1. Factors Influencing Medical Student’s Specialty Choice: A Longitudinal Study
Rachel Bramson, MD, MS
Scott and White Clinic, College Station, Texas
Family & Community Medicine, College of Medicine
Texas A&M Health Science Center
(in collaboration with Texas Tech College of Medicine)
Iftekhar Ahmed, MA, Betsy G. Jones, EdD, Robert Wiprud, MD, Fiona Prabhu, MD, Shannon DeShazo, MD, Mark English, MD & Samuel Forjuoh, MD, MPH, DrPH

2. Background
Concerns about a decline in medical graduates’ interest in primary care have persisted for many years
While this topic has been studied extensively, many questions remain unanswered
Most previous studies have examined variables at a fixed point in time or over a short period of time
This longitudinal study investigated the influence of previously identified factors on a cohort of medical students over the course of their pre-doctoral training

3. Method
Participants were members of the class of 2007 at two public medical schools in the State of Texas
Collected data on students’ characteristics, attitudes, and behaviors
5 survey points throughout their 4-year enrollment in medical school
A total of 503 responses have been recorded

4. Method (cont.) Number of participants throughout the study period 1
Survey #
Key point
Year
School 1
School 2
Total 1
Orientation, Year 1
2003 71 86
157 2
End Year 1
2004 66
137 4
End Year 3
2006 50 45 95 5
March Year 4
2007 74 40
114

5. Method (cont.)
Survey instruments were developed, pre-tested, and modified based on test results
Five survey questionnaires were developed for five key time points
There were similarities and differences among surveys
Similarities were recurring questions used to assess change in perception/attitude over time
Differences included questions appropriate to a particular time point over the four year curriculum

6. Method (cont.)
Sample size was manipulated using multiple imputation to sustain the longitudinal nature of the study
134 responses that were present in both the first two survey points were selected as the base
Missing responses in time points 3 and 4 were imputed based on the core 134 responses
44/134 and 33/134 responses were imputed in surveys 3 and 4, respectively

7. Result
Specialty Choice (number of responses) throughout survey time points
Survey #
Time Point
Family Medicine
Internal Medicine
Pediatrics
Non-Primary Care 1
Orientation, Year 1 20 9 85 2
End Year 1 21 10 83 3
End Year 3 4 11
107
March Year 4
104

8. Individual Agreement* throughout Time Points (%)
Result
Students’ Perception (% of agreement*) of factors influencing specialty choice decision (very influential factors)
Factors
Individual Agreement* throughout Time Points (%)
Orientation
Year 1
End Year 1
End Year 3
March Year 4
Flexible lifestyle
117
124
126
125
Location of practice
121
120
On-call schedule
108
112
122
Ability to do procedures
109
107
115
111
Ability to provide comprehensive care
Malpractice issues
104
106
114
* Agreement was calculated by combining Strongly Agree and Agree response scores

9. Individual Agreement* throughout Time Points (%)
Result
Factors rated less highly during the early years but gained importance over time
Factors
Individual Agreement* throughout Time Points (%)
Orien-tation
Year 1
End Year 1
End Year 3
March Year 4
Diverse patient population 89 90
114
119
Salary 79 93
115
113
Ability to provide ambulatory care 81 80
109
Approach similar to physician in that specialty 68
116
105
Low stress level 72 87
110
103
Length of residency 85
112 96
* Agreement was calculated by combining Strongly Agree and Agree response scores

10. Result
Students’ Perception (% of agreement*) of various factors influencing students’ specialty choice decision (other factors)
Factors
Individual Agreement* throughout Time Points (%)
Orientation Week - Year 1
End
Year 1
Year 3
March
Year 4
Adult population 43 67
107
104
Prestige/recognition 45 50 90 85
Patient relationships
128
126 65 79
Child patient population 58 59 40
Ability to participate in research project 31 23 29 28
Types of payors 47 51 36
* Agreement was calculated by combining Strongly Agree and Agree response scores

11. Key Factors of Consideration
Increased importance of Prestige/recognition over the course of training
Decreased importance of Patient Relationships over the course of training
Influence of society (increased career emphasis on personal lifestyle rather than service)?
Influence of culture of medicine (emphasis on technology and depth of knowledge in a narrow area)?

12. Limitations
Longitudinal studies with multiple time points more burdensome to subjects
Decreased interest in research participation as students near graduation?
Missing data required use of multiple imputation
Both public institutions
Only one state represented

13. Suggestions Following topics need to be addressed in future studies:
Trend away from Family Medicine and Pediatrics into Non-Primary Care
Pediatric Population not an influential factor
High influence of Adult Population factor
Meaning of this in the social/legal context of medicine

14. Questions?