A STUDY OF MEDICAL-STUDENTS SPECIALTY-CHOICE PATHWAYS - TRYING ON POSSIBLE SELVES

Purpose. To describe the decision-making processes reported by graduat ing medical students in choosing primary care (PC) or non-primary-care (NPC) specialties. Method. Members of the University of Washington Sc hool of Medicine's graduating class of 1995 were invited to participat e in focus groups. Six specialty-choice pathways were defined based on a previously administered survey of recalled preferences at matricula tion and stated choice at the time of the National Resident Matching P rogram. Students were assigned to focus groups based on specialty-choi ce pathway. Transcribed discussions and summaries were thematically co ded and analyzed using grounded theory and quantitative comparisons. R esults. Of 157 students, 140 (89%) completed the initial survey, and 1 33 (85%) provided enough information to be classified by pathway. In a ll, 47 students participated in the focus group discussions. The PC st udents cited PC orientation, diversity of patients and activities, rol e models and mentors, interaction with patients, and overall medical s chool culture as having influenced their choice. The NPC students cite d lifestyle, controllable hours, opportunities to do procedures, thera peutic urgency and effect, active tempo, exciting settings, and intell ectual challenge. Role models influenced PC career choice much more th an NPC career choice, and often served to refute negative stereotypes. The sense of personal fit between themselves and specialties was impo rtant to the students in all groups, but differed in emphasis accordin g to career-choice pathways. Those whose preferences did not change ex perienced a confirmation of pre-existing beliefs, while those who swit ched specialty areas developed a sense of fit through the inclusion or elimination of different practice aspects. These who switched special ty areas reported more negative influences and misunderstanding of the ir initially preferred specialties. Conclusion. The process of special ty choice can be described usefully as a socially constructed process of ''trying on possible selves'' (i.e., projecting oneself into hypoth etical career and personal roles). This may explain role models' excep tional influence in disproving negative stereotypes. Medical students' choices can best be facilitated by recognizing their needs to gain kn owledge not only about specialty content, but also about practitioners ' lives and the students' own present and possible selves.