Changes in US medical students' specialty interests over the course of medical school

BACKGROUND: Studies have examined factors affecting medical students' specialty choice, but little research exists on stability of these specialty interests. OBJECTIVE:To describe patterns of change in specialty interests during medical school and examine associations between specialty change patterns and gender, desire for a high-prestige career, and interest in prevention. DESIGN:Medical students (Class of 2003) at 15 representative US schools were invited to complete surveys during freshman orientation, entry to wards, and senior year. PARTICIPANTS:This analysis used data from 942 students who completed all 3 surveys. MEASUREMENTS:In addition to a number of other items, students were asked to choose the 1 specialty they were most interested in pursuing. RESULTS:The most common specialty choices among freshman students were pediatrics (20%) and surgery (18%); least common choices were psychiatry and preventive medicine (1% each). General internal medicine was the initial specialty choice for 8%. Most students changed their specialty choices, regardless of initial interest. Only 30% of those initially interested in primary care (PC) remained interested at all 3 time points, compared to 68% of those initially interested in non-PC. Female versus male students were more commonly interested in PC at all 3 time points. Senior students interested in non-PC specialties were more likely to desire a high-prestige career (48%) than those interested in PC (31%). CONCLUSIONS:Medical students may benefit from more intensive introduction to some specialties earlier in pre-medical and medical education. In addition, increasing the prestige of PC fields may shape the physician workforce.