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 journey. And I thought, oh, well, I'm not really getting this here in my hospital job in specialty, but maybe that's something I can get in general practice.

So as you say, it's a shame that potentially that's something that's being eroded a bit in current practice.

Speaker B

00:08:14.040 - 00:09:22.490

Yeah, exactly. Yeah, that's a really, really important one.

And that's another study of mine is a very simple survey where I ask more than a thousand gps what they found most rewarding about their career. And it's an open text response and over 45% of respondents wrote down continuity of care.

And in a lot of the discussions we have around continuity of care and its benefits, it's very much patient centered because we know that the quality of improves for patients if they see the same gp. But that kind of. We haven't really thought about that reversed.

So we haven't really thought about what does it mean for a GP to provide continuity of care, to see the same patients.

And clearly now with like, the retention crisis, it's also important that we look at, like, the positive factors, like what do gps really enjoy about the career, what were the reasons why, why they want to become a gp, and how do we kind of protect those things or improve them even more? And I think continuity of care is a very important one there. And I think something we should really, really consider during these policy changes and.

Speaker A

00:09:22.490 - 00:09:44.780

One of the more interesting areas, and maybe one where we can try to make a change or difference in curriculum in medical schools, is those medical school influences that you captured in the literature. And I know, for instance, where I studied, we had really early GP placements in year one of our medical training.

But talk us through how medical school influences impacted on career choices and decisions.

Speaker B

00:09:45.180 - 00:12:06.380

Yeah, so medical school is. Is extremely, like an extremely important time. It's a.

It's a time that, of course, you go from like, knowing about these specialties, knowing about the different career pathways, to actually experiencing them. The most important thing is probably exposure to TP placements.

And actually, like, early exposure was associated with a higher likelihood of pursuing a career in a general practice.

So it's not only the timing, but it's also the quality, which is kind of hard to measure, but a very important thing there was positive role modeling.

So if a medical student during the GP placement is exposed to what they see as a positive role model, then they're more likely to, you know, want to pursue that career as well. And positive role modeling is also, of course, comes down to how much resources is this GP teacher provided with to facilitate the teaching.

So, for instance, a really interesting change is that until 2022, undergraduates GP placements in England received substantially less funding than hospital placements. And right now there's been a change.

It's called the Harmonized Undergraduates Medical Tariff, which for the first time has established equal funding for primary care and secondary care or like the education and placements.

And it would be interesting to see whether, like, improved funding for these GP placements actually also improves the ability of a GP teacher to, you know, give more, maybe more teaching or to. Yeah, to Kind of improve the quality of that.

I think that's another one because it's easy to say, oh, it comes down to just a positive role model or not. But I think it all comes down to the resources they provide, with the time they get, the amount of students they get.

And I think once again, if we set such mandates such as 50% of medical students should become a GP, I think that's the wrong way to go about it. I think it's more, how can we improve the resources for GP teaching and placements such that students have a.

An experience that's fair and that they enjoy? I think those are the kind of policy changes we should think about.

And I think the Harmonized Education Tariff is a very, very positive step in that direction.

Speaker A

00:12:06.780 - 00:12:13.260

And I guess. Are there any other key findings you want to pull out from this paper before we move on to some of the implications and stuff?

Speaker B

00:12:13.420 - 00:12:52.880

I think another one is also the hidden curriculum, and I think that's one that we also. Kind of. Well, I'm actually like, I don't really have any new insights on that, but I think it was by choice, not by chance.

Report from 2016 is still as relevant today as it was when it was published. And I think the kind of.

The policy recommendations from that report are still super important, such as monitoring and addressing the hidden curriculum and also supporting GP role models to counter the misconceptions. Those two kind of policy recommendations are still really, really important.

Speaker A

00:12:53.360 - 00:13:06.480

And I guess, given what you found here, what do you think are your recommendations or what's coming up from the literature about suggestions for how medical students might choose or prioritize general practice as a career choice?

Speaker B

00:13:07.280 - 00:14:38.510

Yeah, I think it comes down to the kind of the two buckets that were also identified by the blend mirror framework. One is the. Well, one is the individual, which I think.

Well, actually you could also look at the individual and see if you promote more diverse recruitment, then maybe the group or the cohorts of medical students are also more diverse and maybe that might represent. That might be helpful with addressing some of the workforce shortages in the future.

And I think very specific thing we should consider there and that we've learned from a lot of, like the US Literature, Australian literature and Canadian literature is specifically the recruitment of medical students from more deprived rural areas, because then according to, like the US literature, Canadian literature and Australian literature, they're more likely to serve in underserved communities. So I think that's the first bucket that the second one is the medical schools.

And I've just said, I think funding there is really important for GP teaching and also like monitoring and addressing the hidden curriculum. And I think the third is like the specialty attributes. So we already talked about continuity of care.

That seems to be a very, very important reason why medical students pursue a career in general practice.

So I think we should consider protecting that more, improving it more, especially on the changes we get with like prioritizing access over continuity of care.

Speaker A

00:14:38.670 - 00:15:04.820

Brilliant.

And it's been really interesting work and I think that this hopefully will help bolster some of the evidence around how we can increase the recruitment of future GPs into practice. So really important work and I think it will have lots of strong policy influences sort of in the future going forward.

So well done with all the this work. But I think that's a great place to wrap things up. So I just wanted to say thanks very much for your time here and for talking about your work.

Speaker B

00:15:05.300 - 00:15:07.300

Thank you so much. I really enjoyed it.

Speaker A

00:15:08.580 - 00:15:23.380

And thank you all very much for your time here and for listening to this bjjp podcast.

Katharina's original research article can be found on bjgp.org and the show notes and podcast audio can be found@bjgplife.com thanks again for listening.

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?

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.

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.

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.

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.

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.

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.

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?

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.

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.

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.

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 journey.

And I thought, oh, well, I'm not really getting this here in my hospital job in specialty, but maybe that's something I can get in general practice.

So as you say, it's a shame that potentially that's something that's being eroded a bit in current practice.

Yeah, exactly.

Yeah, that's a really, really important one.

And that's another study of mine is a very simple survey where I ask more than a thousand gps what they found most rewarding about their career.

And it's an open text response and over 45% of respondents wrote down continuity of care.

And in a lot of the discussions we have around continuity of care and its benefits, it's very much patient centered because we know that the quality of improves for patients if they see the same gp.

But that kind of.

We haven't really thought about that reversed.

So we haven't really thought about what does it mean for a GP to provide continuity of care, to see the same patients.

And clearly now with like, the retention crisis, it's also important that we look at, like, the positive factors, like what do gps really enjoy about the career, what were the reasons why, why they want to become a gp, and how do we kind of protect those things or improve them even more?

And I think continuity of care is a very important one there.

And I think something we should really, really consider during these policy changes and.

One of the more interesting areas, and maybe one where we can try to make a change or difference in curriculum in medical schools, is those medical school influences that you captured in the literature.

And I know, for instance, where I studied, we had really early GP placements in year one of our medical training.

But talk us through how medical school influences impacted on career choices and decisions.

Yeah, so medical school is.

Is extremely, like an extremely important time.

It's a.

It's a time that, of course, you go from like, knowing about these specialties, knowing about the different career pathways, to actually experiencing them.

The most important thing is probably exposure to TP placements.

And actually, like, early exposure was associated with a higher likelihood of pursuing a career in a general practice.

So it's not only the timing, but it's also the quality, which is kind of hard to measure, but a very important thing there was positive role modeling.

So if a medical student during the GP placement is exposed to what they see as a positive role model, then they're more likely to, you know, want to pursue that career as well.

And positive role modeling is also, of course, comes down to how much resources is this GP teacher provided with to facilitate the teaching.

And right now there's been a change.

It's called the Harmonized Undergraduates Medical Tariff, which for the first time has established equal funding for primary care and secondary care or like the education and placements.

And it would be interesting to see whether, like, improved funding for these GP placements actually also improves the ability of a GP teacher to, you know, give more, maybe more teaching or to.

Yeah, to Kind of improve the quality of that.

I think that's another one because it's easy to say, oh, it comes down to just a positive role model or not.

But I think it all comes down to the resources they provide, with the time they get, the amount of students they get.

And I think once again, if we set such mandates such as 50% of medical students should become a GP, I think that's the wrong way to go about it.

I think it's more, how can we improve the resources for GP teaching and placements such that students have a.

An experience that's fair and that they enjoy?

I think those are the kind of policy changes we should think about.

And I think the Harmonized Education Tariff is a very, very positive step in that direction.

And I guess.

Are there any other key findings you want to pull out from this paper before we move on to some of the implications and stuff?

I think another one is also the hidden curriculum, and I think that's one that we also.

Kind of.

Well, I'm actually like, I don't really have any new insights on that, but I think it was by choice, not by chance.

And I think the kind of.

The policy recommendations from that report are still super important, such as monitoring and addressing the hidden curriculum and also supporting GP role models to counter the misconceptions.

Those two kind of policy recommendations are still really, really important.

And I guess, given what you found here, what do you think are your recommendations or what's coming up from the literature about suggestions for how medical students might choose or prioritize general practice as a career choice?

Yeah, I think it comes down to the kind of the two buckets that were also identified by the blend mirror framework.

One is the.

Well, one is the individual, which I think.

Well, actually you could also look at the individual and see if you promote more diverse recruitment, then maybe the group or the cohorts of medical students are also more diverse and maybe that might represent.

That might be helpful with addressing some of the workforce shortages in the future.

And I think very specific thing we should consider there and that we've learned from a lot of, like the US Literature, Australian literature and Canadian literature is specifically the recruitment of medical students from more deprived rural areas, because then according to, like the US literature, Canadian literature and Australian literature, they're more likely to serve in underserved communities.

So I think that's the first bucket that the second one is the medical schools.

And I've just said, I think funding there is really important for GP teaching and also like monitoring and addressing the hidden curriculum.

And I think the third is like the specialty attributes.

So we already talked about continuity of care.

That seems to be a very, very important reason why medical students pursue a career in general practice.

So I think we should consider protecting that more, improving it more, especially on the changes we get with like prioritizing access over continuity of care.

Brilliant.

And it's been really interesting work and I think that this hopefully will help bolster some of the evidence around how we can increase the recruitment of future GPs into practice.

So really important work and I think it will have lots of strong policy influences sort of in the future going forward.

So well done with all the this work.

But I think that's a great place to wrap things up.

So I just wanted to say thanks very much for your time here and for talking about your work.

Thank you so much.

I really enjoyed it.

And thank you all very much for your time here and for listening to this bjjp podcast.

Katharina's original research article can be found on bjgp.org and the show notes and podcast audio can be found@bjgplife.com thanks again for listening.

Bye.