title: Using medical specialty and selection criteria clusters to study specialty selection by Israeli medical students.
abstract: BACKGROUND
  During their final year of medical school, Israeli students must consider which specialty to choose for residency. Based on the vocational counseling literature we presumed that choices are made by selecting from a cluster of related specialties while considering professional and socio-economic issues.
  
  
  METHODS
  Questionnaires distributed to final-year medical students at two Israeli medical schools ascertained inclinations toward various medical specialties and the importance of various selection criteria. Analysis focused on seven specialties where >20% of students reported they had positive inclinations. For each such specialty, the specialty and selection criteria query were compared using unpaired two-tailed Student's t-tests to determine differences between students with positive inclinations toward the specialty with those not so inclined. These data were placed in tables, with the significant differences highlighted to facilitate visual recognition of cluster patterns.
  
  
  RESULTS
  Completed questionnaires were obtained from 317 of 455 students. Students often had positive inclinations toward more than one specialty (specialty clusters) associated with a group of selection criteria (selection criteria clusters). For example, interest in internal medicine was clustered with interest in internal medicine subspecialties, cardiology and research. Furthermore, there was a "reciprocal" aspect to some specialty cluster patterns. For example, those interested in internal medicine had little interest in surgical specialties. Selection criteria clusters revealed occupational interests and socio-environmental factors associated with the specialty clusters. For example, family medicine, which clustered with pediatrics and psychiatry, had a sub-cluster of: Bedside specialty with family orientation affording long-term patient care. Another sub-cluster was time for childrearing and family, only daytime work and outpatient care. Clusters also revealed students' perceptions that differed from expected: Cardiology is changing from a cognitive to a procedure-oriented subspecialty, clustering not only with internal medicine and its subspecialties but also with emergency medicine, surgical subspecialties and anesthesiology.
  
  
  CONCLUSIONS
  The concept that career choice involves selecting from a cluster of related specialties provides information about the specialties students might be considering. Moreover, students are not only looking for individual aspects of a specialty, but for a package including clusters of socio-economic and occupational features. Practically, examining clusters can help in career counseling of medical students and assist residency program directors in marketing their specialties.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Kiryat Hadassah, POB 12000, Jerusalem, 91120, Israel.
authors.forename: Yoram G
authors.initials: YG
authors.lastname: Weiss
authors.affiliation: Hebrew University - Hadassah Henrietta Szold School of Nursing, Jerusalem, Israel.
authors.forename: Rachel Yaffa
authors.initials: RY
authors.lastname: Zisk-Rony
authors.affiliation: Department of Family Medicine, Ben Gurion University Joyce and Irving Goldman School of Medicine, Be'er Sheva, Israel.
authors.forename: Howard
authors.initials: H
authors.lastname: Tandeter
authors.affiliation: Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Jerusalem, Israel.
authors.forename: Uriel
authors.initials: U
authors.lastname: Elchalal
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Kiryat Hadassah, POB 12000, Jerusalem, 91120, Israel.
authors.forename: Alex
authors.initials: A
authors.lastname: Avidan
authors.affiliation: Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Jerusalem, Israel.
authors.forename: Josh E
authors.initials: JE
authors.lastname: Schroeder
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University Medical Center, Hebrew University - Hadassah School of Medicine, Kiryat Hadassah, POB 12000, Jerusalem, 91120, Israel. Charles@hadassah.org.il.
authors.forename: Charles
authors.initials: C
authors.lastname: Weissman
mesh_terms: D002321:Career Choice; D002755:Choice Behavior; D006801:Humans; D007396:Internship and Residency; D007557:Israel; D008511:Medicine / Q000706:statistics & numerical data*; D012577:Schools, Medical; D013337:Students, Medical / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: Career choice; Choosing a medical specialty; Internship; Medical education; Medical specialty selection; Medical students; Residency