Dynamics of Students' Career Choice: a Conceptual Framework-Based Qualitative Analysis Focusing on Primary Care

Abstract

Background: Increasing primary care's attractiveness as a career choice is an important task of socially accountable medical schools. Research has broadly studied influences on medical students' career choice. However, a deeper understanding of the processes behind career decision-making could support medical schools in their efforts to promote primary care careers.

Objective: To explore the dynamics of career choice during medical school with a focus on primary care, based on a previously developed conceptual framework.

Approach: Qualitative study using a phenomenological, inductive-deductive approach DESIGN AND PARTICIPANTS: Individual interviews were conducted from May 2019 to January 2020 with 14 first-year postgraduate trainee physicians, graduates of the Faculty of Medicine in Geneva, Switzerland, purposively sampled based on their interest in primary care during undergraduate studies. The interview guide was developed to elicit narratives about career-related decision-making. Two authors coded the transcripts. Thematic analysis alternated with data collection until thematic saturation was reached. Emerging themes were discussed and refined within the research team.

Key results: Two main themes emerged: (1) developing professional identity, expressed as a changing professional image from unprecise and idealistic to concrete and realistic; priorities changed from content-based to lifestyle-based preferences; (2) individual trajectories of career-related decision-making, determined by different stages of refining professional interests; students navigated this process by employing various strategies, ranging from active exploration to passive behaviors.

Conclusions: This study's narrative approach illustrates the dynamic nature of career choice and refines elements of a conceptual framework previously developed by the authors. Its findings underline the importance of exploration, for which personal experiences and observations of physicians' work are crucial. To advance efforts to make primary care a more attractive career, students must be sufficiently exposed to primary care in a safe and individualized environment and should be supported in all stages of their career choice process.

Keywords: career choice; primary care physicians; qualitative research; undergraduate medical education; workforce.

Figure 1

Based on the findings of a qualitative study of career choice during medical school, concepts of a previously developed conceptual framework (Supplemental Digital Appendix 1) were refined to better illustrate the elements involved in the decision-making process. Part of the original framework is represented in the middle of the figure (drawn from the original publication); elements that were refined are shown through the “magnifying glasses.”

Figure 2

This figure summarizes medical students’ strategies to advance career-related decision-making: Depending on the breadth of professional interests, students apply different strategies to advance career-related decision-making and career planning. This schematic representation may be useful to determine a student’s current situation within the career choice process and may help assisting them with career-related decision-making.