Medical students' and prospective medical students' uncertainties about career intentions: Cross-sectional and longitudinal studies

Aim: To explore changes and uncertainty in medical (and prospective medical) students' career intentions in a 5-year problem-based curriculum. Methods: Six postal questionnaire surveys of medical students and one survey of prospective medical students sought career intentions from three entry-cohorts (one also seeking why they chose medicine, and one, the reason for the career intention). Results: From the 973 (91.4%) 2001/02 admission interviewees responding, 74/189 (39.2%) of those admitted and remaining 'in-year' re-reported career intentions 5 years later (2006/07). Of the 1999 entrants (start-Year 1; end-Year 1; and mid-Year 3) and 2001 entrants (start-Year 1 and end-Year 1), 61.2-77.9% responded. Up to mid-programme, only 9.5-18.8% reported general practice, significantly more of whom described altruistic reasons for choosing medicine (2001 entrants). Tracked longitudinally, career intentions stayed relatively stable, but a small significant retreat from general practice over Year 1 predated clinical placements. From pre-admission to mid-Year 5, uncertainty decreased significantly, but 14.9% replied 'do not know' both times. Significantly more prospective students from the least affluent English or Welsh postcodes specified a career intention. Conclusion: Many students might delay considering career intentions, particularly general practice. Socioeconomic determinants of early medical career decision making merit further study.