The attractions of medicine: the generic motivations of medical school applicants in relation to demography, personality and achievement

Abstract

Background: The motivational and other factors used by medical students in making their career choices for specific medical specialities have been looked at in a number of studies in the literature. There are however few studies that assess the generic factors which make medicine itself of interest to medical students and to potential medical students. This study describes a novel questionnaire that assesses the interests and attractions of different aspects of medical practice in a varied range of medical scenarios, and relates them to demographic, academic, personality and learning style measures in a large group of individuals considering applying to medical school.

Methods: A questionnaire study was conducted among those attending Medlink, a two-day conference for individuals considering applying to medical school for a career in medicine. The main outcome measure was the Medical Situations Questionnaire, in which individuals ranked the attraction of three different aspects of medical practise in each of nine detailed, realistic medical scenarios in a wide range of medical specialities. As well as requiring clear choices, the questionnaire was also designed so that all of the possible answers were attractive and positive, thereby helping to eliminate social demand characteristics. Factor analysis of the responses found four generic motivational dimensions, which we labelled Indispensability, Helping People, Respect and Science. Background factors assessed included sex, ethnicity, class, medical parents, GCSE academic achievement, the 'Big Five' personality factors, empathy, learning styles, and a social desirability scale.

Results: 2867 individuals, broadly representative of applicants to medical schools, completed the questionnaire. The four generic motivational factors correlated with a range of background factors. These correlations were explored by multiple regression, and by path analysis, using LISREL to assess direct and indirect effects upon the factors. Helping People was particularly related to agreeableness; Indispensability to a strategic approach to learning; Respect to a surface approach to learning; and Science to openness to experience. Sex had many indirect influences upon generic motivations. Ethnic origin also had indirect influences via neuroticism and surface learning, and social class only had indirect influences via lower academic achievement. Coming from a medical family had no influence upon generic motivations.

Conclusion: Generic motivations for medicine as a career can be assessed using the Medical Situations Questionnaire, without undue response bias due to demand characteristics. The validity of the motivational factors is suggested by the meaningful and interpretable correlations with background factors such as demographics, personality, and learning styles. Further development of the questionnaire is needed if it is to be used at an individual level, either for counselling or for student selection.

Figure 1

Path diagram showing the relationships between the different variables. Paths are only included for which t ≥ 4.0. Positive paths are shown as solid black lines, and negative paths as dashed red lines, with path coefficients (path coefficient; t) shown in black or red respectively. The thickness of lines is proportional to the size of the path coefficient. Only causal relationships from the B (beta) matrix are shown, and can only pass from left to right. Clusters of variables regarded as causally equivalent are shown in the same colour, and in general are vertically above one another, although on some occasions they have been moved slightly to one side or other to make the diagram clearer. Associations between causally equivalent variables are modelled in the Φ (phi) matrix, which is saturated within vertical groups and zero elsewhere, and are not shown here (and that in particular explains the apparent absence of a link between being male and being from an ethnic minority). An attempt has been made to avoid lines crossing one another, or lines passing behind variable boxes, but that is not always possible in a diagram of this complexity.

Figure 2

A reduced version of figure 1 in which the only paths shown are those with direct or indirect influences upon generic motivational factor 1 (Indispensability). All variable names have been left in the diagram, and are in the same positions as in figure 1.

Figure 3

A reduced version of figure 1 in which the only paths shown are those with direct or indirect influences upon generic motivational factor 2 (Helping people). All variable names have been left in the diagram, and are in the same positions as in figure 1.

Figure 4

A reduced version of figure 1 in which the only paths shown are those with direct or indirect influences upon generic motivational factor (Respect). All variable names have been left in the diagram, and are in the same positions as in figure 1.

Figure 5

A reduced version of figure 1 in which the only paths shown are those with direct or indirect influences upon generic motivational factor (Science). All variable names have been left in the diagram, and are in the same positions as in figure 1.