|Year : 2021 | Volume
| Issue : 2 | Page : 112-117
Determining factors affecting the medical interns' choice of specialties among governmental universities in Riyadh
Ahmed Tariq Al Suwaidan1, Lama Abdullah Al Luhidan1, Khaled Abdullah Al Barrak1, Rehab Abdullah Al Mubrick2, Hessah Ibrahim Al Suwaidan3, Rawan Abdulaziz Al Shammari4, Rima MHD Belal Barakeh3, Moath Khalid Al-Ghusoon3, Bander Munir Al Rwaily5, Sulaiman Abdullah Al Shammari6
1 College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
2 Data Warehouse, Ministry of Health, King Saud University, Riyadh, Saudi Arabia
3 College of Medicine, King Saud University, Riyadh, Saudi Arabia
4 College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
5 College of Medicine, Imam Mohamed Bin Saud Islamic University, Riyadh, Saudi Arabia
6 Department of Family and Community Medicine, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
|Date of Submission||30-May-2020|
|Date of Decision||20-Jun-2020|
|Date of Acceptance||25-Jun-2020|
|Date of Web Publication||25-Aug-2020|
Sulaiman Abdullah Al Shammari
Department of Family and Community Medicine, College of Medicine, King Saud University Medical City, P.O. Box 2925, Riyadh 11461
Source of Support: None, Conflict of Interest: None
The nature of experience during the medical study at university may play an essential role in choosing the specialty. Background: The aim of this study is to determine the effect of national universities in general and on medical interns' career choice, taking into consideration the gender difference. Furthermore, to find out when national universities educate their students about the different specialties. Methods: This was a cross-sectional study that included 234 Saudi medical intern students from four different medical colleges in national universities in Riyadh. These were King Saud University, Princess Nourah Bint Abdulrahman University (PNU), Imam Mohamed Bin Saud Islamic University, and King Saud bin Abdulaziz for Health and Science (KSAU-HS) with consideration of gender differences and availability. All participants who are selected randomly completed an online questioner with a unique code. Results: Around two-thirds (66%) of the participants ensured that their national universities had a positive influence in choosing the specialties dividing equally between both genders. According to the participants' perceptions, all the items of the medical education system did not affect in choosing the specialty except three of them that have a positive effect which are elective experience (43.59%), clinical year (40.6%), and the personality of instructor (38.46%). Furthermore, one-third (33%) of the participants emphasized that their universities educated them about the specialties in the 3rd year. The most common decisive factor was an elective experience of 19.36%, whereas the most common negative factors were improper block duration and the personality of the instructor by 14.52%. Conclusion: Most national universities had a positive effect on their students' career choice, and they educated pregraduate students about specialties.
Keywords: Choosing the specialties, intern students, the effect of a public university, the effect of the national university
|How to cite this article:|
Al Suwaidan AT, Al Luhidan LA, Al Barrak KA, Al Mubrick RA, Al Suwaidan HI, Al Shammari RA, Belal Barakeh RM, Al-Ghusoon MK, Al Rwaily BM, Al Shammari SA. Determining factors affecting the medical interns' choice of specialties among governmental universities in Riyadh. J Nat Sci Med 2021;4:112-7
|How to cite this URL:|
Al Suwaidan AT, Al Luhidan LA, Al Barrak KA, Al Mubrick RA, Al Suwaidan HI, Al Shammari RA, Belal Barakeh RM, Al-Ghusoon MK, Al Rwaily BM, Al Shammari SA. Determining factors affecting the medical interns' choice of specialties among governmental universities in Riyadh. J Nat Sci Med [serial online] 2021 [cited 2021 Jun 13];4:112-7. Available from: https://www.jnsmonline.org/text.asp?2021/4/2/112/294058
| Introduction|| |
Choosing a medical specialty is considered one of the most critical decisions in medical carrier, especially for undergraduate medical students and interns because each one of them has his nature, personality, atmosphere, experience, and interest that can be suitable for some specialties rather than other.,,,,,,,, As a result of these factors, choosing the specialty is a complex process affected by personal, financial, social, and educational factors, especially the institution, because it plays a role in interns' experience and impression of the specialties.
There were many studies concern to search about this idea, like a study published in 2017 from five different countries in South Asia concerned about various factors that affecting choosing the specialty and correlated them with the postgraduate carrier among 1st-year medical students. Furthermore, the study reported that there were significant effects of the gender, location of residence, and the qualification of the parents (P < 0.001 in all of them) with choosing the specialties. Furthermore, personal interest, intellection, excellent quality of life, and early experience had clear influences in choosing the specialty. In addition to that, there was a Pakistani study published in the same year assessed the possible factors that had an effect on choosing specialties among their graduate medical students. The working hours were the most effective factor among the participants, with 24.92%, followed by emotional attachment with 22.71% than the high income with 12.68%. The origin of the country showed a significant relationship in choosing the future carrier (P = 0.006), especially the surgical specialties (P = 0.005) and nonclinical specialties (P = 0).
Moreover, a Nigerian study in 2016 tried to figure out the most critical factors in choosing the specialties among 457 final year medical students. More than half of them chose their medical specialty after taking the clinical rotation, especially the obstetrics and gynecology followed by surgery then pediatrics, which were parts of their medical curriculum. Furthermore, the lectures (30.6%) and the organized department (28.5%) were the top two factors that encouraged the students to choose that specialty. However, the personal interest (58.2%) and the relevance services (24.5%) were the common two factors that affected the participants to be surgeons. In addition, there was another Taiwan study in 2013 among the first, 7th-year medical students and postgraduate students to figure out the specialty choices and briefly the factors that influenced that. Depending on the result, the personal interest and academic achievements were in the profoundly impacting factors among the 7th-year medical students. Besides these studies, there was a Nepal study in 2013 in six Nepal colleges among the residents, interns, first and 6th-year medical students ensured that the most common cause after serving the sick was personal interest. The fourth cause was the best course available in the university, and the sixth cause was the research interest.
Many studies in the middle east tried to evaluate the reasons for choosing specialties. A self-administrated cross-section Sudanese study published the factors or reasons for choosing the specialties among 887 medical students from both genders in preclinical and clinical years. The most common reason was the personal interest, with 39.7% followed by proving the help to the community with 26.6%, then the available job opportunity with 8.5% besides financial reasons with 7%. However, there was no single reason from the list represented the nature of the environment or experience in the college of medicine in university. Furthermore, there was a Kuwait study in 2012 aimed to assess the most critical causes in choosing the specialties by conducting self-administrated questioners among their medical students expect the 1st-year medical students. More than 45% of the medical students reported that the excellent prognosis of the diseases with the specialty had the most substantial influence in choosing the specialty, while the second rank was the challenging nature of the specialty, which attracted 40% of their students. The third rank was common between the two reasons, which were good social life and good prestige in the community with 30%. In addition to these studies, there was a study inside Saudi Arabia, especially at Dammam University in 2014, including 179 participants from the clinical years and interns aimed to demonstrate the factors affecting the selection of the medical specialty. According to participants' opinions, the most common factor was the lifestyle with a percentage of around 44.7%, followed by subspecialty choices with 13%. After that, the nature of experience during the clinical rotation was the third common factor, with 11.4%. Furthermore, there was another study conducted in Al-Hafouf at King Faisal University among 109 first-medical year students. Most of them (60%) confirmed that the potential for patient interaction would be a significant factor influencing their decision.
Furthermore, the primary interest/aptitude for the specialty was one of the main factors affecting the choice, with 57%. Furthermore, around about 55% agreed that a challenging specialty would positively influence their choice. Interestingly, males were more like to choose a specialty based on actual interest/aptitude for the specialty, financial rewards, and scope of research (P = 0.006, 0.002, and 0.002, respectively).
Because of lacking comprehensive local studies that assessed the effect of the medical colleges on interns in national universities in Saudi Arabia, especially Riyadh city, we aimed to do research that expressed the general influence of these medical colleges on their interns in choosing the medical specialty considering gender variations. Furthermore, this study tried to assess the concern of these medical colleges in their students' future and the onset of their education program about choosing the medical specialties. Furthermore, this study evaluated the common elements of the medical education system in medical colleges to know the impact of these elements in choosing the specialty in each gender. Finally, the present study figured out the single most decisive and single most negative factors among both genders in respondents.
| Methods|| |
This was a prospective cross-sectional study approved by the institutional review board at King Saud University (KSU), Riyadh, Saudi Arabia, and all participants signed the written informed consent. It involved 234 Saudi interns from four different governmental medical colleges, which were KSU, King Saud bin Abdelaziz for Health and Science (KSAU), Princess Norah Bint Abdulrahman University (PNU), and Imam Mohamed Bin Saud Islamic University (IMSIU). The sample size was calculated by using Raosoft website with 95% confidence interval, 5% of margin error, 50% of sample distribution and 566 as a population size by adding all the interns together from these four governmental medical colleges (69.5% of them were males and 30.5% were females). The recommended sample size was 230 interns after using the Raosoft website, but we add four interns over the recommended sample size to distribute the questioner equally between each gender available in these medical colleges. The questioner distribution was 117 participants for each gender in general. As a result, the questioners among males were distributed equally between KSU, IMSIU, and KSAU because there were no males in the PNU. On the other hand, the questioners among females were distributed equally between KSU, PNU, and KSAU because there were no graduated female interns in IMSIU at that time (female medical students in IMSIU was in the 4th year in their university curriculum at the time of the study). These questioners, which sent through E-mails, were randomly distributed after taking the written constant from participants by choosing random 39 numbers from each student lists from each gender in each medical college after communicating with responsible authorities.
We developed an online questioner that had three main parts. The first part was about some of the essential demographic data such as the age, gender, name of the university, and numbers of semesters in both basics and clinical years. Furthermore, there was a space to a particular number, which was a unique number given by the author to an individual participant to identify, organize the electronic submission, and avoid the duplication. The next part had 13 questions focused on evaluating the effects of the medical system elements with scale answers like positive effect, no effect, adverse effect, and other which included either I do not know, or I did not take it. Some questions were assessing the effects of basic and clinical years besides their duration, organization, and their block orders. Also, other questions tried to assess the effect of the educations educational tools like anatomy or physiology laboratories, problem-based learning (PBL), grades, and personality of the block instructors in choosing the specialty. The last part was about the effect of each university and its most common negative and decisive factor in choosing the specialty.
We organized the data in an excel sheet then coded and analyzing them by using JMP version 13 statistical analysis program, A Business Unit of SAS Campus Drive, Cary, NC 27513, USA. We perform a Chi-square test to assess the effects of the governmental institutions on the intern students. Furthermore, a correlational analysis carried out to investigate any relationship between the governmental institutions and other factors from the research participants.
| Results|| |
According to [Table 1], which represented the demographic and academic characteristics of the participants, the mean age of the 234 participants was 24.2 ± 0.9 years old. The youngest participant's age was 22 years old, and the oldest one was around 30 years old. Around three-quadrant (77%) of participants agreed that their universities were concerned with educating them about the specialties with different onsets. One-third of them (33.74%) ensured that their universities have started to educate them about the specialties since the 3rd year. Other participants who represented one quadrant (23%) thought that there was no concern from their universities, or they did not have an answer to this question. Furthermore, the table showed that the number of participants from the KSU and KSAU-HS was double than of participants from PNU and IMSIU due to gender availability in these four governmental medical colleges.
Regarding the universities' effect on the medical students' future career choice, the positive effect was the most common effect among the participants, with a percentage of around 65% regardless of their ages, genders, and medical colleges, as shown in [Table 2]. Furthermore, around 57% of the participants who exposed to positive effects chose that their colleges helped them to limit their choices more than expand them. Furthermore, there was almost no difference in gender distribution in participants who experienced a positive effect. On the other hand, there were 20% of the participants expressed a negative effect during their pregraduate medical years. However, the percentage of male participants among these who exposed to harmful effects was similar to the percentage of female participants regardless of the name of their medical colleges. The rest of the participants who represented 15% did not have a clear answer to that question. There was no clear biostatistical significance between choosing the specialties and the age or gender in choosing the specialties, but the name of medical colleges or national universities showed statically significant (P = 0.0047, P < 0.05).
|Table 2: The effect of universities on the decisions of interns versus characteristics (n=234)|
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There were many elements of the medical education system related to the blocks as listed in [Table 3], such as duration, order, numbers, grades, show, and nature of the blocks. Most of the participants emphasized that all these elements had no effect in choosing their specialties, but some of them had significant P values like orders of the block (0.04, P < 0.05) and nature of the blocks (0.02, P < 0.05). Furthermore, the clinical years showed a positive effect, with a percentage of around 40%, especially in the male. On the other hand, more than half of the participants complained that the basic years, unfortunately, negatively influenced them in choosing the specialty, especially among the females. Besides, the elective experience besides the personality of the instructors had a good effect on interns in choosing the specialties with a percentage of around 43%, 38%, respectively. Around 22% of participants affected positively by the personality of the instructors were male, who was higher than the percentage of the female interns. There was no significant variation in gender distribution among interns who exposed to positive effects during the elective experience. Unfortunately, around two-thirds of participants (62%), especially females, reported that the PBL session was one of the harmful elements that did not help them to choose the specialty. Near to the half of the participants ensured that no apparent effect toward positive or negative directions from providing extra-lectures about choosing the specialties and using the education tools such as anatomical, physiological laboratories, or microscopes. Finally, the elective experience, PBL sessions, and education tools had significant P values, which were (P-value is 0.011, 0.020, and 0.013 retrospectively), which ensured the association between these medical elements and choosing the specialty.
|Table 3: The effect of medical education element on the intern decision in choosing the specialties (n=234)|
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[Table 4] shows the most common single positive factors in choosing the specialties according to the participants' opinions with regardless of the genders, which was an elective experience (19.36%), pleasant experience during clinical years (18.40%) and kind personality of the instructors (10.70%). Furthermore, the order of the single positive factor was similar according to the female participants' opinions except replacing natures of blocks with the great personality of instructors. On the other hand, there was a significant variation in the opinion between the female and male participants regarding the order of the single negative factors in choosing the specialties. Short block duration was the single negative factor among males, while the lousy personality of the instructors, and I did not know shared the first rank according to the females' opinions. As a result of that, the bad personalities of instructors and short block duration were together in the first rank of the most common single negative factors in both genders, with a percentage around 15% for each one.
|Table 4: The intern perception about the most positive and negative governmental factors in selection the specialties (n=234)|
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| Discussion|| |
The present study was conducted across both male and female interns from four medical colleges in different governmental universities, which were IMSIU, KSU, PNU, and KSAU-HS, to report the influence of them in their interns in choosing specialties in Riyadh city. According to the participants' opinions, the medical colleges, in general, had a good environment that affected most of their interns positively in choosing the specialties. This result was similar to the reported finding in other studies which was that students who had suspicious to determine their future career specialty are guided and supported by the environment of their medical colleges in specialties that fit their interest in hospitals or healthcare institutions even although they had high loads and human resources shortages.,, More than 75% of the respondents in the present study agreed that the universities had educated them about their future specialties with a variation of the onset of education because they were from different medical colleges. A study in Taiwan that showed training and learning environment considered as factors influenced the career choices of the medical student, especially in a 7th year. Provide new guidance to medical students in their future career choice will give them reasonable comprehension of being a doctor, that may motivate and lead toward a field that turns out to be much more apparent.
Many studies have demonstrated a significant impact on clinical years and training programs on students' future career decisions, which could be related to exposing them to more specialties at a later stage or the curriculum that gave them more experience and understanding of each medical specialty., The participants in the present study had a profoundly positive influence over the clinical years. This result was similar to a Kuwaiti study that showed students in later years of study were more likely to report that they had chosen their future specialty compared to basic year.
Nature and order of blocks, PBL sessions, and educational tools influenced student perception, which gives a clear understanding of the valuable role of curriculum strategy planning. Therefore, a planned curriculum provides the ability and knowledge that gives students the appropriate experience and responsibility that will help him or her in a future career as a medical student. Furthermore, elective blocks showed a high level of agreement associated with future career choice. These associations were approved in Saudi study were clinical rotation experience, and subspecialty choices reflected the most critical factors on the future specialty choice considered a valuable instrument for the improvement of the learning skills and to have a chance to assess and determine their future specialty interest.,
Remarkably, respondents considered instructor personality had a significant influence factor on student choice. A study in Nepal highlighted the importance of role model teachers as a significant influence on choosing a specialty. However, that leads to an essential aspect that the teacher could influence the classroom environment by inspiring and emphasizing student choices positively or have a pressure on them and adverse effect on their perception that lead to a negative outcome., On the other hand, many studies tried to measure the effect of student spatiality preference in general.,,, However, there is no spotlight on the university or educational institution strategy consider an essential aspect of student future career decisions.
| Conclusion|| |
There are a great effort and impact of the national universities on their medical students, but they need to improve their medical education system to have a greater effect on the students.
Limitation and recommendation
The sample size in this study was only limited to Saudi Intern participation from colleges of medicine in national universities. Another limitation was gender availability because there are no male participants in PNU, and there is no female participant from IMSIU at the time of the study. As a result, we recommend that conducting a huge study includes Saudi participants from both national and private universities, which include the female intern from IMSIU, especially in the coming 2 years.
All the participants signed the written informed consent. Additionally, the institutional review board at college of medicine in King Saud University, Riyadh approved the study (Research project No. E-17-2777 on 2 January 2018).
I would like to acknowledge the student affairs staff in King Saud University, Imam University, Princess Norah universities and King Saud bin Abdulaziz University for Health Sciences for their cooperation providing us with the list of the student names and their phones numbers and E-mails to facilitate the process of random choosing of the sample size in each university. Also, I would like to thank the chief intern and chief resident in King Khaled hospital, Al Shamasi Hospital, and King Abdulaziz medical city to help us by facilitating the process of research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kumar A, Mitra K, Nagarajan S, Poudel B. Factors influencing medical students' choice of future specialization in medical sciences: A cross-sectional questionnaire survey from medical schools in china, Malaysia and regions of South Asian association for regional cooperation. N Am J Med Sci 2014;6:119-25.
Zia S, Abbas M, Sulaiman M, Sheikh SM. Career choices of medical doctors at graduate level A multicenter study. Pak J Med Sci 2017;33:1086-90.
Ossai EN, Uwakwe KA, Anyanwagu UC, Ibiok NC, Azuogu BN, Ekeke N. Specialty preferences among final year medical students in medical schools of southeast Nigeria: Need for career guidance. BMC Med Educ 2016;16:259.
Chung YC, Lin CY, Huang CN, Yang JH. Perceptions on gender awareness and considerations in career choices of medical students in a medical school in Taiwan. Kaohsiung J Med Sci 2013;29:629-35.
Hayes BW, Shakya R. Career choices and what influences Nepali medical students and young doctors: A cross-sectional study. Hum Resour Health 2013;11:5.
Alawad AA, Khan WS, Abdelrazig YM, Elzain YI, Khalil HO, Ahmed OB, et al
. Factors considered by undergraduate medical students when selecting specialty of their future careers. Pan Afr Med J 2015;20:102.
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.
Alshahrani M, Dhafery B, Al Mulhim M, Alkhadra F, Al Bagshi D, Bukhamsin N. Factors influencing Saudi medical students and interns' choice of future specialty: A self-administered questionnaire. Adv Med Educ Pract 2014;5:397-402.
Kaliyadan F, Amin TT, Qureshi H, Al Wadani F. Specialty preferences of 1(st) year medical students in a Saudi Medical School - Factors affecting these choices and the influence of gender. Avicenna J Med 2015;5:134-9.
] [Full text]
Wouters A, Croiset G, Schripsema NR, Cohen-Schotanus J, Spaai GWG, Hulsman RL, et al
. Students' approaches to medical school choice: Relationship with students' characteristics and motivation. Int J Med Educ 2017;8:217-26.
Bunker J, Shadbolt N. Choosing general practice as a career - the influences of education and training. Aust Fam Physician 2009;38:341-4.
Mahoney R, Katona C, McParland M, Noble L, Livingston G: Shortage specialties: Changes in career intentions from medical student to newly qualified doctor. Med Teach 2004;26:650-4.
Khader Y, Al-Zoubi D, Amarin Z, Alkafagei A, Khasawneh M, Burgan S, et al
. Factors affecting medical students in formulating their specialty preferences in Jordan. BMC Med Educ 2008;8:32.
Aldahash RA, Alqahtani GM, Alkahtani AK, Alnuaim HA, Alhathlol OA, Alshahrani NS: Reasons for choosing Dermatology as a career choice. J Health Specialties 2016;4:288.
Azu OO, Naidu E, Naidu J. Choice of speciality amongst first-year medical students in the Nelson R. Mandela School of Medicine, University of KwaZulu-Natal. Afr J Prm Health Care Fam Med. 2013;5:7.
[Table 1], [Table 2], [Table 3], [Table 4]