Why Neurology (or Not)? A Longitudinal Qualitative Study of Career Decision-Making of First-Year Medical Students

Abstract Objective: The growing shortage of neurologists is in part due to suboptimal recruitment. Little is known about students’ decision-making regarding a career in neurology, particularly early in training. Using a longitudinal qualitative approach, we aimed to understand factors that influence first-year medical students’ decisions about neurology. Methods: We conducted 1-on-1 semi-structured interviews with 15 first-year medical students at 1 institution before and after the pre-clinical neurology course (2018-2019). In the first interview, we asked about career intentions, factors likely to influence specialty choice, and perceptions of neurology. In the second interview, we asked about changes in students’ views over the year. Using thematic analysis we generated codes and clustered coded data into themes. Results: The two most prominent factors influencing career choice in general were lifestyle and personal interest. No students expressed concerns about lifestyle in neurology. Most students were neutral about neurology or had a positive personal interest, which typically increased after the neurology course. Students frequently worried about content difficulty and the curative potential of neurology. Conclusion: Interventions should include early education about the factors important to students in determining specialty choice, including lifestyle, and address potentially negative perceptions of neurology. Increasing time allotment to the pre-clinical neurology course may combat perception of the content as difficult.