Influences of Medical Students' Career Choices

Abstract

Introduction: Understanding the factors that influence medical graduates’ career choices can help to inform the development of a curriculum that can contribute to shaping New Zealand’s future medical workforce. The aim of this thesis was to explore the 24 question items contained in the ‘Factors Influencing Career Choice’ (FICC) domain of the Medical Schools Outcomes Database Exit Questionnaire (MSOD-EQ) that measure the potential influences on medical students’ future career choices. Methods: A review of the published literature was conducted to identify any previous research published on the topic and to inform the type of analytical approach to be taken in the analysis of the existing FICC domain of the MSOD-EQ. A quantitative analysis using exploratory factor analysis (EFA) followed by a confirmatory factor analysis (CFA) was used to investigate the psychometric properties of the 24 items contained within the FICC domain. Two CFAs were employed; the first to confirm the factors identified by the initial EFA and the second to investigate stability between the cohorts. Data collected by the MSOD group for the years 2017, 2018 and 2019 were utilised comprising a total of N= 991. Results: Out of the thirteen eligible studies that met the inclusion criteria, three main themes with 13 sub-themes were identified from the literature review. These were: ‘Work-life balance’, ‘Professional needs’ and ‘Experience with the specialty’. The EFA, conducted on the 2017 cohort, helped to identify four main factors or constructs underlying the FICC domain. These were, Placement Experiences, Work Flexibility, Vocational Characteristics and Finances and Rewards. In addition, the first CFA, conducted on the 2018 cohort, enabled the confirmation of the four-factor structure that was developed after the EFA. The second CFA, conducted on the 2019 cohort, confirmed a similar reoccurring pattern thus confirming stability across cohorts, although only a marginal fit was generated. Conclusions: The factors developed from the CFA model with the best fit was used in the final literature synthesis. The first CFA model (the best fitted model - 2018) and the subsequent four factors are generally consistent with the findings of the literature review. Difficulties with not achieving exemplary fits for both the CFA models could be due to underlying issues with the psychometric properties being affected by “noise” or ambiguities in the current FICC domain from the existing question items. These ambiguities might be due to either partial coverage of the content of the FICC domain or wording flaws, e.g., double or triple barrelled item stems obscuring the effectiveness of the questionnaire. Future research addressing the specificity and sensitivity of the current FICC domain of the MSOD-EQ can improve the utility of the factors and more accurately measure influences that impact medical students’ future career choice.