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30 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90 3 CHAPTER 3: WHY DO STUDENTS CHOOSE TO STUDY GENERAL PRACTICE: QUALITATIVE AND QUANTITATIVE STUDY WITH 7 TH YEAR MEDICAL STUDENTS ON MOTIVATIONS TO CHOOSE OR NOT THE GP PROFESSION 3.1 OBJECTIVES The previous chapter identified the factors influencing GPs’ attraction, recruitment and retention from the national and international literature. Are they relevant for the Belgian context? This chapter specifically focuses on the Belgian situation. Each country has indeed its own health care system, medical training tradition and labor market equilibrium and it is important to ensure that the Belgian situation is in accordance with the literature findings from the US, Australia and the UK. This chapter studies the influence of the medical school, of the working conditions, of the level of income on the students' decision to choose (or not) general practice as a career. 3.2 LITERATURE The aim of this survey among students is to look at the interaction of factors related to medical students’ specialty choice in Belgium. A specific narrative literature review first focused on the choice of GP profession among students (see appendix 3.1). It served as a guidance for the development of the interview schedule at the beginning of the project, before the systematic literature review described in the second chapter. The factors related to the choice of the specialty family medicine/general practice (factors related to GPs attraction) follow the chronological pathway of any specialty choice 22 . 3.3 RESEARCH QUESTION • a first set of factors concern medical students’ characteristics when entering medical school (personal and professional identity). These include their personal characteristics (age, gender, personality), background (socio-economic, rural living area, medical background of the family), their values and their intentions (expectations on income, attitude towards and interest in primary care/general practice); • the second set includes the medical school and experiences that occur during the process of medical education (classes and practice training = relays in primary care/general practice): curriculum and mainly time allocated to family medicine/general practice, role-models (mostly negative ones), peer encouragement and informal culture of the school (attitudes, comments regarding primary care, strong hierarchical perceptions); • finally, a group of factors relates to the outcomes of the process of medical education including perceptions about specialties (characteristics and content), career intentions (expectations regarding the profession e.g. income, status, working conditions, relationship with patients, interest in family medicine/general practice) and the influence of financial debt. The main research question is: “Which reasons do influence the choice of general practice among Belgian students?”
KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 31 Three sub-questions define the scope of the research: 3.4 METHODS • Which factors are related to specialty choice before medical school? • Which factors are related to specialty choice during medical education? • Which factors do attract students in the GP profession in Belgium? Qualitative interviews were first performed. The qualitative survey method is indeed an appropriate method to make an inventory and describe ideas, experiences and actual behavior of a population 127 , 128 . The results of this qualitative study were complemented with a quantitative approach that allowed triangulating the results. 3.4.1 Qualitative interview study The focus of the interview was to explore the reasons for choosing or not choosing general practice as a career and to get an insight in the process of choice. 3.4.1.1 Qualitative instrument The data were collected by semi-structured interviews based on an interview guide (interview protocol). Three different researchers conducted semi-structured interviews with students allowed a standardization of the process as the interviews. The use of an interview guide also supported tackling the important topics in each interview by all interviewers. After a standardized introduction 128 , the interview guide had open-ended questions (see appendix 3.2. and 3.3.). In this way the interviewees had enough space to tell their stories, but on the other hand this method ensured a comparable approach by the 3 interviewers. The chronological natural process of specialty choice was the frame of the interview guide 21 : characteristics, attitudes and intentions before entering medical school; experiences during and with the medical curriculum, and the final career choice. So the interview guide was divided in three major parts and students were encouraged to go over and to talk about the elements having influenced their decision during these phases. During the pilot interviews remembering was not easy and students reconstructed these elements again throughout the interview. Questions regarding the process of choice were repeated but with different wording or from a different angle to give the interviewees the opportunity to add elements or to go more in depth 127 . The initial interview guide was developed in Dutch and then translated into French by the French-speaking interviewer. This draft version was adapted after feedback from the steering group and 3 pilot interviews (2 in Dutch, 1 in French). The major adaptation was the deletion of the section on choice of university because this part did not provide any useful information during the pilot interviews. A translator, not involved in the project, performed the back translation. A few small (words) corrections were made to the interview guide following this back translation. 3.4.1.2 Participants A purposeful sample of 24 (12 in Flanders and 12 in Walloon) seventh year medical students in Belgium was recruited. The choice of seventh year students allowed to recruit students at the end of their ‘choice trajectory’ i.e., interviewees able to provide an information on the whole choice process.
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