Professional and academic pre-qualifications, career preferences and aspirations in working as a rural doctor

Abstract

Introduction: Internationally, countries are struggling to provide health care in rural areas. In Germany, where the medical school's admissions system rewards prior experience, there are a significant number of students with professional experience (e.g., paramedics, nurses). To date, there has been little research on this pre-experienced subgroup. In a rather exploratory approach, preferences for specialty training were compared between students with and without pre-qualifications. The primary aim of the study was to analyze how pre-qualifications and career types according to Holland's RIASEC (acronym for realistic, investigative, artistic, social, enterprising, conventional) model contribute to interest in working as a rural doctor.

Methods: Overall, 2,370 medical students at different stages of their studies (i.e., 3rd, 6th, 10th semester, and final year) completed the questionnaire. Students indicated interest in working as a rural doctor on a 9-point scale, and expressed interest in up to three specialist training programs from a list of 16. In addition, students answered questions about professional and academic pre-qualifications (i.e., vocational training in the medical field, academic degree, voluntary service) and completed a 6-item questionnaire on vocational interests according to the RIASEC model. The study was a multicenter cross-sectional study conducted at all five medical schools in the federal state of Baden-Württemberg, Germany.

Results: Results show differences in career aspirations according to different pre-qualifications, especially for the pre-qualifications vocational training and voluntary service. The strongest association was found between having completed vocational training and interest in Anesthesiology, OR = 3.92 [3.22, 4.76]. A linear mixed model revealed that higher interest in practical-technical (realistic RIASEC type) or social activities (social RIASEC type), and lower interest in intellectual-research activities (investigative RIASEC type) predicted interest in rural practice, whereas pre-qualifications did not contribute significantly to the model.

Discussion: The findings contribute to a better understanding of the career preferences of medical students with pre-qualifications. Previous experience may lead to the formation of a professional identity and community of practice (CoP) before medical school, which may also influence career preferences. To promote interest in rural medicine, medical schools could encourage interest in social and practical-technical activities within the curriculum and strengthen the profile of general practice.

Keywords: RIASEC; professional and academic pre-qualifications; rural doctor; specialty choice; vocational interests.

Figure 1

Hexagon of six career types according to Holland’s RIASEC model, adapted from Holland (77).

Figure 2

Overview of data collection among medical students at different semester levels across medical schools and survey periods.

Figure 3

Overview of all predictors included in the regression analysis with interest in rural practice as the dependent variable.

Figure 4

Specialist training preferences of medical students with completed vocational training in the medical field (A), prior academic degree (B) or voluntary service (C). The figure shows the percentage of interest in different specialties separately for medical students with and without the corresponding pre-qualification. All associations are sorted by the strength of the association (Odds Ratio, OR). Above the dashed line are OR>1 (higher interest in each specialty for pre-qualified medical students compared to those without pre-qualification), and below the line are OR<1 (lower interest in each specialty for those with the corresponding pre-qualification compared to those without). Statistically significant OR are highlighted with an asterisk (*). Medical students could indicate up to three preferences. OR can indicate the strength of an association (51). As there are only reference values for OR>1 (see statistical analysis, method section), in the following the inverse value for all significant OR<1 is reported. Panel A: Ophthalmology (1/OR = 2.94), Neurology (1/OR = 2.38), Otorhinolaryngology (1/OR = 1.69), Gynecology and Obstetrics (1/OR = 1.67), Psychiatry and Psychotherapy (1/OR = 1.61), Surgery (1/OR = 1.47), Radiology (1/OR = 1.45). Panel B: Pediatrics (1/OR = 2.70). Panel C: Ophthalmology (1/OR = 2.56), Otorhinolaryngology (1/OR = 2.27), Neurology (1/OR = 1.96), other specialty (1/OR = 1.45), Surgery (1/OR = 1.30).