern in both developed and developing countries. It is a complex issue that encompasses a wide range of possible situations. This paper aims to contribute not only to a better understanding of the issues related to imbalance through a critical review of its definition and nature, but also to the development of an analytical framework. The framework emphasizes the number and types of factors affecting health workforce imbalances, and facilitates the development of policy tools and their assessment. Moreover, to facilitate comparisons between health workforce imbalances, a typology of imbalances is proposed that differentiates between profession/specialty imbalances, geographical imbalances, institutional and services imbalances and gender imbalances.
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              Factors associated with medical students' career choices regarding internal medicine.

              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. To describe medical students' career decision making regarding IM and to identify modifiable factors related to this decision making. Web-based cross-sectional survey of 1177 fourth-year medical students (82% response rate) at 11 US medical schools in spring 2007. 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. 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). 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.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2019
                7 March 2019
                : 9
                : 3
                : e022097
                Affiliations
                [1 ] departmentState Key Laboratory of Ophthalmology , Sun Yat-Sen University Zhongshan Ophthalmic Center , Guangzhou, China
                [2 ] departmentZhongshan School of Medicine , Sun Yat-Sen University , Guangzhou, China
                [3 ] departmentZhongshan School of Mathematics , Sun Yat-Sen University , Guangzhou, China
                [4 ] departmentDepartment of Molecular and Cellular Pharmacology , University of Miami School of Medicine , Miami, Florida, USA
                [5 ] departmentCataract , Sun Yat-Sen University Zhongshan Ophthalmic Center , Guangzhou, China
                [6 ] departmentState Key Laboratory of Ophthalmology , Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
                [7 ] departmentCataract , State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
                Author notes
                [Correspondence to ] Dr Haotian Lin; haot.lin@ 123456hotmail.com
                Author information
                http://orcid.org/0000-0003-4672-9721
                Article
                bmjopen-2018-022097
                10.1136/bmjopen-2018-022097
                6429728
                30850399
                cc3dbfbf-3d50-4403-9b94-17503447650a
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 03 February 2018
                : 15 January 2019
                : 08 February 2019
                Funding
                Funded by: the Guangdong Provincial Natural Science Foundation for Distinguished Young Scholars of China;
                Funded by: Ministry of Science and Technology of China Grants;
                Funded by: the Clinical Research and Translational Medical Center of Pediatric Cataract in Guangzhou City;
                Funded by: National key R & D project;
                Funded by: the Fundamental Research Funds for the Central Universities;
                Funded by: the Guangdong Province Universities and Colleges Youth Pearl River Scholar Funded Scheme;
                Funded by: the Key Research Plan for the National Natural Science Foundation of China Cultivation Project;
                Funded by: the National Natural Science Foundation of China;
                Categories
                Medical Education and Training
                Research
                1506
                1709
                Custom metadata
                unlocked

                Medicine
                medical students,career choice,meta-analysis
                Medicine
                medical students, career choice, meta-analysis

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