Career Choices Among Medical Students of a Medical College

Muhammad Anwar Khan¹, Nosheen Zehra², Saad Azam³, Muhammad Asim Khan³, Abdul Rehman Kakar³

^{1. Department of Medical Education, King Saud Bin Abdulaziz University for Health Sciences, Jeddah; 2. Department of Community Health Sciences, Ziauddin University; 3. Student Fourth year MBBS, Ziauddin University}

ABSTRACT

Background: The proportion of medical students opting for different medical specialties changes over time. Studies have demonstrated that career preference at the time that students begin medical school maybe significantly associated with their ultimate career choice

Objectives: This study was conducted to assess the different medical careers preferences by five years medical students.

Methods: This was a descriptive cross sectional study which was conducted for a year at a private medical university in Karachi among the medical students of all 5 years of MBBS. The sample was calculated to be 384. The sampling technique used to select the sample was simple random. A self-administered questionnaire was given to each student. Data was entered and analyzed on SPSS.

Results: Among 421 students most of the students i.e. 31.6% students selected the field of medicine as they want to serve humanity. Medicine by 24.5% and surgery by 32.9% students were identified as the two most frequently selected sub specialties as a future career. Of all 84% students were interested to practice in US while only 14% intended to stay in Pakistan.

Conclusion: The clear preference is for clinical side with surgery and medicine the top priority. The desire to go abroad for specialization was among the most prominent trends in our study.

Key Words: Career choices, medical students, private medical college

INTRODUCTION

Medical students during their study years experience confusion while choosing future career specialty. There are many contributing factors along with motivation and inclination for deciding future career by medical students. Commonly identified factors that have an impact on career preference are advice from friends or family, admiration of a certain mentor or genuine interest in the specialty, lifestyle choices, a possibility of private practice, an interest in specific diseases, a varied scope of practice, an interest in research and teaching, or to gain a higher income.1

The number of medical students opting for family medicines has declined over the years. A research was conducted with its primary purpose being to identify the carrier preferences of the final year medical students of a Medical University.2 Two hundred and thirty two final year medical students participated in this research. The outcome was that students chose internal medicine, surgery and pediatrics as their first three choices. Clinical specialties were highly rated as compared to family medicine Personal interest was ranked as the most influencing factor that contributed to the choice of specialty. Most respondents preferred working in Pakistan as compared to overseas and for practice selected private set up was more favored compared to other settings. Studies have demonstrated that career preference at the time that students begin medical school maybe significantly associated with their ultimate career choice.2

In a study conducted in Kuwait to evaluate future specialty choices among medical students, 37% were sure about their future medical specialty choice. Pediatrics, general surgery and cardiology were the most desired specialties among the medical students as selected by 12.5%, 11.8% and 11.1% students respectively.3 In Saudi Arabia a study was conducted in 2010 at King Khalid University Medical School that included 590 students in their survey. Surgery was the single most popular specialty amongst both male and female students.4In another study, carried out to determine variation in specialty preferences during medical school training in Saudi Arabia. The most preferred specialty expressed by male students was surgery, followed by internal medicine and orthopedics, while most preferred by female students were surgery, followed by pediatrics and ophthalmology.5 Another study conducted among medical students of University of Nairobi showed surgery, pediatrics, internal medicine and obstetrics as most preferable career options.6 Preference of specialty was significantly varied among male and female medical students as male preferred surgery while female preferred pediatrics.6 This study was conducted to assess the different medical careers preferred by five years medical students. In this study as all the five years were studied so it portray better situation about specialty preference and its association with different medical years.

METHODOLOGY

This descriptive cross sectional study was conducted for two years at a private medical university in Karachi among the medical students of all 5 years. Sample size was calculated by WHO sample size estimation calculator. For sample size calculation anticipated population proportion was taken as 50%, at 95% confidence level and keeping 0.05 margin of error. The minimum number of participants required for inclusion in the sample was calculated as 385 but to avoid data wastage 450 participants were included in the study, 90 students from each year. Both males and females medical students were included in the study. All those students who were present in the class and gave verbal informed consent were included in the study. A self-administered questionnaire was given to each student. The researcher along with his team was present in the class to answer any query. Fifteen minutes were allotted to complete the questionnaire and after that the questionnaires were taken back. Data was entered and analyzed on SPSS version 17. All categorical variables were presented as percentage and frequencies and all numerical variables were presented as mean and standard deviation.

RESULTS

The sample population was from a private medical university in Pakistan, in the metropolitan city of Karachi. Total 450 questionnaires were distributed among students from different years of MBBS yet total of 421 subjects responded. The Response rate was therefore 93.5%. Male and female representation was 203 (48.2%) and 218 (51.8%) respectively. As for the year of medical college, all classes had comparable representation, with a slightly higher proportion from the first and fifth years. Of them 108 (25.7%) were from 1^st year while 73 (17.3%), 74 (17.6%), 67 (15.9%) and 99 (23.5%) were from 2^nd, 3^rd, 4^th and Final year MBBS. Figure 1 is showing the reasons why medical students chose Medicine as a preferred professional field where most of the students answered that it was to help the suffering of people.

Not surprisingly, a large majority 359(85%) of students wanted to pursue clinical medicine, whereas only a minority 62(15%) wanted to take up non-clinical health related fields, including academic, administrative, research-based, and pharmacological and other fields. Those students who selected clinical field of medicine were further inquired about the sub specialty which they intend to pursue after graduation and their choices are presented in table 1. These students were also inquired about their motivation behind selecting these fields and for that 202 (56.3%) students expressed their interest in the fields as the primary reason while 94 (26.2%) students selected on the basis of the earning potential and 63 (17.5%) for some other reasons.

It was also asked from students that if they are planning to go abroad for higher studies and specialization after their graduation, the results was mixed with a quarter of the students 109(26%) were undecided and about 263(62%) intending to go abroad for specialization. A little more than one-tenth 49(12%) had decided they didn’t want to go abroad for specialization. Of those 372 (88.36) who were undecided and sure about to go abroad, 297 (79.8%) were interested in USA, 40 (10.47%) in UK and 35 (9.5%) in some other countries like Australia, Canada etc. Students were asked if they get an opportunity to practice abroad which country they will prefer, for that US was opted by 355 (84.3%) students, UK by 8 (1.9%) while 58 (13.7%) wanted to stay in Pakistan. Of those students who showed their interest to stay in Pakistan even after the completion of their higher studies, 31 (53.5%) wanted to serve Pakistan, 22 (37.9%) due to family and 5 (8.6%) for some other reasons.

DISCUSSION

Our study had a good response rate, and had roughly equal representation for both males and females, and from all the five years of MBBS. The slightly higher response rate from the first and the fifth years may have been due to the greater presence of these students on the campus due to their academic schedules at the time of data collection.

It was of interest to note that more than 30% of the students expressed the clichéd “to help the people’s suffering” as the reason to choose Medicine for a profession. Although it is widely believed that professional students express exaggerated altruism as a motivation to study medicine, other international studies are consistent with the results seen in our study. As an example, a US study conducted in 2009 on 190 medical students showed that the humanitarian impact of the profession was the primary motivation followed by the respect and financial security that it offers.⁷More unique to our study population is the ‘pressure from family’ chosen by 15% of the students as the reason for pursuing Medicine. Studies in different countries have indicated that this is a common phenomenon in the South Asian students where they are urged to choose medicine, engineering or law as a profession because of the prestige it brings to the individual and his family. Asian American might choose their career based on their family’s mission rather on their owninterests.^8-10 Nevertheless, the authors feel that this is an area that should be explored further.

The decision to choose a medical specialty is dictated by several factors including personal interest, compensation, working hours and the practice patterns and local health policies of the geographical location. For example, while it is known that the future earning potential may impact a physician’s choice of specialty.¹¹It has also been studied that non-economic factors such as length of residency, predictable working hours, prestige of practice, and even the type of medical college attended had an effect on which specialty the students chose.¹² In our study, 33% of the students wanted to pursue General Surgery, while about 24% wanted to pursue General Medicine. The reason most commonly cited for the choice of specialty was personal interest, followed by the earning potential. Ophthalmology and Otolaryngology, usually considered to be very competitive, interested the least number of students.

The second part of our study dealt with the choice of country for practice of medicine. We thought it would be interesting to see how many students intended to practice in Pakistan as compared to moving abroad. Shockingly, a large proportion of students wanted to move to US to practice Medicine. Although, it should be noted that the sample was derived from a private sector medical university where education is costly and is funded wholly by the student’s family; it is generally believed that starting physicians earn significantly more overseas as compared to within Pakistan, and can unburden the financial load of their medical education quicker. Perhaps this should be viewed in the context of the current socioeconomic instability of the country as well. Our study did not explore the reasons for the decision to move abroad. The results of our study are comparable to research conducted in neighboring countries such as India, that share some of the same socioeconomic conditions as our country. It has been estimated that about 10% of Indian physicians—the ‘largest émigré physician workforce’ —practice in US, Canada, UK and Australia.¹³

As for going overseas to pursue specialization only 62% intended to go abroad for specialization. Again, this is a phenomenon that has not been studied extensively outside of Pakistan as it does not occur in the Western countries where students overwhelmingly pursue specialization in their country. Among those who wanted to pursue specialization abroad, 94% listed US as their preference, whereas 2% favored UK. The preference for US is likely related to the technical advancements in Medicine that it is famous for.

The minority of students only 14% that wanted to stay in Pakistan, out those 54% expressed their intention to serve their country as the primary reason for not leaving the country, followed by about 38% students who wanted to be with their families and hence did not want to leave Pakistan. This indicates that social, residential and family ties are important for this group of students.

In this study the sample population was from a medical university in the private sector, and did not include students from the public sector. This may have resulted in the skewed preference for practicing medicine abroad seen in our study. This may be one of the limitations of our study however; our study had a large sample size and a good response rate. It had fairly equal representation of both genders, as well as from all the five years of medical students. From this study we found some realistic facts that have an implications for our policy makers at the government level so that the brain drain can be mitigated via appropriate steps. Study should be repeated with a sample extracted from both the public and private sectors. Physicians are known to urge their children to take up Medicine as a career. While 15% of the students admitted to family pressure for choosing Medicine, it would be interesting to know how many students have physicians as parents, and if that was the reason to choose Medicine. A large majority of the students indicated their preference to move abroad for the practice of medicine. The scope of our study was limited, but this is an area that should be explored in future studies so that steps can be taken at the government level to retain our talent within Pakistan.

CONCLUSION

Overall, our study gives some insight into the factors that are considered by students when opting for Medicine as a career and that dictate their choices when pursuing a specialty. The clear preference is for clinical side with surgery and medicine the top priority. The desire to go abroad for specialization was among the most prominent trends in our study.

REFERENCES

1. Saigal P, Takemura Y, Nishiue T, Fetters MD. Factors considered by medical students when formulating their specialty preferences in Japan: findings from a qualitative study. BMC Med Educ 2007; 7: 31
2. Huda N, Yousuf S. Career preference of final year medical students of Ziauddin Medical University. Educ Health (Abingdon) 2006; 19: 345-53.
3. Al-Fouzan R, Al-Ajlan S, Marwan Y, Al-Saleh M. Factors affecting future specialty choice among medical students in Kuwait. Med Educ Online 2012; 17: 1-7
4. Mehmood SI, Khan MA, Walsh KM, Borleffs JC. Personality types and specialist choices in medical students. Med Teach 2013; 35: 63-8.
5. Mehmood SI, Kumar A, Al-Binali A, Borleffs JC. Specialty preferences: trends and perceptions among Saudi undergraduate medical students. Med Teach 2012;34 Suppl 1: S51-60.
6. Maseghe Mwachaka P, Thuo Mbugua E. Specialty preferences among medical students in a Kenyan university. Pan Afr Med J. 2010; 5: 18.
7. RA Gillies et al. Why a medical career and what makes a good doctor? beliefs of incoming us medical students. Educ Health 2009; 22: 331
8. Leong FTL. Career development and vocational behavior. In: Lee CL, Nolan WSZ editors. Handbook of Asian American Psychology. Thousand Oaks, CA: Sage Publication; 1998, p. 359-98.
9. Leong, FTL, Gupta A. Career development and vocational behaviors of Asian Americans. In: Leong FTL, Inman AG, Ebreo A, Yang LH, Kinoshita L, Fu M, editors. Handbook of Asian American Psychology 2nd ed. Thousand Oaks, CA: Sage Publication; 2007, p 159-78.
10. Tang M, Fouad NA, Smith PL. Asian Americans’ Career Choices: A Path Model to Examine Factors Influencing Their Career Choices. J Vocational Behavior 1999; 54: 142–57.
11. CE P. Physicians in the marketplace, health economics. 2nd ed. Reading, MA: Addison-Wesley, 1997; 1997
12. Kiker BF ZM. Relative future income expectation, expected malpractice premium cost, and other determinants of physician specialty choice. J Health Social Behavior 1998; 39: 152-67
13. Mullan F. Doctors For The World: Indian Physician Emigration. Health Affairs (Millwood) 2006; 25: 380-93