Today, we’re speaking to Catharina Savelkoul, a DPhil student in Health Economics based at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. Title of paper: Factors Influencing UK Medical Students’ Choice of General Practice: A Systematic Review Available at: https://doi.org/10.3399/BJGP.2025.0226 The UK faces a projected shortage of approximately 15,000 GPs by 2036/37, with a declining proportion of UK medical graduates pursuing general practice. Previous research has identified various contributing factors but lacked a contemporary synthesis within a coherent theoretical framework. This systematic review examines factors influencing UK medical students' career decisions, finding three critical influences: curricula that inadequately represents general practice, a persistent negative hidden curriculum, and the impact of clinical placement quality. Our revised Bland-Meurer model incorporates these findings, providing a comprehensive framework to improve GP recruitment. This systematic review identifies the factors that shape UK medical students’ intentions toward general practice. Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions. Speaker A 00:00:01.120 - 00:00:59.530 Hi and welcome to BJJP Interviews. I'm Nada Khan, one of the associate editors of the bjjp. Thanks for listening to this podcast today. In today's episode, we're speaking to Katharina Savalcool. Katharina is a DPHIL student in Health Economics based at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. We're here today to talk about the paper she's recently published in the BJJP titled Factors Influencing UK Medical Students Choice of General A Systematic Review. So, hi Katharine, it's lovely to meet you and to talk about your work. This is a super interesting area to study because we know that there is a push to increase the number of GPs in practice and I guess that does really start from medical school and people's intentions there. But just to start off, could you talk us through why you decided to do this work and what were you aiming to look at here? Speaker B 00:01:00.050 - 00:03:17.090 Yeah, of course. So the goal of this piece of research, of the systematic review was to synthesize the empirical evidence on the factors that influence medical students, GP, career intention. Because we know that the general practice is what makes the NHS functions. It handles over 300 million consultations annually, manages the long term, most long term conditions, issues over a billion prescriptions per year. And we also know that healthcare systems with a strong, with strong primary care achieve like, better population health in general. But at the same time, right now the projected shortages for the UK are approximately 15,000 GPs by 2036, which is of course a large number and shows like a workforce crisis. And then if we look at the policy response to this, they've been like quite ambitious but also largely unsuccessful. So for instance, Health Education England mandated that 50% of all new medical graduates should enter general practice. And this target has never been met. The same goes for the NHS long term workforce plan to increase GP training places by 50% to 6,000 places in 2031. And the interesting part about this is that the policy responses are all about setting this goal. Right? It's about, you know, we're shifting, we're shifting care to the community, we're expanding training places, more medical students should become a gp. But that's all. Yeah, setting like these, these, these strategies, but at the end it almost seems like the, we're achieving the reverse. So that, that kind of brought me to the question of if we want to, you know, make sure that we have a healthy primary care workforce, that the general practice avoids this large crisis in the future, then maybe Instead of setting these ambitious goals, we should look into the question of what draws medical students to the general practice and also what are some of the reasons why they might not become a gp? And I think if we zoom into those factors at medical school, during medical education, you get a lot more interesting insights that can actually inform more effective policy. I think that's the kind of. That was the reason I conducted this systematic review. Speaker A 00:03:17.970 - 00:03:42.850 That's a great summary of what's been going on with GP recruitment in the past little while in terms of policy and the push to increase the number of gps. And this was, as you mentioned, a systematic review that followed pretty conventional review processes. But I wonder if you could tell us a bit about this bland mirror model. It's a framework used in terms of organizing the results and how this informed how you structured the results. Speaker B 00:03:43.990 - 00:04:47.410 Yeah, I think it's for this specific research question, looking into factors that influence decision making. I decided to look up different theoretical frameworks in order to understand this, because decision making at the end of the days is, of course, something that's influenced by many things at the same time. This model specifically, which was, I think first published in 1995, helped a lot with like, systematically categorizing the findings because it identified three principal domains. One is the student characteristics, such as, like, personal values, maybe personality traits. The second one is the specialty characteristics. So what is the. What are the professional opportunities? And the third one is, like, the influences during medical school. And I think if those are the three kind of domains we saw in this across these, like, 30 years of research, and I think it was the most useful way to kind of theorize these factors. Speaker A 00:04:48.210 - 00:05:01.970 Great. So I guess just talk us through what you found, and I suppose it might be helpful to just talk through the different aspects of that model you've just described. So what were the sort of student characteristics that you found in the literature that influenced and informed specialty choice? Speaker B 00:05:02.640 - 00:06:37.050 Yeah, so I think the findings from this came from different types of studies. I think the largest ones were the ones that used a data set called UK met, which kind of has the data on all UK medical students in such demographic variables, but also more information about their educational performance in medical school. And I think these studies showed us like, the kind of the social, demographic, individual characteristics that are associated with a higher likelihood of pursuing a career in a general practice. And then there's these smaller studies which kind of like looked at personal preferences and personality traits. And I think that that's another really interesting question. Right. Because about this, like, specialty choice and Kind of individual preferences, personality traits. A lot of international research is talking about altruism or do people who enjoy social contact more, are they more likely to become gps? And I think this type of research is quite undeveloped in terms of the UK literature, but it was still interesting to look at it and compare it to different studies. And I think for the demographic factors we saw specifically that female students were more likely to choose gender practice graduates on entry. So age was another one we saw. Yeah, so there's like these different kind of demographic factors or personality traits that seem to predispose you to career in a general practice. Speaker A 00:06:37.290 - 00:06:51.930 And what about the characteristics of the specialty itself or working in general practice specifically that drew some medical students to think about it. So these are potentially medical students looking at gps and thinking, oh, I want that lifestyle or I don't or I want that work. Really? Yeah. Speaker B 00:06:52.150 - 00:07:48.350 On this question, first of all, a lot has changed recently. So I think work life balance was something that was mentioned in like the earlier studies, but right now it has changed so much that that's almost like not something we can, yeah, we can use anymore. But another interesting one, and I think one that we should really take seriously, is that a lot of one of the things that draws students to the general practice is the like, long term patient relationships. So continuity of care. And of course right now with the landscape changing and specifically like the prioritization of access over continuity of care, it might be important to kind of, you know, reconsider those changes in light of the fact that a lot of medical students decide on a career in a general practice because of this like continuity of care aspect that's so unique to primary care. So I think that's another really important one. Speaker A 00:07:48.990 - 00:08:13.560 Yeah, I can definitely relate to that. I think one of the reasons I figured out that general practice was for me was that when I was working in A E, I would flag all the patients I'd seen and clarked in and then wanted to know what happened in their...
