The impact of the current medico-legal and regulatory culture in Ireland on the decision of graduate entry medical school students to pursue a career in obstetrics and gynecology

Abstract

Objectives

Medico-legal and regulatory culture has a significant impact on medical practitioners, including the decision of graduates to enter high-risk specialties. This study explores the impact of the current medico-legal and regulatory culture in Ireland on the decision of graduate entry medical students to enter one high risk specialty, obstetrics and gynecology.

Study Design

We conducted a survey of 146 final-year, graduate-entry medical students pre- and post- a 6-week rotation in obstetrics and gynecology in Ireland. Participants were asked to rate the influence (on a four-point scale) of factors such as fear of being sued, being reported to the regulatory body or criminal prosecution on their decision to pursue a career in obstetrics or gynaecology. Data were matched pre- and post-rotation and McNemar-Bowker’s test was used to test for differences in related data. All analysis was conducted using SPSS for Windows version 25.

Results

The responses of 72 students to both questionnaires could be matched (response rate 49.3%). The majority of participants pre-rotation reported that fear of being sued (74%), fear of being reported to the regulatory body (70%) and fear of criminal prosecution (55%) were factors influencing their decision (somewhat or to a great extent) to pursue a career in obstetrics. There were no significant changes post-rotation. Compared to obstetrics, lower proportions of participants pre-rotation considered fear of being sued (54%), fear of being reported to the regulatory body (50%) and fear of criminal prosecution (40%) as factors influencing their decision to pursue a career in gynecology. There were no significant changes post-rotation.

Conclusions

Medico-legal and regulatory culture is shaping the perceptions of graduate entry medical students of obstetrics and gynecology and influencing their decision to pursue a career in the speciality. Understanding the impact of medico-legal culture on career choices including a high-risk specialty such as obstetrics and gynecology is important from both a policy and reform context, and if the healthcare service is to recruit and retain adequate numbers to ensure the safe provision of healthcare.