Factors influencing the choice of specialization – a cross-sectional study with civilian medical students and prospective medical officers in Germany | BMC Medical Education

A total of n = 2,030 medical students took part in the online survey.

Psychometric properties

For the topic “students’ skills and abilities” the exploratory factor analysis revealed a two-factor solution with a total variance (R²) of 65% (KMO = 0.68, Bartlett’s test for sphericity P < 0.001) [please see in detail additional file S3]. The Cronbach’s α value for internal consistency was 0.66. For the topic “general parameters of medical practice” the exploratory factor analysis revealed a five-factor solution with a R² of 56.3% (KMO = 0.68, Bartlett’s test for sphericity P < 0.001) [please see in detail additional file S3]. The Cronbach’s α value for internal consistency was 0.58. The variable “importance of practicing a specialization which requires manual work” received no clear factor loading. After leaving this item from the topic the Cronbach’s α value for internal consistency was 0.60.

Socio-demographics

More women than men responded to the questionnaire. The mean age was 23.9 years (SD = 3.8). Details of the socio-demographics also divided for the two groups – civilian students and prospective medical officers -are shown in Table 1.

Overall, 35 from 38 university locations were included in the survey. Moreover, most of the participants were located at Berlin and Lübeck. Details are shown in Table 2.

Selection of specialist training

63.1% (n = 1,281) of the participants intended to pursue further specialist training, 35.9% (n = 72) of the participants don’t know yet which one’s further specialist training will be chosen and 1.0% (n = 21) decided to choose no further specialist training. The most frequently chosen specializations are shown in Table 3. These were surgery, anesthesiology, general practice and internal medicine. Medical students who were younger and in an earlier semester chose significantly rather surgery. Significantly more male than female students selected the specialization of anesthesiology. For the choice of general practice significant differences were shown for the age of students and sex. Elderly students and female students chosen rather general practice.

Factors influencing career choice

Concerning students’ skills and abilities medical students felt confident in their communication skills (mean = 4.92, SD 0.88), in dealing with performance pressure e.g. in emergency situations (mean = 4.56, SD 1.02), and in leadership tasks (mean = 4.30, SD 1.17), see Table 4.

Moreover, for the different parameters of medical practice it was observed that the most important reasons which influenced the choice were “to have a clear structure and regular feedback during specialist training” (mean = 5.35, SD 0.84) and “the importance of teamwork” (mean = 5.33, SD 0.91). Comparing civilian and prospective medical officers, significant differences were found which are presented within the table.

Correlation analyses with the factors in question were carried out for each of the four different disciplines. Significant correlations were then taken into account in the respective regression analyses.

Regression analysis

Table 5 shows the results of the binary logistic regression models. The influencing factors that showed a p value of < 0.05 in the forward conditional regression were reported. For the choice of surgery as a specialization, seven factors with a Nagelkerke’s R² value of 0.54 (Hosmer-Lemeshow test p < 0.01) were considered in the model. For example, the choice of surgery was significantly associated to work as a senior physician in hospital (ß= 0.60), the importance of a clear structure and regular feedback during specialist training (ß= 0.38), the importance of manual work (ß= 1.44) and less importance concerning long-term relationship with patients (ß= -0.23).

For the desired specialization of anesthesiology, seven factors with a Nagelkerke’s R² value of 0.29 (Hosmer-Lemeshow test p = 0.30) were considered in the model. For example, the choice of anesthesiology was significantly associated to work as a senior physician (ß= 1.37) or specialist (ß= 1.52) in hospital and to work 40 h or less, the importance to handle pressure to perform in emergency situation (ß= 0.82), and less importance concerning long-term relationship with patients (ß= -0.41).

For the desired specialization of general practice, eleven factors with a Nagelkerke’s R² value of 0.52 (Hosmer-Lemeshow test p = 0.73) were considered in the model. The probability to choose general practice increased significantly to work independent as specialist (OR 9.44, CI 4.64; 19.2) or employed as specialist (OR 6.17, CI 2.65; 14.3) in private practice. Moreover, it was significantly associated with the importance to build a long-term relationship with patients (OR 2.47, CI 1.93; 3.17) and less importance with career opportunities (OR 0.60, 0.49; 0.73).

For the desired specialization of internal medicine, seven factors with a Nagelkerke’s R² value of 0.20 (Hosmer-Lemeshow test p = 0.32) were considered in the model. The probability to choose internal medicine increased significantly to be male and to work more than 40 h. Moreover, it was significantly associated with the importance of career opportunities (OR 1.35, CI 1.15; 1.58) and less importance to practice in a specialization which requires manual work (OR 0.61, CI 0.55; 0.69).