Factors influencing the decision to pursue emergency medicine as a career among medical students in Singapore

<p><b>INTRODUCTION</b>The introduction of the residency programme in Singapore allows medical students to apply for residency in their graduating year. Our study aimed to determine the interest levels and motivating factors for pursuing emergency medicine (EM) as a career among medical students in Singapore.</p><p><b>METHODS</b>A self-administered questionnaire was distributed to Year 1-5 medical students in 2012. Participants indicated their interest in pursuing EM as a career and the degree to which a series of variables influenced their choices. Influencing factors were analysed using multinomial logistic regression.</p><p><b>RESULTS</b>A total of 800 completed questionnaires were collected. 21.0% of the participants expressed interest in pursuing EM. Perceived personality fit and having done an elective in EM were strongly positive influencing factors. Junior medical students were more likely to cite the wide diversity of medical conditions and the lack of a long-term doctor-patient relationship to be negative factors, while senior medical students were more likely to cite personality fit and perceived prestige of EM as negative factors.</p><p><b>CONCLUSION</b>Careful selection of EM applicants is important to the future development of EM in Singapore. Our study showed that personality fit might be the most important influencing factor in choosing EM as a career. Therefore, greater effort should be made to help medical students explore their interest in and suitability for a particular specialty. These include giving medical students earlier exposure to EM, encouraging participation in student interest groups and using appropriate personality tests for career guidance.</p>

Framingham risk score inadequately predicts cardiac risk in young patients presenting with a first myocardial infarction

<p><b>INTRODUCTION</b>The Framingham Risk Score (FRS) is a well-validated epidemiologic tool used to assess the risk for a fi rst cardiac event. Because young patients presenting with a fi rst myocardial infarction (MI) tend to have less significant risk profiles compared with older patients, we hypothesized that FRS may underestimate cardiac risk in these patients.</p><p><b>MATERIALS AND METHODS</b>We studied 1267 patients between January 2002 and November 2007 presenting with a fi rst MI. Patients with pre-existing diabetes mellitus and vascular disease were excluded. FRS was calculated for each patient. Patients were divided based on their age: group A (<40 years), group B (40 to 64 years) and group C (> or =65 years).</p><p><b>RESULTS</b>The mean age was 54.7 +/- 11 years, 88.4% of the patients were males. Younger patients were more likely to be assigned with lower scores. Based on FRS, 63.0%, 29.3% and 14.2% of group A, B and C patients were classified as low risk (10-year risk for cardiac events<10%) respectively, P <0.001. The sensitivity of FRS in identifying at least intermediate risk subjects (10-year risk for cardiac events >10%) was 37.0% in group A vs 85.8% in group C (P <0.001). The incidence of newly diagnosed diabetes mellitus was higher in younger patients (12.0% vs 13.2% vs 7.1 % in groups A, B and C respectively, P = 0.027).</p><p><b>CONCLUSIONS</b>FRS inadequately predicts cardiac risk in young patients presenting with a fi rst MI. This could be because a significant proportion of these young patients have undiagnosed diabetes mellitus, a coronary artery disease risk equivalent.</p>