의학교육논단 (Korean Medical Education Review)

  • 제24권3호
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  • Pages.193-204
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  • 2022
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  • 2092-5603(pISSN)
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  • 2093-6370(eISSN)
연세대학교 의과대학 (Yonsei university college of medicine)
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의과대학생을 위한 체제적 진로상담 모델과 전략

A Systematic Career Advising Model and Strategies for Medical Students

  • 이영희 (고려대학교 의과대학 의학교육본부)
  • Lee, Young-Hee (Medical Education Center, Korea University College of Medicine)
  • 투고 : 2022.08.16
  • 심사 : 2022.10.06
  • 발행 : 2022.10.31
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초록

One of the important roles of medical schools is to support medical students in deciding upon their future career path or choosing their specialty. The purpose of this study is to suggest a career advising model and strategies for medical students through a systematic approach. This study consists of three parts. The first part introduces some main career theories: super's career development theory, career decision-making theory, social cognitive career theory, and ecosystem theory. The second part proposes a systematic career advising model using the results acquired from previous studies and theories. This model considers a medical school as a social system that consists of two domains (internal and external). This social system is considered as a complex where various factors interact with each other: students' individual characteristics, institutional policies and culture, curriculum and learning experience, students' perceived specialty characteristics, and aspects of the external environment such as healthcare systems. The third part suggests some career advising strategies based on a systematic approach that medical schools can apply. These research results can be used for designing career advising courses for medical students, integrating various career advising programs and resources of medical schools, and evaluating the outcomes of career advising programs at an institutional level.

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참고문헌

  1. Navarro AM, Taylor AD, Pokorny AP. Three innovative curricula for addressing medical students' career development. Acad Med. 2011;86(1):72-6. https://doi.org/10.1097/ACM.0b013e3181ff7dfc
  2. Sud S, Wong JP, Premji L, Punnett A. Career decision making in undergraduate medical education. Can Med Educ J. 2020;11(3):e56-66.
  3. Navarro A. A model for implementing medical student career development courses. MedEdPORTAL. 2010;6:8197. https://doi.org/10.15766/mep_2374-8265.8197
  4. Pfarrwaller E, Audetat MC, Sommer J, Maisonneuve H, Bischoff T, Nendaz M, et al. An expanded conceptual framework of medical students' primary care career choice. Acad Med. 2017;92(11):1536-42. https://doi.org/10.1097/ACM.0000000000001676
  5. Schroeder SA. Training an appropriate mix of physicians to meet the nation's needs. Acad Med. 1993;68(2):118-22. https://doi.org/10.1097/00001888-199302000-00002
  6. Petrides KV, McManus IC. Mapping medical careers: questionnaire assessment of career preferences in medical school applicants and final-year students. BMC Med Educ. 2004;4:18. https://doi.org/10.1186/1472-6920-4-18
  7. Howse K, Harris J, Dalgarno N. Canadian national guidelines and recommendations for integrating career advising into medical school curricula. Acad Med. 2017;92(11):1543-8. https://doi.org/10.1097/ACM.0000000000001720
  8. Vo A, McLean L, McInnes MD. Medical specialty preferences in early medical school training in Canada. Int J Med Educ. 2017;8:400-7. https://doi.org/10.5116/ijme.59f4.3c15
  9. Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: a cross-sectional study. Med Educ. 2005;39(6):594-604. https://doi.org/10.1111/j.1365-2929.2005.02176.x
  10. Querido SJ, Vergouw D, Wigersma L, Batenburg RS, De Rond ME, Ten Cate OT. Dynamics of career choice among students in undergraduate medical courses: a BEME systematic review: BEME guide no. 33. Med Teach. 2016;38(1):18-29. https://doi.org/10.3109/0142159X.2015.1074990
  11. Cleland J, Johnston PW, French FH, Needham G. Associations between medical school and career preferences in year 1 medical students in Scotland. Med Educ. 2012;46(5):473-84. https://doi.org/10.1111/j.1365-2923.2012.04218.x
  12. Markert RJ. Why medical students change to and from primary care as career choice. Fam Med. 1991;23(5):347-50.
  13. Underwood MJ, Thompson M, McCaskie A. Insight of first-year medical students into their future working conditions. Med Educ. 1990;24(3):210-1. https://doi.org/10.1111/j.1365-2923.1990.tb00002.x
  14. Nieuwhof MG, Rademakers JJ, Kuyvenhoven MM, Soethout MB, ten Cate TJ. Students' conceptions of the medical profession; an interview study. Med Teach. 2005;27(8):709-14. https://doi.org/10.1080/01421590500271159
  15. Gati I, Saka N, Krausz M. Should I use a computer-assisted career guidance system?: it depends on where your career decision-making difficulties lie. Br J Guid Couns. 2001;29(3):301-21.
  16. Liaison Committee on Medical Education. Functions and structure of a medical school: Standards for Accreditation of Medical Education Programs leading to the MD degree. Washington (DC): Liaison Committee on Medical Education; 2016.
  17. Committee on Accreditation of Canadian Medical Schools. CACMS standards and elements: Standards for Accreditation of Medical Education Programs leading to the MD degree [Internet]. Ottawa (ON): Committee on Accreditation of Canadian Medical Schools; 2016 [cited 2022 Jul 27]. Available from: http://cacms-cafmc.ca/sites/default/files/documents/CACMS_Standards_and_Elements-AY_2023-2024.pdf.
  18. Korean Institute of Medical Education and Evaluation. Accreditation standards of KIMEE. Seoul: Korean Institute of Medical Education and Evaluation; 2020.
  19. Patel SG, Ahmed R, Rosenbaum BP, Rodgers SM. Career guidance and the Web: bridging the gap between the AAMC careers in Medicine Web site and local career guidance programs. Teach Learn Med. 2008;20(3):230-4. https://doi.org/10.1080/10401330802199526
  20. Zink BJ, Hammoud MM, Middleton E, Moroney D, Schigelone A. A comprehensive medical student career development program improves medical student satisfaction with career planning. Teach Learn Med. 2007;19(1):55-60. https://doi.org/10.1080/10401330709336624
  21. Lillevang G, Ringsted C. Career counselling and choice of speciality. Ugeskr Laeger. 2008;170(44):3547-9.
  22. Wijnen-Meijer M, Burdick W, Alofs L, Burgers C, ten Cate O. Stages and transitions in medical education around the world: clarifying structures and terminology. Med Teach. 2013;35(4):301-7. https://doi.org/10.3109/0142159X.2012.746449
  23. Reed VA, Jernstedt GC, Reber ES. Understanding and improving medical student specialty choice: a synthesis of the literature using decision theory as a referent. Teach Learn Med. 2001;13(2):117-29. https://doi.org/10.1207/S15328015TLM1302_7
  24. Hur Y, Lee K. Vocational interest types of medical students and its usage in student career counseling program. Korean J Med Educ. 2012;24(4):309-17. https://doi.org/10.3946/kjme.2012.24.4.309
  25. Kim H, Park S, Kim J, Park E, Lee H. Factors influencing the specialty selection of medical students. Korean J Med Educ. 2003;15(2):151-61. https://doi.org/10.3946/kjme.2003.15.2.151
  26. Kang YJ, Hwang JS, Lin Y, Lee HJ, Han SY, Kim DH. Exploring the preconception of the first year of medical students on medicine before entering medical school. Korean J Med Educ. 2021;33(4):369-79. https://doi.org/10.3946/kjme.2021.205
  27. Yune SJ, Kang SW, Koo HB, Kim MJ, Kim JH, Park HG. Perceptions of medical students and professors about non-clinical jobs for physicians. J Educ Innov Res. 2019;29(3):241-56. https://doi.org/10.21024/pnuedi.29.3.201909.241
  28. Hur Y. Development of a career coaching model for medical students. Korean J Med Educ. 2016;28(1):127-36. https://doi.org/10.3946/kjme.2016.19
  29. Von Bertalanffy L. An outline of general system theory. Br J Philos Sci. 1950;1:134-65. https://doi.org/10.1093/bjps/I.2.134
  30. Owens RG, Valesky TC. Organizational behavior in education: adaptive leadership and school reform. 9th ed. Boston (MA): Allyn and Bacon; 2008.
  31. Super DE. Career education and the meanings of work. Washington (DC): U.S. Department of Health, Education, and Welfare, Office of Education; 1976.
  32. Chen CP. Understanding career development: a convergence of perspectives. J Vocat Educ Train. 1998;50(3):437-61. https://doi.org/10.1080/13636829800200053
  33. Kim BH, Lee JK, Yu HS, Hwang MH, Gong YJ, Son JH, et al. Career counseling theory. Seoul: Hagjisa; 2010.
  34. Fouad NA. The construct of career maturity in the United States and Israel. J Vocat Behav. 1988;32(1):49-59. https://doi.org/10.1016/0001-8791(88)90005-X
  35. Super DE, Jordaan JP. Career development theory. Br J Guid Couns. 1973;1(1):3-16. https://doi.org/10.1080/03069887308259333
  36. Ginzberg E. Career development. In: Brown D, Brooks L, editors. Career choice and development. San Francisco (CA): Jossey-Bass; 1984. p. 169-91.
  37. Herr EL, Cramer SH. Career guidance and counseling through the life span: systematic approaches. 4th ed. New York (NY): Harper Collins; 1992.
  38. Lee SY, Lee MJ, Lee SH. Analysis on students' career preparation in one Korean medical school: based on the relationship and trend between career maturity and specialty indecision. J Korean Med Sci. 2022;37(37):e277. https://doi.org/10.3346/jkms.2022.37.e277
  39. Yoo HH, Park KH, Kim SY, Im SJ. The effectiveness of a career design program for medical students. Korean Med Educ Rev. 2015;17(3):131-9. https://doi.org/10.17496/kmer.2015.17.3.131
  40. Harren VA. A model of career decision making for college students. J Vocat Behav. 1979;14(2):119-33. https://doi.org/10.1016/0001-8791(79)90065-4
  41. Dawes RM. Rational choice in an uncertain world. San Diego (CA): Harcourt Brace Jovanovich College Publishers; 1988.
  42. Bland CJ, Meurer LN, Maldonado G. Determinants of primary care specialty choice: a non-statistical meta-analysis of the literature. Acad Med. 1995;70(7):620-41. https://doi.org/10.1097/00001888-199507000-00013
  43. Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs (NJ): Prentice-Hall; 1986.
  44. Hackett G, Betz NE. A self-efficacy approach to the career development of women. J Vocat Behav. 1981;18(3):326-39. https://doi.org/10.1016/0001-8791(81)90019-1
  45. Mitchell AM, Jones GB, Krumboltz JD. Social learning and career decision making. Cranston (RI): Carroll Press; 1979.
  46. Lent RW, Brown SD, Hackett G. Toward a unifying social cognitive theory of career and academic interest, choice, and performance. J Vocat Behav. 1994;45(1):79-122. https://doi.org/10.1006/jvbe.1994.1027
  47. Fernandez A, Chen V, Quan J, Martinez A, Flowers L, Aronson L. Evaluation of a medical student research and career development program to increase diversity in academic medicine. Acad Med. 2019;94(8):1220-8. https://doi.org/10.1097/ACM.0000000000002760
  48. Bronfenbrenner U. Toward an experimental ecology of human development. Am Psychol. 1977;32(7):513-31. https://doi.org/10.1037/0003-066X.32.7.513
  49. Buddeberg-Fischer B, Stamm M, Buddeberg C, Bauer G, Haemmig O, Knecht M, et al. The impact of gender and parenthood on physicians' careers: professional and personal situation seven years after graduation. BMC Health Serv Res. 2010;10:40. https://doi.org/10.1186/1472-6963-10-40
  50. Soethout MB, Heymans MW, Ten Cate OT. Career preference and medical students' biographical characteristics and academic achievement. Med Teach. 2008;30(1):e15-22. https://doi.org/10.1080/01421590701759614
  51. Lambert EM, Holmboe ES. The relationship between specialty choice and gender of U.S. medical students, 1990-2003. Acad Med. 2005;80(9):797-802. https://doi.org/10.1097/00001888-200509000-00003
  52. Guntern S, Korpershoek H, van der Werf G. Prestige added to Holland's vocational interest scales for the prediction of medical students' aspired work environments. J Career Assess. 2016;24(2):333-46. https://doi.org/10.1177/1069072715580418
  53. Brown AJ, Swinyard W, Ogle J. Women in academic medicine: a report of focus groups and questionnaires, with conjoint analysis. J Womens Health (Larchmt). 2003;12(10):999-1008. https://doi.org/10.1089/154099903322643929
  54. Fadem BH, Nicolich MJ, Simring SS, Dauber MH, Bullock LA. Predicting medical specialty choice: a model based on students' records. J Med Educ. 1984;59(5):407-15.
  55. Jarecky RK, Donnelly MB, Rubeck RF, Schwartz RW. Changes in the patterns of specialties selected by high and low academic performers before and after 1980. Acad Med. 1993;68(2):158-60. https://doi.org/10.1097/00001888-199302000-00014
  56. Enoch L, Chibnall JT, Schindler DL, Slavin SJ. Association of medical student burnout with residency specialty choice. Med Educ. 2013;47(2):173-81. https://doi.org/10.1111/medu.12083
  57. Crimlisk HL, McManus IC. The effect of personal illness experience on career preference in medical students. Med Educ. 1987;21(6):464-7. https://doi.org/10.1111/j.1365-2923.1987.tb01403.x
  58. Schlesinger J, Daley LP. Applying the chaos theory of careers as a framework for college career centers. J Employ Couns. 2016;53(2):86-96. https://doi.org/10.1002/joec.12030
  59. Gorenflo DW, Ruffin MT 4th, Sheets KJ. A multivariate model for specialty preference by medical students. J Fam Pract. 1994;39(6):570-6.
  60. Yune SJ. Park KH. The relationship between MBTI personality type, academic achievement of undergraduate and medical specialty choice of residents: a 5-year follow-up study. Asia Pac J Multimed Serv Converg Art Humanit Sociol. 2018;8(7):391-9.
  61. Wakeford R. Fire the Medical Schools Council if you want more GPs. BMJ. 2014;349:g6245. https://doi.org/10.1136/bmj.g6245
  62. Kuhnigk O, Hofmann M, Bothern AM, Haufs C, Bullinger M, Harendza S. Influence of educational programs on attitudes of medical students towards psychiatry: effects of psychiatric experience, gender, and personality dimensions. Med Teach. 2009;31(7):e303-10. https://doi.org/10.1080/01421590802638048
  63. Svirko E, Goldacre MJ, Lambert T. Career choices of the United Kingdom medical graduates of 2005, 2008 and 2009: questionnaire surveys. Med Teach. 2013;35(5):365-75. https://doi.org/10.3109/0142159X.2012.746450
  64. Coffeng LE, Visscher AJ, Ten Cate OT. The influence of early clinical experiences on career preference of male and female medical students. Med Teach. 2009;31(7):e323-6. https://doi.org/10.1080/01421590802650084
  65. Hafferty FW. Beyond curriculum reform: confronting medicine's hidden curriculum. Acad Med. 1998;73(4):403-7. https://doi.org/10.1097/00001888-199804000-00013
  66. Meurer LN, Bland CJ, Maldonado G. The state of the literature on primary care specialty choice: where do we go from here? Acad Med. 1996;71(1):68-77. https://doi.org/10.1097/00001888-199601000-00020
  67. Bradner M, Crossman SH, Vanderbilt AA, Gary J, Munson P. Career advising in family medicine: a theoretical framework for structuring the medical student/faculty advisor interview. Med Educ Online. 2013;18:21173. https://doi.org/10.3402/meo.v18i0.21173
  68. Phillips SP, Clarke M. More than an education: the hidden curriculum, professional attitudes and career choice. Med Educ. 2012;46(9):887-93. https://doi.org/10.1111/j.1365-2923.2012.04316.x
  69. Holmes D, Tumiel-Berhalter LM, Zayas LE, Watkins R. "Bashing" of medical specialties: students' experiences and recommendations. Fam Med. 2008;40(6):400-6.
  70. O'Donoghue S, McGrath D, Cullen W. How do longitudinal clerkships in general practice/primary care impact on student experience and career intention?: a cross-sectional study of student experience. Educ Prim Care. 2015;26(3):166-75. https://doi.org/10.1080/14739879.2015.11494336
  71. Scott I, Wright B, Brenneis F, Brett-Maclean P, McCaffrey L. Why would I choose a career in family medicine?: reflections of medical students at 3 universities. Can Fam Physician. 2007;53(11):1956-7.
  72. Mihalynuk T, Leung G, Fraser J, Bates J, Snadden D. Free choice and career choice: clerkship electives in medical education. Med Educ. 2006;40(11):1065-71. https://doi.org/10.1111/j.1365-2929.2006.02614.x
  73. Ek EW, Ek ET, Mackay SD. Undergraduate experience of surgical teaching and its influence and its influence on career choice. ANZ J Surg. 2005;75(8):713-8. https://doi.org/10.1111/j.1445-2197.2005.03500.x
  74. Maiorova T, Stevens F, Scherpbier A, van der Zee J. The impact of clerkships on students' specialty preferences: what do undergraduates learn for their profession? Med Educ. 2008;42(6):554-62. https://doi.org/10.1111/j.1365-2923.2008.03008.x
  75. Davis BE, Nelson DB, Sahler OJ, McCurdy FA, Goldberg R, Greenberg LW. Do clerkship experiences affect medical students' attitudes toward chronically ill patients? Acad Med. 2001;76(8):815-20. https://doi.org/10.1097/00001888-200108000-00015
  76. Chung C, Maisonneuve H, Pfarrwaller E, Audetat MC, Birchmeier A, Herzig L, et al. Impact of the primary care curriculum and its teaching formats on medical students' perception of primary care: a cross-sectional study. BMC Fam Pract. 2016;17(1):135. https://doi.org/10.1186/s12875-016-0532-x
  77. Pfarrwaller E, Sommer J, Chung C, Maisonneuve H, Nendaz M, Junod Perron N, et al. Impact of interventions to increase the proportion of medical students choosing a primary care career: a systematic review. J Gen Intern Med. 2015;30(9):1349-58. https://doi.org/10.1007/s11606-015-3372-9
  78. Dornan T, Boshuizen H, King N, Scherpbier A. Experience-based learning: a model linking the processes and outcomes of medical students' workplace learning. Med Educ. 2007;41(1):84-91. https://doi.org/10.1111/j.1365-2929.2006.02652.x
  79. Macaulay W, Mellman LA, Quest DO, Nichols GL, Haddad J Jr, Puchner PJ. The advisory dean program: a personalized approach to academic and career advising for medical students. Acad Med. 2007;82(7):718-22. https://doi.org/10.1097/ACM.0b013e3180674af2
  80. Keating EM, O'Donnell EP, Starr SR. How we created a peer-designed specialty-specific selective for medical student career exploration. Med Teach. 2013;35(2):91-4. https://doi.org/10.3109/0142159X.2012.731110
  81. Welbergen L, von der Borch P, Pander T, Dimitriadis K. Battle of the specialties: innovative career counselling for students. Med Educ. 2013;47(5):515. https://doi.org/10.1111/medu.12159
  82. Aagaard EM, Hauer KE. A cross-sectional descriptive study of mentoring relationships formed by medical students. J Gen Intern Med. 2003;18(4):298-302. https://doi.org/10.1046/j.1525-1497.2003.20334.x
  83. Coates WC, Crooks K, Slavin SJ, Guiton G, Wilkerson L. Medical school curricular reform: fourth-year colleges improve access to career mentoring and overall satisfaction. Acad Med. 2008;83(8):754-60. https://doi.org/10.1097/ACM.0b013e31817eb7dc
  84. Murr AH, Miller C, Papadakis M. Mentorship through advisory colleges. Acad Med. 2002;77(11):1172-3. https://doi.org/10.1097/00001888-200211000-00042
  85. Leong FT, Hardin EE, Gaylor M. Career specialty choice: a combined research-intervention project. J Vocat Behav. 2005;67(1):69-86. https://doi.org/10.1016/j.jvb.2004.07.004
  86. Stewart RW, Barker AR, Shochet RB, Wright SM. The new and improved learning community at Johns Hopkins University School of Medicine resembles that at Hogwarts School of Witchcraft and Wizardry. Med Teach. 2007;29(4):353-7. https://doi.org/10.1080/01421590701477423
  87. Davison I, Burke S, Bullock A, Brown C, Campbell C, Field S. Evaluation of a pilot careers advice service for junior doctors. Med Teach. 2006;28(6):561-3. https://doi.org/10.1080/01421590600877889
  88. Clinite KL, DeZee KJ, Durning SJ, Kogan JR, Blevins T, Chou CL, et al. Lifestyle factors and primary care specialty selection: comparing 2012-2013 graduating and matriculating medical students' thoughts on specialty lifestyle. Acad Med. 2014;89(11):1483-9. https://doi.org/10.1097/ACM.0000000000000487
  89. Flum H, Blustein DL. Reinvigorating the study of vocational exploration: a framework for research. J Vocat Behav. 2000;56(3):380-404. https://doi.org/10.1006/jvbe.2000.1721
  90. Savickas ML, Alexander DE, Jonas AP, Wolf FM. Difficulties experienced by medical students in choosing a specialty. J Med Educ. 1986;61(6):467-9.
  91. Kalet A, Krackov S, Rey M. Mentoring for a new era. Acad Med. 2002;77(11):1171-2. https://doi.org/10.1097/00001888-200211000-00041
  92. Ehrlich PF, Seidman PA. Deconstructing surgical education: teacher quality really matters: implications for attracting medical students to surgical careers. Am Surg. 2006;72(5):430-4. https://doi.org/10.1177/000313480607200513
  93. Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994;69(11):861-71. https://doi.org/10.1097/00001888-199411000-00001
  94. University of Alberta, Faculty of Medicine & Dentistry. MD program: career planning [Internet]. Edmonton (AB): University of Alberta, Faculty of Medicine & Dentistry; c2022 [cited 2022 Jun 6]. Available from: https://www.ualberta.ca/medicine/resources/faculty-and-staff/support-wellness/undergraduate/careerplanning/index.html.