Career in internal medicine
Overall, 186 students (44.5%) had plans to pursue a master’s degree in internal medicine. Majority were male (70.4%) and in the fifth year of study (36.6%). Makerere (21.5%) and Busitema (19.4%) universities had the highest number of students with interests in pursuing internal medicine. Students who had passion for becoming a doctor constituted 81.2% of those interested in pursuing internal medicine. At bivariate analysis (Table 3), interest in pursuing internal medicine was significantly associated with preference in practicing in the academia (p=0.035) and students’ interests in research (p=0.001). Age, sex, marital status, students’ institution, and year of study were not significantly associated with interest in pursuing internal medicine.
Table 3
Distribution of interests to pursue internal medicine across students’ demographics, motivation, and practice preference.
Variable
|
Yes (n=186)
Frequency (%)
|
No (n=232)
Frequency (%)
|
Age, years
|
24 (23 - 26)
|
24 (23 - 26)
|
18 - 35
|
107 (57.5)
|
121 (52.2)
|
>36
|
79 (42.5)
|
111 (47.8)
|
Sex
|
|
|
Female
|
55 (29.6)
|
80 (34.5)
|
Male
|
131 (70.4)
|
152 (65.5)
|
Marital status
|
|
|
Divorced / Widower
|
0 (0)
|
1 (0.4)
|
Married / cohabiting
|
18 (9.7)
|
33 (14.2)
|
Single
|
168 (90.3)
|
198 (85.3)
|
University
|
|
|
Busitema University
|
36 (19.4)
|
40 (17.2)
|
Gulu University
|
20 (10.8)
|
28 (12.1)
|
Islamic University in Uganda
|
24 (12.9)
|
30 (12.9)
|
Kampala International University
|
19 (10.2)
|
26 (11.2)
|
King Caesar University
|
24 (12.9)
|
19 (8.2)
|
Makerere University
|
40 (21.5)
|
41 (17.7)
|
Mbarara University of Science and Technology
|
23 (12.4)
|
48 (20.7)
|
Year of study
|
|
|
III
|
57 (30.6)
|
50 (21.6)
|
IV
|
61 (32.8)
|
87 (37.5)
|
V
|
68 (36.6)
|
95 (40.9)
|
Nationality
|
|
|
International
|
15 (8.1)
|
16 (6.9)
|
Ugandan
|
171 (91.9)
|
216 (93.1)
|
Region of origin if Ugandan
|
|
|
Central
|
48 (25.8)
|
66 (28.4)
|
Eastern
|
48 (25.8)
|
55 (23.7)
|
Northern
|
20 (10.8)
|
32 (13.8)
|
Western
|
55 (29.6)
|
62 (26.7)
|
Type of sponsorship in the current degree
|
Government Loan Scheme
|
12 (6.5)
|
12 (5.2)
|
Government merit
|
67 (36)
|
84 (36.2)
|
Private - NGO
|
15 (8.1)
|
16 (6.9)
|
Private - Parents
|
59 (31.7)
|
77 (33.2)
|
Private - Self
|
33 (17.7)
|
43 (18.5)
|
Family member is a doctor
|
|
|
No
|
123 (66.1)
|
144 (62.1)
|
Yes
|
63 (33.9)
|
88 (37.9)
|
Family members' specialty
|
Internal medicine
|
174 (93.5)
|
222 (95.7)
|
Other
|
12 (6.5)
|
10 (4.3)
|
Reason for pursuing MBChB
|
|
|
Persuaded by family and relatives
|
16 (8.6)
|
25 (10.8)
|
To make more money
|
19 (10.2)
|
23 (9.9)
|
Grades dictated admission
|
20 (10.8)
|
25 (10.8)
|
To make my parents proud
|
26 (14)
|
33 (14.2)
|
Passion to become a doctor
|
151 (81.2)
|
170 (73.3)
|
Preferred field of practice
|
|
|
Public service
|
100 (53.8)
|
119 (51.3)
|
Private service
|
62 (33.3)
|
91 (39.2)
|
Research
|
53 (28.5)
|
58 (25)
|
Academia teaching
|
56 (30.1)
|
49 (21.1)
|
Administration
|
22 (11.8)
|
41 (17.7)
|
Interest in research
|
|
|
No
|
17 (9.1)
|
50 (21.6)
|
Yes
|
169 (90.9)
|
182 (78.4)
|
At multivariable logistic regression (Table 4), students with interest in research were 2.5-fold more likely to pursue a career in internal medicine (adjusted odds ratio: 2.5, 95% CI: 1.4 — 4.6, p=0.003).
Table 4
Factors associated with interest in internal medicine.
Variables
|
Adjusted odds ratio (95% CI)
|
P-value
|
Age
|
0.9 (0.9 - 1)
|
0.105
|
Sex
|
|
|
Female
|
1.0
|
|
Male
|
1.1 (0.7 - 1.8)
|
0.548
|
Year of study
|
|
|
I
|
1.0
|
|
IV
|
0.7 (0.4 - 1.1)
|
0.134
|
V
|
0.8 (0.5 - 1.3)
|
0.379
|
Motivation to pursue MBChB
|
|
|
Passion
|
1.5 (0.9 - 2.5)
|
0.092
|
Practice preference
|
|
|
Academia/teaching
|
1.5 (0.9 - 2.3)
|
0.108
|
Administration
|
0.6 (0.3 - 1)
|
0.069
|
Interests in research
|
2.5 (1.4 - 4.6)
|
0.003
|
Attitudes towards internal medicine
Table 5 shows the attitudes of the participants towards internal medicine. Majority of the students strongly agreed that internal medicine requires wide reading (n=303,72.5%) and patient problems in internal medicine are so diverse (n=212, 50.7%). About half of the participants agreed that there is an excellent opportunity for inpatient (n=213, 51.0%) and outpatient care (n=196, 46.9%) in internal medicine. More students agreed that the call schedule in internal medicine was flexible (n=180, 43.1%), and that internal medicine would allow one to have academic/teaching roles (n=173, 41.4%).
The mean attitude scores are presented in Table 5. The mean attitude scores were highest for internal medicine requiring a lot of time (4.6±0.7), patients’ problems being diverse (4.4±0.8), making one a good researcher (4.1±0.9), and allowing one to have academic / teaching career (4.0±0.9), indicating overall agreement with the statements. The mean attitude scores were lowest for internal medicine having low patient load (2.2±1.0), being boring to practice (2.3±1.1), physicians having a lot of free time (2.6±1.0) and having attractive salaries (2.7±0.9), indicating overall disagreement.
Table 5. Attitudes of the participants towards internal medicine.
Attitude
|
SD
|
D
|
N
|
A
|
SA
|
Mean (SD)
|
Internal medicine requires wide reading
|
3 (0.7)
|
4 (1)
|
25 (6)
|
83 (19.9)
|
303 (72.5)
|
4.6 (0.7)
|
Patient problems in internal medicine are so diverse
|
0 (0)
|
13 (3.1)
|
36 (8.6)
|
157 (37.6)
|
212 (50.7)
|
4.4 (0.8)
|
Internal medicine makes you a good researcher
|
5 (1.2)
|
18 (4.3)
|
81 (19.4)
|
159 (38)
|
155 (37.1)
|
4.1 (0.9)
|
Internal medicine will allow me to have academic / teaching role
|
12 (2.9)
|
12 (2.9)
|
75 (17.9)
|
173 (41.4)
|
146 (34.9)
|
4 (0.9)
|
I admire physicians
|
16 (3.8)
|
39 (9.3)
|
90 (21.5)
|
147 (35.2)
|
126 (30.1)
|
3.8 (1.1)
|
There is an excellent opportunity for inpatient care in internal medicine
|
10 (2.4)
|
26 (6.2)
|
98 (23.4)
|
213 (51)
|
71 (17)
|
3.7 (0.9)
|
Patients die often in internal medicine
|
12 (2.9)
|
46 (11)
|
109 (26.1)
|
127 (30.4)
|
124 (29.7)
|
3.7 (1.1)
|
There are good opportunities to work as a physician abroad
|
7 (1.7)
|
21 (5)
|
158 (37.8)
|
141 (33.7)
|
91 (21.8)
|
3.7 (0.9)
|
There is an excellent opportunity for outpatient care in internal medicine
|
8 (1.9)
|
34 (8.1)
|
111 (26.6)
|
196 (46.9)
|
69 (16.5)
|
3.7 (0.9)
|
There are many future job opportunities to a physician in Uganda
|
12 (2.9)
|
43 (10.3)
|
143 (34.2)
|
141 (33.7)
|
79 (18.9)
|
3.6 (1)
|
Joining Internal medicine requires a very high CGPA
|
5 (1.2)
|
38 (9.1)
|
166 (39.7)
|
143 (34.2)
|
66 (15.8)
|
3.5 (0.9)
|
Internal medicine will allow me to have time for my family and spouse
|
21 (5)
|
52 (12.4)
|
133 (31.8)
|
131 (31.3)
|
81 (19.4)
|
3.5 (1.1)
|
There are less procedures in internal medicine
|
19 (4.5)
|
88 (21.1)
|
75 (17.9)
|
153 (36.6)
|
83 (19.9)
|
3.5 (1.2)
|
Call schedule in internal medicine is flexible
|
17 (4.1)
|
54 (12.9)
|
126 (30.1)
|
180 (43.1)
|
41 (9.8)
|
3.4 (1)
|
Support network in internal medicine is excellent
|
11 (2.6)
|
47 (11.2)
|
169 (40.4)
|
143 (34.2)
|
48 (11.5)
|
3.4 (0.9)
|
Internal medicine training facilities are of excellent quality
|
11 (2.6)
|
76 (18.2)
|
149 (35.6)
|
128 (30.6)
|
54 (12.9)
|
3.3 (1)
|
The quality of current internal medicine trainees has encouraged me to pursue a career in internal medicine
|
21 (5)
|
87 (20.8)
|
149 (35.6)
|
112 (26.8)
|
49 (11.7)
|
3.2 (1.1)
|
Abbreviations: S A, strongly agree; A, agree; N, neutral; D, disagree; S D, strongly disagree. Attitudes were scored as; strongly agree- 5, agree- 4, neutral- 3, disagree- 2, and strongly disagree- 1.
Motivation to undertake research.
Most of the students (84.0%) were interested in research (Table 6). Among these, the desire to discover new things (74.1%), passion (31.6%), mentorship (31.6%), income (29.1%), and need for collaborations (29.1%) were the top five reasons for interests in research. Among the 67 students not interested in research, long time required, hectic research processes, and the need for wide reading were the most frequent reasons.
Table 6
Interests in undertaking research among the study participants.
Variable
|
Frequency
|
Percent
|
Interested in research
|
|
|
Yes
|
351
|
84.0
|
No
|
67
|
16.0
|
Reason for interest
|
|
|
Discovering new things
|
260
|
74.1
|
Passion
|
111
|
31.6
|
Mentorship
|
111
|
31.6
|
Money
|
102
|
29.1
|
Collaborations
|
102
|
29.1
|
Academic promotion
|
100
|
28.5
|
Awards and recognition
|
90
|
25.6
|
Travel
|
67
|
19.1
|
Others
|
10
|
2.8
|
Reason for lack of interest
|
|
|
Research requires a lot of time
|
32
|
47.8
|
Research is hectic
|
31
|
46.3
|
It requires a lot of reading
|
16
|
23.9
|
I am not good at writing
|
15
|
22.4
|
I lack mentors
|
14
|
20.9
|
Research requires a lot of money
|
11
|
16.4
|
Publishing is a hard process
|
10
|
14.9
|
Others
|
5
|
7.5
|