Thresholds of becoming: an exploration of threshold concepts as a means to support professional identity formation in competency-based curricula.

Inherent in every clinical preceptor's role is the ability to understand the learning needs of individual trainees, enabling them to meet their potential. Competency-based medical education frameworks have been developed to this end, but efforts to identify behaviours and activities that define competence are based on mapping knowledge, skills and ability, which can be difficult to integrate into a comprehensive picture of who the trainee is becoming. Professional identity formation, in contrast, prioritizes attention to who trainees are becoming, but provision of detailed guidance to preceptors on how to best support this form of development is challenging. The tension that results limits our ability to optimally support learners as strengths in competency development may mask professional identity development gaps and vice versa. To address this tension, this paper examines how the theory of threshold concepts - troublesome ideas that, once appreciated, fundamentally change how you understand and approach a particular activity - can shine light on professional identity formation and its relationship with developing competence. The recognition and identification of threshold concepts is offered as a means to improve our ability to identify, discuss and support behaviours and actions that impact the learner's capacity to act competently as they develop their identity at various stages of training.

Which students will choose a career in psychiatry?

OBJECTIVE: In Canada, availability of and access to mental health professionals is limited. Only 6.6% of practising physicians are psychiatrists, a situation unlikely to improve in the foreseeable future. Identifying student characteristics present at medical school entry that predict a subsequent psychiatry residency choice could allow targeted recruiting or support to students early on in their careers, in turn creating a supply of psychiatry-oriented residency applicants. METHOD: Between 2002 and 2004, data were collected from students in 15 Canadian medical school classes within 2 weeks of commencement of their medical studies. Surveys included questions on career preferences, attitudes, and demographics. Students were followed through to graduation and entry data linked anonymously with residency choice data. Logistic regression was used to identify early predictors of a psychiatry residency choice. RESULTS: Students (n = 1502) (77.4% of those eligible) contributed to the final analysis, with 5.3% naming psychiatry as their preferred residency career. When stated career interest in psychiatry at medical school entry was not included in a regression model, an exit career choice in psychiatry was predicted by a student's desire for prestige, lesser interest in medical compared with social problems, low hospital orientation, and not volunteering in sports. When an entry career interest in psychiatry was included in the model, this variable became the only predictor of an exit career choice in psychiatry. CONCLUSION: While experience and attitudes at medical school entry can predict whether students will chose a psychiatry career, the strongest predictor is an early career interest in psychiatry.

Obstetrics and gynaecology as a career choice: a cohort study of canadian medical students.

OBJECTIVE: to describe the characteristics of medical students interested in obstetrics and gynaecology and to build a model that predicts which of these students will choose obstetrics and gynaecology as their career. STUDY DESIGN: students were surveyed in 2002, 2003, and 2004 at the commencement of their medical studies. Data were collected on career choice, attitudes to practice, and demographics at medical school entry and on career choice at medical school exit. RESULTS: three items present at entry to medical school were predictive of students ultimately choosing a career in obstetrics and gynaecology: having this career as one of their first three career choices at entry (having it as their first choice was the strongest predictor), being female, and desiring a narrow scope of practice. CONCLUSION: students choosing a career in obstetrics and gynaecology have attributes at medical school entry that differentiate them from students interested in other specialties. Identifying these attributes may guide education in and recruitment to obstetrics and gynaecology.

An analysis of long-term outcomes of the impact of curriculum: a comparison of the three- and four-year medical school curricula.

PURPOSE: To determine the long-term effects of curriculum length on physician competence, the authors compared the performance of graduates from the University of Calgary (U of C; a school with a three-year curriculum) with matched samples from the University of Alberta (U of A) and from other Canadian schools with a four-year curriculum. METHOD: The authors used data from the College of Physicians and Surgeons of Alberta, Physician Achievement Review (PAR) program to determine curricular outcomes. The authors analyzed PAR program data, comprising reviews from medical colleagues, nonphysician coworkers (e.g., nurses, pharmacists), patients, and the physicians themselves, for 166 physicians from U of C, U of A, and other universities. They compared groups using one-way analysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA), with years since graduation as a covariate, and a Cohen d effect size calculation to assess the magnitude of the differences. RESULTS: The authors analyzed review data for 498 physicians. The results of ANCOVA showed that no significant differences existed among schools for the self and the patient aggregate mean questionnaire scores. Aggregate mean questionnaire scores from the medical colleague and coworker surveys were significant, albeit with a small effect size. MANCOVA showed small but significant differences among schools on the aggregate mean factor scores for medical colleague, coworker, and patient questionnaires. CONCLUSIONS: Although differences among schools exist, they are small. They suggest at least equivalent performance for graduates of three- and four-year medical schools who practice in Alberta.

Choosing a career in psychiatry: factors associated with a career interest in psychiatry among Canadian students on entry to medical school.

OBJECTIVE: To report the proportion of Canadian medical students interested in a career in psychiatry at medical school entry and to describe the unique demographics and career influences associated with this early interest. METHODS: From 2001 to 2004, during the first 2 weeks of medical school, a 41-item survey of career choice, demographics, and attitudes toward various aspects of medical practice was distributed to all students in 18 classes at 8 Canadian medical schools. Associations between early career interest, demographics, and career influences were explored. RESULTS: Of the 2096 completed surveys, 3.2% of students named psychiatry as their first career choice. While 34% of students considered psychiatry a possible career option, 54.9% stated that they had not considered this option. Students interested in psychiatry were more likely than other students to have an undergraduate education in the arts, to have close family or friends practicing medicine, and to have worked voluntarily with people with mental illness. Students interested in psychiatry had a lesser social orientation than students interested in family medicine but had a greater social orientation and lesser hospital orientation than students interested in other specialties. CONCLUSIONS: Enhanced psychiatric care may be aided by the selective recruitment into medical school of students with a demonstrated empathy toward people with mental illness, an educational background in the arts, and a strong social orientation. As career influences change throughout medical school, participants in this study will be re-surveyed at graduation to better understand the evolution of career choice decision-making throughout medical school.

Whether or wither some specialties: a survey of Canadian medical student career interest.

BACKGROUND: Given the looming shortage of physicians in Canada, we wished to determine how closely the career preference of students entering Canadian medical schools was aligned with the current physician mix in Canada. METHODS: Career choice information was collected from a survey of 2,896 Canadian medical students upon their entry to medical school. The distribution of career choices of survey respondents was compared to the current physician specialty mix in Canada. RESULTS: We show that there is a clear mismatch between student career choice at medical school entry and the current specialty mix of physicians in Canada. This mismatch is greatest in Urban Family Medicine with far fewer students interested in this career at medical school entry compared to the current proportion of practicing physicians. There are also fewer students interested in Psychiatry than the current proportion of practicing physicians. CONCLUSION: This mismatch between the student interest and the current proportion of practicing physicians in the various specialties in Canada is particularly disturbing in the face of the current sub-optimal distribution of physicians. If nothing is done to correct this mismatch of student interest in certain specialties, shortages and misdistributions of physicians will be further amplified. Studies such as this can give a window into the future health human resources challenges for a nation.

Emergency medicine as a career choice: a descriptive study of Canadian medical students.

BACKGROUND: Studies indicate that a student's career interest at medical school entry is related to his or her ultimate career. We sought to determine the level of interest in emergency medicine among students at the time of medical school entry, and to describe characteristics associated with students primarily interested in emergency medicine. METHODS: We surveyed students in 18 medical school classes from 8 Canadian universities between 2001 and 2004 at the commencement of their studies. Participants listed their top career choice and the degree to which a series of variables influenced their choices. We also collected demographic data. RESULTS: Of 2420 surveys distributed, 2168 (89.6%) were completed. A total of 6.1% (95% confidence interval 5.1%-7.1%) of respondents cited emergency medicine as their first career choice. When compared with students primarily interested in family medicine, those primarily interested in emergency medicine reported a greater influence of hospital orientation and a lesser influence of social orientation on their career choice. When compared with students primarily interested in the surgical specialties, those primarily interested in emergency medicine were more likely to report medical lifestyle and varied scope of practice as important influences. When compared with students primarily interested in the medical specialties, those who reported interest in emergency medicine were more likely to report that a hospital orientation and varied scope of practice were important influences, and less likely to report that social orientation was important. CONCLUSION: Students primarily interested in emergency medicine at medical school entry have attributes that differentiate them from students primarily interested in family medicine, the surgical specialties or the medical specialties. These findings may help guide future initiatives regarding emergency medicine education.

Choosing a career in surgery: factors that influence Canadian medical students' interest in pursuing a surgical career.

BACKGROUND: Interest in both general surgery and surgical subspecialties has been declining among Canadian medical students. Studies have shown that a student's desire to practise surgery is largely determined before entry into medical school. As part of a larger study of students' career preferences throughout medical school, we sought to identify the level of interest in surgical careers and the factors that influence a student's interest in pursuing a surgical career. METHODS: We surveyed students from 18 different classes at Canadian medical schools at the commencement of their studies between 2001 and 2004. We asked the students to list their top career choices and the degree to which a series of variables influenced their choices. We also collected demographic data. We performed a factor analysis on the variables. RESULTS: Of 2420 surveys distributed, 2168 (89.6%) were completed. A total of 21.0% of respondents named a surgical specialty as their first choice of career. We found that male students were more likely to express interest in a surgical specialty than female students, who were more likely to express interest in either family medicine or a medical specialty. Compared with students interested in a career in family medicine, those interested in a surgical or medical specialty were younger, more likely to be single and more likely to be influenced by prestige when making their career choices. Students interested in a career in surgery were less influenced by medical lifestyle and a varied scope of practice, less likely to demonstrate a social orientation and more likely to be hospital-oriented than students interested in either family medicine or a medical specialty. Male students interested in a career in surgery were more hospital-oriented and less likely to demonstrate a social orientation than female students interested in surgical careers. CONCLUSION: We identified 5 factors and a number of demographic variables associated with a student's interest in a surgical career.