Table 2.

List of studies, extracted themes and findings

Study	Scope and context of practice	Lower interest or intellectually less challenging	Influence of role models and society	Prestige	Poor remuneration	Medical school influences on specialty choice	Post graduate training
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 -

+: Positive perceptions. -: Negative perceptions. n: Neutral perceptions.