The Significance of Experiencing Clinical Responsibilities for Specialty Career Choice

Aim Medical trainees make career choices in the final year of medical school or after graduation, if they do not continue with residency directly. Most Dutch medical students are trained in vertically integrated (VI) curricula, with early clinical experience and a gradual increase in clinical responsibilities. Students in such curricula have been reported to make career choices at an earlier stage than graduates from more traditionally designed curricula. Many Dutch graduates build further clinical experience after graduation as physicians-not-in-training (PNITs) before beginning residency. We explored how students make career choices and whether pre-residency clinical responsibilities influence this choice. Method A qualitative study with a phenomenology approach was used. The authors conducted a longitudinal interview study of medical students with two intervals over a 2-year period. The interview questions covered how trainees establish career preferences and which factors affect preference and choice over time. Results Experiencing clinical responsibility was a key factor for career preference during all interview rounds. Being a PNIT who makes diagnostic and therapeutic decisions, have their own patients and have significant patient care responsibilities creates opportunities to build an image of a future context of employment. Some participants mentioned that their experience of having full responsibility as a PNIT was pivotal in a career preference change. Conclusion Clinical responsibility as a student or a PNIT appears to be important for career preference and choice. The experience of responsibility as a medical doctor forces trainees to reflect on personal needs and to consider which career preference fits best.

Windows to the soul: “Now close your eyes.”

A regional campus dean reflects on his recent acquisition of a new clinical responsibility as medical support to an inpatient behavioral health unit. Having taught the neurological exam to students for almost 35 years, this experience caused him to pause and consider a new perspective on teaching the routine exam. The author has no conflict of interest to report and IRB approval for Treatment of Human Subjects and Treatment of Animal Subjects is not applicable.

Letter to William Gillespie

In this letter, Winnicott asks Gillespie to share clinical responsibility on a difficult case, including a description of this phase of the case.