How Do Medical Students and Doctors in the UK Health System Reach Decisions About Specialty Choices Through Their Undergraduate and Postgraduate Training?

Background The process of making a specialty choice is one of the most important decisions of a doctor's career. This choice is dynamic and multifaceted, with important contributing decisions made at various career stages. To understand the complexities behind these career decisions and help target recruitment of undersubscribed specialties, we must understand the influences on specialty choice and how these influences change as careers progress, from undergraduate to fully qualified doctors. This research aimed to define what influences these decisions, and uniquely denote how these influences evolve as trainees' careers progress, by investigating three components: what decision-making processes do participants use at different times, how they weigh different factors and influences, and does the importance of these factors and influences changes at different points. Methodology The data for this naturalistic qualitative research project were collected using semi-structured interviews, with nine participants spanning a continuum of career stages, from final-year medical students to doctors who had completed a Certificate of Completion of Training (CCT; hereafter referred to as post-CCT doctors). We analysed the data thematically and used the data gathered to produce a conceptual model. Results This research demonstrated that, as time progresses within careers and trainees gather more experience, their reliance on stereotypes and other wider social narratives reduces, while the influence of wider social roles increases. This model also hypothesises four phenotypes of specialty decision-making: early committers, re-thinkers, repeated re-committers, and late committers. Other themes of influencing factors included interest in the specialty, placement experience, and gender. Conclusions These findings show the complexity of factors affecting specialty choice and illustrate the dynamic nature of the decision. The variance of specific influences with age, such as wider social narratives, indicates implications for both medical schools and the Royal Colleges with regard to both support and recruitment.