Behavioral Exploration of Career and Specialty Choice in Medical Students

Article excerpt

Understanding the process by which students naturally construct and internalize their educational experiences relating to career development is important to career counseling. The author investigated how exploratory behaviors during a community-based field experience course contributed to the vocational development of 1st-year medical students. Behavioral exploration data regarding medical career development and specialty decision making were collected from 91 first-year medical students before and after they engaged in an exploratory behavioral activity, the Ambulatory Care Experience course. Findings suggest that students had not progressed in their medical career development and that more uncertainty existed among students after completing the course.

For years, researches have studied factors believed to influence medical specialty choice (Calkins, Willoughby, & Arnold, 1987; Deckert, Beckham, Hall, & Holmes, 1991; Dorsey, Jajoura, & Riitecki, 2005; Kassebaum & Szenas, 1994; Lambert & Holmboe, 2005). Despite the abundance of literature on this topic, results are inconsistent and inconclusive, and there is still little known about the process by which medical students choose a specialty and how certain aspects of medical education and training (e.g., courses, clerkships, rotations) directly influence specialty decision making. Although voids regarding these topics exist in the medical education literature, other disciplines provide an understanding of the career decision-making process in general. For example, as reflected in vocational psychology literature, historically, indecision regarding vocational choice has been traditionally perceived as unfortunate, problematic, and even bordering on pathologic (Grites, 1981; Krumbottz, 1992). Medical school environments have been viewed as contributing to the pressure students feel to decide on a specialty (Zimny & Senturia, 1973).

Although not directly linked to physician career development, the complexity of the career decision-making process in general has been well documented in the literature by career psychologists. Alternative perspectives on career decision making have been presented with ideas that can be applied to the career of medicine. For example, Germeijs and De Bocck (2003) studied sources of career indecision and identified three factors. One of the factors, the information factor, pertains to feeling informed about alternatives during the decision-making process. In medicine, given that there are more than 100 specialties from which students can choose, there are many options and alternatives for specialty choices. One way in which medical students gain information about specialty options is through their exposure to clinical environments and to physicians they encounter in their medical training. Little is known, however, about how these exploratory experiences relate to medical career development.

Career decision making has been conceptualized as occurring continuously during the lue span and not necessarily limited to early adulthood. Individuals may not make only one career decision but, when faced with different life events, may revise their career decisions over time. Career indecision can occur during these transitions (Osipow, 1999). For individuals who pursue careers in medicine, there are many transition points at which indecision can occur. First, the individual has to decide to choose medicine as a career, but not long after they begin their education at medical school, questions begin to arise about what medical specialty to enter. The decision about specialty choice is revisited as medical students progress through the curriculum and are exposed to different areas of medicine. For some students, additional transition points for medical specialty choice include whether to enter a subspccialty of medicine, and if so, which one. Although models for career decision making exist, aspects of identity development related to indecision have not been addressed (Kelly & Lee, 2002). …