|Year : 2014 | Volume
| Issue : 2 | Page : 110-113
Speciality choices of final year medical students: A 10-year follow-up
Mukhtar Ahmed Gadanya1, Anas Ismail2
1 Department of Community Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
2 Department of Radiology, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
|Date of Web Publication||6-Sep-2014|
Dr. Mukhtar Ahmed Gadanya
Department of Community Medicine, Aminu Kano Teaching Hospital, Bayero University, PMB 3011, Kano
Source of Support: None, Conflict of Interest: None
Introduction: The preference of medical specialties by medical graduates may play a role in determining the pattern of the future workforce in the healthcare system. This was a longitudinal study over a 10-year period (2004-14) to determine what progress the graduates have made regarding their specialty choices at the graduation level. Materials and Methods: Structured self-administered questionnaires were administered to 40 final year medical students to determine their preferences for medical specialisation at graduation in 2004. Follow-up interviews were conducted after a10-year period (in 2014) to determine to what extent they were able to realise their objectives. Results: Out of the 40 medical students involved in this study, 24 were males (60%) and 16 were females (40%). Their mean age at graduation level was 27.3 ± 1.97 years. There was a high preference for Obstetrics and Gynaecology (O and G) and Paediatrics at graduation. At 10 yearspost graduation, 5 students had reached the level of Consultants, 20 were at the level of Senior Registrars while 15 were at the level of Registrars and Medical officers. At 10 years post-graduation, there was a preference for Family Medicine, Internal Medicine, Radiology, and Community Medicine; despite the predominance of Paediatrics and O and G at graduation. Whenthe age at graduation of these students was compared with their current status, those at the rank of consultants showed a younger age at graduation level of 26.4 ± 0.55 years, compared with Senior Registrars (27.45 ± 1.54 years), and medical officers/others (27.60 ± 2.50 years). However, these differences were not of statistical significance [one-way analysis of variance (ANOVA) F = 0.778, P = 0.467]. Pursuing the preferred area of specialisation at the graduation (P = 0.04) was associated with more progress in post-graduate training. Conclusion: Specialty choices are determined by availability of training posts, with choice of specialty at the level of graduation, giving way to what is pragmatically available and feasible. However, pursuing preferred area of specialisation at graduation is associated with more progress in career. Furtherstudies are required to determine the contribution of other factors in determining career progress and sticking to preferred area of specialisation at graduation.
Keywords: Career choice, follow-up, medical students, preference, progress
|How to cite this article:|
Gadanya MA, Ismail A. Speciality choices of final year medical students: A 10-year follow-up. Niger J Basic Clin Sci 2014;11:110-3
|How to cite this URL:|
Gadanya MA, Ismail A. Speciality choices of final year medical students: A 10-year follow-up. Niger J Basic Clin Sci [serial online] 2014 [cited 2019 Dec 14];11:110-3. Available from: http://www.njbcs.net/text.asp?2014/11/2/110/140362
| Introduction|| |
Medical education exposes the undergraduate students to a range of medical specialties over a period of five to six years. While a proportion of students may contemplate or even decide on areas of specialisation, many may not decide on future area of specialisation, until they have graduated. Some studies were concentrated on the personal characteristics of the individuals, and how these personal characteristic attributes shape their career preferences, but with limited longitudinal follow-up. Others researches were concentrated on the careers of specific groups, such as femaledoctors and other demographic characteristics.  For example, there are findings that the male graduates often prefer technical and instrument-oriented specialties, while the female prefer specialties that are relation oriented. 
The preference of medical specialties chosen by medical graduates plays an important part in the future workforce in the healthcare system, especially during periods when the doctor-patient ratio is too high or too low compared to the standards set by the World Health Organisation.  According to African human health resources context, there is the misdistribution of doctors across all levels of healthcare in the public and private sectors, both in rural and urban areas and between the specialties. 
With the continuing evolution of healthcare delivery and with advances in medical technology, studying career preference can help in providing important information, thereby aiding theplanning of educational programmes, setting priorities, and planning for the provision of adequate health care. The preference of medical students for future specialty, their flexibility regarding location and workload, and their views on the compatibility of work and family life is essential for the planning for the provision of workforce. ,
The study aimed at identifying the career preferences of the final year medical students, to determine factors associated with specialisation choices, and to determine to what extent they were able to achieve their objectives after 10 years.
| Materials and Methods|| |
Structured questionnaires were administered to a class of final year medical students while they were preparing for their final examinations. There were 40 students in the class, and they all completed the self-administered questionnaires at graduation . Socio-demographic characteristics and the intended areas of specialisation were recorded. Ten years thereafter, interviewer-administered questionnaires were administered by telephone to the same group of study subjects (now medical doctors) to determine their current professional status. There was no loss to follow-up.
The generated results were summarised and analysed using Statistical Package for Social Sciences (SPSS version 16.0) software. Chi-square test was used for comparison of proportions, and t-tests/analysis of variance (ANOVA) was used for comparing means of normally distributed continuous variables that were appropriate. The level of significance was set at 95%.
| Results|| |
A total of 40 final year medical students were involved in this study; consisting of 24 (60%) males and 16 (40%) females. Their mean age at graduation level was 27.38 years + 1.9 years. Majority of them (36/40) were of Hausa ethnic background while 2 were Yoruba; with 1 being Igbo and 1 foreign student (Bengali).
[Figure 1] and [Figure 2] shows the current status of these students at 10-year post-graduation level; 5 students had reached the level of consultants (12.5%), 20 were at the level of senior registrars (50%) while 15 were at the levels of registrars and medical officers (37.5%). Figure I: Current rank of the study participants
|Figure 2: Proposed area of specialisation at graduation level (in 2004) and the current area of specialisation (in 2014)|
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The proposed specialty of these students at graduation level and at 10 years after graduation is shown in [Figure 2]. There was high predilection to Obstetrics and Gynaecology and Paediatrics (20%) at graduation level. At graduation, only 10 respondents (25%) were fully decided about their choices for future specialisation; while the remaining 30 (75%) are not so certain about their choice.
Despite Obstetrics and Gynaecology being the favourite specialty and the intended areas of specialisation at graduation level, none of them were pursuing the specialty at the time of the study.
When the age at graduation of these subjects were compared to their current status, those at the rank of consultants showed a younger age at graduation level (of 26.4 ± 0.55 years). The Senior Registrars graduated at the mean age of 27.45 ± 1.54 years. Other students graduated at the mean age of 27.60 ± 2.50 years. However, these differences were not of statistical significance (one-way ANOVA F = 0.778, P = 0.467).
[Table 1] showed the relationship between the gender and the current rank at 10 years. Although there are more males in the rank of the consultants and senior registrars, the gender difference was not of statistical significance.
|Table 1: Showing the gender distribution of various ranks of the students and the rank at 10-year post-graduation level|
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| Discussions|| |
The 40 final year medical students who participated in this study had the mean age of 27.38 years at the graduation level. This is slightly older than the mean (± SD) age of 21.1 ± 2.0 years reported by Khader et al.  in their review of 440 medical students in Jordan. The older age of graduation in our subjects could have been due to frequent interruption of academic calendars by industrial disputes in Nigeria.
There was a high preference for Obstetrics and Gynaecology and Paediatrics (20%). At 10-year post-graduation level, 5 students had reached the level of consultants (12.5%), 20 were at the level of senior registrars (50%) while 15 were at the level of registrars and medical officers (37.5%).
There was preponderance to Family Medicine, Internal Medicine, Radiology, and Community Medicine. Despite the choice of Obstetrics and Gynaecology at graduation level, none of them were pursuing this specialty at the time of the study. The pattern of career choice in this study differs from that of many countries. For example, out of 253 students examined by Al-Faris et al. in Saudi Arabia, the most frequently chosen specialties were Internal Medicine (17%), Surgery (16%), Paediatrics (14%), and Obstetrics and Gynaecology (11%). On the other hand, review of medical interns in Mangalore (India) showed that the most preferred specialties were Internal Medicine, Surgery, Obstetrics and Gynaecology and Paediatrics; whereas only 10/250 interns wanted to specialise in a preclinical or paraclinical subjects.  Despite the preference for Obstetrics and Gynaecology, none of the subjects in this study are specialising in this specialty. This may be as a result of differences in their perceptions about these specialties as students, and their different experiences in these departments as house officers. In addition to the opportunities for private medical practices, family constraints and less interest in going to distant places for training could have been the reason of having more males achieving higher levels in their career compared to the female students. Furthermore, limited certainty about the career option at graduation level could account for the difference between the specialty choice at the graduation level and current specialty practiced by these students. This though was appreciated from the survey of 68,906 doctors done by Goldacre et al.  as most practicing surgeons reviewed had made an unambiguous decision to become surgeons by the first year after qualifying as doctors: 88% of men and 79% of women who eventually practiced in surgery had specified a surgical career as their sole first choice of career in their first post-qualification year.
Our results also showed that those at the rank of consultants graduated at a younger age compared to the senior registrars and others. Although these differences were not of statistical significance, those who achieve higher levels in their career could have been more focused and probably have better/faster education background at the lower levels of education.
There were more males in the ranks of the consultant and senior registrars (though the gender-differences were not of statistical significant). This can be attributed to the marital factor, as in these subjects were more of married females than males. According to Heiligers,  medical students living together with a partner influence the choice of continuing medical education and are more likely to prefer general practice to a medical specialty, compared to students who are not living with a partner. Furthermore, medical students who are living with a partner are less likely to prefer a surgery specialty than a non-surgery specialty, compared to medical students who are not living with a partner.  Nevertheless, future research could focus more in detail on the role of the partner in the process of career choice.
| Conclusion|| |
Post-graduation is an important part of a doctor's career path. The preference of medical students for future specialty, their flexibility regarding location and workload, and their views on the compatibility of work and family life may be important consideration in planning. Knowing these factors may help in modifying policy such a way that would encourage younger doctors to pursue fields that are on higher demands in the healthcare industry.
In addition, more longitudinal studies should be carried out, to find the impact of the medical school experience/house job and that of primary and secondary education in determining the future medical workforce.
| References|| |
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[Figure 1], [Figure 2]