Analysis Identifies Reasons for Medical Students Choosing Neurology Residency

Author(s):

Many applicants referenced an early interest and exposure to neurology, often describing their first courses in neurology sparking their desire to learn more about how the brain works.

Sarah Grzebinski, MD

Using a large-scale computational linguistics approach, recently published data identified motivations behind medical students that choose neurology, which can in turn inform educational approaches.¹

The investigators concluded that incorporating these themes into medical school neuroscience courses, neurology clerkships, and Student Interest Group in Neurology (SIGN) events may offer neurology educators an opportunity to enhance recruitment. Pushing for more to enter the neurology specialist has been a topic of much discussion in recent years, and for good reason: within an overall ongoing physician shortage in the US, some projections suggest that by 2025, there will be a 19% shortfall in the proper ratio of neurologists to patients needing neurologic care.² Another estimation the National Center for Health Workforce Analysis estimates that while the supply of US neurologists may have grown by 11% between 2013 and 2025, demand will have grown by 16%.³

Lead author Sarah Grzebinski, MD, research assistant, Mount Sinai School of Medicine, and colleagues analyzed a total of 2405 personal statements over 5 years submitted by applicants to Mount Sinai between 2013 and 2017. They hypothesized that specific words and themes would be mentioned in residency personal statements with high frequencies indicating students’ motivations.

Linguistic analysis was performed using term frequency (TF), TF-inverse document frequency (TF-IDF), and K-means clustering. TF identified patterns and frequently repeated phrases and word in each corpus through Antconc, a text analysis toolkit. Demographics and applicant characteristics were extracted from the database using R-programming.

The 3 most frequently mentioned disease states were stroke (TF 2178), epilepsy (TF 970), and dementia (TF 944), whereas diseases such as amyotrophic lateral sclerosis (ALS; TF 220) and carpal tunnel (TF 10) were referenced less often. Grzebinski et al wrote, “We identified that several themes—including personal connections to patients with neurologic disease, the deductive reasoning that distinguishes our field, and the potential for future research and discovery—are powerful motivators for students to apply in neurology, suggesting that embedding these concepts in neurology curricular exposure may foster interest and potentially enhance recruitment to our field.”

Consistently identified themes found in personal statements included (1) fascination with the brain and interest in neuroscience and the mysteries encountered while studying the brain, (2) references to past research and interest in future research experience, (3) the desire to help those in need to heal, (4) early interest in and exposure to neurology, (5) continued pursuit of learning and potential for discovery, (6) application for time and relationships with patients, (7) shared family connection or history with neurologic illness, and (8) intellectual curiosity/interest in puzzles and problem-solving.

Investigators sorted through "looking forward” statements to better understand desires of applicants. They found common themes such as (1) contribution to research, (2) expansion of knowledge and continuity of learning, (3) interaction with a diverse patient population, (4) enhancement of patient quality of life, (5) motivation to become a better physician and improve personal character, and (6) contribution and connection to a team.

When evaluating differences between genders, male responders were more likely to highlight technology and training, while female respondents were more likely to mention love, culture, family members, and support. Additionally, men seemed to highlight experiences and accomplishments; women were more likely to emphasize teamwork and mentorship.

Grzebinski and colleagues also acknowledged that personal statements could carry an inherent bias as medical students may be writing what they believe an evaluation committee wants to hear rather than what truly draws them to the field of neurology. There are ongoing efforts to include further subgroup thematic analyses, comparative studies with applications to other fields, and extending this study over subsequent years to evaluate changing themes of interest among neurology applicants.

REFERENCES

1. Grzebinski S, Cheung H, Sanky C, Ouyang J, Krieger S. Educational research: why medical students choose neurology. Neurology. Published online July 6, 2021. doi: 10.1212/WNL.0000000000011753

2. Fall TM, Storm MV, Chakrabarti R, et al. Supply and demand analysis of the current and future US neurology workforce. Neurology. 2013;81(5):470-478. doi: 10.1212/WNL.0b013e318294b1cf.

3. National Center for Health Workforce Analysis. Health Workforce Projections: Neurology Physicians and Physician Assistants. March 2017. Accessed July 26, 2021. https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/bhw-factsheet-neurology.pdf