Main findings
Career selection in medical students is a complex and dynamic process
(13). Undergraduate experiences on clinical placements have been cited
by several studies to contribute to career selection (14-16). Following
our review of the literature, this is the first research study to
explore the impact of a clinical placement in obstetrics on medical
student’s career choices using a mixed methods approach.
The results of the questionnaire and interviews have demonstrated
student interest in obstetrics both before and after a clinical
placement in obstetrics and gynaecology. Obstetrics involves healthcare
professionals facilitating safe childbirth whilst attempting to empower
the women during a momentous moment in their lives, which was
highlighted by students as a positive and unique feature.
Student experiences during clinical placements will inevitably vary and
so undergraduate exposure to obstetrics may vary not only between
universities, but also hospital placements within the same university.
In addition, the previous requirement by many medical schools to
“witness a certain number of births” has been removed from many
medical school curricula, which may contribute to the reduction in
exposure students have to this unique environment and thus reducing this
impact this can have on choosing obstetrics as a career (10).
Commonly, medical students describe their experiences of observing
childbirth as an enriching and emotionally fulfilling experience,
contributing positively to their wellbeing and a strong reason to
consider a career in obstetrics and gynaecology, or at least consider a
foundation year job in the specialty. It is important to consider the
variation in exposure students will have to childbirth and this can
include the frequency and type of deliveries they see. Students describe
the difficulties in exposure to uncomplicated vaginal births, due to
opportunities and patient refusal or student midwives prioritisation.
This is an important point to consider for the impact of exposure on
career choice but also the implications for their own future birth
choices as a clinical placement in obstetrics and gynaecology may be the
only exposure students have to childbirth before they have their own
children. In addition to promoting the benefits of a clinical placement
in obstetrics and gynaecology, students may also benefit from
opportunities to discuss the perceived problematic aspects of the
specialty, including the concerns about work life balance demonstrated
in our study.
The introduction of the European Working Time Directive (EWTD) in 2003
has reduced the undesirable impact of working long hours on work-life
balance, yet some students still find the current practice of out of
hours and shift work off putting. Shadowing junior doctors can provide a
realistic representation of life in obstetrics and gynaecology, and the
mentorship provided is known to improve interest in a career in
obstetrics and gynaecology (17). Studies have shown that a positive
experience of a clinical placements, which includes positive learning
experiences, being integrated into the team, and having role models and
mentors, can increase interest in a career in that specialty (18, 19).
Support from mentors and role models can further promote the positive
aspects of the specialty and also protect students from professional
burnout.