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.