Intracurricular Factors Influencing Medical Students' Specialty Choice: A Systematic Review

Background: Medical school graduates are faced with the difficult decision of choosing a specialty training program. Understanding the decision criteria as well as the intracurricular factors-which have been studied less frequently and thus lack clarity-may help to prevent an impending shortage of certain specialists and to ensure the recruitment of young doctors into supposedly less popular specialties. Evidence-based changes to the medical curriculum are needed to support the balanced development of health care systems with demand-driven staffing of all specialties, especially in the outpatient sector and in rural areas. The aim of this systematic review was to identify the intracurricular factors that influence medical students' choice of specialty that have been described in the international literature. Methods: A systematic review was conducted by searching Medline. After applying the inclusion and exclusion criteria to the 2537 primary results and 19 hits from an additional manual search, data were extracted from 334 studies. In addition, a quality assessment of all included studies was performed. Results: A total of 14 influencing factors were identified from the reviewed literature, of which "clinical-practical experience", "clinical role models", and "voluntary offerings" were mentioned most frequently. We sorted the factors into four main categories: "Teaching"; "Teaching environment, influence and interaction"; "Curriculum"; and "Voluntary work". The studies were highly heterogeneous regarding research methods and the quality of reporting. Conclusion: Involving students in the planning and structuring of clinical phases, active feedback, voluntary offerings, seminars/ simulations, and involvement in the clinical team can increase a specialty preference. Conversely, discrimination, prejudice and poor quality of teaching and clinical exposure may act as a deterrent. It is necessary to sensitize medical staff regarding their role and influence in the decision-making process. Further prospective and qualitative research is needed to address this issue adequately.