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Using the Delphi Method to Classify Medical Specialties.

One medical specialty classification system applicable for research and career counseling is the person-oriented versus technique-oriented taxonomy. Given that the model was conceptualized in die 1960s, verification based on how medical specialties are practiced and viewed today is necessary. Five specialists in medical career development and advising verified the categorization of specialties. Based on their review, 100% consensus was reached regarding grouping of specialties. This outcome validates the taxonomy of medical specialties and supports its continued use for medical career specialty advising and choice.

Keywords: medical specialty choice, medical student career development, career specialty choice, person-oriented and technique-oriented medical specialties, medical career advising

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Researchers investigating medical specialty choice, as well as advisors and career counselors working with medical students on specialty decision making, rely on up-to-date models to guide their work. One model of medical specialty classification that has immense applicability for research, and for career advising and counseling, is the person-oriented versus technique-oriented taxonomy. This approach to conceptualizing medical specialties was first suggested in the late 1960s (Wasserman, Yufit, & Pollock, 1969; Yufit, Pollock, & Wasserman, 1969), reappeared in the early 1990s (Zeldow, Devens, & Daugherty, 1990), and has been used in more recent studies (Borges & Gibson, 2005; Manuel, Borges, & Jones, 2009; Pedersen, Bak, Dissing, & Petersson, 2011; Taber, Hartung, & Borges, 2011).

Person-oriented specialties refer to specialties that have an orientation toward people, whereas technique-oriented specialties deal more with techniques and instruments (Yufit et al., 1969). Person-oriented specialties are described by Yufit and colleagues (1969) as family medicine, internal medicine, obstetrics/ gynecology, pediatrics, physical medicine and rehabilitation, and psychiatry. Specialties categorized as technique-oriented include surgery, anesthesiology, dermatology, emergency medicine, otolaryngology, pathology, and radiology. Researchers and physicians who reviewed and critiqued our work have criticized the model, questioning how particular specialties are categorized. Coupled with die model's conceptualization dating back to the 1960s, we aim to verify its use based on how medical specialties are practiced and viewed today.

Method

Analysis

We used the Delphi method to verify the model conceptualized by Yufit and colleagues (1969) for classifying specialties as either person-oriented or technique-oriented. The Delphi method, used to obtain convergence of opinion on a specific topic (Yousuf, 2007), is a widely recognized survey method in medical education and other disciplines. The method relies on a panel of experts to reach consensus about a topic or problem. Several rounds of discussion are conducted before experts indicate their final judgment or view.

Participants and Procedure

All Delphi panelists in the present study were members of the Association of American Medical Colleges Careers in Medicine (CiM) Advisory Committee with expertise in specialty classification. Panelists were physicians (three men, two women) representing person-oriented (e.g., psychiatry, pediatrics) and technique-oriented specialties (e.g., emergency medicine, pathology) with mid--to senior-level experience in student affairs. All were practicing clinicians with over 10 years in academic medicine. Panelists convened during a 2013 CiM professional development conference and assisted with verifying the categorization of specialties by participating in three rounds of the Delphi method as seen in Tables 1 and 2. The group's task was to determine the final grouping of person-oriented versus technique-oriented specialties using an iterative process. The questionnaire completed by participants comprised the original grouping of specialties by Yufit and colleagues (1969) of person-oriented (i.e., family medicine, internal medicine, obstetrics/gynecology, pediatrics, physical medicine and rehabilitation, and psychiatry) and technique-oriented specialties (i.e., surgery, anesthesiology, dermatology, emergency medicine, otolaryngology, pathology, and radiology). Participants used a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree) to indicate their agreement with the respective specialties listed under the headings of person-oriented specialties and technique-oriented specialties.

Results

At the end of three rounds of the Delphi method, using the median as the measure of central tendency, a 100% consensus was reached regarding the grouping of specialties composing person-oriented versus technique-oriented specialties, as seen in Tables 1 and 2. The grouping of specialties in these areas matched exactly with the model from the 1960s.

Discussion

The current study highlights that physicians who serve on national committees regarding specialty choice, and who also advise and work closely with medical students on choosing a specialty, determined the classification model from the 1960s as suitable for contemporary use. Practice implications for the current study include the continued use of the taxonomy for advising and counseling students about specialty choice. Medical students often enter medical school with limited knowledge about die career options and specialties open to them, and they may not have had enough experience to choose from the wide variety of specialties that exist. Classifying specialties along the person-oriented and technique-oriented framework can assist students in identifying a more manageable subset of specialties to more fully explore. Specifically, for students who are uncertain or undecided about choosing a particular specialty, the taxonomy can be useful to assist them in broadly differentiating medical specialties. Students can use the taxonomy to align themselves with one group of specialties over another (i.e., person-oriented or technique-oriented) for the sake of simplicity and clarity as they work through the decision-making process. Often, students are pressured by friends, family, faculty, and administrators to have identified a choice of specialty early on in medical school, and this alignment may help them feel less overwhelmed.

A growing body of research has explored factors associated with the person-oriented versus technique-oriented medical specialty model. Researchers have explored personality differences in medical students and physicians using the person-oriented versus technique-oriented framework. These studies, which used a wide variety of measures including the Myers-Briggs Type Indicator (Sliwa & Shade-Zeldow, 1994), the Personal Attributes Questionnaire (Zeldow et al., 1990), and the Personality Research Form (Borges & Gibson, 2005), support personality differences within the taxonomy. As for other medical student characteristics, qualities, and skills, social-dominance orientation has been linked to interest in entering a technique-oriented specialty (Lepiece, Reynaert, van Meerbeeck, & Dory, 2016).

Differences in communication skills exist for medical students pursuing person-oriented versus technique-oriented specialties (Tsao, Simpson, & Treat, 2015). Students entering technique-oriented specialties received higher ratings on communication skills during their technique-oriented clerkships compared with their person-oriented clerkships. Empathy, however, tends to be higher among medical students interested in person-oriented specialties (Chen, Lew, Hershman, & Orlander, 2007). Regarding gender, fewer male medical students compared with female medical students preferred person-oriented specialties (Pedersen et al., 2011). The increasing volume of literature investigating person-oriented versus technique-oriented medical specialties provides justification for verifying applicability of the model for current research.

Limitations

Although panelists represented both person-oriented and technique-oriented specialties, not all specialties within those areas were represented. It is possible that, had all specialties been represented on the panel, their opinions and views may have achieved a different consensus on how specialties within the taxonomy should be classified. Further investigations could replicate the current study with panelists who represent all specialties within the taxonomy. Future studies might also include further classification of additional specialties to cover at least the core medical specialties that students consider for initial entry into specialty training. This could then be expanded, if possible, to identifying its capacity to describe and define subspecialty areas of medicine. Another area of research could involve examining a further differentiation of characteristics within each specialty group. As students continue to narrow their options, what other variables may be important in helping them choose their specialty? Can the taxonomy be used as a higher level organizer that can be incorporated into existing assessment resources available to support specialty choice, such as die Medical Specialty Preference Inventory, available in the Association of American Medical Colleges CiM program (www.aamc.org/cim)? Despite its limitation, our study provides an updated validation of the person-oriented versus technique-oriented taxonomy of medical specialties. It also supports the continued use of the model in contemporary research on medical specialty choice and in medical specialty career advising.

Received 02/14/17

Revised 07/10/17

Accepted 07/10/17

DOI: 10.1002/cdq.12124

Nicole J. Borges, University of Mississippi Medical Center; George V. Richard, Association of American Medical Colleges, Washington, DC. Correspondence concerning this article should be addressed to Nicole J. Borges, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216-4505 (e-mail: nborges@umc.edu).

References

Borges, N. J., & Gibson, D. D. (2005). Personality patterns of physicians in person-oriented and technique-oriented specialties. Journal of Vocational Behavior, 67, 4-20.

Chen, D., Lew, R., Hershman, W., & Orlander, J. (2007). A cross-sectional measurement of medical student empathy. Journal of General Internal Medicine, 22, 1434-1438.

Lepiece, B., Reynaert, C., van Meerbeeck, P., & Dory, V. (2016). Social dominance theory and medical specialty choice. Advances in Health Sciences Education, 21, 79-92.

Manuel, R. S., Borges, N. J., & Jones, B. J. (2009). Person-oriented versus technique-oriented specialties: Early preferences and eventual choice. Medical Education Online, 14, 1-7.

Pedersen, L. T., Bak, N. H., Dissing, A. S., & Petersson, B. H. (2011). Gender bias in specialty preferences among Danish medical students: A cross-sectional study. Danish Medical Bulletin, 58, A4304.

Sliwa, J. A., & Shade-Zeldow, Y. (1994). Physician personality types in physical medicine and rehabilitation as measured by the Myers-Briggs Type Indicator. American Journal of Physical Medicine and Rehabilitation, 73, 308-312.

Taber, B. J., Hartung, P. J., & Borges, N. J. (2011). Personality and values as predictors of medical specialty choice. Journal of Vocational Behavior, 78, 202-209.

Tsao, C. I. P., Simpson, D., & Treat, R. (2015). Medical student communication skills and specialty choice. Academic Psychiatry, 39, 275-279.

Wasserman, E., Yufit, R. I., & Pollock, G. H. (1969). Medical specialty choice and personality: II. Outcome and post-graduate follow-up results. Archives of General Psychiatry, 21, 529-535.

Yousuf, M. I. (2007). Using experts' opinions through Delphi technique. Practical Assessment Research & Evaluation, 12, 1-8.

Yufit, R. I., Pollock, G. H., & Wasserman, E. (1969). Medical specialty choice and personality. Archives of General Psychiatry, 20, 89-99.

Zeldow, P. B., Devens, M., & Daugherty, S. R. (1990). Do person-oriented medical students choose person-oriented specialties? Do technique-oriented medical students avoid person-oriented specialties? Academic Medicine, 65, S45-S46.
TABLE 1
Individual Participant Scores and Median
Scores for Person-Oriented Specialties

                     Family      Internal
                    Medicine     Medicine

Participant        1    2   3   1    2   3

1                  5    5   5   5    5   5
2                  5    5   5   3    4   4
3                  5    5   5   5    4   4
4                  4    4   4   4    4   4
5                  5    5   5   4    4   4
Median score (a)   5    5   5   4    4   4

                    Obstetrics/   Pediatrics
                    Gynecology

Participant        1     2    3   1    2   3

1                  2     2    2   5    4   4
2                  3     3    3   4    4   4
3                  3     3    3   5    4   4
4                  3     3    3   4    4   4
5                  2     3    3   4    4   4
Median score (a)   3     3    3   4    4   4

                      Physical
                    Medicine and    Psychiatry
                   Rehabilitation

Participant        1     2     3    1    2   3

1                  3     3     3    5    5   5
2                  4     4     4    5    5   5
3                  4     4     4    5    5   5
4                  4     4     4    4    4   4
5                  3     3     3    5    5   5
Median score (a)   4     4     4    5    5   5

Note. Numbers under each specialty indicate Delphi round.
Scores indicate participant's level of agreement with the
classification of each specialty as person-oriented on a
Likert scale ranging from 1 (strongly disagree) to 5
(strongly agree).

(a) Median scores calculated by specialty for each
of the person-oriented specialties after Rounds 1,
2, and 3 of the Delphi method.

TABLE 2
Individual Participant Scores and Median Scores
for Technique-Oriented Specialties

                     Surgery      Anesthesiology

Participant        1    2    3    1      2     3

1                  5    5    5    5      5     5
2                  4    5    5    5      5     5
3                  5    5    5    5      5     5
4                  4    4    4    4      4     4
5                  5    5    5    5      5     5
Median score (a)   5    5    5    5      5     5

                                   Emergency
                   Dermatology      Medicine

Participant        1    2    3    1    2    3

1                  4    4    4    3    4    4
2                  4    4    4    4    4    4
3                  3    4    4    4    4    4
4                  3    4    4    3    4    4
5                  4    4    4    4    4    4
Median score (a)   4    4    4    4    4    4

                   Otolaryngology    Pathology      Radiology

Participant        1      2     3   1    2    3    1    2    3

1                  5      5     5   5    5    5    5    5    5
2                  5      5     5   5    5    5    5    5    5
3                  5      5     5   5    5    5    5    5    5
4                  4      4     4   5    5    5    5    5    5
5                  4      4     4   5    5    5    5    5    5
Median score (a)   5      5     5   5    5    5    5    5    5

Note. Numbers under each specialty indicate Delphi round.
Scores indicate participant's level of agreement with the
classification of each specialty as technique-oriented on
a Likert scale ranging from 1 (strongly disagree) to
5 (strongly agree).

(a) Median scores calculated by specialty for each of
the technique-oriented specialties after Rounds 1, 2,
and 3 of Delphi method.
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Author:Borges, Nicole J.; Richard, George V.
Publication:Career Development Quarterly
Date:Mar 1, 2018
Words:2117
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