Background
Methods
Study design, sample development and study sample
Academic career | Other career in medicine | |||
---|---|---|---|---|
Females n (%) | Males n (%) | Females n (%) | Males n (%) | |
Specialty aspired to
| ||||
- Primary Care | 0 | 0 | 29 (14.7) | 20 (12.0) |
- Internal Medicine | 1 (11.1) | 6 (18.8) | 56 (28.5) | 48 (29.0) |
- Surgery | 3 (33.4) | 12 (37.5) | 11 (5.6) | 30 (18.1) |
- Gynecology | 0 | 0 | 25 (12.7) | 1 (0.6) |
- Anesthesiology | 1 (11.1) | 1 (3.1) | 18 (9.1) | 16 (9.6) |
- Pediatrics | 2 (22.2) | 4 (12.5) | 23 (11.7) | 5 (3.0) |
- Psychiatry | 0 | 0 | 15 (7.6) | 10 (6.0) |
- Other specialty | 2 (22.2) | 5 (15.6) | 15 (7.6) | 27 (16.3) |
- no clinical field | 0 | 4 (12.5) | 5 (2.5) | 9 (5.4) |
Total | 9 (100.0) | 32 (100.0) | 197 (100.0) | 166 (100.0) |
Instruments
Quantitative data
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Questions concerning socio-demographic data
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Career aspired to (private practice, hospital or academic career), and chosen medical specialty
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Sense of Coherence Scale (SOC-13)[25] (seven-point Likert scale), a measure of a person's resistance to stress and his/her ability to manage stress.
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Personal Attributes Questionnaire, GE-PAQ, German Extended Personal Attributes Questionnaire [26], a self-rating instrument for the assessment of gender-role orientation. Only the Instrumentality (PAQ-I) scale (8 items, six-point Likert scale) was used which contains instrumental traits (e.g. independent, decisive, to be proactive, goal-oriented) considered socially desirable to some degree in both sexes but stereotypically more characteristic of males.
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Career-Motivation Questionnaire [27] (seven-point rating scale), Intrinsic (i.e. enjoyment of and interest in professional activities) and Extrinsic Career Motivation Scale (i.e. striving for promotion, income, prestige) and the Extraprofessional Concerns Scale (i.e. prioritizing family, convenient working hours, job security) were applied.
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Mentor-Protégé Relationships Questionnaire [17] consisting of five scales (Likert scale 0 – 4) measuring career-support type. We only used the Networking scale (4 items) and the Support in career planning scale (3 items). These two scales describe the crucial aspects of mentoring. Our data analyses show that the two scales are highly correlated (r = 0.71). We therefore combined them into one scale named "Mentoring-Experience Scale (MES)", Cronbach's alpha = 0.92.
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Career-Success Scale (CSS) [2] consisting of 7 items addressing scientific activities (number of research projects, lectures, publications, grants, criteria which correspond to the requirements for tenure track)
Qualitative data
Statistical analyses
Results
Academics and non-academics: person- and career-related factors
Academic career mean (SD) | Other career in medicine mean (SD) | univariate p | univariate partial eta2
| |
---|---|---|---|---|
Sense of Coherence SOC-13 | 5.07 (0.85) | 5.10 (0.86) | 0.640 | 0.001 |
PAQ Instrumentality | 4.51 (0.49) | 4.19 (0.68) | 0.026 | 0.012 |
Intrinsic career motivation | 6.33 (0.42) | 6.13 (0.50) | 0.030 | 0.012 |
Extrinsic career motivation | 4.02 (0.71) | 3.69 (0.85) | 0.188 | 0.004 |
Extraprofessional concerns | 3.80 (1.06) | 4.33 (1.00) | 0.004 | 0.020 |
Mentoring | 2.59 (0.94) | 1.69 (0.98) | < 0.001 | 0.047 |
Career Success Scale | 6.24 (2.80) | 1.28 (1.65) | < 0.001 | 0.387 |
Career paths of junior academics interviewed
Process of receiving career support
Category | Examples | ||
---|---|---|---|
1. | Making onself out as a proactive junior academic | 1. | I had to make an active effort to obtain support. The research project came about because we discussed it and I volunteered to tackle it. |
2. | I did not know my superior personally and tried to join his research group. As we were both happy to work together, things developed from there. | ||
3. | Projects were worked out together. The senior physician gave me ideas and supported me in putting them into practice. | ||
2. | Motivating activities by senior academics and mentors | 4. | My mentor herself was very actively involved in mentoring. She had spent 3 years in America where they have mentoring programs. |
5. | My thesis supervisor approached me, we worked his ideas out together, I then put most of them into practice on my own. In time I also developed my own projects and presented them to the relevant people. It was a fluid transition towards independence. | ||
6. | I was in a mentoring program for 1 year. On the whole it was helpful. Everyone was allocated a mentor. I had a professor of anesthesiology. He tended to give me general advice on career issues. As he was in a different specialty he could not provide much help in building up a network. In the mentoring program we also had a few workshops on the qualifications you needed to be eligible for habilitation, how to plan this route and how you could continue academic work in parallel to specialist clinical training. | ||
7. | In the children's hospital in Bern we have a mentoring project which I joined. My mentor worked in the same hospital and had some influence there. Thanks to this person we were able to get some research projects and my further clinical training back on track. | ||
3. | Supportive senior staff at different hierarchical levels | 8. | In Basel the medical school course includes primary care physician training. And this gave rise to a relationship with a family doctor in Basel who now advises me. He has become a mentor to me, especially on the personal level. I also receive a lot of encouragement from the Professor. This is a friendship which arose from my being able to solve his computer problems. I pose no danger to a professor about to retire (although I have no intention of being a danger). I am also supported by colleagues who are a year ahead of me; we are all in this together, everyone has the same problems. |
9. | I received support from senior physicians and heads of department, more in the sense of informal mentoring. Part of the support I received was to ease the pressure in hospital, especially when we wanted to carry out joint clinical studies. | ||
10. | I receive support from my current superior in the sense of mentoring and career planning, also from the laboratory research director, a natural scientist who helps me in my research. | ||
4. | Research resources provides (time, infrastructure, money) | 11. | I received most support from my thesis supervisor, he made it possible for me to spend a year in academia and also financed this with third party funds, he also taught me the academic skills. |
12. | In Bern I had someone who supported me in carrying out research and gave me free time to do it. I was also given access to clinical data and software. | ||
13. | My superior suggested that I could now spend 80% of my time on clinical work and continue doing research for 20%. | ||
14. | I was given support both in planning basic research and in implementing projects, also in how to draw up project applications, present research results to conferences and describe them in publications. | ||
15. | All the conferences I attend are fully paid for, including hotel, flight and car hire. An additional qualification, Master of Science and Clinical Research, is now being funded (CHF 25,000). I am also given the time for this. | ||
5. | Social network and family | 16. | My husband supports me in every way he can. A woman cannot forge a career without a tolerant partner. |
17. | My partner is a biologist and works in research, I discuss quite a lot with her, including future plans, e.g. going abroad. | ||
18. | In my private life there is my wife who is a clinician; she naturally knows what my job entails, can understand my problems and helps me move forward through discussion. | ||
19. | My father-in-law (unfortunately dead now) was also active in research, I had lots of career-specific discussions with him. | ||
20. | My friends support me through our common leisure activities, which balance work. | ||
21. | I received some financial support from my family and parents. |
1. Making oneself out as a proactive junior physician
2. Motivating activities by senior academics and mentors
3. Supportive superior staff at different hierarchical levels
4. Research resources provided (time, infrastructure, money)
5. Social network and family
Experienced career barriers
Category | Examples | ||
---|---|---|---|
1. | Lack of structured residency programs | 1. | Job planning for further training is not very transparent in many specialist fields and hospitals. It is a nuisance having to apply for a job 2 years in advance. Often you do not even get an offer for the whole period of further training. There are still too few further training associations for individual specialist fields. |
2. | There are hardly any structured further training programs for physicians with academic and clinical interests. | ||
3. | In further training you have to be very flexible about where you live and work. I tend to be the social type who wants to stay near family and friends. I would certainly have progressed faster if I didn't mind where I worked. | ||
2. | Interference between clinical training and research activities | 4. | It is difficult to carry on further clinical training and research in parallel. You need to work at least 50% of the time for specialist training, otherwise it is not recognized. There are very few jobs split between 50% research and 50% further clinical training. It is easier to split a job after becoming a specialist. |
5. | It is tremendously difficult to be good at research AND in hospital. I don't know whether I will manage it. It is a great strain, you have to find a way with which you yourself are happy. Clearly a hospital provides services and so you have to be a clinician first and foremost. If I were asked which was more important, a patient or a research project, there would be no question about it being the patient. | ||
6. | If you aspire to an academic career you still have to do the clinical work. You are relied upon to work in your free time. | ||
3. | Insufficient research coaching | 7. | It is difficult to find anyone to initiate you into project planning and research methodology. You always have to keep asking. |
8. | It is not easy to find a research group with a good atmosphere where you are respected but where you also know what you have to achieve, what the targets are. | ||
9. | Far too little support is given in working out projects for a Swiss National Science Foundation grant and for all the preparation and administrative aspects of a stay abroad. | ||
10. | Whether a paper is accepted for a journal depends not only on scientific quality, a part is often played by connections and inside contacts. | ||
4. | Demotivating rivalry | 11. | I have been thwarted by superiors on many occasions. If you are young and successful and achieve recognition from outside you are sometimes perceived as a potential competitor by your superiors. Consequently they do not let you operate. But you are absolutely dependent on this as a surgeon, without operations you cannot become a surgeon; this knocks your motivation. |
12. | Although a lot of senior staff assert that they give us junior academics long-term support, they are often more interested in being listed as co-authors in publications even though they have had hardly any involvement in the projects. But you can't have it out with people because later on you might want to do something in the research line and need a job. As soon as you scare someone off you can say goodbye to further clinical training. | ||
5. | Financial short-comings | 13. | I earn very little in research (CHF 3,500 per month). At 32 it is not pleasant to have to rely on financial support from your parents. It is off-putting when, with all the skills you have acquired to date (technical, intellectual etc.), you have to start at the bottom again. My colleagues who are medics are generally already in senior physician posts and colleagues who work in industry all earn a great deal more than I do. |
6. | Personality related barriers | 14. | Tolerance to frustration and staying power are very important factors in the academic field. Sometimes you can't make any headway for 6 months but still have to motivate yourself to carry on; then you generally make a breakthrough some time afterwards. |
15. | Your own doubt can be the worst hurdle. You begin to wonder whether you are on the right track, whether you are capable enough or good enough. | ||
16. | There are difficulties and hurdles everywhere. I see the whole thing as a sporting challenge. | ||
7. | Gender related barriers | 17. | Women approach things differently, they are less self-assertive and aggressive than men, are more hesitant about aspiring to an academic career at all, and wonder whether it is worth all the effort. |
18. | Not many senior staff believe that women can make a career in surgery. It is hard work convincing them. | ||
19. | It never occurs to senior staff that a woman could habilitate, this happens a lot faster for a young, ambitious man. | ||
20. | The most important thing is self-confidence. You are always hearing that a woman cannot have an academic career and a family at the same time. | ||
8. | Work-family Imbalance | 21. | It is quite difficult to introduce part-time working to many specialist fields, for example intensive-care units. It is often thwarted by management. This is a great career obstacle for assistants who have children and aspire to a challenging career. |
22. | Balancing career planning and family planning is a big problem. It also depends on the partner's attitude. Many women tend to put their career plans on hold to give themselves more time to attend to family chores and leave the man free to pursue his career. If you are a woman aspiring to an academic career you will not start a family until relatively late in life, so you have to expect to be an "old" mother and be fairly certain of not just having a half-time job. |
1. Lack of structured residency programs
2. Interference between clinical training and research activities
3. Insufficient research coaching
4. Demotivating rivalry
5. Financial shortcomings
6. Personality related barriers
7. Gender related barriers
8. Work-Family Imbalance
Recommendations for junior academics
Category | Examples | ||
---|---|---|---|
1. | Career planning | 1. | You should consider the career path you want to take at an early stage, pursue it single-mindedly, think ahead, plan forward, think about what an academic career means, be clear about the amount of time involved, plan a stay abroad in good time. |
2. | You should start on research right after finals or perhaps even complete a PhD course and only then continue clinical training. If you take on a clinical job immediately and want to establish yourself academically at the same time, the effort involved makes this extremely difficult. They are both so different from a methodological point of view that it is hard to cope with them together. If you can concentrate on academic work for a while you learn working techniques, are able to go into things in more depth and set a few projects in motion. This makes it much easier to find your feet. | ||
3. | I would recommend that those who want to make a career in surgery go straight into a large hospital. | ||
4. | Early on you should join an established research team with a good team culture. In such a group you should actively approach people who can advise you and provide a good introduction to academic work. | ||
2. | Interest in and enjoyment of research | 5. | You have to be deeply interested in research and must not stop enjoying it. Quality of life is better if your work gives you pleasure. |
6. | You need power, frustration tolerance and stamina (like a marathon runner or mountaineer, not like someone in the pub). | ||
3. | Mentoring/Networking | 7. | The most important thing of all is to have mentors, firstly as personal advisors and secondly as scientific role models. You should actively seek mentors out. It is difficult to fight your way through alone. At the start it could even be a peer mentor who is a bit ahead of you, but later on an advanced academic should definitely take on the mentoring role; sometimes this can be the head of department or another superior. |
8. | It is important to have a large network, including those of similar age who are somewhat further on. | ||
9. | You have to build a definite network for yourself, not only at local but also at international level. Switzerland is too small to manage without networks. You learn from others the right and wrong moves they have made in their careers. |
1. Career planning
2. Interest in and enjoyment of research
3. Mentoring/Networking
Recommendations for senior staff
Category | Examples | ||
---|---|---|---|
1. | Human resource development | 1. | Identify colleagues with the qualities for an academic career early on, then actively motivate and support them in such a career. |
2. | From the outset hold regular career talks in which presentations and career opportunities are discussed and subgoals are recorded in writing. Hold follow-up discussions to check whether the career is progressing as planned. | ||
3. | Provide young academics with structured coaching on how projects are planned and implemented and the best ways to publish research results. This will help them make faster career progress. | ||
4. | Establish contact with other research groups and send junior staff to conferences so that they can make contacts for themselves. | ||
5. | Show more appreciation of the hard work and dedication of young academics. | ||
6. | At head of department level show a willingness to make protected research time available to clinical trainees so that they have enough time to pursue their studies successfully. Encourage junior academics by providing good basic conditions such as time, infrastructure and research funds. | ||
2. | Role model | 7. | Senior academics should be role models, radiating enthusiasm for their work and their research. As a role model show how different fields such as clinical activity, research and private life can be managed simultaneously with good organization and good resources. This will give young doctors a hopeful and motivating perspective on their career. Senior staff should provide motivated junior academics with a vision. |