Postgraduate attachment to general practice: influence on doctors’ future career intentions

Munro, Neil Macarthur (2011) Postgraduate attachment to general practice: influence on doctors’ future career intentions. Doctoral thesis (DPhil), University of Sussex.

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Recruitment of medical graduates to general practice careers in the UK, as in other
developed countries, remains challenging. Currently general practice attracts fewer
doctors than health care planners anticipate will be needed to meet the burgeoning
health needs of an ageing population. Understanding the factors that influence doctors
in their career choices is important to manpower planners, the profession and society as
a whole.
A two year postgraduate foundation programme for all doctors was introduced into the
UK in 2006. One of its main intentions was to provide doctors with postgraduate
clinical attachments that would assist them in making informed career choices. This has
resulted, for the first time, in large numbers of recent medical graduates experiencing
several specialties before applying for specialty specific training programmes.
The main aim of this thesis was to assess the influence of a four month postgraduate
attachment in general practice in the second foundation year on doctors’ career intent. It
was hypothesised that the attachment would have a positive impact on recruitment to
general practice careers. This hypothesis was tested using a combined quantitative and
qualitative approach.
A literature review examined career decision making in medicine. It was divided
chronologically into sections covering decision making at school, university and in the
early postgraduate years. In addition a section focussed on decision making in careers
other than medicine.
A validated career inventory (sci 59) measuring change in career preference was
selected for use in this study. The output is in the form of career rankings among 59
medical specialties. In addition, a semi-structured interview questionnaire was
developed based on themes emerging from the literature review and was refined following piloting. Interviews were recorded, transcribed and thematically analysed
using NVivo 7.
The study was conducted in the Kent, Surrey and Sussex Deanery between 2005 and
2008. Participants (n=225) included all doctors whose second foundation year
programme included a four month attachment in general practice. They were sent a sci
59 questionnaire at the beginning of their attachment and a further questionnaire at the
end. Those responding to both questionnaires were invited to take part in an interview.
112 participants completed sci 59 questionnaires at the beginning and end of their 4
months attachment. Initial analysis demonstrated a small, statistically non-significant
improvement in career intent towards general practice. Using a measure that reflects
movement in ranking between the two questionnaires, further analysis showed a small,
statistically significant, improvement in the ranking of general practice among
participants who had low initial rankings for general practice.
30 participants were interviewed. Placements in general practice during the second
foundation year were generally regarded in a very positive light. Doctors particularly
valued ongoing relationships with patients as well as involvement with local
communities. They commented on the high quality of supervision and the structured
learning environment of their attachments. General practice was also seen as a better
lifestyle option than other main specialties as well as offering flexible working
New findings included the observation that career ranking for general practice improved
following a four month postgraduate attachment in general practice among those less
inclined to general practice as a career in the first place. Thematic analysis of
transcribed interviews revealed enhanced respect, among foundation doctors, for
general practice as a career option irrespective of their own eventual career intent. This
improved regard for general practice among doctors intent on specialising may be
important in the context of persisting disparagement of general practice by some
students, clinicians and teachers. It may also be helpful in engendering mutual respect
and more effective working relationships between specialists and generalists in the

Item Type: Thesis (Doctoral)
Schools and Departments: School of Education and Social Work > Education
Subjects: R Medicine > R Medicine (General)
R Medicine > R Medicine (General) > R690 Medicine as a profession. Physicians
R Medicine > R Medicine (General) > R735 Medical education
Depositing User: Library Cataloguing
Date Deposited: 07 Jun 2011 09:30
Last Modified: 14 Aug 2015 13:32
Google Scholar:67 Citations

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