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How Future Doctors Choose Their Specialties

Drs. Paul Ciechanowski and colleagues found that 129 fourth year medical students from Univeristy of Arkansas for Medical Sciences who choose to enter primary care specialties are attracted to a patient centered environment that affords a “secure” relating style. Those who choose to enter non-primary care specialties are attracted to career rewards that afford a “self-reliant” relating style. This study assessed how much the med students’ specialty choices were based on students’ own experiences with caregivers and learned ways of interacting with others (”relationship styles based on attachment theory”).

Choosing a medical specialty specialty is an important decision for medical students because students who change course after making a decision may not receive training funding. Additionally, career choice also predicates the type of work environment that the physician engages in. Fourth year medical students were an appropriate group to study because these students have had significant clinical experiences in medical school and the time to carefully consider their options.

Primary care specialties include family medicine, internal medicine, pediatrics, and OB/GYN.

People with a “secure” relationship style feel comfortable depending on and being comforted by other people. This relationship style may be generalized with statements like “It is easy for me to get emotionally close to others” and “I am comfortable depending on other people.”

People with a “self-reliant” relationship style are less comfortable trusting other people and develop a high sense of self reliance early on in life. This relationship style may be generalized with statements like “It is very important for me to feel self-sufficient” or “I prefer not to have other people depend on me.”

Most (59.4%) of the medical students sampled reported a secure relationship style. 19.8% of the medical students reported a self-reliant relationship style. The rest fell into the cautious or support-seeking relationship styles (that are discussed in the study itself if you’re interested). Most of the responders were male (60%).

Future doctors who desired a patient centered career path find “interaction with patients” the most important factor and “financial rewards” the least important factor in their consideration.

Relationship styles apply to the general population, and a study of patients’ relationship styles have found that patients who have a self-reliant relationship style are less likely to collaborate, provide information, and comply with treatment. Considering the relationships styles of both patients and providers will therefore become important in the quality of care and effectiveness of care.

Those of you who may mentor medical students or are medical students may take your relationship style into consideration. For patients, this may give them an insight into why certain types of doctors interact with patients the way they do – keeping in mind not to grossly generalize.

Source: “Using relationship styles based on attachment theory to improve understanding of specialty choice in medicine.” Ciechanowski PS et al. BMC Medical Education 2006, 6:3.

Updated: June 30, 2013 — 8:08 am

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