Specialty-Related Negative Experiences Common During Clerkships

SEATTLE – Third-year medical students often have negative experiences related to the specialty they are interested in when they rotate through clerkships in other specialties, according to a survey presented at the annual meeting of the North American Primary Care Research Group.

In the survey of 603 students, students reported negative experiences during their clinical clerkships whether they were interested in primary care (family medicine, internal medicine, or pediatrics) or in a subspecialty (for example, otolaryngology or orthopedics).

These negative experiences included being discouraged from pursuing their specialty interest, being called offensive names because of it, or receiving poorer grades as a result.

"This study ... confirmed that there is a lot of bashing about student career choices," said investigator Dr. Shou Ling Leong, who is associate vice chair for education, and professor of family and community medicine, at Pennsylvania State University, Hershey. But the widespread nature of the problem was surprising.

"This behavior is worrisome. If we are truly putting down each other’s specialty, what does that say about professionalism?" she commented in an interview. "As physicians, we are held to a high level of professional standards, and if we mistreat each other, we are not serving as good role models for our students."

The findings are especially worrisome when it comes to primary care, given the severe shortage of these physicians nationally and the fact that negative experiences during training likely discourage some students from pursuing careers in the field, according to Dr. Leong.

"Now, this is not the only reason that students may not go into the field. Lifestyles and the amount of debt they owe and a multitude of factors may contribute to career selection," she acknowledged. But "if their supervisors – their professors and their residents – are telling them, ‘Don’t do it, this is not a good field,’ that’s going to have an impact on whether they are going to continue to pursue primary care."

Interspecialty friction can also undermine the medical home approach to care, which is built on collaboration among a team of physicians and other health care professionals, she further noted. "Negativity is going to erode the efficiency and the effectiveness of a team."

For the survey, conducted between 2004 and 2009, Dr. Leong distributed questionnaires to medical students at her college on the last day of their third-year clerkships.

They were asked to rate how frequent and how bothersome various negative experiences were on Likert scales. To determine whether experiences differed by specialty interest, Dr. Leong split the students into groups based on their reported specialty interest at the beginning and end of the year.

All of these groups reported at least some negative experiences related to their specialty interest during each of their clerkships in other specialties, according to results presented in a poster session.

"No matter what field you are going into, if you are on a rotation of a specialty that is different from what you are interested in, someone will tell you that it’s the wrong field," Dr. Leong commented.

The study was not designed to determine whether the negative experiences actually discouraged any students from pursuing primary care, according to Dr. Leong. But given that the students found these events troubling, they may have been a contributing or deciding factor for some.

Comments made in focus groups suggested there may be two subsets of students in this regard. "Those who truly believe in primary care will still go into primary care," she explained. "But those who are still sort of on the fence – ‘I like this, but I’m not completely passionate about it’ – I think that’s the vulnerable group that it probably had an effect on."

Discussing the study’s results, Dr. Leong said that "somehow we need to fix this problem so that, first, our students who are truly interested in primary care should be supported and feel comfortable pursuing the field, and second, if we truly are going to work together, we need to be more respectful of each other."

She noted that sharing the study’s results with faculty, residents, and others involved in medical students’ training could go a long way toward eliminating specialty-related negative experiences during clerkships.

"When people are conscious of what they are doing, perhaps they will then correct their behavior," she said. "By calling awareness to these issues, hopefully we can create a nurturing and respectful learning environment."

Dr. Leong reported that she had no conflicts of interest related to the study.

SEATTLE – Third-year medical students often have negative experiences related to the specialty they are interested in when they rotate through clerkships in other specialties, according to a survey presented at the annual meeting of the North American Primary Care Research Group.

In the survey of 603 students, students reported negative experiences during their clinical clerkships whether they were interested in primary care (family medicine, internal medicine, or pediatrics) or in a subspecialty (for example, otolaryngology or orthopedics).

These negative experiences included being discouraged from pursuing their specialty interest, being called offensive names because of it, or receiving poorer grades as a result.

"This study ... confirmed that there is a lot of bashing about student career choices," said investigator Dr. Shou Ling Leong, who is associate vice chair for education, and professor of family and community medicine, at Pennsylvania State University, Hershey. But the widespread nature of the problem was surprising.

"This behavior is worrisome. If we are truly putting down each other’s specialty, what does that say about professionalism?" she commented in an interview. "As physicians, we are held to a high level of professional standards, and if we mistreat each other, we are not serving as good role models for our students."

The findings are especially worrisome when it comes to primary care, given the severe shortage of these physicians nationally and the fact that negative experiences during training likely discourage some students from pursuing careers in the field, according to Dr. Leong.

"Now, this is not the only reason that students may not go into the field. Lifestyles and the amount of debt they owe and a multitude of factors may contribute to career selection," she acknowledged. But "if their supervisors – their professors and their residents – are telling them, ‘Don’t do it, this is not a good field,’ that’s going to have an impact on whether they are going to continue to pursue primary care."

Interspecialty friction can also undermine the medical home approach to care, which is built on collaboration among a team of physicians and other health care professionals, she further noted. "Negativity is going to erode the efficiency and the effectiveness of a team."

For the survey, conducted between 2004 and 2009, Dr. Leong distributed questionnaires to medical students at her college on the last day of their third-year clerkships.

They were asked to rate how frequent and how bothersome various negative experiences were on Likert scales. To determine whether experiences differed by specialty interest, Dr. Leong split the students into groups based on their reported specialty interest at the beginning and end of the year.

All of these groups reported at least some negative experiences related to their specialty interest during each of their clerkships in other specialties, according to results presented in a poster session.

"No matter what field you are going into, if you are on a rotation of a specialty that is different from what you are interested in, someone will tell you that it’s the wrong field," Dr. Leong commented.

The study was not designed to determine whether the negative experiences actually discouraged any students from pursuing primary care, according to Dr. Leong. But given that the students found these events troubling, they may have been a contributing or deciding factor for some.

Comments made in focus groups suggested there may be two subsets of students in this regard. "Those who truly believe in primary care will still go into primary care," she explained. "But those who are still sort of on the fence – ‘I like this, but I’m not completely passionate about it’ – I think that’s the vulnerable group that it probably had an effect on."

Discussing the study’s results, Dr. Leong said that "somehow we need to fix this problem so that, first, our students who are truly interested in primary care should be supported and feel comfortable pursuing the field, and second, if we truly are going to work together, we need to be more respectful of each other."

She noted that sharing the study’s results with faculty, residents, and others involved in medical students’ training could go a long way toward eliminating specialty-related negative experiences during clerkships.

"When people are conscious of what they are doing, perhaps they will then correct their behavior," she said. "By calling awareness to these issues, hopefully we can create a nurturing and respectful learning environment."

Dr. Leong reported that she had no conflicts of interest related to the study.

SEATTLE – Third-year medical students often have negative experiences related to the specialty they are interested in when they rotate through clerkships in other specialties, according to a survey presented at the annual meeting of the North American Primary Care Research Group.

In the survey of 603 students, students reported negative experiences during their clinical clerkships whether they were interested in primary care (family medicine, internal medicine, or pediatrics) or in a subspecialty (for example, otolaryngology or orthopedics).

These negative experiences included being discouraged from pursuing their specialty interest, being called offensive names because of it, or receiving poorer grades as a result.

"This study ... confirmed that there is a lot of bashing about student career choices," said investigator Dr. Shou Ling Leong, who is associate vice chair for education, and professor of family and community medicine, at Pennsylvania State University, Hershey. But the widespread nature of the problem was surprising.

"This behavior is worrisome. If we are truly putting down each other’s specialty, what does that say about professionalism?" she commented in an interview. "As physicians, we are held to a high level of professional standards, and if we mistreat each other, we are not serving as good role models for our students."

The findings are especially worrisome when it comes to primary care, given the severe shortage of these physicians nationally and the fact that negative experiences during training likely discourage some students from pursuing careers in the field, according to Dr. Leong.

"Now, this is not the only reason that students may not go into the field. Lifestyles and the amount of debt they owe and a multitude of factors may contribute to career selection," she acknowledged. But "if their supervisors – their professors and their residents – are telling them, ‘Don’t do it, this is not a good field,’ that’s going to have an impact on whether they are going to continue to pursue primary care."

Interspecialty friction can also undermine the medical home approach to care, which is built on collaboration among a team of physicians and other health care professionals, she further noted. "Negativity is going to erode the efficiency and the effectiveness of a team."

For the survey, conducted between 2004 and 2009, Dr. Leong distributed questionnaires to medical students at her college on the last day of their third-year clerkships.

They were asked to rate how frequent and how bothersome various negative experiences were on Likert scales. To determine whether experiences differed by specialty interest, Dr. Leong split the students into groups based on their reported specialty interest at the beginning and end of the year.

All of these groups reported at least some negative experiences related to their specialty interest during each of their clerkships in other specialties, according to results presented in a poster session.

"No matter what field you are going into, if you are on a rotation of a specialty that is different from what you are interested in, someone will tell you that it’s the wrong field," Dr. Leong commented.

The study was not designed to determine whether the negative experiences actually discouraged any students from pursuing primary care, according to Dr. Leong. But given that the students found these events troubling, they may have been a contributing or deciding factor for some.

Comments made in focus groups suggested there may be two subsets of students in this regard. "Those who truly believe in primary care will still go into primary care," she explained. "But those who are still sort of on the fence – ‘I like this, but I’m not completely passionate about it’ – I think that’s the vulnerable group that it probably had an effect on."

Discussing the study’s results, Dr. Leong said that "somehow we need to fix this problem so that, first, our students who are truly interested in primary care should be supported and feel comfortable pursuing the field, and second, if we truly are going to work together, we need to be more respectful of each other."

She noted that sharing the study’s results with faculty, residents, and others involved in medical students’ training could go a long way toward eliminating specialty-related negative experiences during clerkships.

"When people are conscious of what they are doing, perhaps they will then correct their behavior," she said. "By calling awareness to these issues, hopefully we can create a nurturing and respectful learning environment."

Dr. Leong reported that she had no conflicts of interest related to the study.