Dynamics of career intentions in a medical student cohort: a four-year longitudinal study.

BACKGROUND: Medical students' career intentions often change between matriculation and graduation, yet little is known about the precise timing and dynamics of individual students' career decisions. This study expands on previous research by exploring the stability of individual students' career intentions over four years and by analyzing associations between unstable career intentions and students' characteristics. METHODS: Medical students from two classes were recruited into a cohort during their first academic year and completed a yearly survey over a four-year period (end of pre-clinical curriculum to graduation). Measures included career intention (specialty and practice type), personality, coping strategies, empathy, and motives for becoming a physician. The authors developed a score ranging from 0 to 10 quantifying instability of career intentions (0 = stable; 10 = unstable). The distribution of the score was analyzed descriptively, and the association between the score and other variables was quantified using a stepwise beta regression model. RESULTS: The sample included 262 students (61% females). The mean score was 3.07 with a median of 3. 18% of students (N = 46) did not change their specialty intention over the four years, whereas 10% (N = 26) changed every year. No further subgroups were identified between these extremes. An intention to work in private practice in year 3 and the motive care for patients were significantly associated with more stable career intentions. CONCLUSION: Most students are situated on a continuum between the two extremes of being firmly committed and undecided. Extrinsic factors may be more important drivers of these fluctuations than personal characteristics and should be explored in future research. This study's findings also provide avenues for supporting students in their career decision-making.

Evidence of antagonistic predictive effects of miRNAs in breast cancer cohorts through data-driven networks.

Non-coding micro RNAs (miRNAs) dysregulation seems to play an important role in the pathways involved in breast cancer occurrence and progression. In different studies, opposite functions may be assigned to the same miRNA, either promoting the disease or protecting from it. Our research tackles the following issues: (i) why aren't there any concordant findings in many research studies regarding the role of miRNAs in the progression of breast cancer? (ii) could a miRNA have either an activating effect or an inhibiting one in cancer progression according to the other miRNAs with which it interacts? For this purpose, we analyse the AHUS dataset made available on the ArrayExpress platform by Haakensen et al. The breast tissue specimens were collected over 7 years between 2003 and 2009. miRNA-expression profiling was obtained for 55 invasive carcinomas and 70 normal breast tissue samples. Our statistical analysis is based on a recently developed model and feature selection technique which, instead of selecting a single model (i.e. a unique combination of miRNAs), delivers a set of models with equivalent predictive capabilities that allows to interpret and visualize the interaction of these features. As a result, we discover a set of 112 indistinguishable models (in a predictive sense) each with 4 or 5 miRNAs. Within this set, by comparing the model coefficients, we are able to identify three classes of miRNA: (i) oncogenic miRNAs; (ii) protective miRNAs; (iii) undefined miRNAs which can play both an oncogenic and a protective role according to the network with which they interact. These results shed new light on the biological action of miRNAs in breast cancer and may contribute to explain why, in some cases, different studies attribute opposite functions to the same miRNA.

Students' intentions to practice primary care are associated with their motives to become doctors: a longitudinal study.

BACKGROUND: Medical schools can contribute to the insufficient primary care physician workforce by influencing students' career preferences. Primary care career choice evolves between matriculation and graduation and is influenced by several individual and contextual factors. This study explored the longitudinal dynamics of primary care career intentions and the association of students' motives for becoming doctors with these intentions in a cohort of undergraduate medical students followed over a four-year period. METHODS: The sample consisted of medical students from two classes recruited into a cohort study during their first academic year, and who completed a yearly survey over a four-year period from their third (end of pre-clinical curriculum) to their sixth (before graduation) academic year. Main outcome measures were students' motives for becoming doctors (ten motives rated on a 6-point scale) and career intentions (categorized into primary care, non-primary care, and undecided). Population-level flows of career intentions were investigated descriptively. Changes in the rating of motives over time were analyzed using Wilcoxon tests. Two generalized linear mixed models were used to estimate which motives were associated with primary care career intentions. RESULTS: The sample included 217 students (60% females). Career intentions mainly evolved during clinical training, with smaller changes at the end of pre-clinical training. The proportion of students intending to practice primary care increased over time from 12.8% (year 3) to 24% (year 6). Caring for patients was the most highly rated motive for becoming a doctor. The importance of the motives cure diseases, saving lives, and vocation decreased over time. Primary care career intentions were positively associated with the motives altruism and private practice, and negatively associated with the motives prestige, academic interest and cure diseases. CONCLUSION: Our study indicates that career intentions are not fixed and change mainly during clinical training, supporting the influence of clinical experiences on career-related choices. The impact of students' motives on primary care career choice suggests strategies to increase the attractivity of this career, such as reinforcing students' altruistic values and increasing the academic recognition of primary care.