Study of Factors Influencing Medical Students in their Choice of Career

Introduction

What makes medicine such a sort-after field? Medicine today is a very highly regarded profession which is well compensated, provides excellent job security and has the opportunity to have a positive influence on the lives of many people¹.

Success in medicine requires hard work and application, both while learning and when entering practice². However, it brings great rewards in terms of job satisfaction and the range of career opportunities within the profession³. Learning about and practicing medicine is also very pleasing, involving as it does a blend of human interactions and applied science². The environment in which different types of medicine are practiced is rich and diverse and obviously continually changing, and doctors continue to learn throughout their working lives.

That is why the students interested in medicine should have the capacity for, and interest in, a lifetime of learning about this fascinating subject. To get the most out of the course a student need to be a keen scientist, with a sound scientific understanding and determination and also an ability to cope up with the demands and pressures of early clinical training³. But are they actually aware of the high demands of this prestigious professional course?? Do they have a realistic understanding of what a career in medicine will involve? We often wonder, is it the genuine passion for the subject and the genuine interest to be of service to the mankind that make students do medicine or is it just their parents??!!! This study gives us the opportunity to find out the factors that drove students to do medicine.

If choosing the medical profession is not hard enough, medical students have an even bigger hurdle ahead of them, which is choosing their line of specialisation. Many factors affect the career choices of graduating medicalstudents. Influences such as strong mentors, formativeacademic and non-academic experiences, and career counselingcan all help aspiring physicians select their particular careers⁴.Similarly, market trends, self-perception of strengths and weaknesses,and anticipated lifestyle can also affect career choice⁵.

It has often been questioned, is gender really an issue? Does money influence one’s decisions? Or is it competition?! A large number of specialising fields and over 50 career options are available in medicine, assuring a medical graduate of finding a profession. But how many medical students are actually aware of these career options?

As mentioned earlier, medical profession brings great rewards in terms of job satisfaction and a variety of career opportunities. However, like any job, there are parts of a doctor’s work that are frustrating, undesirable, and even repetitive or boring. Studies show that doctors work far more hours than the average U.S. professional and cope with large amounts of stress and pressure⁶. Managed care has made it more difficult for U.S doctors to practice as they see fit and limit the amount of time that they can spend with patients. In fact, for some doctors, the upsides of the profession aren’t worth the sacrifice and hassles of the modern health-care environment⁴. This has lead to doctors with long and potentially bright careers to hang up their stethoscopes and quit! But is this the case when it comes to medical students in India? What makes them leave medicine despite the fact that there’s a shortage of doctors making a ratio of one doctor per 1,634 people in India which is considered to be extremely below the ideal standard of doctor-people ratio?^7,8

Medical students’ attitude towards various clinical fields and post graduation has been a major focus of study in the U.S as well as in the United Kingdom, yet there have been very few studies and surveys done on the career choices of Indian medical students. Hence, little is known about career intentions or attitudes of medical students in India. This study aims to reporton the career intentions and attitudes of first and second year medical students. It gives us the opportunity to discover the factors that influence the medical students on their career choices. The study also shows how exposure to more clinically oriented medical professions will affect the choice of careers in medical students.

Aims and Objectives

The study aims to find out factors that influence the choice of career of medical students

Objectives

• To find out the reasons for students to take up medicine as a course of further studies.

• To compare career intentions of 1st year medical students, early in their training, with 2nd year medical students of Kasturba Medical College, Mangalore, in relation to various socio-demographic correlates.

• To compare findings from the 2nd year batch with those from a similar survey conducted on the same batch last year.

Methodology 

We conducted a survey in the study setting of KMC Mangalore with the total study population of 393 MBBS students, which consisted of 216 1^st year and 177 2^nd year students. It was a cross sectional study which lasted from the dates of March 7^th to March 14^th, 2008.

Data was collected through a pilot studied semi-structured questionnaire. The outline of the questionnaire was designed after referring to questionnaires used in similar studies like ours. Certain changes such as clearing any non-specific questions and adding more questions which seemed relevant to our study were made.

Permission was obtained from the Associate Dean Dr. M.V. Prabhu and respective teachers. Then questionnaires were given out to consenting students.

Collected data was tabulated and analyzed by using SPSS version 10 software. Results obtained were presented on tables and graphs wherever appropriate. Lastly the test of significance was carried out using χ2 test on tables in which we thought there would be significant values.

Results

The total study sample was 393 students, comprising of 216 1^st year students and 177 2^nd year students. The response rate among the 1^st and 2^nd year students was 98.18% and 100% respectively.

Table 2: Baseline Characteristics

Majority of the participants have done their schooling solely in India (74%). 55% of the respondents joined directly after school, whereas 30% dropped a year or 2 before joining college. 2.3% of the students had completed a degree prior to joining college.

Both 1^st year and 2^nd year students chose the medical profession because they had a passion for the medical field. It seems that very few 2^nd year students were forced by their parents (3.4%) as compared to the 1^st year students (4.6%). On the other hand, there are very few students in the 1^st year that chose medicine for job security (1.9%) unlike the 2^nd year students who had a higher percentage of 15.3%. Job security & parents’ insistence were the most unlikely reasons for 1st year & 2^nd year students respectively (Table 3).

When asked about their future line of plan, had it not been MBBS, more than 100 students who responded in the OTHERS category specified that they would join ONLY MBBS. As expected, most students (37.2%) felt that they would join engineering had they not been in MBBS. This may possibly be due to the fact that Mathematics is a compulsory subject during pre-university college. Paramedical/Allied Health Sciences were the least sought-after fields which were chosen by the 1^st & 2^nd year students respectively (Table 4).

Interestingly, ALL 1^st year students wanted to pursue a PG degree while 4% of the 2^nd year students DID NOT want to go in for post graduation – perhaps due to the exposure to clinical postings? Both 1^st and the 2^nd year students seemed widely interested in doing an MD/MS (91.7% & 86.4% respectively), with the next popular choice being MRCP/MRCS with only 7.4% & 6.2% of 1^st & 2^nd year students considering it . Even with the very little information they have, 86.6% of 1^st year students wanted to go in for a clinical field & 12.5% of the students could not decide about their choice of career, whereas 0.93% decided for a non-clinical field. Among the 2^nd year students, 84.2% of the students decided for a clinical field, 7.9% having not decided yet & 2.3% for a non-clinical field. This trend of more students opting for a clinical field may be due to the exposure to clinical postings during the 2^nd year (Table 5).

When asked about going in for super-specialization, 79.6% of 1^st year students & 64.4% of 2^nd year students answered on the affirmative, 13.4% & 25.4% answered against it while 6.9% & 10.2% said they had not decided yet (Table 6).

The general trend among 1^st year students is to take up a career in surgery (40.7%) whereas for 2^nd year students it is medicine (24.9%). The least sought after fields are Anaesthesiology for 1^st year students & ENT for 2^nd year students (Table 7).

Regarding non-clinical fields, Forensic Medicine is the most preferred non-clinical field among 1^st years (5.1%) where as post-graduation research is more popular among 2^nd years (2.8%) (Table 8).

According to the data, there is no significant difference between male and female students’ choice of career with relation to choosing a clinical or a non-clinical field. 90.9% of the males & 88.5% of the females taking the survey thought it would be a clinical field they would like to pursue (Table 9).

When asked if there was a chance that the respondents would not be able to pursue the career of their choice, most students felt that Competition remained the major hurdle ahead of them. 27.3% of 1^st year students & 29.4% of 2^nd year students felt that the stiff competition they face would stop them from going in for the career of their choice (Table 10).

Majority of the 1^st & 2^nd year students prefer to practice medicine in their own countries, rather than in a foreign country. This may possibly be due to the fact that most relatives & kin are in their own country & also, due to the possibility of an already functional medical set-up in the family. 33.3% of 1^st year & 26% of 2^nd year students prefer to practice abroad, & 5 of 2^nd year students said they would leave medicine, but still stay in the country (Tables 11a & 11b).

It is seen that among all the respondents, 205 resident Indians, forming 52.16% of the students prefer to practice in their own country, whereas 25 of them (6.36%) preferred to practice abroad. 70 students (17.81% of students) said they had not decided yet & depended on various factors. Among the Malaysians, 18 students (4.58%) prefer their own country, 1 student (0.25%) prefers practising abroad & 8 students had not decided yet. 7 non-resident Indians (1.78%) wanted to practise in their own country, 6 students (1.52%) abroad & 14 students (3.56%) had not decided yet (Table 12).

Most students in 1^st year (16.7%) & 2^nd year (7.3%) feel that if they were to go abroad, it would be due to better prospects available. A better financial reward was the next most popular reason for going abroad, with 10.6% of 1^st year & 6.8% of 2^nd year students feeling so (Table 13).

The current trend seems to be favoring multi-specialty hospitals over government hospitals. 50% of 1^st year students & 49.2% of 2^nd year students preferred multi-specialty hospitals over other options. The next most sought work setting was Government Hospitals for 1^st year students whereas it was private practice among 2^nd year students (Table 14).

For most students in both 1^st year (4.6%) & 2^nd year (7.9%), hectic schedules seem to be the main reason for leaving medicine. Family obligations seem to affect the decisions of 1^st year students (3.7%) more than that compared to 2^nd year students (1.7%). It also seems as though 2^nd year MBBS students are much more concerned with the competition in medicine (2.8%) than the 1^st year students, perhaps due to more exposure to clinical fields (Table 15).

Interestingly, exposure to clinically oriented medical profession has DECREASED the students’ interest to pursue further studies as well as choose a clinical field! Whereas 98% of 1^st year students wanted to pursue a post-graduation course, only 94.4% of 2^nd year students chose to go in for a post-graduation. Also, while 89.9% of 1^st year students wanted to go in for a clinical field, only 84.2% of 2^nd year students wanted to go in for a career in a clinically oriented field – a very interesting find! (Table 16).

There seem to be a dynamic shift in the career choice of the 2^nd year MBBS students of the 2006 batch after clinical exposure. About a quarter of the students presently in 2^nd year are inclined towards general medicine, compared to just 15.6% of the same students before clinical exposure. On the other hand, figures for a career in surgery have come down from 33.2% to 21.5% after clinics. Interest in pediatrics has also increased almost two-fold after clinical exposure (Table 17).

Table 3:What drove students to choose medicine?  

Table 4:If not MBBS?

Table 5: Post-graduation

Table 6: Future career intentions

Table 7:Preference for a profession in a CLINICAL Field: