Twelve tips for having more meaningful conversations with medical students on specialty career choice

Abstract

Making a career choice is a multifaceted process and support for medical students on career choice is pivotal. Not all medical schools have programs or guidelines to support having meaningful conversations with medical students. However, medical students have questions and are seeking answers. This article presents twelve tips for having meaningful conversations with medical students for educators, mentors and internship tutors. The twelve tips have been grouped into three categories: the conversation, the reflection and the actions students can take in the process of their specialty career choice.

Keywords:

• Medicine
• conversations
• specialty career choice
• student support

Introduction

For medical students, choosing a specialty is a complex process. Many students enter medical school with a career preference (Cleland et al. 2014), but few actually start a residency in their early domain of preference (Kaur et al. 2014). One reason is because of the lack of information and overview of all medical specialties. A cohort study by Pfarrwaller et al. (2023) found only 18% of students did not change their specialty intention over 4 years, 10% changed their intention every year, but most students were situated on the continuum between being committed and undecided. It appears medical students have misconceptions about the medical specialties (Underwood et al. 1990; Soethout et al. 2008). As students gain experience, they are encouraged to reflect on their career plans and preferences. The development of their professional identity contributes to this process (Van den Broek et al. 2020). This leads to shifts and better matching of needs with a specialty (Querido et al. 2018). Therefore, medical students must have honest conversations, with a mentor, career officer, a specialist or a resident, who know what kind of questions to ask, and who can answer questions. Resources, guidance and training (Zhao et al. 2023) should be provided to healthcare professionals so they can ensure good mentoring practices and learn how to best support medical students in their career decision-making processes. In one example, in response to students’ requests, the John Hopkins University School Of Medicine Colleges Advisory Program (CAP) was created (Levine et al. 2010). Recent research also emphasized the amount of stress medical students experience during their career decision process and especially during their clerkships (Fris et al. 2022). This article presents twelve tips for having meaningful conservations for those who support medical students in making their career choice. The definition of ‘meaningful’ being: having meaning, serious, important, worthwhile, communicating something that is not directly expressed, it is all about making things explicit. Both researchers have had many conversations with medical students on the brink of choosing a specialty in the past ten years. These conversations have triggered them to wonder what is needed to support medical students positively in this process. One researcher (JM) has discussed the twelve tips in this article with colleagues in medical education and with medical students. Ideally these conversations take place in a longitudinal career advisory program, but if this does not exist then the conversations can occur randomly. In our experience these conversations mainly take place as informal conversations.

Description

Medical trainees need to make an important career choice about a specialty preferences during medical school. ‘What kind of doctor do you want to be?’ is maybe the question most asked to medical students. ‘Do you want to work in primary care, public health or in a hospital?’ Not easy questions to answer, especially not if they are not followed by real conversations about a student’s experiences and needs for fulfillment in working and personal life. To support them it is important to ask questions which stimulate reflection through which the student can gain insight. With these twelve tips we hope you will feel more confident to have honest and authentic conversations with medical students. As Borrelli et al. (2017) prompts: ‘Conversations with doctors, already established in their careers, can provide an invaluable source of data in all these decisions.’ Students can feel that there is a time constraint, and can feel pressurized to make a career choice decision. Career decision is influenced by external factors such as the job market, employment terms and conditions (Zhao et al. 2023). Political expectations and training policies can play a role too. These twelve tips can be added to your toolbox as medical educator. They are ingredients for a good conversation with students on the topic of choosing a medical specialty. Ideally you develop a relationship of trust and pay attention to the overall wellbeing of the student. When medical students were asked for their input they emphasized they would prefer the conversation on specialty career choice to be ongoing, not just a one off conversation. This gives students opportunity to ponder their questions. As one student mentioned she needs time to process the information on such an important topic. The students stressed they would like personal conversations and not general, superficial conversations on the topic of career intentions. This ongoing conversation should start in early undergraduate years and continue through training and beyond.

The conversation

Tip 1

Encourage the student to see this search as a discovery process, an adventure, and as a journey

Students can take a left turn and then they can take a right turn. Encourage them to explore the options, enrich themselves with different kinds of experiences in different fields. Many students have misconceptions, such as the idea that a career decision is a once-in-a-lifetime and irreversible decision (Hechtlinger et al. 2019). By helping the student see this search as a process and adventure you hope to influence their dysfunctional beliefs. This will reduce their stress; during the journey there will be transition moments and change is to be expected continually. Students should be encouraged to develop coping skills to effectively deal with these moments of transition and to make the most of these discovery opportunities (Teunissen and Westerman 2011). Transitions do not cease at graduation but go on even well beyond retirement.

Tip 2

Speak positively about all the different options the student has

Speak positively about all specialties even the ones you are less familiar with or do not appeal to you. Be aware of negative comments, stereotyping and banter. Wainwright et al. (2019) conclude that banter often comprises stereotypes and caricatures, but despite its biases and distortions, it may still aid career choice. The challenge is not to ban banter, but to provide more accurate and reliable knowledge and experiences of what working life is like in different specialties. It is important that healthcare professionals refrain from undermining specific specialties (Zhao et al. 2023). Speak positively about all the options a student has including the option of working in a more rural setting (Lennon et al. 2019). This provides a very different working environment and context for life and practice (Cleland et al. 2016; Cuesta-Briand et al. 2020).

Tip 3

Inspire the student to do what they want to do and not what their peers are doing or what their parents or family expect them to do

Dare the student to be themselves and to walk the untrodden path in work and life. Every student has his or her own career path and these pathways will differ in stability (Querido et al. 2020). Emphasize that every path is good as it suits a student’s needs. For some students this is a clear path all the way, while for others this will be more clear during their search, also after graduation. A student needs to be aware that peer pressure can have a negative influence on the freedom of choice, in the same way as feeling the pressure to conform to family expectations regarding career choice. On the other hand in research done by Ibrahim et al. (2014) interpersonal relationship networks appear to have no significant influence in determining career choice. Sometimes though, advice from peers or family can also provide useful information.

Tip 4

Have honest conversations with students about work-life balance and wellbeing

Some interns seek a good work-life balance and the flexibility to pursue interests outside of work. They need to know what ability they have to control working hours. You can advise students to seek opinions and experiences from mentors, residents or specialists about the work-life aspect in their working specialties. In a cross-sectional survey of medical students in Germany work-life balance was found to be one of the factors influencing specialty selection (Grasreiner et al. 2018).

The reflection

Tip 5

Ask questions that stimulate reflection

What is a good question? A good question stimulates reflection and is often open-ended. Examples of open questions start with how, what, when, why. In medical education using effective questioning is an important skill- see the twelve tips on this topic (Pylman and Ward 2020). It is also important to create an atmosphere of respect and psychological safety. Such conversations require listening to the student’s responses. There should be no pressure for a perfect answer and there should be no consequences. If the students fear that they might receive lower grades if they do not produce the expected answer then an honest conversation on career speciality cannot take place. This situation could occur during a clerkship if the faculty member who is having this informal conversation is also the assessor of the clerkship. We have heard students say: “when I speak to a pediatrician all they are interested in is whether I want to become a pediatrician too.” Students benefit from honest questions and advice regarding their career preferences discovery process. Even if you are unable to answer their question, hopefully you can refer them to someone who can help them further.

Tip 6

Encourage the student to reflect on the importance of their personal values

Have the students identified their values? Values are typically consistent across the lifespan of a career, while needs may change in different seasons of life. Values can be a good compass to guide students but they need to be able to identify their values. As defined by Bland et al. (1995), a medical career choice results from a balance between the students’ career desires and their perception of the characteristics of a specialty. A positive attitude towards the patient group of the specialty and a personal preference for a medical career are associated with the medical career choice of graduating students (Querido et al. 2016). And in Mexico, a middle-income country, personal values and the perceived characteristics of the specialty are more determinant than career needs to satisfy (Gutiérrez-Cirlos et al. 2019).

Tip 7

Ask the student whether they have identified role models

Positive role models not only help to shape the professional development of our future physicians, they also influence their career choices (Passi et al. 2013; Passi and Johnson 2016). Help students identify positive role models. Ask students, “Who are the doctors who inspire you and whom you admire?” Encourage students to reflect on why they admire and are inspired by certain role models. By demonstrating enthusiasm, job satisfaction, and passion for their work role models have an important influence on student choice.

Tip 8

Ask the student whether they have experienced a sense of belonging during one of the clerkships?

Qualitative research by Singh and Alberti (2021) explored why medical students in the UK changed their career preferences. A theme that emerged was the importance of belonging and fitting in. Participants in the study described ‘feeling at home’ and ‘they were my kind of people’. They could envisage themselves working within the specialty in the future. Working successfully with increased clinical responsibilities creates moments when students are aware of being a practitioner rather than a student. This feeling ‘like a doctor’ emerges when students are challenged with greater patient care responsibilities (Van den Broek et al. 2020).

Actions students can take

Tip 9

Encourage the student to discover which aspects of a certain specialty appeal to them

To aid the process of choosing, it is useful for students to keep a log of reasons for and against certain careers. It can be continually updated, reflected upon, and referred to in future applications (Borelli et al. 2017). Each specialty varies in terms of intellectual stimulation, academic focus, diversity, practicality, patient‑centred care, or team‑based work practice. It is good to consider what patient population the specialty serves as the future doctor will interact with this population daily. One of the factors that influenced British medical students’ career intentions was the weight they placed on the different specialty-related factors (Ibrahim et al. 2014).

Tip 10

Stimulate the taking of responsibility during clerkships

Querido et al. (2020) described the significance of experiencing clinical responsibilities for specialty career choice. The experience of responsibility as a medical doctor forces trainees to reflect on personal needs and to consider which career preference fits best. This process could be similar in medical students. The medical students we spoke to agree with this assumption.

Tip 11

Motivate the student to keep a good times journal as part of the discovery process

A happy moments journal is one which the student writes about what makes them happy during clerkships. They should also relate their negative experiences. Doing this will help to discover what is important and what not in one’s future career. Keeping a journal encourages reflection and stimulates insights.

Tip 12

Stimulate students to seek career guidance

Career guidance helps individuals acquire the knowledge, skills, and experience necessary to identify career options. Support students to find opportunities to learn about the different options they have. Often the clerkships are focused on the hospital-based specialties and; the non-hospital based options like elderly care, public health, care for the disabled, general practice, and occupational health are often less visible for the students or they have had less experience in these specialties. Other unknown specialties are radiology, laboratory medicine and pathology, to name just a few. Career officers have an overview of the domains and of all related medical specialties and can encourage students to gain experiences in a broad range of fields. On the website Career in Medicine more than a hundred and sixty specialties and subspecialties are presented. If medical specialization is not appropriate or not desired, other options could be considered such as a career in medical research, medical education or pharmaceutical work. There should be no barriers to seek career guidance and if students struggle during their search for a specialty, advice from a career officer can be valuable.

Conclusion

During their clerkships medical students experience stress due to the career decisions and specialty choice they have to make. We hope these twelve tips equip you to create precious moments to have more meaningful conversations with medical students on their career intentions and future career choice. We believe medical educators, mentors and staff can all play a crucial role in helping students navigate this challenging phase. The twelve tips can be used not only when speaking to medical students during their clerkships, but throughout early professional life, and even during their trainee experience.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Janneke Z. Muyselaar-Jellema

Janneke Z. Muyselaar-Jellema, MD, Public health educator and coordinator of the Public Health clerkship, Leiden University Medical Center, the Netherlands.

Sophie J. Querido

Sophie J. Querido, Ph.D,. Director of the Central Board for Specialty training in Elderly Care Medicine in the Netherlands (SOON), Utrecht, the Netherlands.