PREFERENCES OF CHOICE OF FUTURE SPECIALTY: INSIGHTS FROM FINAL YEAR MEDICAL STUDENTS IN IBADAN, NIGERIA

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C.O. Ezegwui¹, C.E. Nwaze¹, V.O. Magboh¹, E.B. Olusoji¹, T.A. Lawal²

1. Final Year Medical Student, Alexander Brown Hall, College of Medicine, University of Ibadan, Nigeria.
2. Department of Surgery, University of Ibadan & University College Hospital, Ibadan, Nigeria.

Abstract

Background: The choice of specialty by medical students and early career doctors affects health workforce distribution in any country. In addressing healthcare needs of the populace, appropriate distribution of manpower across board is essential. Several factors come into play in making these choices. This study assessed factors affecting the career choices of final year medical students and how curricular changes may have influenced these.

Methods: This was a cross-sectional study conducted among 236 final year medical students of the University of Ibadan by convenience sampling using selfadministered semi-structured questionnaires. Questions were on sociodemographic characteristics, career counselling, preferred future career and factors affecting these choices. Data were analyzed using SPSS version 21 software.

Results: A total of 236 medical students participated in the study. The mean age of participants was 23.6(±1.9) years. Only 112(47.5%) respondents had received any form of career counseling/guidance in the course of their medical training. The commonest first choice specialties were obstetrics and gynecology 54(22.9%), surgery 44(18.6%) and psychiatry 18(7.6%). Personal interest most often (185, 78.4%) influenced career choice overall, showing significance in obstetrics and gynecology (p=0.02), family medicine (p=0.02) and public health (p<0.001).

Conclusion: The predominant choices of future specialty among final year medical students were obstetrics and gynecology, surgery and psychiatry. The change in curriculum for medical students may have affected the pattern of their choices with more interest shown in previously neglected areas.

Keywords: Future specialty, Medical student, Specialty choice, Final year

Introduction

Medical students have been shown to make critical decisions such as the specialty to pursue further training in, during their medical school years.¹ Although these initial choices may change, the significance of these early stage decisions cannot be undermined, because it is known that medical students tend to eventually specialize in disciplines closely related to these initial choices.^2,3 These choices affect the distribution of the health workforce, and the health sector in general, of any country.

The most important factor affecting career choice among medical students and early interns, in several studies in the literature^4-8 was personal interest. Other factors considered important included career stability, reputation, lifestyle/prestige, career progression, independence and income⁵, potential for high income, perceived benefit to the society⁷ and job satisfaction.⁶ Concerning choice of future specialty, studies carried out in different regions of the country have reported similar trends: surgical specialties^6-8 were the most preferred, when results were analyzed generally without specific attention to gender differences. This was closely followed by obstetrics and gynecology, and pediatrics.^6-9 However, some other studies^10,11 reported obstetrics and gynecology as the most preferred specialty followed by surgery and pediatrics. Whatever the case may be, it is clear that these three specialties are the most desired in our environment. Family medicine^4,5,12,13 and the basic medical sciences^5,7 were the least preferred among various medical students studied. This probably highlights the little attention given to these specialties especially family medicine in various medical curricula. Elsewhere in the United Kingdom, specialties like general practice were reported as the most preferred.¹⁴ This may be due to a more functional healthcare system with well-defined roles and career path for general practitioners at the primary level in high income countries.

In Africa, the average physician to population ratio is 0.22/1,000 in urban areas and less than 0.03/1000^15,16,17 in rural areas, where more doctors are actually needed. This is not surprising in a continent where medical students have shown significantly lower interest in primary care specialties e.g. community medicine/ public health or family medicine^4,5,12,13, whereas these specialties drive the health indices of any country.

The College of Medicine, University of Ibadan has since 2010 implemented a revised curriculum based on present and projected societal needs, for her medical students with key components being horizontal and vertical integration across specialties and organ systems, clinically oriented and competency based medical education with increased emphasis on clinical acumen and skills acquisition.¹⁸ This has increased the amount of time devoted to clinical work, including allocating a two-month clinical rotation in primary care specialty of family medicine, as well as extension of clinical clerkships in psychiatry, radiology and radiodiagnosis. It is unknown if this curriculum change will have any impact on the career choices of medical students trained with it. Findings from his study may guide future curricula revisions. This study assessed the preferences of final year medical students of the University of Ibadan as regards choice of future specialty, what factors affect this as well as gender differences. This is the first study to evaluate the effects of the new curriculum on students’ career choices since its introduction in 2010.

MATERIALS AND METHODS
Study population, design and Ethical considerations
The study was conducted among final year medical students of the College of Medicine, University of Ibadan. The University of Ibadan is federal government funded and located in Ibadan, the largest city in West Africa. It is Nigeria’s premier university with a rich heritage in undergraduate medical training since 1948.
Following ethical approval from the institution’s ethics review board (UI/EC/17/0276), a cross-sectional survey of 236 consenting medical students from two consecutive final year classes selected through convenience sampling using a self administered, semistructured questionnaire was done. Data was collected between January 2017 and February 2018. It was necessary to use two classes in order to achieve the calculated sample size. The students sampled were the first two sets to be trained with the revised medical curriculum. Only final year students were sampled because they are deemed to have clearer views on the scope of medicine, having gone through all rotations. The principles of ethical conduct of research employed was consistent with the declarations of Helsinki. Sample size was calculated, using the Leslie Kish formula for cross-sectional studies and adjustment was made for non-response. Prevalence for the most preferred specialty for the calculation was obtained from a similar study by Odusanya et al.⁶ The 15-item questionnaire was divided into four sections, comprising the sociodemographic characteristics of respondents, desire to study medicine/previous career counselling, preferred future specialty and factors affecting choice of future specialty. Informed consent was obtained and the respondents were required to rank these specialties in order of their preference and indicate how much each of the factors examined affected their choices. The questionnaire was modified from a study by Nighat et al.⁴ They were crosschecked for completeness on each data collection day, before accepting them from the respondents to avoid missing data. The study had a 95% response rate. This study was part of a comprehensive research evaluating career choices and considerations for training in the future among medical students at the University. The study received no external funding.

Data management and analysis
The questionnaires were manually sorted out and checked for errors and omissions at the end of data collection each day. The information obtained was kept confidential. Data collected was divided into categorical and continuous variables. This was entered into a computer and analyzed using the SPSS version 21 software. Continuous variables were summarized using means and standard deviations while categorical variables were summarized using frequencies and proportions. Chi square statistic was used to test for association between categorical variables such as sociodemographic characteristics, choice of specialty and factors affecting choice of specialty. The p value for statistical significance was set at <0.05.