Factors Influencing the Decision to Practise Obstetrics Among Quebec Medical Students: A Survey

Objective: The objectives of this study were to track changes in medical students' interest in obstetrics from the beginning of their studies in medicine to the end of their pre-clinical clerkships and to identify factors that influenced this interest. Methods: This was a cohort study of all Quebec medical students who, in 2003, were about to begin their clerkships (n = 500). A questionnaire was administered at this time (T1) and at the end of the clerkship (T2). The main outcome variables were an intention to provide prenatal care without deliveries and an intention to deliver infants in future practice. Logistic regression analysis was used to assess relationships between the various determinants and the decision to practise obstetrics. Results: A total of 353 students, or 70.6% of the cohort, completed both questionnaires. At the end of their clerkships, 32 students (9.1%) were definitely planning to include complete obstetrical care in their future practices, and 45 (12.7%) said that they probably would. Between the beginning and the end of their clerkships, only 8% of students had changed their minds in favour of an obstetrical career, and 20% had decided against it. An intention to deliver infants is associated with the following factors: considering the practice of obstetrics gratifying (odds ratio [OR] 6.73; 95% confidence intervals [CI] 3.30-13.70); having been exposed to obstetrical care outside the clerkship in obstetrics and gynaecology (OR 4.4; 95% CI 1.6-10.26); having completed university studies before studying medicine (OR 4.08; 95% CI 1.11-15.3); and having had a decisive, positive experience with obstetrics (OR 2.86; 95% CI 0.96-8.50). Students who believed that specialists had played a key role in their decision and that obstetrics is a demanding practice were less likely to plan a career that included delivering infants (OR 0.43; 95% CI 0.23-0.69 and OR 0.35; 95% Cl 0.21-0.59, respectively). Conclusion: This study shows that an interest in practising obstetrics emerges very early in medical training. However, a student's learning experiences during an obstetrical rotation affect this decision. Departments of family medicine and obstetrics and gynaecology may be able to work together to create more positive role models.