14. Influences on choice of a generalist career in general surgery, general internal medicine and general pediatrics

We performed a literature review to summarize the primary influences that encourage or discourage the pursuit of careers in General Surgery (GS), General Internal Medicine (GIM), and General Pediatrics (GP). Relevant studies were identified through a PUBMED and MEDLINE search from 1982 to 2006. All included studies were peer-reviewed and pertained to factors influencing career choice in GS, GIM, GP, and their respective subspecialties. The identified literature was analyzed based on demography, the curriculum, and the nature of the discipline, etc. Consistent factors influencing career choice were established a priori as those supported by ≥2 independent studies or reviews without contradictory findings reported to date. The top two factors favoring the choice of residency in GS are positive clerkship experiences and exposure to positive role models, whereas the top factors discouraging interest in GS are lifestyle issues and the length of residency. As for GIM, influences that favor the specialty include the female gender and preference for GIM upon entry into medical school. Factors that discourage the choice of GIM are high income expectations, the widening salary gap between generalist and specialist, negative clerkship experience and the type of patients in internal medicine. In pediatrics, the top two influences that favor GP are female gender and a predisposition for GP upon entry into medical school. A consistent factor that negatively influences career choice in GP is a favorable attitude towards research. To summarize, the main influences on the choice of a generalist career include gender, role modeling, clerkship experience, lifestyle issues, and financial compensation. Medical schools can encourage the pursuit of generalist careers by enhancing student exposure to positive role models and by providing a positive clerkship experience in GS, GIM, and GP. Kirkham JC, Widmann WD, Leddy D, Goldstein MJ, Samstein B, El-Tamer M, Harari A, Arnell TD, John R, Hardy MA. Medical student entry into general surgery increases with early exposure to surgery and to surgeons. Current Surgery 2006 (Nov-Dec); 63(6):397-400. Arora V, Wetterneck TB, Schnipper JL, Auerbach AD, Kaboli P, Wachter RM, Levinson W, Humphrey HJ, Meltzer D. Effect of the inpatient general medicine rotation on student pursuit of a generalist career. Journal of General Internal Medicine 2006 (May); 21(5):471-475. Cochran A, Melby S, Neumayer LA. An internet-based survey of factors influencing medical student selection of a general surgery career. American Journal of Surgery 2005; 189:742-746