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There are close parallels between Holland's general typology of careers, and the …

Biology Articles » Careers » Mapping medical careers: Questionnaire assessment of career preferences in medical school applicants and final-year students » Discussion

- Mapping medical careers: Questionnaire assessment of career preferences in medical school applicants and final-year students

The primary objectives of this study were to use the empirical method of individual differences scaling to derive maps of the underlying perceived structure of medical career specialities, and to assess the extent to which those maps are similar to those described by Holland in his hexagonal representation of the RIASEC groups of careers. That this method is a valid way of deriving Holland's structure in general is seen in figure 2, in which a broad range of non-medical careers is assessed by non-medical individuals, and the RIASEC structure is readily derived. Of particular importance is that because the analysis used INDSCAL, the dimensions are not arbitrary to rotation, and that the R-S dimension (corresponding to the Things-People dimension) and the IA-EC dimension (corresponding to the Ideas-Data dimension) are the basic underlying structure, as shown by Prediger [35,53]. The "Things-People" dimension also bears a strong similarity to the Technique orientation and People orientation which has also been described in relation to medical specialities [56].

The general population sample also rated four medical specialities, with Surgery and Anaesthetics at one extreme, and Psychiatry at the other, and these medical specialities differed principally along the R-S dimension. That Surgery and Anaesthetics are more concerned with Things, and Psychiatry is more concerned with People fits well with the reduction of Holland's hexagon to the two dimensions of Things-People and Ideas-Data. It is also worth noting that all of the four medical specialities are seen by the general public as being primarily concerned with Ideas rather than with Data, as surely befits medical careers.

The MDS analyses demonstrate that the representation of the various medical specialities by the medical student samples can be captured within a two-dimensional space, as Holland had suggested. The maps shown in figures 3 to 8 indicate that the structures are broadly similar across the three cohorts, and that although there are some minor differences between the applicants and the final-year students, it is the case that overall the similarities are more impressive than the differences. The crucial question therefore concerns whether the medical student maps are homologous to those of Holland's RIASEC typology. If there is a homology, then one may ask what are the Realistic, Investigative, Artistic, Social, Enterprising and Conventional specialities of medicine.

From scrutinising figures 3 to 8 we suggest that the RIASEC structure of medicine is typified by the six prototypical specialities of Surgery, Hospital Medicine, Psychiatry, Public Health, Administrative Medicine and Laboratory Medicine. It should be emphasised that in suggesting this we are not implying a direct comparability in the posts, rather a formal similarity within the limits imposed by being within the domain of medicine, as opposed to that of careers in general.

Surgery – Realistic

Surgeons can be seen as the engineers of medicine, solving problems at high levels of mechanical and technical proficiency, with an emphasis upon practical skills, craftsmanship, and immediate and effective results.

Hospital Medicine – Investigative

The core of Hospital Medicine (Internal Medicine) is diagnosis, achieved by carrying out appropriate investigations. Physicians typify the model of the 'scientist-practitioner', investigating symptoms and signs and relating them to the underlying pathophysiology of the patient.

Psychiatry – Artistic

Psychiatrists, and also General Practitioners, have a more artistic approach to medicine, seeing, interpreting and responding imaginatively to a range of medical, social, ethical and other problems. The emphasis in many ways is on the uniqueness of the patient, the ideas that they are expressing, and the psycho-social theories and concepts which are necessary for interpreting the individual.

Public Health – Social

Although most medicine is concerned with individual patients, the remit of Public Health is primarily social in the sense of applying medicine to society as a whole, treating the 'body politic'. It is noteworthy that in the maps, Public Health is not only at the Social end, but also closer to Data than to Ideas. Public Health manages social and community health by the appropriate analysis of data.

Administrative medicine – Enterprising

The management of hospitals and health-care requires the creative skills of the business executive, the lawyer and the personnel director to achieve a smoothly running system. People, both patients and carers, are at the heart of any health-care system, and therefore administrative medicine is at the People end of the dimension.

Laboratory Medicine – Conventional

The running of efficient systems in haematology, histopathology or chemical pathology requires many of the attributes shared with the accountant or the banker, including the willingness to develop, implement and follow standard procedures within a complex system. The emphasis is inevitably upon the things that do the measurements, and upon the data collected, rather than the ideas or people behind the data and the technology.

The analyses in this paper suggest that in our groups of students there is a broad similarity between preferences for medical careers and the typology found by Holland in careers in general, suggesting that the structures are homologous. Although our study has been restricted to medical students in the UK, our findings are likely to be generalisable, given that the patterns are found in three separate cohorts studied over a decade, and across medical school applicants and final-year students. Just as Holland's typology is found in most studies of careers, over a period of three decades and in many countries, despite a wide range of changes in society, in education, and in the nature of jobs and careers themselves, so we would predict that our typology of medical careers will be robust to such changes. To put it more strongly, we would predict that despite enormous changes in every aspect of medicine over two and a half millennia, just as Hippocrates recognised that surgery is different in many ways from other branches of medicine, and that not every doctor wishes or is able to be a surgeon, so the same applies today and will probably continue to apply as long as medicine is practised. That is likely to be so primarily, as Ackerman has suggested, because Holland's typology is underpinned by wide-ranging, broadly defined individual differences in aptitude and personality [36] which are also likely to be stable across time and cultures [57].

It may at first be felt that our approach to mapping careers is fundamentally different to that of Gale and Grant [58,59], who describe a questionnaire, the Sci-45, which has twelve sub-scales and allows discrimination between 45 different medical specialities as possible careers. However, the purposes of that instrument and our analyses are very different. Gale and Grant aimed at developing a practical instrument for counselling individuals, which would allow a detailed differentiation between careers. In contrast, we aimed at investigating and mapping the broad picture underlying careers. To use an analogy with geography, our map is primarily a large-scale representation of a region such as Britain, which lays out the main north-south and east-west axes and defines the broad regions of that map (Scotland, Wales, South of England, East Anglia), as well as placing the main cities, which are analogous to the specific careers. Gale and Grant in contrast are developing a method of differentiating between the various cities, particularly when, as say in the West Midlands conurbation, some cluster closely together within the map. We therefore expect that underlying the Gale and Grant questionnaire will be two broad dimensions equivalent to those which we have described.

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