title: Factors considered by medical students when formulating their specialty preferences in Japan: findings from a qualitative study.
abstract: BACKGROUND
  Little research addresses how medical students develop their choice of specialty training in Japan. The purpose of this research was to elucidate factors considered by Japanese medical students when formulating their specialty choice.
  
  
  METHODS
  We conducted qualitative interviews with 25 Japanese medical students regarding factors influencing specialty preference and their views on roles of primary versus specialty care. We qualitatively analyzed the data to identify factors students consider when developing specialty preferences, to understand their views about primary and subspecialty care, and to construct models depicting the pathways to specialization.
  
  
  RESULTS
  Students mention factors such as illness in self or close others, respect for family member in the profession, preclinical experiences in the curriculum such as labs and dissection, and aspects of patient care such as the clinical atmosphere, charismatic role models, and doctor-patient communication as influential on their specialty preferences. Participating students could generally distinguish between subspecialty care and primary care, but not primary care and family medicine. Our analysis yields a "Two Career" model depicting how medical graduates can first train for hospital-based specialty practice, and then switch to mixed primary/specialty care outpatient practice years later without any requirement for systematic training in principles of primary care practice.
  
  
  CONCLUSIONS
  Preclinical and clinical experiences as well as role models are reported by Japanese students as influential factors when formulating their specialty preferences. Student understanding of family medicine as a discipline is low in Japan. Students with ultimate aspirations to practice outpatient primary care medicine do not need to commit to systematic primary care training after graduation. The Two Career model of specialization leaves the door open for medical graduates to enter primary care practice at anytime regardless of post-graduate residency training choice.
authors.affiliation: University of Michigan Medical School, M4101 MSI Box 0624, 1301 Catherine Road, Ann Arbor, MI 48109, USA. psaigal@gmail.com
authors.forename: Priya
authors.initials: P
authors.lastname: Saigal
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Takemura
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishiue
authors.forename: Michael D
authors.initials: MD
authors.lastname: Fetters
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002321:Career Choice; D002322:Career Mobility; D003657:Decision Making; D004501:Education, Medical; D004504:Education, Medical, Undergraduate; D005260:Female; D006280:Health Workforce; D006801:Humans; D007396:Internship and Residency; D007407:Interviews as Topic; D007564:Japan; D008297:Male; D008511:Medicine / Q000639:trends; D017145:Models, Educational; D011320:Primary Health Care; D036301:Qualitative Research; D012945:Social Values; D013038:Specialization; D013337:Students, Medical / Q000523:psychology*