Understanding medical students’ intercalation decisions to preserve the clinical academic pipeline: a mixed-method survey

Understanding medical students’ intercalation decisions to preserve the clinical academic pipeline: a mixed-method survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Understanding medical students’ intercalation decisions to preserve the clinical academic pipeline: a mixed-method survey Jun Jie Lim, Chris Roberts, Olivia Graham, Sophie Coady, Jack Topliss, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4592927/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Oct, 2025 Read the published version in BMC Medical Education → Version 1 posted 4 You are reading this latest preprint version Abstract Introduction: Clinical academics are pivotal in advancing innovations by integrating clinical practice with education and research. The clinical academic workforce in the UK has struggled with a persistent shortage, now reaching a critical point. A recent nationwide decline in medical students opting for intercalated degrees, which provide early research exposure during undergraduate medical education, significantly contributed to the workforce crisis. However, the underlying factors for this recent decline in intercalation remain unclear. This study investigates the factors influencing medical students' decisions to intercalate, focusing on personal motivations, and perceived value in the context of rising living costs and changing national policies. Methods: We utilised a mixed-methods survey to explore the factors influencing medical students' decisions regarding intercalation. Quantitative data from closed-ended questions were analysed using descriptive statistics and chi-square tests to identify associations between variables. Thematic analysis of qualitative data from open-ended questions was conducted using Vroom's expectancy theory as an interpretive lens. Results: A total of 50 students completed the questionnaire. The chi-square test demonstrated a significant association (p = 0.001) between the cost-of-living crisis and the decision to intercalate. The thematic analysis of non-intercalators highlighted the theme of financial burden, including reduced student loans, increased debt, and family financial stress. Conversely, we developed the theme of effective financial strategies and support systems from intercalators. The perception of career benefits significantly influenced intercalation decisions (p < 0.001). Furthermore, a change in policy to remove extra consideration for intercalated degree holders in UK foundation applications significantly affected decisions (p = 0.014). Thematic analysis of non-intercalators identified the lack of perceived career advantage, including a loss of extrinsic motivation and perceived unrecognition. Intercalators cited long-term career benefits, research skills and confidence, portfolio building and networking as their primary motivators. Conclusions: Our study provided new insights into the socioeconomic, policy-related, and motivational differences among students that influence intercalation decisions. Financial constraints and the removal of extra consideration for intercalated degrees in physician training selection were major deterrents, particularly for students from diverse backgrounds. Future research should focus on developing targeted interventions to mitigate challenges and support a diverse and equitable clinical academic workforce. Undergraduate medical education research intercalation academic medicine Vroom's expectancy theory Introduction Clinical academics are doctors who undertake clinical education and research alongside treating patients; hence, they play a crucial role in providing the evidence base for improved patient care and cutting-edge treatments( 1 ). The clinical research workforce has been facing a shortage for nearly two decades internationally, with some nations reaching a crisis point( 2 ). In the United Kingdom (UK), medical academia is experiencing a ‘deepening crisis’, with some specialties such as primary care, accounting for only 0.4% of clinical academics ( 3 ). The House of Lords Science and Technology Committee’s inquiry into the shortage of clinical academics highlighted the concerns of a decrease in intercalated degree uptake, which offers students in medical training the initial exposure to research ( 4 ). The decline of intercalating medical students meant that fewer future clinicians were exposed to research early in their careers, which could limit later opportunities and reduce the proportion of younger clinical academics. Furthermore, the decline in the clinical academic workforce will significantly challenge the National Health Service (NHS) Long-Term Workforce plan and the government’s vision for the future of UK clinical research( 4 ). An intercalated degree in a medical program signifies an additional year of focused study undertaken during the standard undergraduate medical degree curriculum. This program allows students to supplement their medical training by pursuing in-depth knowledge in a specific discipline relevant to the field. The successful completion of an intercalated degree results in the awarding of two qualifications: a medical degree and an additional degree, typically a Bachelor of Science ( 5 ). The advantages of intercalation are well-documented in the literature, including enhancements in learning styles ( 6 ), exam performance ( 7 – 9 ), academic skills ( 10 , 11 ), research productivity ( 12 , 13 ), long-term career prospects ( 14 , 15 ), and the likelihood of pursuing academic careers ( 14 , 16 – 18 ). However, a study examining seven medical schools across the UK revealed a modest intercalation rate of only 10.5% between 2014 and 2020 ( 19 ). In recent years, there has been a significant nationwide decline in the number of medical students opting to intercalate, with estimates indicating a decrease of approximately 35–45% in the past 12–24 months ( 20 ). Despite the urge from The House of Lords on the government to determine the underlying factor regarding the decrease in intercalating students ( 4 ), an existing gap remains in the literature. Evidence suggests two primary contributors to this decline within the UK. First, medical students have been experiencing financial struggles and insufficient funding, exacerbated by the prevailing cost-of-living crisis and inflationary pressures ( 21 ). A national survey in the UK highlighted that many medical students are cutting down on essential living costs and working during term time ( 22 ), with some working multiple jobs during their intercalated year ( 23 ). In addition, those students who intercalate will rely on NHS bursaries for an extra year of study, and this bursary is reported to cover only one-third of their living expenses ( 22 ). This financial strain is particularly acute for students from a widening participation background. Second, one of the most common reasons cited for intercalation is gaining a competitive career edge ( 24 ). The selection process for foundation training programmes in the UK used to award up to five extra points for intercalated degrees, which boosts students’ chances of securing their preferred foundation posts( 9 ). However, this point advantage has recently been removed ( 25 ). Subsequently, specialised programmes featuring dedicated academic blocks also ceased considering intercalated degrees in their selection processes starting in 2025 ( 26 ). Theoretical framework Understanding students’ decisions surrounding intercalation requires a complex analysis of their aspirations and perceived costs and benefits. Vroom’s expectancy theory offers a valuable framework for exploring students’ decisions to intercalate and their belief in intercalations’ desired outcomes through three main variables: expectancy, instrumentality, and valence( 27 ). Expectancy refers to students' belief that their effort will lead to successful intercalation. What factors served as facilitators or barriers to successful intercalation among medical students? The second aspect of Vroom’s theory is instrumentality, which reflects the student's belief that successful intercalation will lead to rewards. Does decreasing academic recognition of intercalated degrees in UK foundation applications affect students’ perceptions of rewards around intercalations? The last component of Vroom’s theory was the value students placed on the rewards of intercalation, known as valence. We proposed that there is a difference in the perceived advantage or disadvantage of intercalation between students, which could affect their decisions. As the value of each of the three variables increases, we hypothesised that students’ motivation towards intercalation increases. Given the importance of curbing the declining intercalation rates to preserve the clinical-academic pipeline, this research paper aims to investigate the influence of financial considerations, personal motivations, and the perceived value of intercalation on students' decision to intercalate in the current climate of a rising cost-of-living and the removal of points for intercalation in the UK foundation application process. Our research questions are as follows: What factors influence the cost-benefit analysis of students’ decisions around intercalation? How do students perceive the advantages and disadvantages of intercalation, and how does this factor into their decisions? Methods Research context At the University of Sheffield, medical degrees are offered as a five-year undergraduate course. Pre-clinical years are system-based, and clinical years are rotational and longitudinal placements. The Sheffield Medical School retains a traditional assessment system. All medical students are given the opportunity to undertake an intercalated degree after their third year. Upon return from successful intercalation the following September, the students will face December exams. Following graduation, medical students in the UK enter a two-year foundation program to gain further practical experience before specialising. At the time of the study, the selection into foundation had changed from meritocracy-based, such as considering educational decile performances in medical school and additional educational achievements (e.g., intercalated degrees), to a preference-informed allocation system. Study design and population The knowledge and understanding of the phenomenon of intercalation are explored from a post-positivist orientation. We distributed a mixed-method survey to third-year medical students (n=280) and intercalating students (n=97) in Sheffield in the academic year 2022/23. Our inclusion criteria were full-time third-year medical students and intercalating students at The University of Sheffield; all other students were excluded. Data collection and interpretation are primarily objective, but subjectivity is valued from the qualitative data gathered from the open responses, aiming to test, refine, and refute our hypothesis. Data collection Our literature review revealed no surveys connected to the study's research questions, so we developed a mixed-method survey instrument. We based our initial survey domains on the literature review and revised our questions based on discussion outcomes with research team members and a small panel of intercalating medical students. The finalised survey contained four main types of items: (1) demographic questions related to gender, ethnicity and widening participation parameters; (2) binary (yes/no) questions on the impact of external factors on students’ decisions around intercalation; (3) qualitative open-ended questions to explore ‘how’; and (4) multiple-choice questions on students’ perceptions of the benefits and disadvantages of intercalation. The survey was piloted with a sample of medical students to enhance clarity and relevance . (Supplementary Material) Quantitative data analysis. The responses to the closed-ended questions were analysed using descriptive statistics and chi-square tests. We generated descriptive statistics such as frequency tables and percentages to summarise the distribution of responses for each question. Chi-square tests were used to identify associations between categorical variables, such as the impact of the cost-of-living crisis on the decision to intercalate or the influence of the removal of the points system on student motivation. Qualitative analysis Open-ended questions within the survey provided qualitative data in the form of student quotes (n = 250). Thematic analysis, informed by the Miles and Huberman framework(28), was applied to analyse these quotes, using a multi-stage approach. A dominant category coding approach was adopted during thematic analysis. Codes were developed based on the research questions and initial readings of the data. Each quote was reviewed, and the dominant theme or factor influencing the student's decision was identified. This approach ensured a focused analysis while acknowledging the potential presence of secondary considerations. Quotes were assigned to a single dominant category, even if they mentioned multiple factors, to avoid inflating frequencies and maintain analytical rigour. Subsequently, the researchers reviewed and discussed the coded data, refined the coding scheme and explored potential relationships between themes. Finally, the identified themes were named and defined, with representative quotes chosen to illustrate each theme. Throughout the analysis, a focus was maintained on ensuring trustworthiness and credibility(29). This involved employing a clear and transparent coding process and triangulation by comparing qualitative findings with quantitative data and existing literature. Ethical approval The study was approved by the University of Sheffield Medical School Ethics Committee (Ref: 048087) and all students provided voluntary, informed written consent to participate. Results In total, 50 participants were involved in this study, comprising 29 third-year medical students (response rate 10%) and 21 intercalating medical students (response rate 22%). Among the third-year students, 16 (55%) decided not to intercalate, while 13 (45%) decided to intercalate in the coming year. We grouped students who decided to intercalate (i.e., starting intercalation in the coming year) and who are currently intercalating together and compared them with non-intercalators. We presented the quantitative results related to cost-benefit analysis on intercalation decisions and used the qualitative results to unpack the quantitative findings. Demographics Table 1 shows the participants’ demographics, which were predominantly female (74%) and white (78%), attended non-selective state schools (64%) before university, had at least one parent who attended university (74%), and had no caring responsibilities (94%). No correlation was observed between gender, ethnicity, school attended (state school vs independent school), caring responsibility, and students’ decision to intercalate. A significant correlation was observed (p = 0.023) between parental university status and students’ intercalation decisions. Students whose parents held university degrees were more likely to be currently intercalating or starting intercalation (85%) compared to those who did not (50%). Table 1 Participants’ demographics and correlation with intercalation decisions Criteria Respondents n (%) Chi-Square ( χ 2 (2) ) P-value Gender Women 37 (74%) Men 12 (24%) Non-binary 1 (2%) 2.831 0.586 Ethnicity White 39(78%) Mixed/Mixed ethnic groups 3(6%) Asian/Asian British 4(8%) Black/African/Caribbean/Black British 3(6%) Other ethnic group 1(2%) 6.682 0.571 School background Non-selective state school (UK) 31 (62%) Selective state school (UK) 5 (10%) Independent/fee paying school (UK) 13 (26%) Independent/fee paying school (outside UK) 1 (2%) 8.160 0.227 Parental background At least one parent had a university degree 37 (74%) Neither parent had a university degree 13 (26%) 7.582 0.023 Caring responsibility Yes 1(2%) No 47 (94%) Prefer not to say 2 (4%) 2.212 0.697 Financial impact and cost-benefit analysis of intercalation decisions The chi-square test demonstrated a significant association (p = 0.001) between the cost-of-living crisis and the decision to intercalate. Students impacted by the cost-of-living crisis were significantly less likely to intercalate, with 81% of students deciding not to intercalate being impacted compared to 32% of students starting or currently intercalating. Additionally, students perceived that accruing another year of debt (76%) was the biggest disadvantage of intercalation (Table 5). The thematic analysis of the students who decided not to intercalate due to being affected by the cost-of-living crisis revealed the theme of financial burden, with the prominent codes being reduced student loans, increased debt, and living costs. In contrast, students who decided to intercalate cited effective financial strategies and support systems, such as being unaffected by the cost-of-living crisis and being well-supported by their parents (Table 2). Table 2 Thematic analysis of the effect of financial pressures on intercalation decisions Decision Theme Codes Quotes Non-intercalators Financial constrains Reduced student loan ‘Tight finances on NHS bursary and reduced student loan for 2 years after intercalation are not liveable as my family cannot afford to support me.’ Increased student debt ‘The rising costs mean I don't want to graduate with even more debt and have a larger graduate tax coming out of my earnings every month. Family financial stress ‘Borrowing money from parents who don’t earn a lot adds extra stress’ Living costs ‘I had to live at home because the cost of living was too high. I can't afford rent.’ Lack of funding for masters ‘Can’t afford to pay as I wanted to study for a Masters ’. Losing an earning year ‘Intercalation would mean that I lost a year of salary’ Lack of institutional support ‘Funding is terrible, as a WP[widening participation] students, I feel that I am not provided with equal opportunities’ Intercalators Effective financial strategies and support system Financially privileged ‘I am in the lucky position where I am relatively unaffected by the cost-of-living crisis’ Well-supported by parents ‘I am fortunate enough to be well supported by my parents’ Part-time job ‘I am working a part time job alongside intercalation to support my studies’ Scholarship ‘I was lucky to receive a very generous scholarship which helped my decision’ Financial planning in advance ‘I thought carefully and planned my funding a year in advance to make sure I could afford to intercalate’ Navigating career benefits and policy influences in intercalation decisions Aside from the cost of intercalation, students' decisions to intercalate were significantly influenced by their perception of the benefit to their future careers. The chi-square test demonstrated a significant difference (p<0.001) between the perception of the benefit of intercalation towards a future career, with 100% of students who were starting or currently intercalating saying intercalation was beneficial to their future career, compared to 44% of non-intercalators. Furthermore, a significant association (p = 0.014) was found between the removal of additional points for intercalated degrees in UK foundation applications and students’ intercalation decisions, with 63% of non-intercalators stating that removing points impacted their decision, compared to 26% of students starting or currently intercalating. The thematic analysis of the students who decided not to intercalate revealed the theme of lack of perceived career advantage, cited the loss of extrinsic motivation, point incentives, cost-ineffective, lack of recognition, limited career benefits, and preferring post-graduate degrees. In contrast, students who intercalated responded that the change in points did not affect their decision-making. They cited long-term career benefits, research skills and confidence development, and portfolio building (Table 3). Table 3 Thematic analysis of the effect of career advantages on intercalation decisions Decision Themes Codes Quotes Non-intercalators Lack of perceived career advantage Loss of extrinsic motivation ‘I think the additional points scored from intercalation was a big motivational factor for many.’ Loss of point incentives ‘Removal of points on all levels of medical training means intercalation doesn't count for as much on paper now.’ Cost-ineffective ‘I think there are cheaper, less time-consuming methods.’ Perceived unrecognition ‘I had considered it before but now it seems people are not being recognised by the system for the extra degree’ Limited career benefit ‘Intercalation is only beneficial if it is related to a future career specialty.’ Favouring post-graduate degrees ‘It is much more valuable to do a master’s after graduation’. Intercalators Perceived value outweighs points incentives Longer-term career benefit ‘Intercalation no longer gets you extra points, but I believe in subsequent job applications, my intercalated degree will show evidence of academic curiosity and well-roundedness.’ Research skills and confidence ‘Intercalation has given me the knowledge and confidence to undertake other research opportunities in the future.’ Portfolio building ‘My intercalation supervisor has helped me gain posters and publications to help with my CV.’ Networking ‘Intercalation gave me the chance to meet academics/ professionals in a specific field.’ Providing alternate career avenues ‘If I decide not to be a doctor in the future, intercalated degree gives further qualifications in research to pursue careers in other areas’. Impact of perceived advantages and disadvantages on intercalation decisions Our study revealed a significant difference in perceptions of benefits between students who decided to intercalate and those who decided not to (Table 4 & Table 5). Students who chose to intercalate were significantly more likely to believe that intercalation has the benefits of broadened knowledge (p=0.006), gaining new skills (p=0.009), and improved learning habits for future studies (p=0.010). On the other hand, students who chose not to intercalate were significantly more likely to think that intercalation is only advantageous to students who want a clinical academic career (p=0.010). Table 4 Perceived advantages of intercalation Perceived benefit (number ‘yes’/ total/ percentage) N* (/16) S* (/13) C* (/21) All (/50) P value A break from MBChB course 13 11 19 43 (86%) n-sig Study a topic of interest in more depth 15 11 17 43 (86%) n-sig Gain new skills 9 13 18 40 (80%) 0.009 Broadens knowledge 8 13 17 38 (76%) 0.006 Experience in Research 10 10 17 37 (74%) n-sig Improves long term career prospects 9 10 18 37 (74%) n-sig Study a topic related to a career I have in mind 12 9 13 34 (68%) n-sig A chance to get a publication 10 10 14 34 (68%) n-sig Students get an extra summer holiday 6 9 13 28 (56%) n-sig Improves learning habits for future studies 2 6 13 21 (42%) 0.010 *NI– non-intercalators, SI – starting intercalation, CI - currently intercalating Table 5 Perceived disadvantages of intercalation Perceived disadvantages (number ‘yes’/ total/ percentage) N* (/16) S* (/13) C* (/21) All (/50) P value Another year of debt 15 10 13 38 (76%) n-sig Another year of study 13 11 10 34 (68%) 0.031 Taking a year out in the middle of the phase will be detrimental to my exam results at the end of the phase 10 8 9 27 (54%) n-sig Finish in a different year to my friends 8 11 7 26 (52%) 0.014 Stress of learning skills that are not directly/obviously applicable to medicine 4 4 4 12 (24%) n-sig It is only advantageous to students who want a clinical academic career 4 0 0 4 (8%) 0.010 More intense than medicine 0 0 4 4 (8%) 0.050 *NI – non-intercalators, SI – starting intercalation, CI – currently intercalating Discussion This study illustrated the significant impact of the prevailing cost-of-living crisis on medical students’ intercalation decisions and detailed the specific financial concerns facing students today, which is particularly relevant in the current socio-economic climate. Furthermore, we extended the intercalation literature by highlighting the equity and diversity issues faced by first-generation university students and those from socioeconomically disadvantaged backgrounds. Our study also provided new empirical evidence of how recent policy changes in foundation programme applications affected student decisions surrounding intercalation. Previous studies have excluded non-intercalators due to low response rates; therefore, this study added value by comparatively analysing the perceived advantages and disadvantages of intercalation between students and non-intercalating students. Furthermore, applying Vroom’s expectancy theory as a theoretical lens provides a structured approach to understanding the motivational dynamics and deepens our analysis. Expectancy Consistent with Vroom’s expectancy theory, the escalating cost-of-living crisis has significantly limited students’ expectancy of successful intercalation. We found that a greater percentage of medical students cited financial constraints as the primary deterrent for intercalation than did those in previous studies (10, 24, 30, 31). As the cost-of-living crisis prevails, medical students face increased financial burdens and expressed concerns regarding funding, student debt, living costs, family strain and the lack of institutional support. As a result, students who faced financial burdens increasingly opted against taking an intercalated year, prioritising immediate entry into the workforce to prevent additional student debt and losing a year of earnings as a doctor(10, 30). Instrumentality Additionally, our study has provided the data to support existing speculations in the literature (32) that removing points for intercalated degrees across all foundations and higher medical training selections in the UK significantly impacted students’ decisions to intercalate. While this change aims to widen academic opportunities, having an intercalated degree still provides a significant advantage, particularly for students aspiring to pursue competitive specialty training pathways (33). According to Vroom, one’s sense of control in the performance-to-reward process and the presence of performance-related policies are essential to instrumentality. Therefore, the lack of recognition of intercalated degrees in national medical training selection and the perceived lack of control in the ‘performance-to-reward process’ significantly reduce students’ motivation to intercalate. Furthermore, the lack of instrumentality and perceived devaluation of intercalation's career advantage could make the additional financial commitment more difficult for students to justify, especially against a backdrop of existing financial pressures. This could discourage early engagement in research activities (32), and risk cultivating a future cadre of clinicians that lack academic rigour (34). Valence Consistent with Valence, the third variable in Vroom’s theory, students who choose to intercalate continue to recognise its value beyond points, echoing findings from the existing literature (35-39). Students intercalate to demonstrate enthusiasm and commitment to prospective employers and achieve publications and presentations. Additionally, intercalation facilitates networking and making connections that can benefit future speciality applications (10, 14, 24). Conversely, students who decided not to intercalate perceived limited relevance to their future non-academic clinical careers. This contrasts with existing evidence, which suggests that intercalation cultivates general academic, clinical, and inter-professional skills, benefiting a broad range of students beyond mere benefits to academically focused career paths (14, 40-42). This disparity between students’ views may reflect a lack of comprehensive information available to students to inform their decisions (30). Our findings revealed that students who are the first in the family to attend university are significantly less likely to intercalate, with the lack of institutional support to intercalate raised by students from socioeconomically disadvantaged backgrounds. Consistent with Vroom’s theory, students with diverse backgrounds experienced lower expectancy of successful intercalation, lower instrumentality, and placed less value on the rewards of intercalation (i.e. valence) due to the multifaceted barriers to intercalation. These findings contribute to the literature on inequality within the clinical academic workforce (43). Furthermore, the variations in graduates’ achievements acquired through intercalation could exacerbate differential attainment as research opportunities are less available to socioeconomically disadvantaged students (33, 44). The decline in intercalation, therefore, raises equality and diversity concerns in the pipeline of future clinical academics (45), which could undermine the foundation of clinical academia. Implications This study highlighted a pressing need to address the barriers to intercalation, as the decline in intercalation rates could have far-reaching consequences, including a decrease in the number of highly trained academic clinicians (46), diminished exposure to research (47), and a less diverse clinical workforce (33). It is imperative for stakeholders to collaboratively address the multifaceted issues influencing students' decisions about intercalation. At the national level, increased funding opportunities and grants are needed to support equal opportunities and engagement with academia (48), particularly for students from the poorest backgrounds. At the local level, medical schools could provide targeted financial support for students keen to intercalate and support bursaries and scholarship applications. Educators should ensure that students have access to comprehensive information about the benefits of intercalation, not only for academic careers but also for broadening clinical and professional skills. Providing resources and hosting workshops that focus on the diverse benefits of intercalation can help students appreciate the long-term advantages of taking an intercalated year, helping them make more informed decisions and potentially increasing intercalation rates. In the concerted effort to train future clinical academics, it is imperative to explore alternative avenues for students to engage in research and academic pursuits. Integrating research opportunities within the regular medical curriculum, such as through summer internships or elective periods dedicated to research, can provide a taste of research without significant financial or time commitments. Future comparative studies across multiple institutions involving surveys and interviews of supervisors for intercalated degrees could provide insights into how various educational and financial policies impact students' decisions to intercalate and identify best practices that could be adopted more widely. Moreover, further research should help determine the barriers faced by students with widening participation and diverse backgrounds to develop targeted interventions to mitigate challenges. This could help create a more supportive and equitable environment for medical students considering intercalation and ensure that policies support the inclusion of students from all backgrounds in the clinical academic workforce. Strengths and limitations By combining the insights gleaned from quantitative and qualitative analysis, this is the first study in the UK to provide a rich and nuanced understanding of the factors that shape students' decisions regarding intercalation in the context of increased financial pressure and major UK foundation policy changes. Our study encountered a relatively low response rate from students at a single institution, and our sample consisted of a greater proportion of students currently intercalating, which could have introduced bias into the results and potentially limited the generalizability of our findings. However, the focus on the richness of qualitative data and the triangulation between quantitative and qualitative data enhance consequential validity. Furthermore, the researchers’ close proximity to the participants increases the phenomenological validity of our study. We acknowledge that our survey instrument was developed specifically for this study and has not been validated. Consequently, issues may be related to the phrasing of individual questions and respondents' interpretations. Therefore, we must acknowledge the possibility of inference bias in our qualitative analysis. However, despite this potential bias, we found high consistency between the quantitative and qualitative data, increasing our findings' empirical validity. Conclusion Our study provided new insights into the socio-economic, policy-related, and motivational differences among students that influence intercalation decisions. Intercalation is an essential avenue for nurturing the next generation of clinician-scientists adept at integrating scientific advancements into clinical practice. Preserving access to research opportunities is paramount in preventing further decline in our clinical academic pipeline. The decision to intercalate has always involved a complex cost-benefit analysis, weighing financial and time investments against potential academic and career advantages, particularly for students from diverse backgrounds. Further research and targeted interventions are imperative to preserve the future vitality and diversity of our clinical academic workforce. Abbreviations United Kingdom (UK) National Health Service (NHS) Declarations Acknowledgements Not applicable Author contributions CS conceptualised the project. JL led the data analysis, with input from CR, OG, SC, JT, and CS. JL, OG, SC, and JT prepared the initial drafts for the manuscript, which were critically revised by CR and CS. 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Qualitative data analysis: An expanded sourcebook: sage; 1994. Guba EG, Lincoln YS. Fourth generation evaluation. Thousand Oaks, CA, US: Sage Publications, Inc; 1989. pp. 294–p. Nicholson JA, Cleland J, Lemon J, Galley HF. Why medical students choose not to carry out an intercalated BSc: a questionnaire study. BMC Med Educ. 2010;10:25. Park SJ, McGhee CN, Sherwin T. Medical students' attitudes towards research and a career in research: an Auckland, New Zealand study. N Z Med J. 2010;123(1323):34–42. Ahmed A, McGoldrick D. The removal of educational achievements by the UK Foundation Programme: What does this mean for oral and maxillofacial trainees? Br J Oral Maxillofac Surg. 2022;60(1):99. Wan JCM, Byrne MHV, Alexander L. Changes to medical recruitment may increase inequality of access to clinical academia. Med Teach. 2023;45(5):555. Ganesh Kumar A, Kallikas G, Hassan M, Dev IK, Basu S. Removing Educational Achievement Points From the Foundation Programme Application System: Is This the Right Decision? JMIR Med Educ. 2021;7(3):e27856. Boulassel MR, Burney I, Al-Wardy N, Habbal O, Al-Rawas O. Students' Perceived Benefits of Integrating a BSc in Health Sciences within a Medical Degree at Sultan Qaboos University. Sultan Qaboos Univ Med J. 2020;20(2):e187–93. Agha R, Fowler A, Whitehurst K, Rajmohan S, Gundogan B, Koshy K. Why apply for an intercalated research degree? Int J Surg Oncol (N Y). 2017;2(6):e27. Park SJ, Liang MM, Sherwin TT, McGhee CN. Completing an intercalated research degree during medical undergraduate training: barriers, benefits and postgraduate career profiles. N Z Med J. 2010;123(1323):24–33. Alamri Y, Magner K, Wilkinson TJ. Would you do it again? A qualitative study of student and supervisor perceptions of an intercalated MBChB/PhD programme. BMC Med Educ. 2019;19(1):471. Meguid EA, Allen WE. An Analysis of Medical Students' Attitude and Motivation in Pursuing an Intercalated MSc in Clinical Anatomy. Med Sci Educ. 2019;29(2):419–30. Sorial AK, Harrison-Holland M, Young HS. The impact of research intercalation during medical school on post-graduate career progression. BMC Med Educ. 2021;21(1):39. Muir F, Law S. Students' perceptions and experiences of a new Teaching in Medicine BMSc intercalated degree programme. Med Teach. 2014;36(5):403–8. El-Hassan M. Impact of Intercalated Degree on Post-graduate Career Progression and Academic Development in the UK: A Rapid Review of the Literature. Cureus. 2022;14(4):e24569. Finn GM, Crampton PES, Kehoe A, Tiffin PA. Will removing intercalation undermine our clinical academic foundations? BMJ. 2021;374:n1527. Baig SS. Medicine’s class problem extends to intercalated degrees, research, and specialty training. BMJ. 2019;367:l6770. Barratt J, Sharp D, Dhillo WS, Pugh C. Unwelcome changes to the Specialised Foundation Programme recruitment. Lancet. 2024;403(10434):1333. Evered DC, Anderson J, Griggs P, Wakeford R. The correlates of research success. Br Med J (Clin Res Ed). 1987;295(6592):241–6. Rainbow S, Dorji T. Impact of COVID-19 on medical students in the United Kingdom. Germs. 2020;10(3):240–3. Boyle SE, Cotton SC, Myint PK, Hold GL. The influence of early research experience in medical school on the decision to intercalate and future career in clinical academia: a questionnaire study. BMC Med Educ. 2017;17(1):245. Additional Declarations Competing interest reported. CR is a Senior Editorial Board member of BMC Medical Education. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4592927","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":316992977,"identity":"e8b13e85-5470-4a85-a210-bb05b3ad78c6","order_by":0,"name":"Jun Jie Lim","email":"","orcid":"","institution":"The University of Sheffield","correspondingAuthor":false,"prefix":"","firstName":"Jun","middleName":"Jie","lastName":"Lim","suffix":""},{"id":316992978,"identity":"b1f5a736-9cef-4ed4-83fb-09458ca58090","order_by":1,"name":"Chris Roberts","email":"","orcid":"","institution":"The University of Sheffield","correspondingAuthor":false,"prefix":"","firstName":"Chris","middleName":"","lastName":"Roberts","suffix":""},{"id":316992979,"identity":"4e0a7ebf-60b6-443d-a8d1-927b90c81bd6","order_by":2,"name":"Olivia Graham","email":"","orcid":"","institution":"The University of Sheffield","correspondingAuthor":false,"prefix":"","firstName":"Olivia","middleName":"","lastName":"Graham","suffix":""},{"id":316992980,"identity":"0935958d-a202-4609-8c10-1a23a65f2194","order_by":3,"name":"Sophie Coady","email":"","orcid":"","institution":"The University of Sheffield","correspondingAuthor":false,"prefix":"","firstName":"Sophie","middleName":"","lastName":"Coady","suffix":""},{"id":316992981,"identity":"efea6675-b5ee-4a27-b278-16303d1e0b54","order_by":4,"name":"Jack Topliss","email":"","orcid":"","institution":"The University of Sheffield","correspondingAuthor":false,"prefix":"","firstName":"Jack","middleName":"","lastName":"Topliss","suffix":""},{"id":316992982,"identity":"1d0b64b7-e34f-461d-91ee-bb316e1dffd4","order_by":5,"name":"Carolyn Staton","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEklEQVRIie2RsWrDMBCGzwiURY7WM4bkFQ4KJUPxs8gYMrWQsdCQKgTspXROoS/RJbODIV0cunpsyAsEDMWFEqpkVpyMGfRxk7jv9B8H4HBcNyxnAD3JgWk8Poi2bgWmiSuj3AQpeBcrgo6KPqdIzb693yaayPClrkePhN3OdFrBOAIqc6uCOScmVILB+3oRzktCLpazAawSoLW2KmSKgWJI1cOC+enfhGOcIvAc6MsejKCz8xr1bJT7be3vzS/9jVH2bYowpYqDAqGvjYJeaio/GQwLMSrE8DN4mw9vQ7E67BLPBvFrIoIT68ss+9g0d09SYrKtxZiwnxXLavcT9bqlsiczt7AMU2cO6XA4HI52/gELIFIulfVdLQAAAABJRU5ErkJggg==","orcid":"","institution":"The University of Sheffield","correspondingAuthor":true,"prefix":"","firstName":"Carolyn","middleName":"","lastName":"Staton","suffix":""}],"badges":[],"createdAt":"2024-06-17 08:53:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4592927/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4592927/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-025-07609-6","type":"published","date":"2025-10-02T15:56:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":92883563,"identity":"e798ee49-0c5b-4874-bb6d-08def3aee891","added_by":"auto","created_at":"2025-10-06 15:59:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1098658,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4592927/v1/4c71519f-6f5a-4fc1-94f3-df01fe5eaee4.pdf"}],"financialInterests":"Competing interest reported. CR is a Senior Editorial Board member of BMC Medical Education.","formattedTitle":"Understanding medical students’ intercalation decisions to preserve the clinical academic pipeline: a mixed-method survey","fulltext":[{"header":"Introduction","content":"\u003cp\u003eClinical academics are doctors who undertake clinical education and research alongside treating patients; hence, they play a crucial role in providing the evidence base for improved patient care and cutting-edge treatments(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The clinical research workforce has been facing a shortage for nearly two decades internationally, with some nations reaching a crisis point(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In the United Kingdom (UK), medical academia is experiencing a \u0026lsquo;deepening crisis\u0026rsquo;, with some specialties such as primary care, accounting for only 0.4% of clinical academics (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The House of Lords Science and Technology Committee\u0026rsquo;s inquiry into the shortage of clinical academics highlighted the concerns of a decrease in intercalated degree uptake, which offers students in medical training the initial exposure to research (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The decline of intercalating medical students meant that fewer future clinicians were exposed to research early in their careers, which could limit later opportunities and reduce the proportion of younger clinical academics. Furthermore, the decline in the clinical academic workforce will significantly challenge the National Health Service (NHS) Long-Term Workforce plan and the government\u0026rsquo;s vision for the future of UK clinical research(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAn intercalated degree in a medical program signifies an additional year of focused study undertaken during the standard undergraduate medical degree curriculum. This program allows students to supplement their medical training by pursuing in-depth knowledge in a specific discipline relevant to the field. The successful completion of an intercalated degree results in the awarding of two qualifications: a medical degree and an additional degree, typically a Bachelor of Science (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The advantages of intercalation are well-documented in the literature, including enhancements in learning styles (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), exam performance (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), academic skills (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), research productivity (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), long-term career prospects (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), and the likelihood of pursuing academic careers (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). However, a study examining seven medical schools across the UK revealed a modest intercalation rate of only 10.5% between 2014 and 2020 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In recent years, there has been a significant nationwide decline in the number of medical students opting to intercalate, with estimates indicating a decrease of approximately 35\u0026ndash;45% in the past 12\u0026ndash;24 months (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Despite the urge from The House of Lords on the government to determine the underlying factor regarding the decrease in intercalating students (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), an existing gap remains in the literature.\u003c/p\u003e \u003cp\u003eEvidence suggests two primary contributors to this decline within the UK. First, medical students have been experiencing financial struggles and insufficient funding, exacerbated by the prevailing cost-of-living crisis and inflationary pressures (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). A national survey in the UK highlighted that many medical students are cutting down on essential living costs and working during term time (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), with some working multiple jobs during their intercalated year (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In addition, those students who intercalate will rely on NHS bursaries for an extra year of study, and this bursary is reported to cover only one-third of their living expenses (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). This financial strain is particularly acute for students from a widening participation background. Second, one of the most common reasons cited for intercalation is gaining a competitive career edge (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The selection process for foundation training programmes in the UK used to award up to five extra points for intercalated degrees, which boosts students\u0026rsquo; chances of securing their preferred foundation posts(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). However, this point advantage has recently been removed (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Subsequently, specialised programmes featuring dedicated academic blocks also ceased considering intercalated degrees in their selection processes starting in 2025 (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e"},{"header":"Theoretical framework","content":"\u003cp\u003eUnderstanding students\u0026rsquo; decisions surrounding intercalation requires a complex analysis of their aspirations and perceived costs and benefits. Vroom\u0026rsquo;s expectancy theory offers a valuable framework for exploring students\u0026rsquo; decisions to intercalate and their belief in intercalations\u0026rsquo; desired outcomes through three main variables: expectancy, instrumentality, and valence(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Expectancy refers to students' belief that their effort will lead to successful intercalation. What factors served as facilitators or barriers to successful intercalation among medical students? The second aspect of Vroom\u0026rsquo;s theory is instrumentality, which reflects the student's belief that successful intercalation will lead to rewards. Does decreasing academic recognition of intercalated degrees in UK foundation applications affect students\u0026rsquo; perceptions of rewards around intercalations? The last component of Vroom\u0026rsquo;s theory was the value students placed on the rewards of intercalation, known as valence. We proposed that there is a difference in the perceived advantage or disadvantage of intercalation between students, which could affect their decisions. As the value of each of the three variables increases, we hypothesised that students\u0026rsquo; motivation towards intercalation increases. Given the importance of curbing the declining intercalation rates to preserve the clinical-academic pipeline, this research paper aims to investigate the influence of financial considerations, personal motivations, and the perceived value of intercalation on students' decision to intercalate in the current climate of a rising cost-of-living and the removal of points for intercalation in the UK foundation application process. Our research questions are as follows:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat factors influence the cost-benefit analysis of students\u0026rsquo; decisions around intercalation?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHow do students perceive the advantages and disadvantages of intercalation, and how does this factor into their decisions?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eResearch context\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt the University of Sheffield, medical degrees are offered as a five-year undergraduate course. Pre-clinical years are system-based, and clinical years are rotational and longitudinal placements. The\u0026nbsp;Sheffield Medical School retains a traditional assessment system. All medical students are given the opportunity to undertake an intercalated degree after their third year. Upon return from successful intercalation the following September, the students will face December exams. Following graduation, medical students in the UK enter a two-year foundation program to gain further practical experience before specialising. At the time of the study, the selection into foundation had changed from meritocracy-based, such as considering educational decile performances in medical school and additional educational achievements (e.g., intercalated degrees), to a preference-informed allocation system. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design and population \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe knowledge and understanding of the phenomenon of intercalation are explored from a post-positivist orientation. We distributed a mixed-method survey to third-year medical students (n=280) and intercalating students (n=97) in Sheffield in the academic year 2022/23. Our inclusion criteria were full-time third-year medical students and intercalating students at The University of Sheffield; all other students were excluded. Data collection and interpretation are primarily objective, but subjectivity is valued from the qualitative data gathered from the open responses, aiming to test, refine, and refute our hypothesis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur literature review revealed no surveys connected to the study\u0026apos;s research questions, so we developed a mixed-method survey instrument. We based our initial survey domains on the literature review and revised our questions based on discussion outcomes with research team members and a small panel of intercalating medical students. The finalised survey contained four main types of items: (1) demographic questions related to gender, ethnicity and widening participation parameters; (2) binary (yes/no) questions on the impact of external factors on students\u0026rsquo; decisions around intercalation; (3) qualitative open-ended questions to explore \u0026lsquo;how\u0026rsquo;; and (4) multiple-choice questions on students\u0026rsquo; perceptions of the benefits and disadvantages of intercalation. The survey was piloted with a sample of medical students to enhance clarity and relevance . (Supplementary Material)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative data analysis.\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe responses to the closed-ended questions were analysed using descriptive statistics and chi-square tests.\u0026nbsp;We generated descriptive statistics such as frequency tables and percentages to summarise the distribution of responses for each question. Chi-square tests were used to identify associations between categorical variables, such as the impact of the cost-of-living crisis on the decision to intercalate or the influence of the removal of the points system on student motivation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOpen-ended questions within the survey provided qualitative data in the form of student quotes (n = 250). Thematic analysis, informed by the Miles and Huberman framework(28), was applied to analyse these quotes, using a multi-stage approach. \u0026nbsp;A dominant category coding approach was adopted during thematic analysis. Codes were developed based on the research questions and initial readings of the data. Each quote was reviewed, and the dominant theme or factor influencing the student\u0026apos;s decision was identified. This approach ensured a focused analysis while acknowledging the potential presence of secondary considerations. Quotes were assigned to a single dominant category, even if they mentioned multiple factors, to avoid inflating frequencies and maintain analytical rigour. Subsequently, the researchers reviewed and discussed the coded data, refined the coding scheme and explored potential relationships between themes. Finally, the identified themes were named and defined, with representative quotes chosen to illustrate each theme. Throughout the analysis, a focus was maintained on ensuring trustworthiness and credibility(29). This involved employing a clear and transparent coding process and triangulation by comparing qualitative findings with quantitative data and existing literature.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the University of Sheffield Medical School Ethics Committee (Ref: 048087) and all students provided voluntary, informed written consent to participate. \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn total, 50 participants were involved in this study, comprising 29 third-year medical students (response rate 10%) and 21 intercalating medical students (response rate 22%). Among the third-year students, 16 (55%) decided not to intercalate, while 13 (45%) decided to intercalate in the coming year. We grouped students who decided to intercalate (i.e., starting intercalation in the coming year) and who are currently intercalating together and compared them with non-intercalators. We presented the quantitative results related to cost-benefit analysis on intercalation decisions and used the qualitative results to unpack the quantitative findings.\u003c/p\u003e\n\u003ch2\u003eDemographics\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eTable 1 shows the participants\u0026rsquo; demographics, which were predominantly female (74%) and white (78%), attended non-selective state schools (64%) before university, had at least one parent who attended university (74%), and had no caring responsibilities (94%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo correlation was observed between gender, ethnicity, school attended (state school vs independent school), caring responsibility, and students\u0026rsquo; decision to intercalate. A significant correlation was observed (p = 0.023) between parental university status and students\u0026rsquo; intercalation decisions. Students whose parents held university degrees were more likely to be currently intercalating or starting intercalation (85%) compared to those who did not (50%).\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eTable 1 Participants\u0026rsquo; demographics and correlation with intercalation decisions\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCriteria\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRespondents\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChi-Square (\u003c/strong\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e(2)\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Women\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e37 (74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Men\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e12 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Non-binary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e1 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e2.831\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e0.586\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003eEthnicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;White\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e39(78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Mixed/Mixed ethnic groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e3(6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Asian/Asian British\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e4(8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Black/African/Caribbean/Black British\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e3(6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Other ethnic group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e1(2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e6.682\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e0.571\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003eSchool background\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Non-selective state school (UK)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e31 (62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Selective state school (UK)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e5 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Independent/fee paying school (UK)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e13 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Independent/fee paying school (outside UK)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e1 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e8.160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003eParental background\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;At least one parent had a university degree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e37 (74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Neither parent had a university degree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e13 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e7.582\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003eCaring responsibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e1(2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e47 (94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.563025210084035%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Prefer not to say\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e2 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e2.212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.478991596638654%\" valign=\"top\"\u003e\n \u003cp\u003e0.697\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eFinancial impact and cost-benefit analysis of intercalation decisions\u003c/h2\u003e\n\u003cp\u003eThe chi-square test demonstrated a significant association (p = 0.001) between the cost-of-living crisis and the decision to intercalate. Students impacted by the cost-of-living crisis were significantly less likely to intercalate, with 81% of students deciding not to intercalate being impacted compared to 32% of students starting or currently intercalating. Additionally, students perceived that accruing another year of debt (76%) was the biggest disadvantage of intercalation (Table 5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe thematic analysis of the students who decided not to intercalate due to being affected by the cost-of-living crisis revealed the theme of financial burden, with the prominent codes being reduced student loans, increased debt, and living costs. In contrast, students who decided to intercalate cited effective financial strategies and support systems, such as being unaffected by the cost-of-living crisis and being well-supported by their parents (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eTable 2 Thematic analysis of the effect of financial pressures on intercalation decisions\u0026nbsp;\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.092436974789916%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDecision\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.77310924369748%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.991596638655462%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCodes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.142857142857146%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuotes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.092436974789916%\" rowspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003eNon-intercalators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.77310924369748%\" rowspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003eFinancial constrains\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.991596638655462%\" valign=\"top\"\u003e\n \u003cp\u003eReduced student loan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.142857142857146%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;Tight finances on NHS bursary and reduced student loan for 2 years after intercalation are not liveable as my family cannot afford to support me.\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.944812362030905%\" valign=\"top\"\u003e\n \u003cp\u003eIncreased student debt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.0551876379691%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;The rising costs mean I don\u0026apos;t want to graduate with even more debt and have a larger graduate tax coming out of my earnings every month.\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.944812362030905%\" valign=\"top\"\u003e\n \u003cp\u003eFamily financial stress\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.0551876379691%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;Borrowing money from parents who don\u0026rsquo;t earn a lot adds extra stress\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.944812362030905%\" valign=\"top\"\u003e\n \u003cp\u003eLiving costs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.0551876379691%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;I had to live at home because the cost of living was too high. I can\u0026apos;t afford rent.\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.944812362030905%\" valign=\"top\"\u003e\n \u003cp\u003eLack of funding for masters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.0551876379691%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;Can\u0026rsquo;t afford to pay as I wanted to study for a Masters \u0026rsquo;.\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.944812362030905%\" valign=\"top\"\u003e\n \u003cp\u003eLosing an earning year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.0551876379691%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;Intercalation would mean that I lost a year of salary\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.944812362030905%\" valign=\"top\"\u003e\n \u003cp\u003eLack of institutional support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.0551876379691%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;Funding is terrible, as a WP[widening participation] students, I feel that I am not provided with equal opportunities\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.092436974789916%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eIntercalators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.77310924369748%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eEffective financial strategies and support system\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.991596638655462%\" valign=\"top\"\u003e\n \u003cp\u003eFinancially privileged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.142857142857146%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;I am in the lucky position where I am relatively unaffected by the cost-of-living crisis\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.944812362030905%\" valign=\"top\"\u003e\n \u003cp\u003eWell-supported by parents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.0551876379691%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;I am fortunate enough to be well supported by my parents\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.944812362030905%\" valign=\"top\"\u003e\n \u003cp\u003ePart-time job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.0551876379691%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;I am working a part time job alongside intercalation to support my studies\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.944812362030905%\" valign=\"top\"\u003e\n \u003cp\u003eScholarship\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.0551876379691%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;I was lucky to receive a very generous scholarship which helped my decision\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.944812362030905%\" valign=\"top\"\u003e\n \u003cp\u003eFinancial planning in advance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75.0551876379691%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;I thought carefully and planned my funding a year in advance to make sure I could afford to intercalate\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eNavigating career benefits and policy influences in intercalation decisions\u003c/h2\u003e\n\u003cp\u003eAside from the cost of intercalation, students\u0026apos; decisions to intercalate were significantly influenced by their perception of the benefit to their future careers. The chi-square test demonstrated a significant difference (p\u0026lt;0.001) between the perception of the benefit of intercalation towards a future career, with 100% of students who were starting or currently intercalating saying intercalation was beneficial to their future career, compared to 44% of non-intercalators. Furthermore, a significant association (p = 0.014) was found between the removal of additional points for intercalated degrees in UK foundation applications and students\u0026rsquo; intercalation decisions, with 63% of non-intercalators stating that removing points impacted their decision, compared to 26% of students starting or currently intercalating.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe thematic analysis of the students who decided not to intercalate revealed the theme of lack of perceived career advantage, cited the loss of extrinsic motivation, point incentives, cost-ineffective, lack of recognition, limited career benefits, and preferring post-graduate degrees. In contrast, students who intercalated responded that the change in points did not affect their decision-making. They cited long-term career benefits, research skills and confidence development, and portfolio building (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eTable 3\u0026nbsp;Thematic analysis of the effect of career advantages on intercalation decisions\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.537190082644628%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDecision\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.561983471074381%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eThemes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.75206611570248%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCodes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.14876033057851%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuotes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.537190082644628%\" rowspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003eNon-intercalators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.561983471074381%\" rowspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003eLack of perceived career advantage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.75206611570248%\" valign=\"top\"\u003e\n \u003cp\u003eLoss of extrinsic motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.14876033057851%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;I think the additional points scored from intercalation was a big motivational factor for many.\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.37931034482759%\" valign=\"top\"\u003e\n \u003cp\u003eLoss of point incentives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.62068965517241%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;Removal of points on all levels of medical training means intercalation doesn\u0026apos;t count for as much on paper now.\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.37931034482759%\" valign=\"top\"\u003e\n \u003cp\u003eCost-ineffective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.62068965517241%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;I think there are cheaper, less time-consuming methods.\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.37931034482759%\" valign=\"top\"\u003e\n \u003cp\u003ePerceived unrecognition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.62068965517241%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;I had considered it before but now it seems people are not being recognised by the system for the extra degree\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.37931034482759%\" valign=\"top\"\u003e\n \u003cp\u003eLimited career benefit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.62068965517241%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;Intercalation is only beneficial if it is related to a future career specialty.\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.37931034482759%\" valign=\"top\"\u003e\n \u003cp\u003eFavouring post-graduate degrees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.62068965517241%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;It is much more valuable to do a master\u0026rsquo;s after graduation\u0026rsquo;.\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.537190082644628%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eIntercalators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.561983471074381%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003ePerceived value outweighs points incentives\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.75206611570248%\" valign=\"top\"\u003e\n \u003cp\u003eLonger-term career benefit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.14876033057851%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;Intercalation no longer gets you extra points, but I believe in subsequent job applications, my intercalated degree will show evidence of academic curiosity and well-roundedness.\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.37931034482759%\" valign=\"top\"\u003e\n \u003cp\u003eResearch skills and confidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.62068965517241%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;Intercalation has given me the knowledge and confidence to undertake other research opportunities in the future.\u0026rsquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.37931034482759%\" valign=\"top\"\u003e\n \u003cp\u003ePortfolio building\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.62068965517241%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;My intercalation supervisor has helped me gain posters and publications to help with my CV.\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.37931034482759%\" valign=\"top\"\u003e\n \u003cp\u003eNetworking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.62068965517241%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;Intercalation gave me the chance to meet academics/ professionals in a specific field.\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.37931034482759%\" valign=\"top\"\u003e\n \u003cp\u003eProviding alternate career avenues\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.62068965517241%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;If I decide not to be a doctor in the future, intercalated degree gives further qualifications in research to pursue careers in other areas\u0026rsquo;.\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eImpact of perceived advantages and disadvantages on intercalation decisions\u003c/h2\u003e\n\u003cp\u003eOur study revealed a significant difference in perceptions of benefits between students who decided to intercalate and those who decided not to (Table 4 \u0026amp; Table 5). Students who chose to intercalate were significantly more likely to believe that intercalation has the benefits of broadened knowledge (p=0.006), gaining new skills (p=0.009), and improved learning habits for future studies (p=0.010). On the other hand, students who chose not to intercalate were significantly more likely to think that intercalation is only advantageous to students who want a clinical academic career (p=0.010).\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eTable 4 Perceived advantages of intercalation\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived benefit (number \u0026lsquo;yes\u0026rsquo;/ total/ percentage)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(/16)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eS* \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(/13)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.166666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eC*\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(/21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.666666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(/50)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eA break from MBChB course\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.5%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.166666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.666666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e43 (86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003en-sig\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eStudy a topic of interest in more depth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.5%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.166666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.666666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e43 (86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003en-sig\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eGain new skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.5%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.166666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.666666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e40 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eBroadens knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.5%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.166666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.666666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e38 (76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eExperience in Research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.5%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.166666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.666666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e37 (74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003en-sig\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eImproves long term career prospects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.5%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.166666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.666666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e37 (74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003en-sig\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eStudy a topic related to a career I have in mind\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.5%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.166666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.666666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e34 (68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003en-sig\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eA chance to get a publication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.5%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.166666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.666666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e34 (68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003en-sig\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eStudents get an extra summer holiday\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.5%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.166666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.666666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e28 (56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003en-sig\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eImproves learning habits for future studies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.5%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.166666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.666666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e21 (42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*NI\u0026ndash; non-intercalators, SI \u0026ndash; starting intercalation, CI - currently intercalating\u003c/p\u003e\n\u003ch3\u003eTable 5 Perceived disadvantages of intercalation\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived disadvantages (number \u0026lsquo;yes\u0026rsquo;/ total/ percentage)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN* (/16)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eS* (/13)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eC* (/21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(/50)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003eAnother year of debt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"top\"\u003e\n \u003cp\u003e38 (76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003en-sig\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003eAnother year of study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"top\"\u003e\n \u003cp\u003e34 (68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003eTaking a year out in the middle of the phase will be detrimental to my exam results at the end of the phase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"top\"\u003e\n \u003cp\u003e27 (54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003en-sig\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003eFinish in a different year to my friends\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"top\"\u003e\n \u003cp\u003e26 (52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003eStress of learning skills that are not directly/obviously applicable to medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"top\"\u003e\n \u003cp\u003e12 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003en-sig\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003eIt is only advantageous to students who want a clinical academic career\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"top\"\u003e\n \u003cp\u003e4 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003eMore intense than medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.833333333333333%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"top\"\u003e\n \u003cp\u003e4 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*NI \u0026ndash; non-intercalators, SI \u0026ndash; starting intercalation, CI \u0026ndash; currently intercalating\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study illustrated the significant impact of the prevailing cost-of-living crisis on medical students\u0026rsquo; intercalation decisions and detailed the specific financial concerns facing students today, which is particularly relevant in the current socio-economic climate. Furthermore, we extended the intercalation literature by highlighting the equity and diversity issues faced by first-generation university students and those from socioeconomically disadvantaged backgrounds. Our study also provided new empirical evidence of how recent policy changes in foundation programme applications affected student decisions surrounding intercalation. Previous studies have excluded non-intercalators due to low response rates; therefore, this study added value by comparatively analysing the perceived advantages and disadvantages of intercalation between students and non-intercalating students. Furthermore, applying Vroom\u0026rsquo;s expectancy theory as a theoretical lens provides a structured approach to understanding the motivational dynamics and deepens our analysis.\u003c/p\u003e\n\u003ch2\u003eExpectancy\u003c/h2\u003e\n\u003cp\u003eConsistent with Vroom\u0026rsquo;s expectancy theory, the escalating cost-of-living crisis has significantly limited students\u0026rsquo; expectancy of successful intercalation. We found that a greater percentage of medical students\u0026nbsp;cited financial constraints as the primary deterrent for intercalation\u0026nbsp;than did those in previous studies\u0026nbsp;(10, 24, 30, 31). As the cost-of-living crisis prevails, medical students face increased financial burdens and expressed concerns regarding funding, student debt, living costs, family strain and the lack of institutional support. As a result,\u0026nbsp;students who faced financial burdens increasingly opted against taking an intercalated year, prioritising immediate entry into the workforce to prevent additional student debt and losing a year of earnings as a doctor(10, 30). \u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eInstrumentality\u003c/h2\u003e\n\u003cp\u003eAdditionally,\u0026nbsp;our study has provided the data to support existing speculations in the literature\u0026nbsp;(32)\u0026nbsp;that removing points for intercalated degrees across all foundations and higher medical training selections in the UK significantly impacted students\u0026rsquo; decisions to intercalate.\u0026nbsp;While this change aims to widen academic opportunities, having an intercalated degree still provides a significant advantage, particularly for students aspiring to pursue competitive specialty training pathways\u0026nbsp;(33).\u0026nbsp;According to Vroom,\u0026nbsp;one\u0026rsquo;s sense of control in the performance-to-reward process and the presence of\u0026nbsp;performance-related policies are essential to instrumentality. Therefore, the lack of recognition of intercalated degrees in national medical training selection and the perceived lack of control in the \u0026lsquo;performance-to-reward process\u0026rsquo; significantly reduce students\u0026rsquo; motivation to intercalate. Furthermore,\u0026nbsp;the lack of instrumentality and perceived devaluation of intercalation\u0026apos;s career advantage could make the additional financial commitment more difficult for students to justify, especially against a backdrop of existing financial pressures. This could discourage\u0026nbsp;early engagement in research activities\u0026nbsp;(32), and risk cultivating a future cadre of clinicians that lack academic rigour\u0026nbsp;(34).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eValence\u003c/h2\u003e\n\u003cp\u003eConsistent with Valence, the third variable in Vroom\u0026rsquo;s theory, students who choose to intercalate continue to recognise its value beyond points, echoing findings from the existing literature\u0026nbsp;(35-39). Students intercalate to demonstrate enthusiasm and commitment to prospective employers and achieve publications and presentations. Additionally, intercalation facilitates networking and making connections that can benefit future speciality applications\u0026nbsp;(10, 14, 24). Conversely, students who decided not to intercalate perceived limited relevance to their future non-academic clinical careers. This contrasts with existing evidence, which suggests that intercalation cultivates general academic, clinical, and inter-professional skills, benefiting a broad range of students beyond mere benefits to academically focused career paths\u0026nbsp;(14, 40-42). This disparity between students\u0026rsquo; views may reflect a lack of comprehensive information available to students to inform their decisions\u0026nbsp;(30).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur findings revealed that students who are the first in the family to attend university are significantly less likely to intercalate, with the lack of institutional support to intercalate raised by students from socioeconomically disadvantaged backgrounds. Consistent with Vroom\u0026rsquo;s theory, students with diverse backgrounds experienced lower expectancy of successful intercalation, lower instrumentality, and placed less value on the rewards of intercalation (i.e. valence) due to the multifaceted barriers to intercalation. These findings contribute to the literature on inequality within the clinical academic workforce\u0026nbsp;(43). Furthermore, the variations in graduates\u0026rsquo; achievements acquired through intercalation could exacerbate differential attainment as research opportunities are less available to socioeconomically disadvantaged students\u0026nbsp;(33, 44). The decline in intercalation, therefore, raises equality and diversity concerns in the pipeline of future clinical academics\u0026nbsp;(45), which could undermine the foundation of clinical academia.\u003c/p\u003e\n\u003ch2\u003eImplications\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThis study highlighted a pressing need to address the barriers to intercalation, as the decline in intercalation rates could have far-reaching consequences, including a decrease in the number of highly trained academic clinicians\u0026nbsp;(46), diminished exposure to research\u0026nbsp;(47), and a less diverse clinical workforce\u0026nbsp;(33).\u0026nbsp;It is imperative for stakeholders to collaboratively address the multifaceted issues influencing students\u0026apos; decisions about intercalation.\u0026nbsp;At the national level, increased funding opportunities and grants are needed to support equal opportunities and engagement with academia\u0026nbsp;(48), particularly for students from the poorest backgrounds. At the local level, medical schools could provide targeted financial support for students keen to intercalate and support bursaries and scholarship applications. Educators should ensure that students have access to comprehensive information about the benefits of intercalation, not only for academic careers but also for broadening clinical and professional skills. Providing resources and hosting workshops that focus on the diverse benefits of intercalation can help students appreciate the long-term advantages of taking an intercalated year, helping them make more informed decisions and potentially increasing intercalation rates.\u003c/p\u003e\n\u003cp\u003eIn the concerted effort to train future clinical academics, it is imperative to explore alternative avenues for students to engage in research and academic pursuits. Integrating research opportunities within the regular medical curriculum, such as through summer internships or elective periods dedicated to research, can provide a taste of research without significant financial or time commitments.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFuture comparative studies across multiple institutions involving surveys and interviews of supervisors for intercalated degrees could provide insights into how various educational and financial policies impact students\u0026apos; decisions to intercalate and identify best practices that could be adopted more widely. Moreover, further research should help determine the barriers faced by students with widening participation and diverse backgrounds to develop targeted interventions to mitigate challenges.\u0026nbsp;This could help create a more supportive and equitable environment for medical students considering intercalation\u0026nbsp;and\u0026nbsp;ensure that policies support the inclusion of students from all backgrounds in the clinical academic workforce.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\n\u003cp\u003eBy combining the insights gleaned from quantitative and qualitative analysis, this is the first study in the UK to provide a rich and nuanced understanding of the factors that shape students\u0026apos; decisions regarding intercalation in the context of increased financial pressure and major UK foundation policy changes. Our study encountered a relatively low response rate from students at a single institution, and our sample consisted of a greater proportion of students currently intercalating, which could have introduced bias into the results and potentially limited the generalizability of our findings. However, the focus on the richness of qualitative data and the triangulation between quantitative and qualitative data enhance consequential validity. Furthermore, the researchers\u0026rsquo; close proximity to the participants increases the phenomenological validity of our study. We acknowledge that our survey instrument was developed specifically for this study and has not been validated. Consequently, issues may be related to the phrasing of individual questions and respondents\u0026apos; interpretations. Therefore, we must acknowledge the possibility of inference bias in our qualitative analysis. However, despite this potential bias, we found high consistency between the quantitative and qualitative data, increasing our findings\u0026apos; empirical validity.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study provided new insights into the socio-economic, policy-related, and motivational differences among students that influence intercalation decisions. Intercalation is an essential avenue for nurturing the next generation of clinician-scientists adept at integrating scientific advancements into clinical practice. Preserving access to research opportunities is paramount in preventing further decline in our clinical academic pipeline. The decision to intercalate has always involved a complex cost-benefit analysis, weighing financial and time investments against potential academic and career advantages, particularly for students from diverse backgrounds. Further research and targeted interventions are imperative to preserve the future vitality and diversity of our clinical academic workforce.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUnited Kingdom (UK)\u003c/p\u003e\n\u003cp\u003eNational Health Service (NHS)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCS conceptualised the project. JL led the data analysis, with input from CR, OG, SC, JT, and CS. JL, OG, SC, and JT prepared the initial drafts for the manuscript, which were critically revised by CR and CS. JL coordinated revisions of the manuscript in preparation for its submission. All authors gave their approval for the final version to be published and agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot funded.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the University of Sheffield Medical School Ethics Committee (Ref: 048087), and all participants provided voluntary, informed written consent to participate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided voluntary, informed written consent for the publication of all questionnaire responses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCR is a Senior Editorial Board member of BMC Medical \u0026nbsp;Education.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTransforming health through innovation. 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BMJ. 2021;374:n1527.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaig SS. Medicine\u0026rsquo;s class problem extends to intercalated degrees, research, and specialty training. BMJ. 2019;367:l6770.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarratt J, Sharp D, Dhillo WS, Pugh C. Unwelcome changes to the Specialised Foundation Programme recruitment. Lancet. 2024;403(10434):1333.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEvered DC, Anderson J, Griggs P, Wakeford R. The correlates of research success. Br Med J (Clin Res Ed). 1987;295(6592):241\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRainbow S, Dorji T. Impact of COVID-19 on medical students in the United Kingdom. Germs. 2020;10(3):240\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoyle SE, Cotton SC, Myint PK, Hold GL. The influence of early research experience in medical school on the decision to intercalate and future career in clinical academia: a questionnaire study. BMC Med Educ. 2017;17(1):245.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Undergraduate, medical education research, intercalation, academic medicine, Vroom's expectancy theory","lastPublishedDoi":"10.21203/rs.3.rs-4592927/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4592927/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eClinical academics are pivotal in advancing innovations by integrating clinical practice with education and research. The clinical academic workforce in the UK has struggled with a persistent shortage, now reaching a critical point. A recent nationwide decline in medical students opting for intercalated degrees, which provide early research exposure during undergraduate medical education, significantly contributed to the workforce crisis. However, the underlying factors for this recent decline in intercalation remain unclear. This study investigates the factors influencing medical students' decisions to intercalate, focusing on personal motivations, and perceived value in the context of rising living costs and changing national policies.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eWe utilised a mixed-methods survey to explore the factors influencing medical students' decisions regarding intercalation. Quantitative data from closed-ended questions were analysed using descriptive statistics and chi-square tests to identify associations between variables. Thematic analysis of qualitative data from open-ended questions was conducted using Vroom's expectancy theory as an interpretive lens.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eA total of 50 students completed the questionnaire. The chi-square test demonstrated a significant association (p\u0026thinsp;=\u0026thinsp;0.001) between the cost-of-living crisis and the decision to intercalate. The thematic analysis of non-intercalators highlighted the theme of financial burden, including reduced student loans, increased debt, and family financial stress. Conversely, we developed the theme of effective financial strategies and support systems from intercalators. The perception of career benefits significantly influenced intercalation decisions (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, a change in policy to remove extra consideration for intercalated degree holders in UK foundation applications significantly affected decisions (p\u0026thinsp;=\u0026thinsp;0.014). Thematic analysis of non-intercalators identified the lack of perceived career advantage, including a loss of extrinsic motivation and perceived unrecognition. Intercalators cited long-term career benefits, research skills and confidence, portfolio building and networking as their primary motivators.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eOur study provided new insights into the socioeconomic, policy-related, and motivational differences among students that influence intercalation decisions. Financial constraints and the removal of extra consideration for intercalated degrees in physician training selection were major deterrents, particularly for students from diverse backgrounds. Future research should focus on developing targeted interventions to mitigate challenges and support a diverse and equitable clinical academic workforce.\u003c/p\u003e","manuscriptTitle":"Understanding medical students’ intercalation decisions to preserve the clinical academic pipeline: a mixed-method survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-08 06:16:57","doi":"10.21203/rs.3.rs-4592927/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-20T17:16:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-19T14:07:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-19T14:06:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2024-06-17T08:52:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ad775b4c-03b2-4dd3-89a9-2b93e9bc89cc","owner":[],"postedDate":"July 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T15:58:27+00:00","versionOfRecord":{"articleIdentity":"rs-4592927","link":"https://doi.org/10.1186/s12909-025-07609-6","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-10-02 15:56:50","publishedOnDateReadable":"October 2nd, 2025"},"versionCreatedAt":"2024-07-08 06:16:57","video":"","vorDoi":"10.1186/s12909-025-07609-6","vorDoiUrl":"https://doi.org/10.1186/s12909-025-07609-6","workflowStages":[]},"version":"v1","identity":"rs-4592927","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4592927","identity":"rs-4592927","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}