Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

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58 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90 their close family. Students whose parents are physician tend to choose non-primary care/general practice specialties. This may be a reflection of the socioeconomic status, increased knowledge on the specialties, the relative status of primary care/general practice in the medical community and the family support for their choices 17 , 21 , 133 The multivariate model clarified the importance of the profession of the father and the importance of having a mother GP in relation with the future specialty choice. There is a negative relationship between having a specialist as a father and becoming a GP and a positive relationship between having a mother GP and becoming a GP. The educational level of the mother also plays a role: GP students have more often mothers with higher secondary degree or short-term non-university higher educational degree. The effect of the education of the father was not statistically significant, as already found in the literature 20 , 37 , 58 . Future GP students tend to be female: the literature shows indeed that female students 22 , 24 , 30 , 31 seem to view the GP more positively than male students. 3.7.2.3 Decision to become a GP: few change during the curriculum At the beginning of their studies about one third (29%) of future GP students already had the idea of becoming a GP. One fifth (17%) had another specialization in mind but changed their mind during education. The rest of the GP students started their studies without having any specific specialty in mind made their choice during their curriculum. The recruitment during the curriculum is therefore important, but a preference for family medicine/general practice at matriculation is a powerful predictor for the estimated numbers of students in general practice six years later 20 , 21 , 134 . It has therefore been recommended to use recruitment and selection processes to select students who will choose family medicine/general practice 135 . 3.8 FACTORS DURING THE CURRICULUM RELATING TO SPECIALTY CHOICE The role model of the GPs, the clerkships and the impact of general practice in the 18 , curriculum influence the choice for general practice. In Belgium as in other countries 21 , 42 , 45 , 47 77 not only the “official” curriculum but also the culture within the medical faculty of influence. The bivariate quantitative study shows that the specialty choice, most importantly for students opting for a specialty, becomes clearer during the process of medical education. 3.8.1.1 Perception of general practice during medical training General practice is perceived as a difficult profession with a lot of uncertainties during the clinical decision making process. Many specialist students considered it as less intellectual challenging with a lot more routine work than the clinical specialties. It is also considered as a lonely working professional (especially by specialist students), having a high workload without any attractive financial aspect. On the other hand the GP profession is appreciated for its variety in the work, autonomy and the privilege of working with patients in different stages of their life. These attracting and discouraging perceptions are in line with the literature findings of the literature review 28 , 61 , 62 , 63 , 64 , 65 . The only difference in this study is the complexness of the job which represents a positive aspect of the GP profession in the literature 54 , 61 , 64 , 66 but is less clear in our findings and differs between both groups of students. It is obvious that the GP profession deals with an image problem. Students who do not see the future opportunities of the profession tend to choose another specialty. This perception problem about the content and opportunities of the GP profession was already described by Coppens & Panhuyzen 2005 136 . GP students and non-GP students hold different views on the GP profession. GPs tend to like the variety of work and tend to cope better with the uncertainties of the job, whereas the non-GP students rather observe the difficulty of uncertainties and the
KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 59 routine work involved. We do not know to what extent this conflicting observation is based on a spontaneous reaction or comes from a real decision process for choosing a career. GPs deal with complexity. 3.8.1.2 Culture of medical faculties and lack of ambassadors for general practice LATE CONTACT WITH GENERAL PRACTICE Students argue that general practice as a discipline is not brought to the fore in the undergraduate curriculum. The first contacts with general practice are not frequent and come late during the curriculum. So, students have most interactions with medical specialist teachers. In this study only about one third of students have had contact with general practice clerkships in the first few years of the curriculum. Here differences between faculties may play a role. Studies suggest that primary care/general practice needs to have more than a teaching role, but should be a real role model in the medical school, in order to positively affect specialty choice. IMPORTANCE OF ROLE MODELS IN GP However, both studies show that role modeling is important to attract students in all specialties. Based on the interviews with students, role models (teachers, supervisors) during education but also in their private life (GP in the family, own GP) are the most important information sources and factors influencing the decision 18 , 19 . The quantitative study pointed out that clerkships and supervisors mostly influenced GP students. However, using a multivariate model, only the influence of the family or acquaintances working in the medical sector seemed to be important for choosing general practice in seventh year of education. Most studies showed a positive association between a positive role model and the choice for a specialty, but negative experiences have even more impact for switching away from family medicine/general practice. 21 , 28 , 34 , 51 , 53 33 , 54 , 55 , 58 , 59 , 60 . Unfortunately, there is a lack of valued professors of general practice in the curricula. The students therefore negatively perceive the image of the discipline. Courses in general practice are too general, too much focused on the bio-psycho-social model and the organization of the health care. VALUES WITHIN THE MEDICAL FACULTIES The culture of medical faculties with values oriented towards specialties reinforces the negative perception of general practice by the students. The transmission of values within the academic world may therefore be an important determinant for the choice of a future career. This finding is supported by other researchers who described the 18 , 26 , 32 , 42 , 46 79 , importance of a global academic commitment towards general practice 47 77 . The quantitative results show that the hidden (informal) curriculum plays an important but paradoxical role. Future GPs are more sensitive but less influenced by it. 3.8.2 Factors attracting students to choose the GP profession in Belgium About one third of the students, mostly female students, positively choose general practice as a specialty in the middle of the curriculum. In some universities however, students may still opt for a career in general practice after having been dismissed for specialization, in the second semester of the final year. Both studies highlighted the main reasons for the choice of GP. 3.8.2.1 Positive match The qualitative study showed that the respondents identified a personal affinity. A few other studies already highlighted the importance of personal characteristics in the choice process: personal values 137 , personal relationship styles 138 and interests and character 139 . Also in a Belgian study by Beullens, individual interest was found to be the
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