Attachment theory in health care: the influence of relationship style on medical students' specialty choice

• Published in: Medical education Vol. 38; no. 3; pp. 262 - 270
• Main Authors: Ciechanowski, Paul S, Russo, Joan E, Katon, Wayne J, Walker, Edward A
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.03.2004; Blackwell; Wiley Subscription Services, Inc
• Subjects: Adult; Career Choice; Choice Behavior; Curriculum subjects: programmes and methods; education; Education, Medical; education, medical, graduate/standards; Educational sciences; Female; graduate/standards; Humans; Interpersonal Relations; Male; medical; Medical and paramedical education; Medicine; Odds Ratio; Primary Health Care; Socioeconomic Factors; Specialization; Students, Medical - psychology; Teaching methods; Medicine; Higher Education; Behaviour; Training Path; Doctor-patient relation; Interpersonal Relation; Occupational choice
• ISSN: 0308-0110; 1365-2923
• DOI: 10.1046/j.1365-2923.2004.01767.x

Introduction  Converging sources suggest that patient−provider relationships in primary care are generally of greater intensity and duration than those in non‐primary care specialties. In this study, we hypothesised that Year 2 medical students whose close relationships were characterised by security and flexibility would be more likely than students who were less comfortable in close relationships to plan to pursue primary over non‐primary care postgraduate training. Methods  We determined the relationship styles and demographic characteristics of 144 Year 2 medical students. We also gathered information regarding their predicted choices of postgraduate training, which were clustered into primary or non‐primary care categories. We compared student choices with respect to their interpersonal relationship styles based on attachment theory. Results  Prevalences of attachment styles were similar to those found in the general population, with 56% of students rating themselves as having a secure relationship style. Students with a secure style were more likely to choose primary care (61%) over non‐primary care compared to those whose styles were characterised by self‐reliance, support‐seeking or caution (41% chose primary care). Compared to those with a secure relationship style, students with a cautious style [OR = 5.9 (1.9, 18.7)] and students with a self‐reliant style [OR = 2.4 (0.96, 5.9)] were more likely to choose non‐primary over primary care, after controlling for gender. Conclusions  Assessing relationship styles using attachment theory is a potentially useful way to understand and counsel medical students about specialty choice.