Canadian medical students’ interest in pursuing careers in research, education and administration is on the rise, signalling future physicians’ interest in enhancing the health-care system rather than simply being a part of it.
It is often assumed that the primary goal of Canadian medical education, and the aspiration of those students, is to produce clinicians who provide care in a variety of medical disciplines. Medical schools also must prepare future physicians to fill roles as educators, researchers and administrators to ensure the Canadian medical system continues to advance, support and lead. Understanding the career interests and intentions of Canadian medical students allows medical schools to provide appropriate training and helps inform the direction of health care.
The Association of Faculties of Medicine of Canada (AFMC) delivers questionnaires in most of Canada’s medical schools, including the 17 Academic Health Sciences Centres (AHSC) and 22 Distributed Medical Education (DME) campuses. The questionnaires are considered valuable by medical schools, especially in their medical education accreditation surveys. The AFMC questionnaires are among the only methods of systematically gathering information about student experiences in Canadian MD education programs. AFMC surveys produce detailed information at entry, prior to starting clinical rotations and at the end of medical school. The entry questionnaire includes a question regarding “career intention” on respondents’ career plans.
In both AHSC and their geographically separate DME campuses, responses to the career intention question significantly changed after 2019 (see attached Table 1). There was high reported intention of clinical practice in 2019 that fell considerably in 2020 and 2021 at both AHSC and DME campuses (see Table 1). Meanwhile, the intent to pursue Research/Science, Education and Administration by students at both AHSC and DME campuses significantly increased (see Table 1).
One of the influences on this change may be changes to post-graduate residency specialty program descriptions in Canada’s medical schools reported in the Canadian Resident Matching Service (CaRMS). In 2020, CaRMS for the first time asked residency programs to describe explicitly their expectations of scholarly activity in their CaRMS website profiles. Before 2020, CaRMS provided little guidance to applicants about reporting scholarly activities in their applications.
The increase in career intentions in scholarship (research/science and education) may also be influenced by increasing interest in non-clinical career options in the post-pandemic environment and increasing dissatisfaction with clinical practice among Canadian physicians.
Given the shift in career intentions, it is important for medical schools to consider the access students have to a range of scholarly activity in their home campuses that are in alignment with the Canadian Medical Education Directives for Specialists (CanMEDS). CanMEDS states that scholarly activity is an essential competency of practicing physicians and recommends scholarly activity be a mandatory component of physician education in addition to six other core competencies: medical expert, communicator, collaborator, manager, health advocate and professional.
These essential competencies raise questions about what constitutes research and scholarship. Scholarly activities include more than traditional research. Consistent with valuing inquisitiveness, quality improvement of health services and medical education research qualify as scholarly activities. Scholarly activities also can include organized evidence-based clinical discussions, podcasts or social-media initiatives.
Scholarly activities include more than traditional research.
To obtain a deeper understanding of these new findings about career interests, we recommend the AFMC inquire how students choose their career paths and what training and employment opportunities will allow them to achieve their goals. To do so, the AFMC could follow a panel of students through their time in medical school to determine cause and effect relationships – for example, the effects of clinical learning experiences, general skills, preparedness for residency, research opportunities, mistreatment and financial information on attitudes towards scholarly activity. We also suggest that AFMC include items in its questionnaires that would be sensitive to change over students’ time in medical school. Observations made repeatedly at individual levels can be more influential than cross-sectional studies.
As there is a lack of consensus on how to measure engagement in scholarly activity, other questions may more accurately tap into this activity in the questionnaires. There are few reports about formal evaluation of scholarly activity engagement in medical education programs. Information produced by the AFMC questionnaires can be used to identify topics requiring other methods to better understand the questionnaire findings. For example, the shift of career intent to research/science and education could be examined by qualitative research studies using focus groups involving faculty and students.
The shift in career intentions is encouraging as it will result in more trainees engaged in, and not detached from, scholarly activities. The types of “science” that physicians engage in has broadened, from laboratory and clinical investigation to research on health services and implementation, quality improvement in health services, population health, community engagement and health equity.
This signal toward an increased interest in non-clinical careers is promising in the ways future physicians will, in addition to providing clinical care, be engaged in enhancing the health-care system. The trade-offs of balancing clinical and non-clinical roles, although challenging, must be tackled to address the impact on the volume of clinical care provided by physicians and the number of providers that may be needed to continue to meet current and growing future health care needs.
Table 1. AFMC* MD Student Entry Survey by Academic Health Sciences Centre (AHSC) and Distributed Medical Education (DME) Campuses 2019 to 2021
Question: “Please indicate your career intent from the different activities listed below (select all that apply) …”
n= number of respondents
*Association of Faculties of Medicine of Canada
**Participating Academic Health Science Campuses (AHSC):
2019 and 2020: Dalhousie University (Halifax), Northern Ontario School of Medicine (Thunder Bay), Ottawa University (Ottawa), University of Saskatchewan (Saskatoon), Western University (London)
2021: McMaster University (Hamilton), Université de Montréal (Montreal), Northern Ontario School of Medicine (Thunder Bay), University of Ottawa (Ottawa), University of Saskatchewan (Saskatoon), Western University (London)
***Participating Distributed Medical Education (DME) Campuses:
2019 and 2020: Dalhousie University (Saint John), Northern Ontario School of Medicine (Sudbury), University of Saskatchewan (Regina and Prince Albert), Western University (Windsor)
2021: McMaster University (Niagara and Waterloo), Université de Montréal (Trois-Rivières), Northern Ontario School of Medicine (Sudbury), University of Saskatchewan (Regina and Prince Albert), Western University (Windsor)
**** Due to rounding, some columns do not add up to 100.