|Year : 2016 | Volume
| Issue : 4 | Page : 288-293
Reasons for choosing Dermatology as a career choice
Rawan Abdulaziz Aldahash1, Ghada Mohammed Alqahtani1, Alanoud Khaled Alkahtani1, Hala Abdulrahman Alnuaim1, Omar Abdulrahman Alhathlol1, Naif Salem Alshahrani2
1 Department of Clinical Affairs, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
2 Department of Dermatology, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
|Date of Web Publication||12-Oct-2016|
Rawan Abdulaziz Aldahash
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, P. O. Box: 22490, Riyadh 11426
Context: Determining factors that influence medical students' choice in selecting their future careers are the key to achieving a balanced distribution of future doctors among all specialties.
Aims: This study aimed to determine the factors associated with choosing Dermatology as a future career stream among medical students.
Settings and Design: A cross-sectional study using consecutive sampling was carried out among Saudi medical students who were enrolled in King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) during the study.
Subjects and Methods: A validated newly developed English questionnaire was sent via e-mail to 268 eligible students, of which 200 (75.3%) participated.
Statistical Analysis Used: Categorical data were compared using Chi-square test and Fisher's exact test. All tests were two-sided, and P < 0.05 was considered statistically significant.
Results: A total of six (3%) students were considering Dermatology as their first choice, while it was the second choice for seven students (4.7%). Of the participants, 118 (60.8%) found 'the difficulty of getting into a Dermatology residency programme' to be the least attractive factor. Factors that significantly attracted medical students to consider Dermatology as a career choice were the appeal of being a dermatologist, how dermatologists lead a satisfying family life, reliance on clinical diagnostic skills and research opportunities in Dermatology (P = 0.004, 0.024, 0.039 and 0.010, respectively).
Conclusions: A variety of factors influenced the medical students of KSAU-HS when choosing a future specialty. Identification of these factors can help medical student mentors and residency training programme directors to motivate students choose specialties that are limited in our nation.
Keywords: Career choice, dermatology, medical career, medical graduate, medical practitioners, medical specialties
|How to cite this article:|
Aldahash RA, Alqahtani GM, Alkahtani AK, Alnuaim HA, Alhathlol OA, Alshahrani NS. Reasons for choosing Dermatology as a career choice. J Health Spec 2016;4:288-93
|How to cite this URL:|
Aldahash RA, Alqahtani GM, Alkahtani AK, Alnuaim HA, Alhathlol OA, Alshahrani NS. Reasons for choosing Dermatology as a career choice. J Health Spec [serial online] 2016 [cited 2019 Aug 19];4:288-93. Available from: http://www.thejhs.org/text.asp?2016/4/4/288/191912
| Introduction|| |
The specialty of Dermatology as a career choice is frequently cited as a preference among many medical students worldwide.  In Saudi Arabia, the Dermatology residency programme, a 4-year course of intensive training in the field of Dermatology, is still one of the most competitive specialties despite the gradually increasing number of resident training positions since 1999.  The number of Saudi dermatologists has been relatively stable (approximately 1/100,000 in the Saudi Arabian population over the past six years). However, foreign dermatologists have also progressively increased in number in Saudi Arabia (from 1.59/100,000 in 1999 to 2.6/100,000 in 2007). In 2007, the number of dermatologists reached 901 in Saudi Arabia, of which 69.3% were non-Saudi. 
Factors affecting medical students' decision on their career choices have been studied previously. Some of these factors include income, working hours, duration of training, patient load, number of on-calls and the flexibility of a specialty. , Correspondingly, lifestyle has been found to be a critical factor influencing students' career choices. ,,] In addition, the personalities of students play a major role when choosing a particular specialty. ,, Many studies, on the other hand, investigated certain factors considered by specific subgroups such as female doctors and the opinions towards certain specialties, such as General Surgery and Anaesthesia and the effects of these certain factors and opinions on the distribution of workforce in certain departments. ,,
According to a study conducted in the United States,  a matching programme showed that most medical students chose specialties in which they can exert control over the working hours, and that have a higher income and less years of training. This has led to a change in the distribution of applicants across selected specialties from 1996 to 2002.  High-income potentials, the influence of a role model in a specialty, and an inclination towards a specialty before medical school were the most common factors seen when choosing a future specialty in a study conducted in Pakistan. 
In contrast to international studies, a study conducted in Kuwait revealed that out of 387 medical students, only 144 medical students had made a decision regarding their future careers.  Among the most common determining factors were looking for a good treatment outcome and a challenging specialty.  Locally, Mehmood et al., found that male students were more likely to choose medical fields that had less competition, had a shortage of specialists and had a diversity of patient problems, while the prestige perceived from a specialty and teaching opportunities had a greater influence on the choices of female students.  Saudi medical students and interns at the University of Dammam were influenced mostly by lifestyle when they considered their future specialties.  A cross-sectional survey carried out on 1 st year medical students of King Faisal University, Saudi Arabia, revealed a significant gender difference. The important factors affecting their career choices included: Primary aptitude, advice of peers, reputation, financial rewards and the challenges involved. 
King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) is one of the most well-known universities in the Kingdom of Saudi Arabia. The medical college programme is six academic years for stream one (high school graduates) and four and a half academic years for stream two (university graduates). The subject of Dermatology is introduced into the theoretical curriculum in the two preclinical and two clinical years as lectures, but clinical exposure only occurs in the final year of medical school. 
Despite being one of the most highly competitive fields, the number of medical students who consider Dermatology is high. Career choices of medical students usually affect the distribution of physicians in different specialties across the country.  Consequently, studying the preferences of doctors and medical students will aid in improving the educational programmes, planning for a balanced distribution of workforce and evolving the healthcare system to better suit the needs of specialties and the choices of future doctors. , Up to our knowledge, there were no published data on medical students' attitudes towards Dermatology as a career choice in Saudi Arabia. Therefore, this study aimed to explore the factors that would influence medical students to choose Dermatology as the specialty of their future medical careers.
| Subjects and methods|| |
This cross-sectional study was carried out at the College of Medicine, KSAU-HS, in the city of Riyadh, using a self-administered questionnaire. Both males and females enrolled in the clinical phase (years 5 and 6 of medical school) in the college of medicine during the academic year 2015-2016 were included in this study.
Due to the lack of studies regarding this topic, a new English questionnaire was developed. The questionnaire consisted of four sections. The first section was about baseline characteristics of the study participants, while the remaining three sections focused on choosing the preferred specialty, influential factors for those who chose Dermatology, and other factors that pushed medical students away from choosing Dermatology, respectively.
A pilot study of randomly selected 40 medical students was conducted in another university in Riyadh using this study's questionnaire to determine and quantify the content validity of the items. The content validity of the questionnaire revealed content clarity and evoked no confusion from the questions asked. Face validity was done by two faculty members specialised in medical epidemiology and biostatistics. In addition, the internal consistency for the sections was computed using Cronbach's α, which revealed an acceptable consistency of 0.76.
The total number of clinical-phase medical students during the academic year of 2015-2016 was 268, of which 200 participated with a response rate of 75.3%. Of those who participated, 121 were males (60.5%), while 79 were females (39.5%).
For data management and analysis, the Statistical Package for Social Sciences (SPSS) version (IBM Corp. Released 2013. IBM SPSS Statistics for Mac, Version 21.0. Armonk, NY: IBM Corp) 22 was used. Descriptive analyses were carried out by computing the frequencies and percentages for the categorical variables. Categorical data were compared using Chi-square test and Fisher's exact test. All tests were two-sided, and P < 0.05 was considered statistically significant.
Participation in the study was voluntary, and each participant was able to withdraw from the study at any time without the need for a justification or penalty. Agreement to fill the questionnaire was considered consent to participate in the study. The data were treated with confidentiality by the research team. The study protocol received ethical approval from the Institutional Review Board at King Abdullah Medical International Research Centre, National Guard Health Affairs, Riyadh, Saudi Arabia.
| Results|| |
From a sample of 200, 106 students (53%) were in their 5 th year and 94 (47%) students were in their final (6 th ) year of medical school. Most of the respondents (97%) were unmarried, while only 6 (3%) students were married. In terms of academic performance, 98 (47.9%) students reported a grade point average (GPA) of more than 4.5 (out of 5.0), while 93 (46.5%) reported a GPA between 3.5 and 4.49. [Table 1] shows the sociodemographic characteristics of all respondents.
Of the 200 respondents, only 6 (3%) students chose Dermatology as their preferred specialty, while 110 (55%) chose a surgical specialty, and 69 (40.5%) chose a medical speciality. Four students out of six who chose Dermatology as their preferred specialty were females. Five out of the six students who chose Dermatology had a GPA of 4.5 - 5.0. More than half of the participating students (56.5%) had chosen their preferred specialty during the clinical years, while 53 (26.5%) students had made their choice during the basic sciences' years. The remaining 30 (15%) students had made a decision before entering medical school.
Factors in favour of Dermatology as a career choice [Table 2] were how dermatologists lead a satisfying family life (P = 0.024), the appeal of being a dermatologist (P = 0.004), relying on clinical diagnostic skills (P = 0.039) and opportunities for part-time work in Dermatology (P = 0.010).
| Discussion|| |
As medical students are the country's future physicians, the preference towards a career in a certain specialty affects the workforce distribution in certain specialties, as well as the balance of the healthcare system. In recent years, Dermatology has been considered one of the most desired specialties in Saudi Arabia.  There were no studies clarifying the perception and preferences of medical students when choosing Dermatology among other specialities in Saudi Arabia. Therefore, the foremost objective of this study was to assess Saudi medical students' attitude and perceptions towards Dermatology as a future career stream at KSAU-HS.
All of the respondents who chose Dermatology as their preferred speciality were in the 6 th year. This could be related to the fact that the curriculum at KSAU-HS exposes students to the clinical aspect of Dermatology in their final year. In this study, most of the respondents who chose Dermatology had a GPA of more than 4.5, which may be explained by the high academic requirements that students need to fulfil to get accepted in a residency programme for Dermatology.
Lifestyle has become increasingly imperative to the current generation of medical students when choosing a speciality. A study done on medical students of high academic performance at three different medical schools has shown that these students sought specialities with a 'controllable lifestyle' such as Dermatology, Radiology, Psychiatry and Ophthalmology.  A 'controllable lifestyle' is when there is personal time, free of medical practice, for leisure, family, and avocational pursuits and having control over the weekly hours spent on professional responsibilities.  In 2015, dermatologists were ranked among the least burned out physicians, and with more family time.  A Saudi study found that female medical students preferred part-time jobs and specialities with controllable lifestyle due to the difficulties coping with an occupation and family commitments.  In this study, 66% of those who chose Dermatology were females.
Different factors affected students' perceptions towards Dermatology. How dermatologists lead a satisfying family life was seen as an (or) the most important factor affecting Dermatology as the choice of speciality. A previous study by Wright et al., which addressed the impact of role models on medical students, demonstrated the strength of the association between exposure to role models and medical students' choices of clinical fields for residency training. 
'The appeal of being a dermatologist' stood second as a significant factor among the respondents. It was considered as an attractive factor among the majority, which might be related to the financial and occupational satisfaction implied by dermatologists.  This finding opposes what was found in a study conducted by Rosoff and Leone about rating the prestige of medical specialities. They found Dermatology to be generally rated low when doctors and medical students were questioned.  Also, dependence on clinical diagnostic skills in Dermatology is one of the influential factors. Unlike other specialities, laboratory investigations or imaging are rarely needed in Dermatology. Dermatologists are often considered 'skin doctors', but they are actually involved in diagnosing and treating a variety of broader medical conditions that are manifested by skin or hair symptoms. They also deal with a wide array of cases, ages and races, and helping resolve different conditions keeps the work interesting.
The opportunities to conduct research also prompted students to opt for Dermatology. Research in Dermatology in the Kingdom of Saudi Arabia is still in its early stages. It is hindered by a number of factors, including insufficient funding, interest of dermatologists to work in private sectors, and poor integration across the research centres and universities in the Kingdom.  In the years between 1966 and 2004, there were only 140 publications in the field of Dermatology from research institutions in the Gulf Cooperation Council states, with Saudi Arabia being the most prolific contributor.  Hence, this lack of clinical research in Dermatology, when compared with other specialities, has encouraged medical students to choose Dermatology, so they can become pioneers in the field of research in the future.
There are a lot of studies in Saudi Arabia determining the factors affecting undergraduate medical students' decisions when choosing their specialities. However, this study is considered the first to explore student's impressions towards Dermatology specifically. Another strong point of this study is the involvement of all medical students in the clinical phase. It is likely that there are factors that affect medical student's decision before, during and after medical school. Unfortunately, we have not had a comparison between the same sample in the basic year and clinical year for determining accurate factors that influenced medical student to opt for Dermatology as this was only a cross-sectional study. Similar future studies should identify these factors' impact on graduates' career choices over many years to focus on them, and to learn how to use these factors to influence medical students towards particular specialities. Further studies are also encouraged to be done across different universities in Saudi Arabia for comparison and to help with improving the educational programmes, resulting in developing a better healthcare system.
In conclusion, a variety of factors influence the medical students of KSAU-HS when choosing Dermatology as their preferred future speciality. How dermatologists lead a satisfying family life, the appeal of being a dermatologist, opportunities for researches in dermatology, and the reliance on clinical skills for diagnosis were considered the most attractive factors among students. These factors can be used by mentors of medical students and directors of residency training programmes to motivate students to choose specialities that are limited in our nation.
This study has several limitations regarding reasons for favouring Dermatology as a career choice among medical students. These limitations are related to the small sample size, and the lack of a standard definition in some of the questions such as the difficulty in entering Dermatology and the amount of stress that dermatologists might face. The study included students who were not yet exposed to the clinical rotation in Dermatology in their clinical year; thus this can present as a bias in the data. In addition, the study is a cross-sectional design, and there is a need for more appropriate methods to study the reasons for choosing Dermatology among medicals students in different colleges of Saudi Arabia.
The authors would like to duly express their heartfelt appreciation and gratitude to Dr. Abeer Alkhairy and Dr. Mariam Alosfoor for their countless support.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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