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Int J Med Educ. 2018 Dec 27;9:332-339. doi: 10.5116/ijme.5c14.de75.

Factors affecting senior medical students' career choice.

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Central Board for Specialty training for Elderly Care Medicine in the Netherlands (SOON), Utrecht, The Netherlands.
University Medical Center Utrecht, Medical School, The Netherlands.
Royal Dutch Medical Association, The Netherlands.
Dutch Association of Public Health Physicians (VAV), The Netherlands.
University Medical Center Utrecht, Center for Research and Development of Education, The Netherlands.



To gain insight into factors affecting career preference and career choice during the final phase of medical school, above and beyond a model that was presented by Bland and colleagues in 1995 (the "Bland model").


A qualitative study was conducted. One-hour semi-structured interviews were conducted with final-year medical students about career preference and the factors influencing preference and choice. The interviews were transcribed and a thematic analysis was applied, to identify patterns and interrelationships in the data and to compare and contrast these with the Bland model.


Twenty-four students participated. Three critical sets of factors, not present in the Bland model, emerged from the interviews: (a) factors arising from student-initiated information collection, (b) patient population characteristics of a specialty domain, and (c) the characteristics of teams and colleagues within a specialty.


Students appear to actively match and calibrate perceptions of different specialty characteristics with their current personal needs and expected future needs, and to include cues from self-initiated information collection about a speciality. This agency aligns with Billett's workplace learning theory. Next, specialty patient population features appear to be taken into account; this was not unexpected but not included in the Bland model. Finally, the characteristics of teams and colleagues of a specialty were stressed in the interviews. These three components broaden the applicability of the Bland model--originally created for primary-care careers--to medical specialties in general.


career preference; medical students; qualitative interview study; specialty choice

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