In the quantitative part, there were 64 out of 181 senior medical students (Respond rate 35.4%) who participated and submitted the answers. The demographic characteristics of the quantitative part are shown in Table 1.
Table 1: Demographic data of participants in the quantitative part
Demographic characteristics
|
Frequency
(Total = 64)
|
Percent
(%)
|
Gender
|
Female
|
33
|
52
|
Male
|
31
|
48
|
Age
|
22
|
4
|
6
|
23
|
36
|
56
|
24
|
19
|
30
|
25
|
4
|
6
|
29
|
1
|
2
|
Hometown
|
Bangkok metropolitan region
|
53
|
83
|
Southern region
|
5
|
8
|
North-Eastern region
|
2
|
3
|
Eastern region
|
2
|
3
|
Northern region
|
1
|
2
|
Western region
|
1
|
2
|
Among the participated students, 85.9 percent plan to work as a physician and 84.4 percent plan to study further in residency training in the future (Table 2-3). In the attitude part, four out of 64 participants show interest in a career of family physician, but only one participant is strongly interested.
Table 2: Participants’ future plan about their career path
Statements
|
Frequency
(Total = 64)
|
Percent
(%)
|
Do you plan to work as a physician after graduation? (n = 64)
|
Yes
|
55
|
85.9
|
Not sure
|
6
|
9.38
|
No
|
3
|
4.7
|
Do you plan to attend a specialty training in the future? (n = 64)
|
Yes
|
54
|
84.4
|
Not sure
|
7
|
10.9
|
No
|
3
|
4.7
|
Table 3: Specialty that medical students consider as their first choice for future training
Specialties
|
Frequency
(Total = 54)
|
Percent
(%)
|
Pediatrics
|
9
|
14
|
Surgery
|
9
|
14
|
Orthopedics
|
6
|
9
|
Internal Medicine
|
6
|
9
|
Obstetrics-Gynecology
|
4
|
6
|
Anesthesiology
|
4
|
6
|
Emergency Medicine
|
2
|
3
|
Pathology
|
2
|
3
|
Psychiatry
|
2
|
3
|
Otorhinolaryngology
|
1
|
2
|
Ophthalmology
|
1
|
2
|
Radiology
|
1
|
2
|
Family Medicine
|
1
|
2
|
Physical Medicine and Rehabilitation
|
1
|
2
|
Forensic Medicine
|
1
|
2
|
Not Sure
|
4
|
6
|
In the qualitative part, a total of 14 students were chosen using a snowball sampling and from those who met inclusion criteria from the questionnaire to participate in an in-depth interview. The details of all the participants are shown in Table 4.
Table 4: Demographic data of participants in the qualitative part
Subject
|
Gender
|
Age
|
Hometown
|
Order/Total of Siblings
|
Has a family member who is a medical provider?
|
Family Income (Baht/Month)
|
Interested Specialty
|
Plan after Graduation
|
Interested to be a Family Doctor
|
1
|
F
|
24
|
BMR
|
1/4
|
No
|
20000-39999
|
Not Sure
|
GP Internship
|
Not Sure
|
2
|
F
|
24
|
BMR
|
1/2
|
Yes (Cousin)
|
40000-59999
|
Not Sure
|
GP Internship
|
Not Sure
|
3
|
M
|
23
|
NE
|
3/3
|
Yes (Aunt)
|
40000-59999
|
Neurosurgery
|
GP Internship or Fixed Ward
|
No
|
4
|
M
|
23
|
BMR
|
1/1
|
No
|
> 59999
|
Orthopedics
|
Fixed Ward
|
No
|
5
|
M
|
23
|
BMR
|
2/2
|
No
|
40000-59999
|
Obstetrics-Gynecology
|
GP Internship or fixed ward
|
No
|
6
|
M
|
29
|
BMR
|
1/2
|
Yes (Father, Uncle)
|
> 59999
|
None
|
MD-PhD Program
|
No
|
7
|
F
|
23
|
BMR
|
3/3
|
Yes (Uncle)
|
40000-59999
|
Family Medicine
|
GP Internship
|
Yes
|
8
|
F
|
22
|
BMR
|
1/1
|
No
|
40000-59999
|
Forensic Medicine
|
GP Internship
|
Not Sure
|
9
|
M
|
25
|
BMR
|
1/2
|
No
|
> 59999
|
Emergency Medicine
|
GP Internship
|
Not Sure
|
10
|
M
|
24
|
BMR
|
2/2
|
Yes (Uncle, Grandfather)
|
> 59999
|
Surgery
|
Fixed Ward
|
No
|
11
|
M
|
23
|
BMR
|
1/2
|
No
|
40000-59999
|
Emergency Medicine
|
GP Internship
|
Not Sure
|
12
|
F
|
23
|
BMR
|
3/3
|
No
|
> 59999
|
Pediatrics
|
Fixed Ward
|
No
|
13
|
F
|
22
|
BMR
|
2/2
|
Yes (Father, Mother)
|
> 59999
|
Orthopedics
|
GP Internship
|
No
|
14
|
F
|
23
|
S
|
4/4
|
Yes (Brother)
|
40000-59999
|
Pediatrics
|
GP Internship
|
Not Sure
|
F = Female, M = Male, GP = General practitioner, BMR = Bangkok Metropolitan Region, NE = North-eastern region, S = Southern region
There are many factors affecting the medical students’ attitudes toward family medicine as a career choice. The factors can be categorized into two main periods; before entering the medical school, and during the medical school. Both periods have an influence on medical students’ personal life and their attitudes toward choosing family physician as a career choice. The conceptual framework is shown in Figure 1.
Figure 1: Conceptual framework of the findings.
The factors before entering the medical school
This period is an important time for the medical students to make a decision for medical school admission. It also has an impact on their experiences during the medical school. There are four factors in this period.
1. Individual factors
The medical students share particular similar characteristics. For example, they tend to like helping other people. They also had a good high school performance and are multi-talent. They were so proud of their skills but experiences in the medical school might have mitigated the use of these skills.
2. Family factors
Family also plays an important part in influencing students to enter a medical school. Participants who are the first child in a family with low economic status tend to choose a career path of doctor because of the job stability. Participants whose family members are medical personnel would have a chance to see beforehand what it is like to be a doctor. Some families supported their child to become a doctor. However, some did not because they did not want to lose their child to the intensive study.
3. Elementary school factors
A school-peers trend also has an influence on students’ decision. In a school that most students aim to get into a medical school, students tend to be interested in this path too because of the trend and teachers’ expectations. However, in a school without this trend, students decided on their own about their career path.
4. Social factors
In Thai society, being a doctor is considered as having a high social status. There is a social value that a smart child should become a doctor. This has an influence on smart students’ decision to get into a medical school even though they have no inspiration to be a doctor. This value also has a negative effect on other average students to follow their dream jobs as they have to compete with smart students in an admission examination. As a result, it is more difficult for them to get into a medical school.
Factors during the medical school
The experiences during the medical school can be divided into six main themes, all of which have an influence on medical students’ attitudes toward family medicine as a career choice.
1. The late clinical-exposure curriculum
The medical students were exposed to clinical experience only after the fourth year of the program. As a result, they could not grasp the idea of what doctors’ duties and tasks would be in the early years. This caused the 1st-3rd year students to have a poor understanding of how to apply the medical knowledge clinically in the later years.
“In the first three years, I had absolutely no idea how I will apply the knowledge to the practice.” Medical student #8
2. Examination based curriculum
The medical curriculum is divided into department-based rotations such as medicine, pediatrics, and surgery. The medical students had to prepare for an examination at the end of each rotation. Some of the medical problems in the examination were rarely found in real practice. The medical students had to study just for the evaluation rather than for taking real care of patients. Moreover, they extremely gave the highest priority to their grades. Some of them believe that the scores represent their own competency.
“The second year was tough. The examinations were scheduled every two weeks. I had to study for these tests every day.” Medical student #14
3. High competition
The environment in the medical school was very competitive. It can be seen obviously from bed-side teaching. The medical students had to compete with each other to give the correct answer to their professors’ questions. If they could get the answer right, they would look so smart. The smarter students got more acceptance from professors. The competitive environment could also be seen during an examination. This competition eventually affected students’ decision to choose a specialty to study in residency.
“It is better to choose a specialty that I am good at. There are outstanding medical students in each specialty. I cannot beat them if I choose a specialty that I am not master at.” Medical student #3
4. Dehumanized lifestyle
A tight schedule caused the medical students to lack spare time for their own personal life. They had to be away from their families for a long time. They also did not have enough time to participate in extra-curricular activities as they had to be in the same routine activities every day.
“It was so busy during the 5th-6th year. I was too tired to take care of myself. I could not remember the last time I set my hair” Medical student #5
5. Poor understanding of a role of family doctors in real life
Most of the medical students could not understand the role of family physician in reality because they were only exposed to experiences in the medical school. They thought that family doctors play an important role only in a community hospital in suburban areas. This idea is one of many reasons that discourage some medical students to become a family doctor because they do not want to live out of town. Many students had a bad impression of family medicine during their home visit session. Some of them perceived that psychosocial and family assessment are too intrusive into the personal life of a patient and are not physician tasks.
“I am not interested in family medicine because I do not want to work in a suburban area. Most of my friends agree with me especially those who live in Bangkok. We had no clue where family doctors would end up working at but at least that was what we think” Medical student #12
6. The hidden curriculum
The medical students received both positive and negative comments on family physicians from other specialists. Most of the negative comments were about inaccurate treatments provided by family physicians. However, one student heard a positive comment on a home visit skill and competency.
The medical students were obsessed with their future specialty and tried to make their decision early before finishing the medical school. This trend had come up because of the repeated conversations about career path among medical students and with their professors. Moreover, a ‘fixed ward option’, the path that medical students can choose in advance which specialty they want to do during an internship, also plays a crucial role in this trend.
“The ‘Fixed ward option was so popular’. I would probably choose this option too. You could say that we choose an easy way out. Everyone wants to finish residency training as soon as possible so we could finally work and make money.” Medical student #5
Influence on personal life
The factors from before and during the medical school both have an effect on the medical students’ personal lives. They felt stressed and exhausted especially the final year students working on overnight duty. Some of them suffered from depression and burnout. One student told that it was like burning a candle as medical students’ lives were being destroyed day by day to make other people’s lives better.
Some of the medical students had been through experiences in the medical school that diminish their self-esteem. They doubted themselves that they might not be competent enough to be a doctor because they got a low score on their examinations.
Influence on attitudes toward family medicine as a career choice
1. Personal interest
One of the factors affecting a specialty selection is the medical students’ personal interests. For example, the medical students who hate doing procedures are usually interested in medicine, pediatrics, and family medicine. The medical students who like a wide range of knowledge tend to become generalists, such as family physicians, internists, and emergency physicians. In addition, the ones who liked holistic care are usually interested in becoming a family physician.
“I am interested in caring with heart rather than discussing complex and rare diseases” Medical student #8
2. Mastery
The medical students prefer a specialty that they are good at. If they are not a master of preventive healthcare, they may not choose to be a family physician.
3. Family factors
One of the barriers that discourage the medical students to choose family medicine as a career choice is a misconception about workplaces. The medical students whose hometown is Bangkok or a nearby province may not choose to be a family physician because they think that this specialist has to work in a suburban area. Their family members also do not want them to be far away from home. Another barrier is that the family members do not understand the job of a family physician. As a result, they would not support their children to choose this career path.
“It is difficult to explain to my parents what family medicine is. I would rather choose a well-known specialty” Medical student #14
4. Work-life balance
The medical students are interested in careers with a good work-life balance. Family medicine is one of those with such characteristic which could make it more appealing to medical students.
“One of the reasons that I want to be a family physician is a work-life balance. It is my dream to have a family full of weekend activities. It would be great to be a doctor who can spend time with family.” Medical student #7
5. Humanized environment
A learning environment is one of the main factors affecting the medical students’ impression of each rotation. The family medicine rotation has a humanized environment that could make medical students interested in this career path.
“I have observed residences and professors in several departments including family medicine. The way family doctors talk to their patients was very nice.” Medical student #7