Table 2 List of studies, extracted themes and findings

Tolhurst et al. 2005 [16]

▪Diversity, continuity of care +

▪A lot of paperwork-

▪Negative attitudes from specialist and teachers to general practice-

▪Poor remuneration-

▪Undergraduate experiences influenced depending on GPs’ attitudes.+/ -

▪Less intensity and length of training, less long working hours.

▪Community and family context +

▪Serious problems are referred to specialists-

▪Family and friends pressure to choose a specialty -

▪Use of pre-existing skills +

▪Less medical indemnity issues+

▪Discomfort assessing the urgency of undifferentiated problems -

▪Prefer focus on a particular area of expertise -

▪Flexibility and part time work allow having a family +

▪Rural practice: practice a lot of skills +, is workload and a lot of responsibility -

Saigal et al. 2007 [17]

▪Holistic perspective.

▪Common disease, easy to treat.

▪Personality of physicians influences on choice.

▪A second career that follows working first in a sub specialty.

▪The length and quality of the exposure

▪Treat the entire family.

▪The presence of a physician role model or mentor.

▪The atmosphere

▪Community based.

▪Long term care.

▪Good relation doctor-patient+

▪Focused on prevention, triage and medical interviews.

▪Home visits.

▪Primary consultation before seeing specialists.

▪Broad knowledge than specialities.

Scott et al. 2007 [18]

▪Broad scope of practice especially in rural settings+

▪Choosing family medicine seems to limit oneself, especially for high-achieving students-

▪Role models affect the choice +/−

▪Lower prestige.

▪Worries about income during their practice life

▪Little representation of family medicine in the curriculum -

▪The easy of matching with family medicine (−)

▪Enduring relationships with patients.

▪Negative view by other specialists-

▪Second-choice residency.

▪Shorter and physically less demanding residency (+)

▪Good lifestyle, flexibility+

▪The culture of the family medicine residency is appealing. (+)

Thistlethwaite et al. 2008 [19]

▪Continuity of care+

▪Lack of support.

▪Negative role models.-

▪Family medicine has prestige but decreasing.

▪Medical education mainly hospital based.

▪Patient-doctor interaction+

▪Lack of time

▪Negative views of GP expressed by hospital doctors without reasons-.

▪Social status.

▪Having general practice exposure earlier +

▪Holistic care+

▪Not intellectually challenging.

▪Negative media coverage-

▪General practice is seen as inferior choice.

▪General practice exposure was more stimulating than expected: needs hand-on experience not just observation.

▪Skill mix

▪Sell GP as a great job

▪Stimulating and variety+

▪Working with people+

▪Autonomy+

▪Flexible working hours and lifestyle+

▪Rural practice: hard work.

López- Roig et al. 2010 [20]

▪Holistic care +

▪Broad and superficial knowledge -

▪Social and academic persuasion for not choosing family medicine.

▪Lost of social role.

▪Lower salaries. ▪Less probability of additional income when practicing in the private sector

▪Undergraduate experiences are significant.

▪The four year residency programme is unnecessary (−).

▪Special relationship with patients+

▪At the bottom of the medical hierarchy.

▪Almost no exposure to family medicine practice: poor idea of what family medicine practice is.

▪The kindest and more tolerant doctors.

▪Repetitive -

▪Unknown status of family medicine as a medical specialty.

▪Exposure to (a few) good family medicine experiences in later training years.

▪The largest breath but depthless medical wisdom.

▪Lack of intellectual challenge.

▪Lack of professional recognition.

▪Absence of medical “technology”-

▪Lower status and facilities.

▪Devalued type of knowledge needed to practice.

▪Population and health care decision-makers do not appreciate Family medicine.

▪Quasi administrative -

▪Family medicine is a necessary specialty but undesirable as a career option.

▪Elderly patients-

▪Gatekeepers of the health care system.

▪First medical contact and referrer to specialties.

Hogg et al. 2008 [21]

▪Varied, challenging+

▪Lower level of control over the medical care and have to refer to specialist.-

▪Bad mouthing from family and hospital doctors-

▪Lower status than hospital based careers -

▪Perception of the early experiences as not “real” medicine.

▪Preference for a career in hospital settings-

▪Bad mouthing from family

▪Importance of general practice exposure+

▪Work outside the medical hierarchy.

▪No attractive media role models -

▪The best of both worlds: a GPs with a special interest

▪Flexibility +

▪Control over financial affairs, working hours and lifestyle +

▪A backup career when you want to make your life external to the medicine a priority.

Edgcumbe et al. 2008 [22]

▪holistic care +/−

▪General practice as a go-between -

▪hospital doctors made derogatory comments about general practitioners and vice versa but it not influenced students’ career choice.

▪Lower status than hospital based specialists -

▪business aspects of running a practice -.

▪The career intentions were influenced by experiences of clinical training.

▪Short, well structured and flexible compared to hospital-based medicine.

▪variety of conditions + vs monotony –

▪Prefer acute conditions and deal with problems without referral.-

▪The status doesn’t always influences career intentions +

▪the 2003 GP contract impinges on the professional autonomy -

▪This experiences were + or – for some students. (some had negative preconceptions before exposure that decreased with it +)

▪Competition in hospital training is unattractive

▪anxiety for wanting quick answers in diagnosis –

▪mundane/ repetitive -

▪Well paid or overpaid (particularly at earlier stages of career) +

▪Lack of research +/ -

▪relationship with patients +

▪administrative work-

▪A second line option after a hospital career-

▪feeling part of the community +

▪lack of time -

▪public health +

▪low-technology environment-

▪concerns in managing risk -☺

▪Professional isolation -

▪friendly work environment +

▪ work anywhere vs remain in one place after buying into a practice +/−

▪flexibility, lifestyle, easy to have a family +

▪independence +

Chirk-Jenn et al. 2005 [23]

▪holistic, comprehensive +

▪bored by repetition of common illnesses –

▪opinions from colleagues and seniors influenced their perceptions

▪disparity between training and practice: what was taught in their classes was not practised: time pressure. lack of support and difficulty in making decisions in a short consultation (−)

▪patient centred +

▪miss the action in the hospital -

▪lecturers not seem to influence their perceptions (which could be because lecturers weren’t in the real world)

▪positive experience in the attachment

▪ the breadth rather than depth of medicine

▪it teaches skills (communication, evidence-based medicine, counselling) rather than knowledge

▪lacked understanding: equating general practice to part of internal medicine or a combination of all other disciplines.

▪triage patients -

▪private GPs more patient centred than those in the government health centres

▪lack of evidence-based practice -

▪relaxing posting

Firth et al. 2007 [24]

▪range of case mix +

▪mundane diseases and boring -

▪peers saw primary care in a negative light: boring and for taking time off.

▪business-driven negative and stressful for some and attractive to other+/−

▪the majority of scenarios studied based within the hospital setting. This added the notion that GP was less interesting.

▪Importance of the quality and enthusiasm of the teachers to make Foundation training a success.

▪increasing amount of medical

▪Bad speaking by hospital tutors’. It influenced perceptions

▪benefit of being taught in primary care: cases not available in hospital

care within primary care.

▪positive view of GP role +

▪quality of the placement was the most influential factor

▪“Social side” of disease (+)

▪media portrayal of the profession as major influence +/ -

▪benefits of an extended period in general Practice +

▪quality of care +

▪negative experiences difficult to reverse (n)

▪relationships +

▪the attachments improved student’s views +

▪multidisciplinary team +

▪better lifestyle but it was not an important consideration

Mutha et al. 1997 [25]

▪ long –term relationship with patients vs surgical specialities that do interventions with immediate and tangible results + .

▪ the breadth of information required interfered with the ability to achieve competency and mastery -

▪clinicians (residents and attending physicians) influenced students’ career decisions +/−

▪neither debt nor future income influenced decisions.

▪perceptions developed during clinical rotations (n)

▪ intellectually challenging: address a variety and complexity of medical problems +

▪exposure to positive role models influenced some students’ choices +

▪Gender differences: for women, the anticipation of being in a dual-income family allowed them to minimize debt or income as a factor in their decision.

▪inpatient services tended to discount the effects of cognitive specialties.

▪exposure to positive role models was neither necessary nor sufficient for most of the students’ career decisions (n)

▪negative role models had strong dissuasive effects on specialty selections -

▪Women could not identify role models: deterrence from considering particular fields and created anxieties and uncertainties -