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An Expanded Conceptual Framework of Medical Students' Primary Care Career Choice
Eva Pfarrwaller1, Marie-Claude Audétat, Johanna Sommer
1E. Pfarrwaller is lecturer, Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland. M.-C. Audétat is senior lecturer, Primary Care Unit and Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland. J. Sommer is professor of primary care medicine and head, Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland. H. Maisonneuve is primary care physician and senior lecturer, Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland. T. Bischoff is professor of primary care medicine and former head, Institute of General Practice, University of Lausanne, Lausanne, Switzerland. M. Nendaz is professor of internal medicine and medical education, Unit of Development and Research in Medical Education and General Internal Medicine Service, Faculty of Medicine, University of Geneva, Geneva, Switzerland. A. Baroffio is professor of medical education, Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland. N. Junod Perron is primary care physician and senior lecturer, Division of Primary Care Medicine, Geneva University Hospitals, and Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland. D.M. Haller is primary care physician and senior lecturer, Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland, and clinical associate professor, Department of General Practice, University of Melbourne, Melbourne, Australia.
Abstract:
In many countries, the number of graduating medical students pursuing a primary care career does not meet demand. These countries face primary care physician shortages. Students' career choices have been widely studied, yet many aspects of this process remain unclear. Conceptual models are useful to plan research and educational interventions in such complex systems.The authors developed a framework of primary care career choice in undergraduate medical education, which expands on previously published models. They used a group-based, iterative approach to find the best way to represent the vast array of influences identified in previous studies, including in a recent systematic review of the literature on interventions to increase the proportion of students choosing a primary care career. In their framework, students enter medical school with their personal characteristics and initial interest in primary care. They complete a process of career decision making, which is subject to multiple interacting influences, both within and outside medical school, throughout their medical education. These influences are stratified into four systems-microsystem, mesosystem, exosystem, and macrosystem-which represent different levels of interaction with students' career choices.This expanded framework provides an updated model to help understand the multiple factors that influence medical students' career choices. It offers a guide for the development of new interventions to increase the proportion of students choosing primary care careers and for further research to better understand the variety of processes involved in this decision.