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. 2022 Apr 18;22(1):291.
doi: 10.1186/s12909-022-03355-1.

Understanding concepts of generalism and specialism amongst medical students at a research-intensive London medical school

Adam T Misky  1 , Ronak J Shah  1 , Chee Yeen Fung  1 , Amir H Sam  1 , Karim Meeran  1 , Martyn Kingsbury  2 , Victoria Salem  3
Affiliations

Understanding concepts of generalism and specialism amongst medical students at a research-intensive London medical school

Adam T Misky et al. BMC Med Educ. .

Abstract

Background: Many prominent UK medical organisations have identified a need for more generalist clinicians to address the complex requirements of an aging society. We sought to clarify attitudes towards "Specialists" and "Generalists" amongst medical students and junior doctors at Imperial College School of Medicine.

Methods: A survey exploring medical students' beliefs was followed up by qualitative analysis of focus groups of medical students and Imperial-graduate foundation year doctors.

Results: First year medical students associated specialists with academia and higher income, and generalists with ease of training and job availability. Senior (Years 5/6) medical students associated specialists even more firmly with broader influence and academic work, whilst generalists were assigned lower prestige but the same workload as specialists. The medical student focus group discussed concepts of Generalism pertaining only to Primary Care. In contrast, the foundation year doctor focus group revealed that Generalism was now seen to include some hospital care, and the perception that generalists sat lower in a knowledge hierarchy had been challenged.

Conclusion: Perceptions that Generalism is associated with lower prestige in the medical profession are already present at the very start of medical school and seem to be reinforced during undergraduate training. In early postgraduate clinical practice, the perceived knowledge and prestige hierarchy lessens. These findings can help inform curriculum redesign and the promotion of Generalism as a rewarding career aspiration.

Keywords: Career; Curriculum; Generalist; Specialist.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Students were asked to score eighteen professional attributes on a sliding scale, ranging from "applying to specialists" on the far left and "applying to generalists" on the far right. The graph demonstrates percentage deviations from the ‘equally weighted’ score of 5 (which would mean that an attribute is considered to be equally applicable to both generalists and specialists), presented as means ± SEM scores for 101 Imperial College London School of Medicine students in Years 1 and 5/6 of study. Group differences between Year 1 and Years 5/6 mean percentage deviations from neutral were compared using a Mann–Whitney U test
See this image and copyright information in PMC

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