title: The specialty choices of graduates from Brighton and Sussex Medical School: a longitudinal cohort study.
abstract: BACKGROUND
  Since 2007 junior doctors in the UK have had to make major career decisions at a point when previously many had not yet chosen a specialty. This study examined when doctors in this new system make specialty choices, which factors influence choices, and whether doctors who choose a specialty they were interested in at medical school are more confident in their choice than those doctors whose interests change post-graduation.
  
  
  METHODS
  Two cohorts of students in their penultimate year at one medical school (n = 227/239) were asked which specialty interested them as a career. Two years later, 210/227 were sent a questionnaire measuring actual specialty chosen, confidence, influence of perceptions of the specialty and experiences on choice, satisfaction with medicine, personality, self-efficacy, and demographics. Medical school and post-graduation choices in the same category were deemed 'stable'. Predictors of stability, and of not having chosen a specialty, were calculated using bootstrapped logistic regression. Differences between specialties on questionnaire factors were analysed.
  
  
  RESULTS
  50% responded (n = 105/277; 44% of the 239 Year 4 students). 65% specialty choices were 'stable'. Factors univariately associated with stability were specialty chosen, having enjoyed the specialty at medical school or since starting work, having first considered the specialty earlier. A regression found doctors who chose psychiatry were more likely to have changed choice than those who chose general practice. Confidence in the choice was not associated with stability. Those who chose general practice valued lifestyle factors. A psychiatry choice was associated with needing a job and using one's intellect to help others. The decision to choose surgical training tended to be made early. Not having applied for specialty training was associated with being lower on agreeableness and conscientiousness.
  
  
  CONCLUSIONS
  Medical school experiences are important in specialty choice but experiences post-graduation remain significant, particularly in some specialties (psychiatry in our sample). Career guidance is important at medical school and should be continued post-graduation, with senior clinicians supported in advising juniors. Careers advice in the first year post-graduation may be particularly important, especially for specialties which have difficulty recruiting or are poorly represented at medical school.
authors.affiliation: University College London Medical School (UCLMS), Room GF/664, Royal Free Hospital, London, NW3 2PF, UK. k.woolf@ucl.ac.uk.
authors.forename: Katherine
authors.initials: K
authors.lastname: Woolf
authors.affiliation: London Deanery, The Careers Unit, Room ST201, Stewart House, 32 Russell Square, London, WC1B 5DN, UK. drcarolineelton@gmail.com.
authors.forename: Caroline
authors.initials: C
authors.lastname: Elton
authors.affiliation: Brighton & Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, East Sussex BN1 9PX, UK. M.J.Newport@bsms.ac.uk.
authors.forename: Melanie
authors.initials: M
authors.lastname: Newport
mesh_terms: D001291:Attitude of Health Personnel; D002321:Career Choice; D015510:Clinical Medicine; D015331:Cohort Studies; D016001:Confidence Intervals; D004504:Education, Medical, Undergraduate; D005260:Female; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D010549:Personal Satisfaction; D012307:Risk Factors; D012577:Schools, Medical; D012737:Sex Factors; D013038:Specialization / Q000639:trends*; D018709:Statistics, Nonparametric; D013337:Students, Medical; D006113:United Kingdom; D055815:Young Adult