Choice of Specialization
I share with you this reflection on the choice of specialization in medicine.
I am a pneumologist and infectiologist mainly, somnologist incidentally (discipline even not yet gestation in Cameroon), but I will not speak about these disciplines that I like all. No, I would rather suggest ways to choose the specialization, in fact for the choice of a training and / or a trade in general.
I propose a reflection on the ROM model for Rêve-Opportunité-Motivation.
1- The dream:
It belongs to the subjective, it is the passion, the deep desire, the irreproachable envy, it is not known from where it comes. It is sometimes said “I have always wanted to be …. since childhood”. Is this the result of desires or wishes, thoughts, prayers of ascendants? Or the fruit of his own impressions, observations, reflections stored somewhere in the back of the brain in an unconscious way? Dimension metaphysical, spiritual, may be, or existence of a neurobiological substratum? (Neuro-science researchers may enlighten us here). However, this component can weigh heavily and be a powerful engine for the choice and exercise of a profession. But success and fulfillment will depend on the capacity of the subject to realize, assume and adapt to the realities of the craft of his dreams, which unfortunately the dream itself has the gift of presenting only rarely.
The dream is the IDEALIST or SUBJECTIVE component of the choice process.
2- The opportunity.
On a scale of values, the opportunity component could be ranked all the way down, because of the impression that the subject choosing it would let itself be driven by events, would be passive and just wait for the good opportunity and the right time to jump on it . The current context in our country, with its pauperization, the difficulties of employment everywhere else, tend to favor this component of the choice of trade, which is understandable and not at all blameworthy. Moreover, choice based on opportunity can be very effective, provided that the subject is endowed with two essential and complementary things:
The real will to serve (his community, his country, humanity),
Awareness of its adaptive capacities.
Because all our specialized cells of our organism come from the totipotent stem cell (I still see Professor Koueke teach us at the FMSB *, almost 20 years ago 🙂 :-)), as much as each of us Has the potential to exercise any profession, it is sufficient to surround oneself with the specific environment necessary, to give oneself the physical, intellectual, mental, sentimental, spiritual weapons, etc., as the case may be. And in our field, if we already have the dream (already discussed) and / or the motivation (next point) for medicine, the specialty in my opinion matters little and the opportunity is then of paramount importance. Because all areas of medicine have in common the goal of improving the health of a given patient (clinical medicine) and / or whole populations (public health and assimilated). Each discipline is then only a member, a small organ of this magnificent body, each one participating in its own way but indispensable to this praiseworthy objective. I am convinced (it is not scientific but instinctive and empirical) that a small survey in this forum of doctors will show that the majority of specialists have found themselves there by opportunity, then they “adored”, (try?) . So you see, the opportunity, even the opportunism, is not necessarily pejorative.
Opportunity is the PRAGMATIC component of the choice process.
Motivation is the set of forces that trigger and trigger behavior. It would tend to place it at the top of the value scale, in the process of choosing a trade. But still have to consider the type of motivation! For it is a vast domain, covering a fairly wide and varied spectrum.
To try to make simple, we will say that it has two components:
The reasons for commitments: what drives the subject to choose a particular trade / training, this is what is discussed here for many about the choice of the medical specialty;
The motivational dynamics: what drives the subject to continue being motivated when he is already in training or in the field, that is what it is all about students, residents and doctors already on the ground , That we are all.
The reasons for commitments are described in several models, the most complete and operational being the model of self-determination, which appears as a continuum with at the bottom of the scale the amotivation (total absence of motivation) and at the top the Intrinsic motivation “superior”, passing through:
Extrinsic motivation through external regulation: search for social status, hope for rewards (including salary and other benefits), avoidance of sanctions, etc.
Extrinsic motivation by introjected regulation: guilt of not being able to perform certain acts, or on the contrary pride in exercising certain professions or being able to perform certain life-saving acts, wink to surgeons, resuscitators or others “Vice-God Of medicine
The extrinsic motivation by regulation identified: one does what is important for oneself, for one’s aspirations, regardless of whether it is interesting, rewarding or not.
As for intrinsic motivation, which is the “higher” form of motivation, its components are :
The need for autonomous development: It pushes the individual to construct new goals in order to strive for progress and to go beyond what he has already achieved
The need for accomplishment: forces guiding the individual’s behaviors towards activities leading to success and enabling him to avoid failures.
Conceptions of the self and its environment: a force built around cognitive representations (based on the history, the antecedents) in which the individual will project himself. It is the example of individuals who engage in a medical or social sector, because they only consider their job satisfaction through the humanistic and philanthropic dimension associated with their future job.
The relation to knowledge: according to Charlot, this new notion in the field of the human sciences has the interest of revealing an innovative dimension of knowledge “as meaning and pleasure”. It is the pleasure of learning, the pleasure of knowing or satisfaction to overcome difficulties.
I will not develop the motivational dynamics here, but I will be happy to send the article on the motivation ** by mail to whoever wants (you suspect that all this motivational leis is not of me! :-)).
Finally, on this third point, the motivation would be the INTELLECTUAL or OBJECTIVE component of the process of choice of trade.
Seen in this light, all the presentations of each trade (advantages and disadvantages) can at most stimulate a little extrinsic motivation, very little intrinsic, and will have no effect on the passion (which is buried in each of us ) And the opportunity (which will arise when it will or will be created, but must be seized when the time comes).
Here. End of the homily. Thank you to those who have gone all the way.
08 May 2016
* Faculty of Medicine and Biomedical Sciences
** Pelaccia T. et al. Medical Pedagogy 2008; 9: 103-21.