Open Access Highly Accessed Research article

Using relationship styles based on attachment theory to improve understanding of specialty choice in medicine

Paul S Ciechanowski1*, Linda LM Worley2, Joan E Russo1 and Wayne J Katon1

Author Affiliations

1 Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA

2 Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

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BMC Medical Education 2006, 6:3  doi:10.1186/1472-6920-6-3

Published: 11 January 2006

Abstract

Background

Patient-provider relationships in primary care are characterized by greater continuity and depth than in non-primary care specialties. We hypothesized that relationship styles of medical students based on attachment theory are associated with specialty choice factors and that such factors will mediate the association between relationship style and ultimately matching in a primary care specialty.

Methods

We determined the relationship styles, demographic characteristics and resident specialty match of 106 fourth-year medical students. We assessed the associations between 1) relationship style and specialty choice factors; 2) specialty choice factors and specialty match, and 3) relationship style and specialty match. We also conducted mediation analyses to determine if factors examined in a specialty choice questionnaire mediate the association between relationship style and ultimately matching in a primary care specialty.

Results

Prevalence of attachment styles was similar to that found in the general population and other medical school settings with 59% of students rating themselves as having a secure relationship style. Patient centeredness was directly associated, and career rewards inversely associated with matching in a primary care specialty. Students with a self-reliant relationship style were significantly more likely to match in a non-primary care specialty as compared to students with secure relationship style (OR = 5.3, 95% CI 1.8, 15.6). There was full mediation of the association between relationship style and specialty match by the specialty choice factor characterized by patient centeredness.

Conclusion

Assessing relationship styles based on attachment theory may be a potentially useful way to improve understanding and counsel medical students about specialty choice.