The study was conducted between April and May 2019. There were 178 students registered final year medical students. However, 33 of these were not available at the university during the study period. Therefore, 145 medical students were eventually recruited into the study. The recruitment of study participants is shown in Figure 1.. Out of these, 135 students returned their questionnaires giving a response rate of 93%.
Sociodemographic Characteristics of Fifth year Medical students at MakCHS
Out of the 135 medical students that participated in the study, 91(67.4%) were males and 44(32.6%) were females, giving a male to female ratio of 2:1. Their ages ranged between 21 years and 47 years, with a median of 24 (IQR: 24, 26). The sociodemographic characteristics of the students are shown in Table 1 and Table 2.
Specialty Career Preferences among final year Medical students at MakCHS
Obstetrics and Gynecology was the most commonly preferred career as a first choice, with 34 (25.2%) students selecting it; followed by careers in Surgery, Internal Medicine and Pediatrics respectively as represented in Figure 2. Careers in Family Medicine, Anesthesia and ENT were not selected by any student. The “others” first choice category consisted of Business, Clinical epidemiology and Biostatistics, Forensic Medicine and voluntary medical work.
Obstetrics and Gynecology was still the most preferred second choice with 27 (20%) students selecting it. The “others” second choice category consisted of Nano medicine/ nuclear medicine and political science/public administration.
Pediatrics was the most preferred third choice with 22 (16.3%) students selecting it. The “others” third choice category consisted of Biogenetics science, health informatics and sports medicine. The details of the various choices as selected by the students are illustrated in Figure 2.
Comparison of first choice specialty preference across the sociodemographic characteristics
The distribution of the first choice specialty was compared across the various categories of the sociodemographic characteristics using the chi-square test. The test showed that there was a significant relationship between the first choice preference and sex (p = 0.04), marital status (p < 0.01), having children (p < 0.01) and sponsorship (p = 0.04) (Table 3). On adjustment using multivariate logistic regression, sex was the only factor with a statistically significant odds ratio (OR) (OR=0.37; 95%CI (0.17-0.84); p=0.02). Therefore, the female medical students are 63% less likely to select surgical disciplines as a specialty career preference compared to the male medical students. The results for the odds are shown in Table 4.
The female medical students were less likely to select surgical disciplines like Obstetrics and Gynecology and General Surgery when compared to their male counterparts (Figure 3).
Factors influencing specialty career preferences of the medical students
Three FGDs were conducted in May 2019 among 15 males and 16 females whose ages ranged from 21 to 35. The students were well distributed in terms of places of origin and different backgrounds with one foreign students included. Most of the students had a specialty career preference in mind at the time of the study.
Analysis of these FGDs revealed two major themes which are summarized in Table 5 with the key representative quotes from the students.
Theme 1: Facilitators of specialty career preference
The students selected various careers and based their preferences on the following influencing factors.
1. Presence of role models and mentors:
A key facilitator to selecting a specialty career preference among medical students was presence of role models and mentors as illustrated by a participant“… She is not only a surgeon but also a mother. The way she takes you, she respects you even though you are an undergraduate. She is really good and really motivates you to think about more of surgery. Her surgeries are so clean” (Mature entrant FGD). Presence of mentors is also very crucial since these mentors offer guidance for the student as they build their careers.
2. Organization in the department
Most of the students in the discussions mentioned that an organized department was a sure facilitator for selection of a career preference. A mature student also highlighted the importance of the organization of the discipline “When you look at those two departments, they have a good streamlined program. They try to bring out their lectures very well, associate with students very well, and evaluate well when compared to other departments.” (Mature entrant FGD)
3. Controlled lifestyle:
Ability to have a controlled lifestyle also motivated students to select certain specialties. This controlled lifestyle means that one is able to balance between work, family, leisure and any other activities. A male student reflected this as “I feel like psychiatrists have better working hours, surgeons are called in at 2am because a patient has gone into cardiac arrest or a mother has gone into labour.” (Male FDG).
Other facilitators highlighted in the discussions included a positive or good experience during clinical rotation, attitudes of the specialists in the discipline, assurance of a good life due to better financial remuneration, availability of job opportunities, family influence, media, and peer influence.
Theme 2: Barriers to selection of specialty career preference
1. Perceived poor and miserable specialists
The students’ perception of the specialists to be poor and miserable is a major barrier to the selection of certain specialties “…if I look at certain specialty and to me all the doctors look poor and miserable, the residents are broke and suffering…I am not inspired by all that knowledge they have.” (Female FGD). Therefore most students tend to avoid specialties where it is assumed that there is a weight of challenges and financial difficulties attached.
The prolonged amount of time spent in training within a certain specialty compared to others is also a barrier. This was especially among female students who had a concern about settling and starting a family before they are too old as shown in this quote “…well we have a biological clock to worry about…I will always go for shorter courses mainly in research with more money.” (Mature entrant FGD).
2. Uncontrollable lifestyle attached to a career
The uncontrollable lifestyle of a specialty career is also a barrier in selection of certain careers since students want to be able to balance between life and work. There are some careers that are very demanding (especially surgical-related careers) and may not allow time for any other activities or for family “Given the kind of mother I would like to be I may not be able to do emergency medicine; maybe because I have not got guidance from a successful emergency medicine specialist. But from what we see on TV, clearly you cannot take care of your kids and be an emergency medicine specialist.” (Female FGD)
3. Inadequate exposure during clinical rotations
Inadequate exposure to a specialty during the clinical years may also be a barrier since a student may not able to appreciate the various aspects of the discipline “I think the challenge there is the small duration we spend or the inadequate duration we are given. “We have to learn and understand because we are going to manage human beings.” (Mature entrant FGD)
Other barriers to selection of specialty career preference include: Inadequate training methods used in delivering the curriculum, perceived high risk for litigation cases, strict assessments given in a rotation, lack of career guidance and students’ negative experience during clinical rotations.