Theories and theoretical frameworks used in general practice career choice research: a scoping review

The number of medical graduates choosing to specialise as a general practitioner (GP) has not kept pace with need. Understanding how GP specialisation decisions are made has never been more critical. To date, much of the literature in GP specialisation choice is pragmatic and practice-focused, less strongly underpinned by existing theories or theoretical frameworks relating to the decision-making process of medical students or junior doctors. Our aim was to scope the evidence on the use of theories and theoretical frameworks in general practice career choice selection research.

The review was conducted and reported in accordance with JBI guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). PubMed, Web of Science, Embase, and Scopus databases were searched. Only contexts where specialty decisions mostly occur after medical school graduation (e.g. Australia, United Kingdom) were considered for inclusion. Titles and abstracts of all articles were dual-screened against inclusion criteria, followed by full text review of articles.

After removing duplicates, 2,396 titles and abstracts were screened followed by full-text review which identified 30 studies meeting the inclusion criteria. Of these, eight were from Australia, 20 from the UK, one from New Zealand, and one was multi-national. Most studies utilised qualitative methodology (N = 21) or mixed methods (N = 6). These draw from 15 distinct theories/frameworks, while 15 studies explained implicit theories. Twenty-two studies produced some form of theory or framework as an outcome within the study. Subsequent citation of these frameworks has generally been low. There was clear agreement that GP career decision-making was complex.

Our review identified the application and production of many different frameworks relating to GP specialty decision making, both from adapting explicit theories from a range of disciplines and professions, and identification of implicit theories. Researchers undertaking future studies around general practice career decisions are encouraged to utilise and build upon existing theories and frameworks, rather than creating new ones, to avoid duplication of results.