#KeyLIMEPodcast 218: Does the apple fall far from the tree?

Reference

Griffin B, Hu W. Parental career expectations: effect on medical students’ career attitudes over time. Med Educ. 2019 Feb 7. [Epub ahead of print]

Reviewer

Linda Snell (@LindaSMedEd)

Background

Entry into training for a medical career presupposes a strong motivation; four factors reflecting personal interests have been identified: indispensability, helping people, being respected, and valuing science. In the broad literature on career choice, intrinsic motivation which may reflect personal interests seems to drive career choice. This literature is mainly from western cultures which emphasize individualism,  independence and autonomy.

As well, parents have a strong supportive influence on career decision-making. Less is known about parental expectations and wishes.

In interdependent cultures, career choice may be motivated by a desire or need to fulfill parent expectations.

The authors propose that lack of independence in a career choice might indicate lower personal interest in and motivation for achieving. Parent expectations may also shape what is valued about a chosen career, including status, prestige, financial stability, and social upward mobility.

It is unknown whether this initial motivation of medical students (as affected by parental influence) has longer-term effects on career satisfaction and performance.

Purpose

Research questions were:

• What is the demographic profile and initial career values of medical school applicants who perceived more parent influence regarding their career choice?
• How does parental influence impact outcomes in medical school ( academic performance, career attitudes, well being, and career intentions)?

Key Points on the Methods

Following an admissions interview at one med school in Australia, all students (n=370) asked to complete a survey on on attitudes and motivation regarding their choice of medicine as a career.

Those students accepted to med school received an annual survey x all 5 years of the program.

Survey data were linked: pre-admission, end of first year, end of 5 years and also to end of year exam results.

Measures: parent influence, demographics (SES, age, gender, parent education, ‘culture’..), values, academic marks, career attitudes, career intentions and expectations. These all seemed to be questions selected from diverse but validated scales

Appropriate uni- and multivariate analyses done, comparing parental influence, controlling for other factors.

Key Outcomes

• parent support correlated with parent education level
• culture related to perceived parent expectations (non-western > western)
• valuing medicine for prestige inversely related to opportunity to be of service
• applicants to medicine whose parents communicated strong expectations about acceptable careers were likely to be younger, come from a non-Western background and possibly adopted similar views to their parents in that they expressed higher value of medicine for its prestige and less value of its opportunity for service.
• parent support not associated with intention to practice in an under-served area
• high parent expectations correlated to regret for choosing medicine (ambivalence) and burnout after year 1, perhaps as not a good ‘fit’ personally
• parent influence not related to exam performance

Limitations: ‘direct entry’ from high school so students 4+ years younger than many ‘graduate entry’ programs, where there may be less parental influence; self report; does not proceed into residency or practice.

Implications: “career advisors might provide parents and me school applicants a realistic preview of the demands of medicine and the importance of considering individual suitability alongside family expectations. Once in medicine, part of a professionalism program could train students to explore their motivations to do medicine, examine their family origins, and proactively address well-being and self-care.”

Key Conclusions

The authors conclude…”the first study (in the field of general career research or in research on medical students) to examine the long-term effects of parent influence beyond the actual choice of career. The results showed that receiving informational support about careers from parents had no long term effect on medical students nor did it appear to influence what aspects of medicine were valued by applicants to medical school.”

“there may be some downstream disadvantages for those who experience strong expectations, for particularly in terms of career satisfaction and psychological well-being during medical school.“

Spare Keys – other take home points for clinician educators

There is a whole field of career research out there, some in medicine.

What happens to individual  survey questions from validated questionnaires when removed from the whole?

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