Medical Specialty Choice and Related Factors of Brazilian Medical Students and Recent Doctors

Exploring Factors Influencing Medical Trainees' Specialty Choice: Insights from a Nationwide Cross-Sectional Survey in Jordan

Phenomenon: Choosing a medical specialty is a critical decision that significantly impacts medical students' future career. Understanding the factors influencing this decision-making process is important for medical educators, policymakers, and healthcare providers to develop effective strategies that support and guide students in making informed decisions. Approach: We distributed an online self-administered questionnaire to clinical-year medical students (Years 4 to 6) and interns from all medical faculties in Jordan. The questionnaire gathered demographic information, specialty preferences, and factors influencing specialty decision-making. We analyzed the data using descriptive statistics and logistic regression. Findings: 1805 participants completed the questionnaire (51.7% women). General surgery was the most preferred specialty among both genders, followed by internal medicine. Women significantly preferred family medicine, pediatrics, obstetrics and gynecology, and dermatology, whereas men significantly preferred urology, orthopedic surgery, neurosurgery, general surgery, and internal medicine. The factors that most strongly influenced respondents' specialty preferences were the specialty's perceived stress levels and working hours, whereas the least influential factors were the specialty's perceived prestige and role models in the specialty. Women's specialty preferences were significantly more influenced by their family than men's. Men were substantially more influenced by specialties' perceived action-orientation and stress levels than women. Insights: Gender significantly influences medical trainees' specialty preferences in Jordan. Women tended to prefer specialties that provided greater work-life balance, such as family medicine, pediatrics, obstetrics and gynecology, and dermatology, while men were more drawn toward competitive and profitable surgical specialties like orthopedic surgery, neurosurgery, urology, and general surgery. Additionally, family had a stronger influence on women's decisions, likely due to cultural and social expectations prioritizing marriage and family for women. Career counseling and mentorship programs are needed to provide guidance, support, and networking opportunities that can help women overcome barriers and biases that may hinder their career advancement.

Factors Influencing Specialty and Training Center Choices Among Saudi Medical Residents

AIM

This cross-sectional study aims to identify and quantify the factors influencing Saudi medical residents in selecting their desired specialty and primary training center, while examining the associations between these factors.

METHODS

The study received approval from an institutional ethical committee at King Abdulaziz University. An electronic questionnaire was designed and validated via content, face validity, and the Content Validity Index. The sample size was calculated based on a 95% CI and a 5% margin of error. The study targeted all current residents in the current Saudi Specialty Certificate Programs. Descriptive statistics summarized demographic characteristics, training-related information, and factors influencing the selection of a specialty and training center. Fisher's exact test and Chi-square tests were employed for data analysis.

RESULTS

A total of 387 respondents completed the survey, with a 32.3% response rate. The majority of respondents were male (n = 232, 59.9%), and the majority were also married (n = 67.2%), with internal medicine (n = 92, 23.8%) and family medicine (n = 74, 19.1%) being the most prevalent specialties. Notably, 89.4% (n = 346) reported matching into their first-choice specialty, and 67.2% (n = 260) into their first-choice training center. Furthermore, 90.2% (n = 349) had prior training (elective/internship) in their chosen specialty, and 63% (n = 244) had previous training (elective/internship) at their primary training center. Prior exposure to both specialty and center significantly resulted in them being the resident's top choice (p < 0.01). Multiple factors influencing the choice of either the specialty or the center were found to have statistically significant associations with the gender, specialty, residency level, sector of the training center, and timing of the specialty decision (p < 0.05).

CONCLUSION

This study reveals the substantial influence of early experiences on Saudi medical residents' specialty and training center choices. It also uncovers gender disparities and variations in the influence of specialty-related factors. Future research with larger and more diverse samples is recommended to gain a deeper understanding of the multifactorial decision-making processes, enabling the development of strategies to better meet the evolving needs and preferences of healthcare professionals in Saudi Arabia.

Investigating factors that influence residency program selection among medical students

BACKGROUNDS

Medical students and interns face several decisions during their career development. One of the most critical decisions they have to make is choosing a residency program that suits their career goals and aspirations. The selection process can be challenging, as several factors can influence the decision-making process. There was limited research on the role of GPA and opportunities in residency program selection. Therefore, this study examines the factors that influence interns' and 5th-year medical students' choices of residency programs.

METHODS

Observational and analytical cross-sectional studies were conducted at King Saud University (KSU) in Riyadh, Saudi Arabia. A sample of 5th-year medical students as well as medical interns was included in the study. This study only includes students who were interested in choosing a residency program in one of these eight domains: Medicine, Family Medicine, Orthopedics, Pediatrics, Radiology, Surgery, Obstetrics/Gynecology, and Ophthalmology.

RESULTS

The total number of students with 5th-year medical students was 205 (60.1%) and the number of students with medical interns was 135 (39.5%). The majority of students (51.0%) had a GPA above 4.5 out of 5, followed by 3.5 to 4.5 among 146 (42.8) students, and only 21 (6.2) had a GPA below 3.5. Those students with less than a 3.5 GPA out of 5 were found not to have any favorite residency program specialties when it came to academic achievement. Furthermore, in the case of those students whose GPA was 3.5 to 4.5, they had a certain mindset when it came to choosing a residency program. A 1.9 times greater likelihood of selecting obstetrics and gynecology (OR = 1.9, p = 0.19) was achieved by students with GPAs between 3.5 and 4.5, followed by a 1.5 times greater probability of selecting radiology (OR = 1.5; p = 0.55). High achievers, ophthalmology (OR = 1.7; p = 0.32) and surgery (OR = 1.4; p = 0.31) were the most popular residency programs. A student with a high GPA (mean score = 7.3) also chooses his or her career based on better opportunities than a student with a low GPA (mean score = 6.8).

CONCLUSIONS

The study highlights the correlation between academic achievement and preferred specialties for future careers among medical students. While the study's findings should be considered in the context of various other factors such as lifestyle, social life, and income can influence students' preferred specialties for residency programs.

Ophthalmology as a career choice among medical students in Eastern India - A cross-sectional study

Purpose

Several factors influence medical students to choose a specialty branch for post-graduate training, and it is important to understand them so that strategies can be made to make it more attractive and hence the shortage in the workforce can be addressed. This study aimed to identify the factors that influenced under-graduate medical students to choose ophthalmology as their specialty for post-graduate training.

Methods

It was a descriptive, cross-sectional, questionnaire-based study, carried out among medical students at a tertiary academic institute in eastern India. In this survey tool, 25 questions were divided into different sections: demographic data, factors influencing the choice and perceptions about ophthalmology as a career option, and the impact of rotatory internship posting on the choice of subject. The various factors were then scored and indexed appropriately.

Results

There were 515 participants. The median age was 23 years. The major influencing factor for choosing ophthalmology was "adequate time" (52.04%), and the discouraging factor was "steep learning curve" (58.64%). Age had an odds ratio of 0.781, showing that the lower the age, the higher the chances of being positively inclined toward ophthalmology as a career choice. Similarly, major deciding factors, perceptions, and experiences in ophthalmology had odds ratios of 1.841, 1.725, and 2.057, respectively, showing a positive inclination.

Conclusion

The study states that a steep learning curve, personal attitudes, and misconceptions may dissuade the students from taking this subject, but adequate clinical exposure and experience, as well as role models during the internship, can create a positive impact on career choice.

Determining Factors Influencing Specialty Preferences of Iranian Medical Doctors: A Qualitative Study

Background

The medical specialty choice of physicians directly affects the healthcare system, community wellbeing, and their own professional life. It is therefore important to identify its underlying factors to predict such medical career choices and to draw up a comprehensive evidence-based public health policy and health human resources planning. The present qualitative study aimed to identify these determinants of career choices through semi-structured interviews with medical doctors in the context of country-specific social and cultural characteristics.

Methods

The present qualitative study was carried out in 2019-2020 at Shiraz University of Medical Sciences (Shiraz, Iran). The target population was medical students, junior doctors, and medical residents. The purposive sampling method was used to recruit the participants and sampling continued until data saturation, i.e., no new information could be extracted. Data were collected through individual, face-to-face, semi-structured interviews and analyzed using the conventional content analysis method. Inductive thematic analysis was used to interpret the data based on which a thematic map was developed illustrating the factors influencing medical specialty preferences in Iran. Data trustworthiness was assessed according to the criteria proposed by Guba and Lincoln.

Results

Analysis of the interview data resulted in three main themes and fourteen sub-themes. The main themes were "Personal determinants", "Career-related factors", and "Interpersonal influences". The most important sub-themes were personal interests, income, and prestige.

Conclusion

The determinants influencing the specialty preferences of Iranian medical doctors are identified. Our findings will facilitate the development of a comprehensive evidence-based public health policy, health human resources planning, and appropriate medical education policy.

What do Iranian physicians value most when choosing a specialty? Evidence from a discrete choice experiment

BACKGROUND

Choosing a specialty by physicians is fundamentally linked to the performance of health systems and public health outcomes. Identifying the determinants of specialty selection is important to health policy for targeting resources and planning the development of services. This study examined preferences of Iranian physicians for medical specialty using a discrete choice experiment (DCE) method.

METHODS

In this study, the attributes of the DCE were determined using rigorous qualitative approach. Then we applied D-efficiency criteria to design the DCE and validated it at a pilot study. In the final survey, we recruited participants from six Iranian provinces and analyzed data using conditional logit model. We estimated willingness to pay (WTP) for non-monetary attributes.

RESULTS

The WTP analysis revealed that the most important non-monetary attributes in the selection of a specialty were job burnout, opportunity for procedural activities, and job prestige. The results imply that the attributes that were related to the quality of personal life was more important only for physicians who preferred to choose non-surgical specialties.

CONCLUSIONS

The findings demonstrate that traditional gender patterns of specialty selection are changing and quality of personal life characteristics might be the most important factor when developing policies to recruit physicians into non-surgical specialties.

Medical students' attitudes towards and views of general practice careers in Singapore: a cross-sectional survey and qualitative analysis

BACKGROUND

Like many other countries, Singapore needs to support its ageing population by attracting more doctors into general practice (GP) and family medicine (FM). To achieve this requires a better understanding of what attracts or deters medical students. We conducted a cross-sectional survey among medical students in Singapore.

METHODS

An online survey was distributed to students from all three medical schools to understand their likelihood of choosing primary care careers, what they valued in their careers, their attitude towards different aspects of general practice and family medicine relative to other medical fields, and the positive and negative perceptions of primary care held by themselves, their lecturers, and clinical mentors. They were able to elaborate the negativity encountered in the open-ended questions. Quantitative data was analyzed with descriptive statistics, principal component analysis, and linear regression; qualitative data was analyzed thematically.

RESULTS

The survey was completed by 391 students. Slightly over half indicated a likelihood of choosing a career in primary care. For their own careers, the students valued job satisfaction and career development opportunities the most. They perceived careers in primary care as being most likely to offer reasonable hours and close patient relationships, but least likely to offer career advancement potential relative to other medical fields. Their likelihood of choosing primary care careers was significantly predicted by what they value in their own career and their attitudes toward GP/FM relative to other medical fields, but not by the perceptions of GP/FM by others. Free-text responses illustrated how students encounter derogatory comments about GP/FM: the work being "mundane and repetitive", the careers non-competitive, and the doctors poor in clinical competence.

CONCLUSION

While the shortage of primary care doctors is a global issue, our findings highlight the value of situating inquiries in localized contexts. Medical curriculum should emphasize the critical role of primary care in the healthcare system and primary care doctors should be given due recognition to build a strong and motivated primary care workforce to serve the future healthcare needs of the population.

Patients' preferences regarding physicians' gender: a clinical center cross-sectional study

BACKGROUND

Even with the significant growth of female representation within medicine, inequality and prejudice against this group persist.

OBJECTIVE

To analyze patients' preferences regarding the gender of physicians in general and according to different specialties, and the possible reasons behind their choice.

DESIGN AND SETTING

Cross-sectional study at the Clinical Center of the University of Caxias do Sul, Brazil.

METHODS

Over a three-month period in 2020, 1,016 patients were asked to complete a paper-based 11-item questionnaire.

RESULTS

The majority (81.7%; n = 830) of the patients did not have a preference regarding the gender of physicians in general. The preference rate for same-gender physicians was 14.0% (n = 142/1,016), and this preference was more common among female than among male patients (17.6% versus 7.0%; odds ratio, OR = 2.85; 95% confidence interval, CI = 1.80-4.52; P < 0.001). When asked about their preference for the gender of the specialist who they were waiting to see, the overall preference rate for a same-gender professional was 17.2% (n = 175). Preference for same-gender specialists was higher for specialties essentially based on pelvic or breast examination (i.e. gynecology, urology, proctology and mastology), compared with others (33.4% versus 9.7%; OR = 4.69; 95% CI = 3.33-6.61; P < 0.001).

CONCLUSIONS

The patients' model for choice of their physician does not seem to involve physicians' gender in general or in the majority of medical specialties. The data presented in this study may make it easier to understand patients' preferences and concerns.

Virtual Reality Simulator Use Stimulates Medical Students' Interest in Orthopaedic Surgery

Purpose

To investigate whether the use of a VR arthroscopic simulator can influence medical students’ attitudes toward a career in orthopaedic surgery.

Methods

Twenty-five medical students completed seven unsupervised sessions on a VR hip-arthroscopic simulator. All participants completed a pre-simulator and post-simulator pseudo-anonymized questionnaire consisting of 10 questions: six 10-point Likert scale questions addressing their interest in orthopaedics, surgery, and arthroscopy; and four 5-point Likert scale questions addressing their attitudes toward simulation. Prepaired and postpaired datasets were analyzed using Wilcoxon signed rank test.

Results

Interest in both orthopaedics and surgery was found to increase after simulator use (orthopaedics: 5.3 ± .3 to 8.4 ± .2, P = .0001; surgery: 5.8 ± .3 to 9.0 ± .2; P = .0001). It was also found that simulator use increased participants’ interest in arthroscopy (5.4 ± .3 to 8.0 ± .3; P = .0001) and hip-arthroscopy (5.0 ± .3 to 7.6 ± .3; P = .0001). Participants reported they were more likely to attend endoscopic and arthroscopic surgical lists after simulator use (endoscopic: 6.9 ± .3 to 8.4 ± .2; P = .0003; arthroscopic: 5.9 ± .3 to 8.4 ± .2; P = .0001). After using the simulator, participants felt more strongly that VR simulation is a valuable training modality (P = .0025), that simulation should be a mandatory part of orthopaedics and surgical training (P = .0001 and P = .0001), and that access to VR simulators improves the quality of surgical training (P = .0024).

Conclusions

These results demonstrate that exposure to VR arthroscopic simulation increased medical students’ interest in orthopaedics, surgery, and arthroscopy, without the need for direct supervision. Following VR simulator use, students reported they were more likely to engage with training opportunities, including arthroscopic and endoscopic surgery.

Clinical Relevance

Understanding factors that stimulate interest in orthopaedic surgery may help programs attract the broadest pool of potential trainees.

A National Survey on the characteristics of Iranian General Practitioners and Their Preferred Specialty: A Need to Transition toward Preventive Medicine

Background:

The shortage and unbalanced distribution of physicians has adverse effects on the provision of equitable services at all levels of health care and especially at the prevention and primary care levels. The choice of specialty can seriously change the structure and composition of the physician workforce. Therefore, this study aimed to investigate the relationship between background characteristics of Iranian general practitioners' (GPs) and their preferred specialty fields.

Methods:

In this mixed-method study, first, 12 medical doctors participated in a nominal group technique to determine the most important background characteristics that affect GPs' preferences for specialty selection. In the second phase, we conducted a survey among 680 GPs in six provinces from different geographic regions. We gathered data using a researcher-made checklist and analyzed them using an adjusted multivariate regression.

Results:

The adjusted analysis showed that being female, being married, being in an older age group, having children, graduation from universities located in the provincial centers, and decision for living and practicing in the less-populated areas were significantly associated with the Iranian GPs' preferences for non-surgical specialties.

Conclusions:

This study provided evidence that could inform national health workforce policy-makers to avoid unbalanced distribution of physicians and accordingly to ensure the provision of equitable services at all levels of healthcare and especially at the primary care level. Other effective factors on the selection of specialty should be evaluated at the national level using specific surveys and econometrics studies such as discrete selection experiment to move toward preventive medicine.

Student’s confidence in mental health practice before and after psychiatry rotation: a follow up study

ABSTRACT Objectives The primary objective was to measure the effect of psychiatry rotation in students self-confidence (SC) for managing mental health (MH) issues. Methods An eighteen questions version of “Preparation for Hospital Practice Questionnaire” (PHPQ) adapted for MH was applied before, after and six months later the psychiatry rotation. Sociodemographic and experience with mental illness was measured as confounding factors. Results Hundred and ten students were recruited and four factors were identified: “Diagnosis elaboration and basic care” (F1), “Crisis management and prevention” (F2), “External sickness determinants” (F3) and “Personal distress with clinics” (F4). Cronbach Alpha ranged from 0.71 to 0.90. Previous MH training were not frequent (9.09%), and associated with better SC in F2 (after p < 0.05, 6m p = 0.03). Previous mental disorder was frequent (42.16%), and associated with more SC on F2 (p < 0.01) and F3 (p = 0.03) before course, but only on F3 after (p < 0.01) and not 6 months later. Male gender had more SC in F4 (p < 0.01) before course, but after course and 6m later female gender became more SC in F1 (after p = 0.02, 6m p = 0.01) and equivalent in F4. All factors had higher scores after and 6 months later (p < 0.001). The class considered that an interview script is very important for their SC, and improves assistance (mean > 9.0/10.0). Conclusion Obligatory rotation in MH improved SC in students. Previous training and gender were related with long lasting effects in SC.

A thematic network for factors affecting the choice of specialty education by medical students: a scoping study in low-and middle-income countries

BACKGROUND

Medical specialty selection is a complex phenomenon that can affect the performance of health systems, community health, and physicians' lives. It is essential to identify the key factors influencing the choice of specialty for evidence-based policymaking. This scoping review aimed to provide a comprehensive map of evidence regarding the factors influencing the choice of specialty by medical students (MS) in low-and middle-income countries (LMICs) and also to determine knowledge gaps.

METHODS

We carried out a systematic search on six online databases from January 2000 to May 2020. We used a five-step scoping review method proposed by Arksey and O'Malley. We synthesized the data using a quantitative content analysis approach. Then, we developed a thematic network as a conceptual map for a better understanding of the concept.

RESULTS

The analysis led to the development of five main themes, including personal determinants, life fulfillment aspects, influential career aspects, educational determinants, and interpersonal effects. Moreover, the most frequent sub-themes were specific personal factors, controllable lifestyle, quality of working life, and future working conditions.

CONCLUSION

This review provided evidence on the factors influencing the choice of specialties. In order to support physician workforce policy with more precise evidence, it is necessary to explore the weight and ranking of these factors based on the socioeconomic contexts of the countries. This study also indicated that factors such as ethical values, various aspects of medical philosophy, and immigration tendencies are areas for further investigations.

Excess of cardiovascular deaths during the COVID-19 pandemic in Brazilian capital cities

INTRODUCTION

During the COVID-19 pandemic, excess mortality has been reported, while hospitalisations for acute cardiovascular events reduced. Brazil is the second country with more deaths due to COVID-19. We aimed to evaluate excess cardiovascular mortality during COVID-19 pandemic in 6 Brazilian capital cities.

METHODS

Using the Civil Registry public database, we evaluated total and cardiovascular excess deaths, further stratified in specified cardiovascular deaths (acute coronary syndromes and stroke) and unspecified cardiovascular deaths in the 6 Brazilian cities with greater number of COVID-19 deaths (São Paulo, Rio de Janeiro, Fortaleza, Recife, Belém, Manaus). We compared observed with expected deaths from epidemiological weeks 12-22 of 2020. We also compared the number of hospital and home deaths during the period.

RESULTS

There were 65 449 deaths and 17 877 COVID-19 deaths in the studied period and cities for 2020. Cardiovascular mortality increased in most cities, with greater magnitude in the Northern capitals. However, while there was a reduction in specified cardiovascular deaths in the most cities, the Northern capitals showed an increase of these events. For unspecified cardiovascular deaths, there was a marked increase in all cities, which strongly correlated to the rise in home deaths (r=0.86, p=0.01).

CONCLUSION

Excess cardiovascular mortality was greater in the less developed cities, possibly associated with healthcare collapse. Specified cardiovascular deaths decreased in the most developed cities, in parallel with an increase in unspecified cardiovascular and home deaths, presumably as a result of misdiagnosis. Conversely, specified cardiovascular deaths increased in cities with a healthcare collapse.

Factors influencing medical students' choice of specialization: A gender based systematic review

BACKGROUND

Students' choice of medical specialties has evolved throughout year, with a growing interest in quality of life and in technological specialties. We investigated the repartition of such choices in the world and its influencing factors with a focus on the gender's influence, for helping policy-makers to deal with medical shortage and territorial to specialty disconnect.

METHODS

A systematic search was conducted on MEDLINE and Scopus from January 2010 to January 2020. Data extraction and analysis followed JBI and PRISMA recommendations. The selected articles had to focus on medical students, detail their choice of specialty, and look for factors influencing their choice. Articles were excluded if they only assessed the attractiveness of a specialty, or evaluated a public policy. This review was registered on PROSPERO, CRD 42020169227.

FINDINGS

751 studies were screened, and fifty-four were included. Surgery and internal medicine were the most wanted specialties, both in occidental and non-occidental countries. The main factors influencing the choice of specialty were lifestyle, work-life balance and discipline interest, with variation across different countries. Gender clearly affected this choice with 63.7% of men willing radiology and 14.7% of men in obstetrics and gynecology.

INTERPRETATION

Influential factors vary with specialty and are affected by the country of residence. Gender has a great impact in students' willingness to work in specific specialties. Policymakers should adapt their appealing strategies according to the country and the medical discipline concerned.

FUNDING

The authors have no support or funding to report.

American Society of Clinical Oncology-Sponsored Oncology Student Interest Groups in Latin America

PURPOSE

To describe the characteristics of the members of the ASCO-sponsored Oncology Student Interest Groups (OSIGs) in Latin America.

METHODS

This was a multicenter cross-sectional study. We surveyed 97 OSIG members from three medical schools in Peru and Mexico. We administered a 60-question survey covering topics including personal background, oncology training experience, and professional practice expectations and preferences.

RESULTS

A little more than one half of the surveyed OSIG members were female. More than one half had a visa to visit the United States and had an advanced level of English. One half of the OSIG members were also ASCO members. Most participants agreed or strongly agreed that participation in their OSIG increased their interest in cancer-related specialties (94%) and provided professional networking opportunities (94%) and that it was accessible to all students (91%). Most participants believed that their OSIG had sufficient resources to carry out its activities. Students were asked to rate their interest when they entered medical school versus at the time of the survey. Most of the members were strongly interested in pursuing surgical oncology. The majority of members were somewhat interested or very interested in palliative care and medical oncology.

CONCLUSION

To our knowledge, this is the first study that provides data on medical student perceptions of the Latin American OSIGs sponsored by ASCO. Student perceptions of medical oncology and the impact of OSIGs were generally positive. Given the shortages of oncology specialists in Latin American and elsewhere, strategies to engage medical students in the pursuit of cancer-related careers are becoming increasingly essential.

Impact of artificial intelligence on the choice of radiology as a specialty by medical students from the city of São Paulo

OBJECTIVE

To evaluate the impact of artificial intelligence (AI) on undergraduate medical students' choice of radiology as a specialty.

MATERIALS AND METHODS

In February 2019, an anonymous online survey was sent to medical students. The research contemplated questions on how much students think they know about AI technologies, how much AI discourages them from choosing radiology as a specialty, and whether they believe there is a threat to the radiology job market.

RESULTS

A total of 101 students, most of them doing their internship, answered the questionnaire. More than half of them (52.5%) said they believe AI poses a threat to the radiology job market, but 64.3% claimed not to have proper knowledge about these new technologies, and 31.7% said they would like more information on the technologies' operation and progress before making a decision on whether or not to practice radiology as a specialty.

CONCLUSION

A significant proportion of the surveyed students perceive AI as a threat to the radiological practice, which impacts their career choice. However, the majority claims to have insufficient knowledge of it and believes more information is needed for decision-making.

Saudi medical students' views on obstetrics and gynecology as a future career specialty

Background:

The specialty of obstetrics and gynecology is showing a widening gap between the vacant positions and the number of applicants as reported by the Saudi Commission for Health Specialties (SCFHS). This study was conducted to explore the medical students’ views on obstetrics and gynecology as a future career and identify factors influencing these views.

Methods:

An observational survey was conducted on 148 medical students in years 5 and 6 at Jazan University between June 2019 and July 2019. Participants completed a self-report online questionnaire covering their sociodemographic details, interest in obstetrics and gynecology, and views on the specialty.

Results:

Overall, obstetrics and gynecology was selected as the first specialty choice by 8.8% and second choice by 17.6%. Intention to take a career in obstetrics and gynecology was associated with female sex (P = 0.01). While over half of the participants emphasized the merits of obstetrics and gynecology as exciting, interesting, and challenging, over 40% viewed the specialty as stressful, over one-third described it as demanding, and over one-quarter appreciated its riskiness.

Conclusion:

This study showed that 8.8% of the respondents chose obstetrics and gynecology as their first career choice. Sex was the only factor influencing the views of medical students on the specialty, with more females favoring the specialty than males. To improve its appeal, students should be supplied with more information about the specialty and its training opportunities, as well as exposure to areas of special interest.

The role of private education in the selection of primary care careers in low and middle-income countries. Findings from a representative survey of medical residents in Brazil

BACKGROUND

Primary health care (PHC) doctors' numbers are dwindling in high- as well as low-income countries, which is feared to hamper the achievement of Universal Health Coverage goals. As a large proportion of doctors are privately educated and private medical schools are becoming increasingly common in middle-income settings, there is a debate on whether private education represents a suitable mean to increase the supply of PHC physicians. We analyse the intentions to practice of medical residents in Brazil to understand whether these differ for public and private schools.

METHODS

Drawing from the literature on the selection of medical specialties, we constructed a model for the determinants of medical students' intentions to practice in PHC, and used secondary data from a nationally representative sample of 4601 medical residents in Brazil to populate it. Multivariate analysis and multilevel cluster models were employed to explore the association between perspective physicians' choice of practice and types of schools attended, socio-economic characteristics, and their values and opinions on the profession.

RESULTS

Only 3.7% of residents in our sample declared an intention to practice in PHC, with no significant association with the public or private nature of the medical schools attended. Instead, having attended a state secondary school (p = 0.028), having trained outside Brazil's wealthy South East (p < 0.001), not coming from an affluent family (p = 0.037), and not having a high valuation of career development opportunities (p < 0.001) were predictors of willingness to practice in PHC. A low consideration for quality of life, for opportunities for treating patients, and for the liberal aspects of the profession were also associated with future physicians' intentions to work in primary care (all p < 0.001).

CONCLUSIONS

In Brazil, training in public or private medical schools does not influence the intention to practice in PHC. But students from affluent backgrounds, with private secondary education, and graduating in the rich South East were found to be overrepresented in both types of training institutions, and this is what appears to negatively impact the selection of PHC careers. With a view to increasing the supply of PHC practitioners in middle-income countries, policies should focus on opening medical schools in rural areas and improving access for students from disadvantaged backgrounds.

Specialty choice determinants among Mexican medical students: a cross-sectional study

BACKGROUND

The choice of medical specialty is related to multiple factors, students' values, and specialty perceptions. Research in this area is needed in low- and middle-income countries, where the alignment of specialty training with national healthcare needs has a complex local interdependency. The study aimed to identify factors that influence specialty choice among medical students.

METHODS

Senior students at the National Autonomous University of Mexico (UNAM) Faculty of Medicine answered a questionnaire covering demographics, personal experiences, vocational features, and other factors related to specialty choice. Chi-square tests and factor analyses were performed.

RESULTS

The questionnaire was applied to 714 fifth-year students, and 697 provided complete responses (response rate 81%). The instrument Cronbach's alpha was 0.8. The mean age was 24 ± 1 years; 65% were women. Eighty percent of the students wanted to specialize, and 60% had participated in congresses related to the specialty of interest. Only 5% wanted to remain as general practitioners. The majority (80%) wanted to enter a core specialty: internal medicine (29%), general surgery (24%), pediatrics (11%), gynecology and obstetrics (11%) and family medicine (4%). The relevant variables for specialty choice were grouped in three dimensions: personal values that develop and change during undergraduate training, career needs to be satisfied, and perception of specialty characteristics.

CONCLUSIONS

Specialty choice of medical students in a middle-income country public university is influenced by the undergraduate experience, the desire to study a subspecialty and other factors (including having skills related to the specialty and type of patients).

Profiling recent medical graduates planning to pursue surgery, anesthesia and obstetrics in Brazil

BACKGROUND

Lack of providers in surgery, anesthesia, and obstetrics (SAO) is a primary driver of limited surgical capacity worldwide. We aimed to identify predictors of entry into Surgery, Anesthesia, and Obstetrics and Gynecology (SAO) fields and preference of working in the public sector in Brazil which may help in profiling medical students for recruitment into these needed areas.

METHODS

A questionnaire was applied to all Brazilian medical graduates registered with a Board of Medicine from 2014 to 2015. Twenty-three characteristics were analyzed. Logistic regression was used to determine predictors' influence on outcome.

RESULTS

There were 4601 (28.2%) responders to the survey, of which 40.5% (CI 34.7-46.5%) plan to enter SAO careers. Of the 23 characteristics analyzed, eight differed significantly between those who planned to work in SAO and those who did not. Of those eight characteristics, just three were significant predictors in the regression model: preference for working in the hospital setting, having spent more than 70% of their clinical years in practical activities, and valuing the substantial earning potential. These three factors explained only 6.3% of the variance in SAO preference. Within the graduates who preferred SAO careers, there were only two predictors for working in the public sector ("preparatory time before medical school" and valuing "prestige/status").

CONCLUSIONS

Factors affecting specialty and sector choice are multifaceted and difficult to predict. Future programs to fill provider gaps should identify methods other than medical student profiling to assure specialty and sector needs are met.

Public Transportation Environment and Medical Choice for Chronic Disease: A Case Study of Gaoyou, China

Current research on the built environment and medical choice focuses mainly on the construction and optimization of medical service systems from the perspective of supply. There is a lack of in-depth research on medical choice from the perspective of patient demand. Based on the medical choice behaviour of patients with chronic diseases, this article identifies the spatial distribution and heterogeneity characteristics of medical choice and evaluates the balance between medical supply and demand in each block. On this basis, we explored the mechanism of patient preferences for different levels of medical facilities by considering the patient's socioeconomic background, medical resource evaluation, and other built environment features of the neighbourhood by referring to patient questionnaires. In addition to socioeconomic characteristics, the results show that public transportation convenience, medical accessibility, and medical institution conditions also have significant influences on patient preferences, and the impact on low-income patients is more remarkable. The conclusions of the study provide a reference for the promotion and optimization of the functions of urban medical resources and the guidance of relevant public health policies.

Factors influencing subspecialty choice among medical students: a systematic review and meta-analysis

OBJECTIVE

To characterise the contributing factors that affect medical students' subspecialty choice and to estimate the extent of influence of individual factors on the students' decision-making process.

DESIGN

Systematic review and meta-analysis.

METHODS

A systematic search of the Cochrane Library, ERIC, Web of Science, CNKI and PubMed databases was conducted for studies published between January 1977 and June 2018. Information concerning study characteristics, influential factors and the extent of their influence (EOI) was extracted independently by two trained investigators. EOI is the percentage level that describes how much each of the factors influenced students' choice of subspecialty. The recruited medical students include students in medical school, internship, residency training and fellowship, who are about to or have just made a specialty choice. The estimates were pooled using a random-effects meta-analysis model due to the between-study heterogeneity.

RESULTS

Data were extracted from 75 studies (882 209 individuals). Overall, the factors influencing medical students' choice of subspecialty training mainly included academic interests (75.29%), competencies (55.15%), controllable lifestyles or flexible work schedules (53.00%), patient service orientation (50.04%), medical teachers or mentors (46.93%), career opportunities (44.00%), workload or working hours (37.99%), income (34.70%), length of training (32.30%), prestige (31.17%), advice from others (28.24%) and student debt (15.33%), with significant between-study heterogeneity (p<0.0001). Subgroup analyses revealed that the EOI of academic interests was higher in developed countries than that in developing countries (79.66% [95% CI 70.73% to 86.39%] vs 60.41% [95% CI 43.44% to 75.19%]; Q=3.51, p=0.02). The EOI value of prestige was lower in developed countries than that in developing countries (23.96% [95% CI 19.20% to 29.47%] vs 47.65% [95% CI 34.41% to 61.24%]; Q=4.71, p=0.01).

CONCLUSIONS

This systematic review and meta-analysis provided a quantitative evaluation of the top 12 influencing factors associated with medical students' choice of subspecialty. Our findings provide the basis for the development of specific, effective strategies to optimise the distribution of physicians among different departments by modifying these influencing factors.

Why ophthalmology? Analysis of the motivating factors influencing the choice of ophthalmology as a career among different generations in Brazil

OBJECTIVES

The increasing demand for medical specialties with flexible working hours has been associated with the important role of quality of life as a determining factor when choosing a career in medicine, which might change the motivations for pursuing a career in ophthalmology. We aim to identify the main determinants of ophthalmology as a career choice as well as the reasons that motivated previous generations to follow this path.

METHODS

Responses to self-administered online questionnaires were analyzed.

RESULTS

A total of 225 responses were analyzed, including those of baby boomers (21), generation X (48), generation Y (131) and generation Z (25). Although the main reasons for choosing ophthalmology as a career are the same for all the generations in this study (flexible working hours, self-satisfaction from helping people improve their vision and the possibility of performing surgical procedures), some reasons for this career choice are more important to the younger generations (short-term results and short procedures), and some are more important to the older generations (the influence of an ophthalmologist in the family).

CONCLUSION

The main reasons for choosing ophthalmology as a career are essentially the same over time. The differences in secondary motivations could be explained by generational differences.

Specialty preferences and influencing factors: a repeated cross-sectional survey of first- to sixth-year medical students in Jena, Germany

BACKGROUND

Given the expected increase in those entering retirement, the number of practising physicians is predicted to decrease. Conversely, the number of physicians needed is set to increase, due to higher demands resulting from the increasing average age of the German population. This may cause a deficit in the availability and accessibility of medical care for the population in Germany, as well as in other countries. As such, there needs to be a specific focus on the next generation of physicians. Will they fill the gap in those medical specialties where it is most needed? This study aims to investigate (a) preferences for medical specialties over time and (b) the reasoning behind these preferences among students.

METHODS

Over three subsequent years, all medical students from the Jena Faculty of Medicine were repeatedly invited to participate in an online survey. The questionnaire consisted of three parts to explore the students' (1) preferred postgraduate specialty, (2) the reasons for their decision and (3) socio-demographic data. Data analysis was performed using Fisher's exact tests and logistic regression analysis.

RESULTS

The number of students completing the questionnaire in a given year ranged from 180 to 320, resulting in a total number of 720 completed questionnaires. Between 40 and 50% of the students preferred internal medicine as postgraduate specialty. About 25% of the students were interested in a surgical specialty. Diagnostics and psychiatric medical fields were preferred by about 10% of all students for each field in each year of the survey. A large percentage (about 18%) of the students remained undecided. The factors influencing the students' specialty preferences were most frequently reconciliation of work and family life, career goals as well as predicted workload. The factors depended on the preferred medical specialty.

CONCLUSION

The influencing factors should be taken into account for recruiting prospective residents. Doing so could increase the chance to attract the number of physicians needed to ensure adequate medical care in the field of interest, according to the growing health needs of the population.

Factors influencing medical students' choice of emergency medicine as a career specialty-a descriptive study of Saudi medical students

Background

Choosing a medical specialty is a poorly understood process. Although studies conducted around the world have attempted to identify the factors that affect medical students’ choice of specialty, data is scarce on the factors that influence the choice of specialty of Saudi Arabian medical students, in particular those planning a career in emergency medicine (EM). In this study, we investigated whether Saudi medical students choosing EM are influenced by different factors to those choosing other specialties.

Methods

A cross-sectional survey was conducted at King Saud bin Abdulaziz University for Health Sciences (KSAUHS), Riyadh, Saudi Arabia. The questionnaire distributed among all undergraduate and postgraduate medical students of both sexes in the second and third phases (57% were males and 43% were females).

Results

A total of 436 students answered the questionnaire, a response rate of 53.4%. EM group was most influenced by hospital orientation and lifestyle and least influenced by social orientation and prestige provided by their specialty. Unlike controllable lifestyle (CL) group and primary care (PC) group, EM reported lesser influence of social orientation on their career choice. When compared with students primarily interested in the surgical subspecialties (SS), EM group were less likely to report prestige as an important influence. Moreover, students interested in SS reported a leaser influence of medical lifestyle in comparison to EM group. When compared with CL group, EM group reported more interest in medical lifestyle.

Conclusions

We found that students primarily interested in EM had different values and career expectations to other specialty groups. The trends in specialty choice should be appraised to meet future needs.