Surgery or General Medicine – • Patrícia Lacerda Bellodi

Original Article
a study of the reasons
underlying the choice of
medical specialty
Hospital das Clínicas, Faculdade de Medicina da Universidade de São
Paulo, São Paulo, Brazil

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INTRODUCTION
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area; the view that this kind of medical prac- ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
ABSTRACT
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tice is the only one possible, because “to be in CONTEXT: The reality of medical services in Brazil
At the moment of choosing a specialty, the medicine is to be a general doctor”; opportu- points towards expansion and diversification of
medical knowledge. However, there are few Bra-
medical student looks within himself and at nity to be involved in psychological and so- zilian studies on choosing a medical specialty.
the work possibilities. He searches for the op- cial aspects of medicine; desire to contribute
OBJECTIVE: To investigate and characterize the proc-
tion that will allow the best integration of these to the community; need to keep options open; ess of choosing the medical specialty among Brazil-
two worlds: the internal and the external. He and finally, because they confer less value to ian resident doctors, with a comparison of the choice
between general medicine and surgery.
thinks about who he is, what his interests are, aspects such as remuneration and lifestyle.9-18
TYPE OF STUDY: Stratified survey.
what is important to him, what he could do The students that choose surgery justify
well, and what the rewards that might be ex- their choice in terms of the opportunity for SETTING: Hospital das Clínicas, Faculdade de
Medicina, Universidade de São Paulo (HC-FMUSP).
pected are. General medicine, surgery, pe- practical procedures and operations offered by
METHODS: A randomized sample of resident doctors
diatrics, psychiatry and others: there are many the field of surgery; their enjoyment of emer- in general medicine (30) and surgery (30) was
possibilities and these are becoming ever more gency care; the effective results; the limiting interviewed. Data on sociodemographic charac-
teristics and the moment, stability and reasons for
numerous, due to the creation of subspecialties of patients’ problems; the practical applica- the choice of specialty were obtained.
within the traditional specialties. Probably for tion of scientific knowledge; the research op- RESULTS: The moment of choice between the two
this reason, one of the most frequent themes portunities; the predominance of in-hospital specialties differed. Surgeons (30%) choose the
specialty earlier, while general doctors decided
within medical education research relates to the practice; the prestige of this field within the progressively, mainly during the internship (43%).
choice of medical specialty, especially today, in medical profession; the opportunity for lead- Most residents in both fields (73% general medi-
cine, 70% surgery) said they had considered an-
view of the concern about the training and dis- ership; their desire to exercise authority; their other specialty before the current choice. The main
tribution of generalists.1-8 greater interest in diagnosis and treatment than reasons for general doctors’ choice were contact
with patients (50%), intellectual activities (30%)
To understand this subject, several factors in interpersonal aspects of patient care; the and knowledge of the field (27%). For surgeons
must be considered: sociodemographic data, the greater remuneration; the lower degree of un- the main reasons were practical intervention
(43%), manual activities (43%) and the results
moment of choice, stability of the choice, aca- certainty in diagnosis; and the greater respect obtained (40%). Personality was important in the
demic aspects, factors of influence, personality enjoyed by residents in this field.9-18 choice for 20% of general doctors and for 27%
of surgeons.
characteristics and also opinions and percep- An important and extensive study19 of
DISCUSSION: The reasons found for the choice
tions regarding the various specialties.1-8 Espe- specialty profiles has shown that Brazil today between general medicine and surgery were con-
cially in relation to the choice between the gen- recognizes 64 specialties. The major fields in sistent with the literature. The concepts of wanting
to be a general doctor or a surgeon are similar
eral medicine and surgical fields, the results in which specialists were concentrated until throughout the world. Personality characteristics
the literature have been quite consistent.9-18 1997 were, in decreasing order: pediatrics, were an important influencing factor for all resi-
dents, without statistical difference between the
In general, students cite the following rea- general surgery, general medicine, specialties, as was lifestyle. Remuneration did not
sons behind their decision to opt for general gynecology-obstetrics, anesthesiology, ortho- appear as a determinant.
medicine: opportunity for a better degree and pedics, cardiology, psychiatry, ophthalmol- CONCLUSION: The results from this group of Brazil-
quality of contact with patients; patient type ogy and radiology. In the 1980s the most ian resident doctors corroborated data on choos-
ing a medical specialty from other countries with
(e.g. elderly, chronic); opportunity for broad sought-after specialties were pediatrics, gen- different social and educational characteristics.
and comprehensive caregiving; diagnostic eral medicine, gynecology-obstetrics, general This congruence indicates that the choice involves
very similar desires and needs in different settings
challenge; intellectual content; satisfaction in surgery, cardiology, psychiatry, anesthesiology and has little dependence on the students’ educa-
tional context.
deepening the study of the patient; ambula- and orthopedics. Doctors receiving the great-
tory practice; contact with practitioners in the est remuneration are concentrated in KEY WORDS: Career choice. Medical specialties.
Medical education. Residents. Brazil.

Sao Paulo Med J 2004; 122(3):81-6.

Ana Carolina S. Busse - [email protected] - CPF: 076.321.215-60

 82 São Paulo Medical Journal — Revista Paulista de Medicina

specialties such as occupational medicine, Nearly half admitted to having experienced ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

METHODS
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urology and plastic surgery.19 difficulties in their choice of specialty.

Men form the majority in some special- Another study21 comparing three groups Subjects
ties, especially in the fields of surgery, ortho- of freshman students verified that there was The participants were 60 residents in the
pedics, urology and radiology. The presence considerable similarity among the students in first year (R1) and second year (R2) of the
of women is more pronounced in other areas the values that they attributed to the various residence programs in surgery and general
such as pediatrics, general medicine, pathol- specialties: the prestige associated with surgery medicine of Hospital das Clínicas, Faculdade
ogy, gynecology-obstetrics and psychiatry. and pediatrics; the profitability of surgery and de Medicina, Universidade de São Paulo (HC-
Most of the specialists are young and in the psychiatry; the doctor-patient relationship in FMUSP). Their distribution was as follows:
30 to 39-year age group.19 psychiatry and general practice; the intellectual • General Medicine Group (Gen Med): 15
The reality of the medical services market capacity in general practice and pediatrics; and R1 (7 men and 8 women); 15 R2 (8 men
in Brazil is pointing towards expansion and the possibility of controlling working hours in and 7 women).
branching out of medical knowledge and a public health service and psychiatry. • Surgery Group (Surg): 15 R1 (10 men and
variety of highly specialized medical services A study22 investigating the relationship 5 women); 15 R2 (11 men and 4 women).
already exist. The subspecialties originate from between gender and specialty choice found In both the general medicine and surgery
pediatrics, radiology, orthopedics and trauma- that, in Brazil, in comparison with other places fields, the first two years of residence are in a
tology, plastic surgery, cardiology etc. They are in the world, there is still a significant differ- general area, such that those who prefer may
increasingly common and constitute “micro- ence between men and women in the choice then choose a subspecialty.
cosms of the process of medical care divi- of certain specialties. Women tend toward The two groups were randomly consti-
sion.”19 However, despite this diversity, there pediatrics and men toward surgery and ortho- tuted, with an attempt to compose a balanced
are few studies concerning the choice of medi- pedics. There has been a decrease in the choice sample with regard to sex. The final composi-
cal specialty in Brazil. of general medicine for both sexes and an in- tion of each group was due to the gender char-
In a study involving final-year students at crease in the choice of anesthesiology among acteristics of the total resident population in
eight medical schools, the author20 verified men and radiology among women. the two specialties. Surgery is still a predomi-
that almost half of the students, when enter- Although the results found in Brazil are nantly masculine career field and, during the
ing medical school, had already thought about not generally discordant with those from other study period, there were only 10 women in
a specialty. For one-quarter of these, their first countries, there are, as already mentioned, very the residence program, one of whom did not
choice prevailed. The students that preferred few national studies. Given the size of the consent to participate in the research. In ad-
psychiatry and surgery presented the highest country and the specific needs of the Brazil- dition, two other residents, both in general
percentage of stability of choice. Differences ian healthcare system, the trends in specialty medicine, did not agree to participate in the
appeared between men and women with re- choice should be appraised continually. study, for personal reasons.
gard to the reasons given for their choices. Men This study aimed to investigate and char- The residents as a whole were young, had
gave greater value to monetary income, im- acterize the process of choosing a medical entered university quite early (before the age
mediate therapeutic results and having private specialty among a group of Brazilian resident of 20 years, on average), were single (only a
work. Women, on the other hand, attributed doctors, especially with regard to comparing few married women), Catholic in their ma-
more importance to an academic career and a the choice between the fields of general medi- jority, with parents in the same profession,
work schedule that would be more regular. cine and surgery. and most of them came from the southeast-

Figure 1. Moment of choice for the future field of work in medicine by medical residents in Hospital das Clínicas (São Paulo, Brazil).

Sao Paulo Med J 2004; 122(3):81-6.

Ana Carolina S. Busse - [email protected] - CPF: 076.321.215-60

 São Paulo Medical Journal — Revista Paulista de Medicina
83

ern region of Brazil and from state capital ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

RESULTS
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considered fields where surgical techniques
cities. Surgery residents were alumni of pub- were also present (gynecology-obstetrics, oph-
lic medical schools, especially FMUSP itself, The moment of choice thalmology, orthopedics etc).
while in the general medicine program there There was a significant difference between
was a larger proportion of students from pri- the two specialties with regard to the moment Reasons for the choice
vate schools. of choice for the future field of work within The reasons given by the residents for their
medicine (Figure 1). It was observed that there choice are shown in Table 2. The reasons in-
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INSTRUMENT
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is less movement among those that choose dicated by general medicine residents were
surgery: 30% of the surgery residents declared mainly the contact with patients (50%), in-
The randomly selected residents that agreed that they had chosen the specialty even before tellectual activities (30%) and knowledge of
to participate in the research were interviewed starting university, in comparison with only the field (27%). When their reasons were com-
in sessions of approximately one hour. 7% of the general medicine residents. For pared with those presented by the surgery resi-
The author developed a questionnaire, those that choose general medicine the deci- dents, statistically significant differences were
with open and closed questions, structured to sion tends to consolidate as the course found in the following categories (illustrated
include aspects considered important in the progresses: 43% of the general medicine resi- with some examples):
decision-making process for the choice of dents, in comparison with only 20% of the • Because of the contact with patients (p =
medical specialty. Data was obtained regard- surgeons, made the choice of specialty during 0.000)
ing sociodemographic characteristics, the the time of internship (p = 0.055). “I am fascinated by the doctor-patient rela-
moment of choice, stability of the choice and tionship; the choice could not be a specialty
the reasons for the choice of specialty. Stability of the choice without a patient...” (Gen Med male)
The answers obtained were classified and Although there was a difference in the · Because of the overall view of the patient
analyzed by the researcher herself, and by two moment of choice between the two specialties, (p = 0.005)
other independent judges. most of the residents in both fields (73% in “In order to have the possibility of seeing the
Data analysis and comparison between the general medicine and 70% in surgery) declared patient in an integrated manner...” (Gen
variables studied were performed by means of that they had considered another specialty Med male)
non-parametric statistical analysis through the before the current choice (Table 1). • Because of preference for intellectual ac-
Mann Whitney U and chi-squared tests, It was observed that general doctors con- tivities (p = 0.001)
adopting the significance level of p = 0.05. sidered several other fields, while the surgeons “Because I like general medicine. I really

Table 1. Stability of the choice for the future field of work in medicine: other prior choices
by medical residents in Hospital das Clínicas (São Paulo, Brazil)
General medicine Surgery

Other Prior Choices Male Fem. Total Male Fem. Total

(n = 15) (n = 15) (n = 30) (n = 21) (n = 9) (n = 30)
% % % % % %

NO 20 33 27 29 33 30
YES 80 67 73 71 67 70

General surgery 47 27 37
Neurology/neurosurgery 13 13 13
Infectology 7 3
Preventive medicine 7 3
Radiology 7 3 5 11 7
Otorhinolaryngology 7 3 5 3
Dermatology 7 3 11 3
Pediatrics 13 20 17 10 11 10
Psychiatry 7 3 5 11 7
General medicine 19 11 17
Oncology 5 3
Orthopedics 19 13
Gynecology/obstetrics 10 11 10
Ophthalmology 5 3
Anesthesiology 5 3
Intensive therapy 10 11 10

Note: Categories are not mutually exclusive.

Sao Paulo Med J 2004; 122(3):81-6.

Ana Carolina S. Busse - [email protected] - CPF: 076.321.215-60

 84 São Paulo Medical Journal — Revista Paulista de Medicina

enjoy clinical reasoning; it gives me pleas- The following aspects were significant for • Because of the type of patient (acute prob-
ure...” (Gen Med male). residents of the surgery area (followed by ex- lems) (p = 0.040)
• Because of the type of intervention (con- amples): “I don’t like chronic patients. [On the other
tinuous preventive) (p = 0.040) • Because of preference for manual activi- hand, through surgery] a young patient goes
“The general doctor follows the patient up ties (p = 0.000) into the hospital and leaves well, even if the
continuously. Chronic disease creates a tie...” “I like to manipulate. The general doctor problem was acute...” (Surg male).
(Gen Med female). thinks he cures, but he doesn’t put his hands
• By elimination, because of a lack of choice on the patient to help...” (Surg male). It is important to highlight that there were
(p = 0.040) • Because of the type of surgical interven- no statistically significant differences between
“I knew what I didn’t want. I never liked tion (practical/objective) (p = 0.000) men and women within each specialty, in re-
surgery; I don’t like procedures...” (Gen Med “The possibility of being practical, objective. lation to the reasons for the choice that were
female). If you can’t operate, then acquire patience...” presented.
• Because the general doctor is the “true (Surg male).
doctor”; general medicine is “what medi- • Because of the results obtained (fast, vis- ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
DISCUSSION
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cine is about” (p = 0.040) ible and effective) (p = 0.000)

“I thought being a doctor would be like this: “Because you can see things happening The general medicine residents’ main rea-
working with reasoning and hypotheses...” through what you are doing. You can see that sons involved essentially two basic aspects of
(Gen Med male). a tumor is being removed...” (Surg male). this clinical field: the subjective relationship
• Because the surgeon is the complete doc- with the patient and cognitive knowledge.
For surgery residents, the most important tor; surgery goes beyond general medicine Some residents summarized these two funda-
reasons related to the practical and objective (p = 0.021) mental aspects of general medicine in their
aspects of surgical intervention (43%), the “He would be, modesty aside... a more com- responses to justify their choice, for instance:
manual activities (43%) and the results ob- plete doctor: he is a general doctor and also “It stimulates more research and has a closer re-
tained (40%). a surgeon” (Surg male). lationship with the patient. I enjoy creating a

Table 2. Reasons for the choice for the future field of work in Medicine by medical residents in Hospital das Clínicas (São Paulo, Brazil)
General edicine Surgery

Why This Speciality? Male Fem. Total Male Fem. Total

(n = 15) (n = 15) (n = 30) (n = 21) (n = 9) (n = 30)
% % % % % %

Contact with patient * 40 60 50

Overall view of patient * 20 27 23
Knowledge of the field 27 27 27 10 11 10
Results obtained * 33 56 40
Preference for intellectual activities * 40 20 30
Preference for manual activities * 38 56 43
I have manual dexterity 11 3
I do not have manual dexterity 7 7 7
Type of intervention (continual and preventive)* 13 13 13
Type of intervention (practical and objective) * 52 22 43
Because of lifestyle 20 27 23 10 7
Because of the diversity of fields 7 3 10 7
By exclusion, lack of option * 27 13
Type of patient (acute problems) * 14 11 13
Type of patient (chronic problems) 13 7
Surgeon is a complete doctor * 14 22 17
Clinical doctor is “the true doctor” * 27 13
Type of personality 7 33 20 29 22 27
Family influence 7 7 7 5 3
Opposition to family influence 7 3
Influence of others 11 3
Identification with a role-model at the medical school 7 3 22 7
Non-parametric Mann-Whitney U test (p < 0.05)

Note: Categories are not mutually exclusive. * Statistically significant difference between the specialties. Intra-group comparison between sexes: Clinical (male = female) –
for all reasons; surgery (male = female) – for all reasons.

Sao Paulo Med J 2004; 122(3):81-6.

Ana Carolina S. Busse - [email protected] - CPF: 076.321.215-60

 São Paulo Medical Journal — Revista Paulista de Medicina
85

stronger bond with the patient. The length of of surgery, as expressed in their responses. tor is to be a general doctor”. Some residents
time you see the patient in the other fields is very There was a desire to be a surgeon, but not in the present study also justified their choice
short... the field of knowledge is more wide-rang- the desire to work as one: “Because of the life- with the response: “because the general doc-
ing: you have to know at least a little of every- style of surgery, without scheduling for anything, tor is the ‘true doctor’; general medicine is
thing. I don’t want to be a super-specialist in without a set time to eat lunch: the surgeon doesn’t ‘what medicine is about’”. This was some-
just one thing...” (Gen Med male). know when it will finish. It’s a lot of hours on times associated with their doctor during
Likewise, the surgeons’ main reasons were your feet...” (Gen Med male). childhood: “In the child’s ideal, the doctor is
related to the fundamental aspects of the field When abilities and personality were the general doctor” (Gen Med female).
of surgery: the technical abilities inherent to considered as internal determinants, they Although the justification among surgery
surgical activity and the less direct and less supplanted the external ones (influence of residents in the present study that “the sur-
personal doctor-patient relationship, which others in the socialization process, social geon is a complete doctor; surgery goes be-
tends to be standardized and usually pro- representation of the field and lifestyle), for yond general medicine” did not appear
grammed. Some answers among the residents residents in the fields of both general medi- among the most frequent reasons indicated
of surgery condensed these aspects, for in- cine and surgery. in the literature, this seems to lead on to an-
stance: “I like to cut and sew. Because of the However, internal determinants as a whole other aspect that is notably present in sev-
type of patient, I would never want to get into were more important in the surgeons’ choice eral studies: omnipotence, arrogance and
geriatrics or neurology. I prefer young people; cases than in the general doctors’ choice. While 57% narcissism as surgeons’ personality character-
that are resolved more smoothly. He/she comes of the residents in general medicine cited abili- istics. “It’s like winning a game or a contest ...
and is operated on: surgery gives the impression ties and personality as determinant factors, the There is some power in performing surgery: this
of a more tangible thing, work with a faster re- proportion for residents in surgery was ap- gives pleasure. You go there and it gets done.
sult.” (Surg male). proximately 73%. For the general doctors, The difficult part is the best part. The surgeon
For the surgeons, their personality traits external determinants prevailed, especially life- solves the situation. We can do clinical treat-
attracted them positively to that specialty. For style, which was mentioned more by the gen- ment: no need to call the other guy, the general
some of the general doctors, their personal eral doctors (23%) than by the surgeons (7%). doctor. A surgeon is more independent, more
characteristics did not so much favor enter- It is interesting to note at this point that complete. Like a general practitioner, he is more
ing the field of general medicine, but rather remuneration, although mentioned in the lit- complete...” (Surg male).
they steered these doctors away from surgery. erature as quite important in the decision to
The general doctors stated in relation to per- specialize in surgery, did not appear as a de- ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
CONCLUSIONS
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sonality: “I did not have a personality profile terminant in Brazil, either for the choice of
for surgery, nor did I have manual dexterity. I general medicine or for the choice of surgery. In summary, the results regarding the
found surgery tedious...” (Gen Med male). To conclude the discussion regarding the process of choosing a medical specialty among
On the other hand, surgery residents factors influencing the choice of each a group of Brazilian residents corroborated
stated, in relation to their personality charac- specialty, it is worth commenting on the data found in other studies on this topic.
teristics, that: “It has to do with personality. I opinions and perceptions showed by the resi- This congruence indicates that becom-
am a practical guy and I don’t like beating about dents. As has been described in the litera- ing a doctor – general doctor or surgeon – is
the bush: the problem is this and it has to be ture, medical students choose the field of a process with very similar questions, desires
solved in this way...” (Surg male). general medicine by “considering that this and needs in different places in the world and
The surgeon’s lifestyle was responsible for approach to medicine is the only one that has little dependence on the student’s edu-
some general doctors’ decision against the field can be practiced and, therefore, to be a doc- cational context.

Sao Paulo Med J 2004; 122(3):81-6.

Ana Carolina S. Busse - [email protected] - CPF: 076.321.215-60

 86 São Paulo Medical Journal — Revista Paulista de Medicina

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References
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1. Bland CJ, Meurer LN, Maldonado G. Determinants of pri- Hospital from 1929 through 1994. Acad Med. 1998; 15. Henry P, Leong FT, Robinson R. Choice of medical specialty:
mary care specialty choice: a non-statistical meta-analysis of the 73(3):313-7. analysis of students’ needs. Psychol Rep. 1992;71(1):215-24.
literature. Acad Med. 1995;70(7):620-41. 8. Odusanya OO, Nwawolo CC. Career aspirations of house of- 16. Kassler WJ, Wartman SA, Silliman RA. Why medical students
2. Campos-Outcalt D, Senf J, Watkins AJ, Bastacky S. The effects ficers in Lagos, Nigeria. Med Educ. 2001;35(5):482-7. choose primary care careers. Acad Med. 1991;66(1):41-3.
of medical school curricula, faculty role models, and biomedi- 9. Coutts-van Dijk L, Bray JH, Moore S, Rogers J. Prospective 17. Rogers LQ, Fincher RM, Lewis LA. Factors influencing medi-
cal research support on choice of generalist physician careers: a study of how students’ humanism and psychosocial beliefs re- cal students to choose primary care or non-primary care
review and quality assessment of the literature. Acad Med. late to specialty matching. Acad Med. 1997;72(12):1106-8. specialties. Acad Med. 1990;65(9 Suppl):S47-8.
1995;70(7):611-9. 10. Batenburg V, Smal JA, Lodder A, de Melker RA. Are profes- 18. Kassebaum DG, Szenas PL. Factors influencing the specialty
3. Meurer LN, Bland CJ, Maldonado G. The state of the litera- sional attitudes related to gender and medical specialty? Med choices of 1993 medical school graduates. Acad Med.
ture on primary care specialty choice: where do we go from Educ. 1999;33(7):489-92. 1994;69(2):163-70.
here? Acad Med. 1996;71(1):68-77. 11. Vaglum P, Wiers-Jenssen J, Ekeberg O. Motivation for medical 19. Machado MH. Os médicos no Brasil: um retrato da realidade.
4. Medical specialty choice: A select bibliography with abstracts. school: the relationship to gender and specialty preferences in a Rio de Janeiro: Editora Fiocruz; 1997.
Acad Med. 1993;68(5):391-436. nationwide sample. Med Educ. 1999;33(4):236-42. 20. Cruz EMTN. A escolha da especialidade em medicina. [thesis]
5. Ellsbury KE, Burack JH, Irby DM, et al. The shift to primary 12. Gorenflo DW, Ruffin MT 4th, Sheets KJ. A multivariate model Campinas (São Paulo): Faculdade de Ciências Médicas da
care: emerging influences on specialty choice. Acad Med. for specialty preference by medical students. J Fam Pract. Universidade Estadual de Campinas; 1976.
1996;71(10 Suppl):S16-8. 1994;39(6):570-6. 21. Nunes ED. A medicina como profissão - contribuição ao estudo
6. Block SD, Clark-Chiarelli N, Singer JD. Mixed messages about 13. Fincher RM, Lewis LA, Jackson TW. Why students choose a da escolha ocupacional entre estudantes de Medicina. Revista
primary care in the culture of U.S. medical schools. Acad Med. primary care or nonprimary care career. The Specialty Choice Brasileira de Educação Médica. 1979;3(2):47-60.
1998;73(10):1087-94. Study Group. Am J Med. 1994;97(5):410-7. 22. Figueiredo JF, Rodrigues M de L, Troncon LEA, Cianflone AR.
7. Krol D, Morris V, Betz J, Cadman E. Factors influencing 14. Osborn EH. Factors influencing students’ choices of primary Influence of gender on specialty choices in a Brazilian medical
the career choices of physicians trained at Yale-New Haven care or other specialties. Acad Med. 1993;68(7):572-4. school. Acad Med. 1997;72(1):68-70.

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PUBLISHING
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INFORMATION
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RESUMO
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Acknowledgments: The author thanks all the residents that Clínica ou Cirurgia – um estudo sobre razões da de atividades intelectuais (30%) e aos conhe-
participated in this study for their collaboration and escolha da especialidade cimentos da área (27%). Para os cirurgiões,
enthusiasm regarding the research objectives.
as principais razões de escolha disseram res-
CONTEXTO: A realidade da Medicina no Bra- peito ao tipo de intervenção prática e objeti-
Meeting, date and place where the paper was pre- sil aponta para uma expansão e uma diversi- va (43%), ao gostar de atividades manuais
sented, if applicable: “Medical Education in a Mul- ficação do conhecimento médico e uma va- (43%) e aos resultados obtidos na área – rá-
ticultural World”, Association for the Study of Medical Edu-
cation (ASME), The Royal College of Surgeons in Ireland,
riedade altamente especializada de serviços pidos e concretos (40%). A personalidade foi
Dublin, Ireland, July 11-13, 2001. médicos. Entretanto há poucos estudos a res- importante na escolha da especialidade para
peito da escolha da especialidade médica em 20% dos clínicos e 27% dos cirurgiões.
nosso país. DISCUSSÃO: As razões da escolha pela clínica
Patrícia Lacerda Bellodi, PhD in Psychology. Mem-
ber of the Center for the Development of Medical Educa- OBJETIVO: Investigar e caracterizar o processo médica ou cirurgia neste estudo foram bem
tion (CEDEM), Faculdade de Medicina, Universidade de da escolha da especialidade médica em um consistentes com os dados da literatura. Pa-
São Paulo. Coordinator of the tutors’ program, Faculdade grupo de residentes brasileiros, comparando rece que os conceitos de “querer ser clínico”
de Medicina, Universidade de São Paulo. Member of the a opção pela clínica médica e pela cirurgia. ou “querer ser cirurgião” são semelhantes no
students’ psychological support group (REPAM), Faculdade
TIPO DE ESTUDO: pesquisa através de amos- mundo. Características de personalidade fo-
de Ciências Médicas da Santa Casa de São Paulo, São
Paulo, Brazil. tra estratificada e randomizada. ram fatores influenciadores importantes men-
LOCAL: Hospital das Clínicas da Faculdade de cionados pelos residentes em geral, sem dife-
Medicina da Universidade de São Paulo (HC- rença estatística entre as especialidades. En-
Sources of funding: CNPq grant no 140584/1994-3
FMUSP). tretanto, na análise qualitativa, a personali-
Conflict of interest: None dade diferiu nas duas especialidades. Estilo
MÉTODOS: Há uma diferença significativa no
Date of first submission: July 27, 2003 momento da escolha entre as duas especiali- de vida configurou-se da mesma forma. Re-
Last received: October 10, 2003 dades. Cirurgiões escolhem mais cedo a es- muneração não apareceu como determinante.
Accepted: November 13, 2003 pecialidade, antes mesmo do início do curso CONCLUSÃO: Em geral, os resultados obtidos
(30%), enquanto a decisão dos clínicos é pro- no Brasil reafirmam estudos realizados em
Address for correspondence: gressiva ao longo do tempo, principalmente outros países com características sociais e
Patrícia Lacerda Bellodi nos dois últimos anos, no internato (43%). educacionais bastante diversas. Esta
R. Dona Luiza Júlia, 12 — Apto. 62 A maioria dos residentes das duas especiali- congruência indica que a escolha da especi-
São Paulo/SP — Brasil — CEP 04542-020
E-mail: [email protected]
dades (73% na clínica e 70% na cirurgia) alidade médica é um processo vocacional que
chegou a considerar outra especialidade, mas envolve desejos e necessidades muito simi-
mostrou-se bastante satisfeita com a escolha lares e pouco dependente do contexto edu-
realizada. As principais razões de escolha pela cacional do aluno.
clínica disseram respeito especialmente ao PALAVRAS-CHAVE: Profissão. Especialidades
contato com o paciente (50%), ao gostar mais médicas. Educação médica. Brasil.
COPYRIGHT © 2004, Associação Paulista de Medicina

Sao Paulo Med J 2004; 122(3):81-6.

Ana Carolina S. Busse - [email protected] - CPF: 076.321.215-60