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ORIGINAL ARTICLE
Year : 2018  |  Volume : 6  |  Issue : 1  |  Page : 23-29

Career choices of final year medical students and interns at King Abdulaziz University: Where does orthopaedics stand?


1 Department of Orthopedics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
2 Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
3 Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
4 Medical Intern, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
5 Department of Family Medicine, King Fahad Ahmed Forces Hospital, Jeddah, Kingdom of Saudi Arabia
6 Department of Orthopedics, King Fahad Ahmed Forces Hospital, Jeddah, Kingdom of Saudi Arabia
7 Department of Orthopedics, Faculty of Medicine, University of Jeddah, Jeddah, Kingdom of Saudi Arabia

Date of Web Publication8-Jan-2018

Correspondence Address:
Abdullah Ashour
Department of Orthopedics, Faculty of Medicine, King Abdulaziz University, P. O. 3829, Abdullah Ibn Umaiyah, Unit No. 14, Jeddah 23234
Kingdom of Saudi Arabia
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DOI: 10.4103/jhs.JHS_49_17

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  Abstract 

Background: An extensive variety of medical specialities challenge medical students, owing to the numerous factors in choosing a profession or area of specialisation. Understanding the factors that lead to their choice of speciality is important to address the job market requirements.
Objective: To determine graduating medical students' aptitude in making a career choice from King Abdulaziz University (KAU). To identify the factors affecting their career choices and determine where Orthopedic Surgery stands as a career choice amongst other specialities; and to assess whether trends and perceptions change once the students graduate and are near completing their internship.
Methodology: A cross-sectional study was conducted amongst 6th year medical students and medical interns at KAU, Jeddah, Saudi Arabia, during the period of February to April 2015. A self-administered questionnaire was formulated and converted electronically and sent to the respondents through E-mail. Responses were recorded in Google spreadsheet and data analysis was done using SPSS version 23.
Results: It was found that amongst the 232 respondents, Internal Medicine was the most prevalent speciality chosen by both 6th year students and interns while Orthopaedic sits at the sixth rank. Personal interest was the most important factor in choosing a speciality followed by positive experience during undergraduate elective rotation. Future job opportunity was also a consideration in addition to previous positive clerkship experience along with the desire to serve the community.
Conclusion: The medical students' speciality of choice at KAU did not lean or was not affected by fixed factors, such as their grade point average, level of education or gender. Instead, their choice of speciality was greatly affected by their personal interest which is considered to be subjective by nature.

Keywords: Career choice, orthopedic surgery, internal medicine


How to cite this article:
Ashour A, Ashour A, Asiri M, Alghamdi M, Jamjoom A, Alghamdi A, Chaudhary A. Career choices of final year medical students and interns at King Abdulaziz University: Where does orthopaedics stand?. J Health Spec 2018;6:23-9

How to cite this URL:
Ashour A, Ashour A, Asiri M, Alghamdi M, Jamjoom A, Alghamdi A, Chaudhary A. Career choices of final year medical students and interns at King Abdulaziz University: Where does orthopaedics stand?. J Health Spec [serial online] 2018 [cited 2018 Jul 22];6:23-9. Available from: http://www.thejhs.org/text.asp?2018/6/1/23/222464


  Introduction Top


Choosing a speciality is one of the most challenging decisions undergraduate students and interns would have to take. Numerous factors are taken into account before coming up with a decision as regards to what speciality they would choose.[1],[2],[3],[4] In the antediluvian times of medical studies, the speciality choices of medical students were uncomplicated; either they choose to become a general practitioner or become a general practitioner, meaning to say there was no ocean of choices at all.[5] On the other hand, the scenario is quite opposite in today's world owing to the advancement of technology which paved the way for the discovery and amassment of numerous specialities.[5] This is one of the reasons why most, if not all, medical students find it really difficult to choose the domain they would prefer to specialise in.

Mahoney et al., propose that initial career guidance and support during medical school and instantaneously after completion may inspire physicians to consider professions in fields where there is scarcity of practicing professionals for them to choose the said area of specialisation.[6] This highlights the fact that proper information and counselling should be offered while taking up medical education, on an organisational foundation, for the students to comprehend and fathom their future career choice and to be completely cognizant about the difficulties and favourable circumstances ahead of them. This fact is in accordance with the findings of Lambert and Goldacre wherein junior doctors preferred to have career guidance after qualification.[7]

Students of the medical college in King Abdulaziz University (KAU) and most of the Kingdom's medical colleges undergo a 6-year study where they are divided into 3 basic and 3 clinical years. Before completing their course, they need to take up internship wherein specialities are chosen. Orthopaedics has become a desirable profession for the students and interns; this is evident by the growth of the Saudi Orthopaedic Residency Programme with regard to the number of trainees and training institutes as well as the dramatic increase of applicants in the residency programme provided yearly by the Saudi Commission for Health Specialties.[8],[9]

There are some studies conducted in Saudi Arabia concerning the reasons or factors that affect speciality selection of medical students. Our study focuses on the speciality of Orthopaedics in this context, with an emphasis on the medical students and interns at KAU.


  Methodology Top


A cross-sectional study was conducted amongst 6th year medical students and medical interns at KAU, Jeddah, Saudi Arabia, during the period of February to April 2015. Ethical approval from the Research and Ethics Committee of KAU-Faculty of Medicine was obtained. A questionnaire was developed after literature review including demographic data (date of birth, gender, level of education, grade point average (GPA) and a question to know if the participant has a 1st degree relative in the medical field or not), questions regarding their speciality of choice with 24-point factor (s) to determine what influenced their choice, question on what is the speciality they would not choose with points to know the factor (s) which caused them to refrain from it and also question as to whether they would prefer to complete their postgraduate education abroad or locally, again with points to know the factor (s) which influenced their choice. The questionnaire was converted into an electronic version using Google forms and sent to the study population through E-mail and the responses were recorded in Google spreadsheet. Participant confidentiality was maintained through the process and data were collected anonymously with no participant identifiers mentioned.

Statistical analysis

Simple descriptive statistics were used to define the characteristics of the study variables through a form of counts and percentages for the categorical and nominal variables while continuous variables were presented by mean and standard deviations. To establish a relationship between categorical variables, this study used Chi-square test. While comparing two group means and more than two group means, an independent t-test and one-way ANOVA with least significant difference as post hoc analysis was, respectively, used. These tests were done with the assumption of normal distribution. Otherwise, Welch's t-test for two group means and Games Howell for more than two groups were used as an alternative. To test the relation of variables measured by both mean, a Pearson correlation was used. Finally, a conventional P < 0.05 was the criteria to reject the null hypothesis.


  Results Top


This study has 232 samples. [Table 1] shows the demographic characteristics of these samples. As shown, 106 (45.7%) were males and 126 (54.3%) were females. The mean age for the samples was 24.57 ± 0.8 and their mean GPA was 1.88 ± 0.5. One-hundred-fifty-four (66.4%) of the samples were 6th-year medical students and 78 (33.6%) were medical interns. Amongst the 232 samples, 39 (16.8%) chose Internal Medicine as their prefered field to specialise in, 24 (10.3%) chose Family Medicine, 21 (9.1%) were still undecided, 18 (7.8%) chose Paediatrics, 16 (6.9%) chose General Surgery, another 16 (6.9%) chose Orthopaedics, 14 (6.0%) chose Obstetrics and Gynaecology, 11 (4.7%) chose Anaesthesia and Radiology was chosen by 10 (4.3%) of them [Table 1] and [Figure 1].
Table 1: Characteristics of the 232 Study Samples

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Figure 1: Speciality Choice

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Also shown in [Figure 1], some of the samples chose other specialities such as, Neurosurgery, Psychiatry, Ear, Nose and Throat (ENT), Emergency Medicine, Dermatology, Urology, Paediatric Surgery, Cardiac Surgery, Forensic Medicine, Adult Critical Care, Community Medicine as well as non-clinical master's degree such as Medical Education.

[Figure 2] shows the factors affecting the respondents' choice of speciality. It was found that an overwhelming 87.5% of the respondents chose their speciality out of personal interest. The other top five factors included: elective rotation (34.5%), future job (31.9%), clerkship (28.9%) and community service (27.6%).
Figure 2: Factors affecting choice of speciality

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The results [Figure 3] also showed that the number one excluded speciality was Obstetrics and Gynaecology wherein 23.3% chose to exclude it; next was General Surgery (19.4%) followed by Internal Medicine (13.4%). The top reasons for specialty exclusion were poor quality of life (47.0%) and workload (42.2%) [Figure 4].
Figure 3: Speciality excluded

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Figure 4: Factors affecting the exclusion of speciality

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The aptitude of the samples to choose a speciality was perceived through their GPA. T-test was used to measure if this had an effect across gender, level of education and their speciality choice, which was found to be in the negative. This signifies that GPAs of the samples does not significantly affect the aptitude or capacity of the samples to decide on both genders, their level of education as well does not have any effect on their choice of speciality, P = 0.768, 0.354 and 0.853, respectively [Table 2]. It was also determined that gender and the respondents' level of education do not have any significant effect on their choice of speciality, P = 0.142 and 0.991, respectively [Table 3].
Table 2: GPA vis-à-vis gender, level of education and speciality choice

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Table 3: Gender and level of education vis-à-vis choice of speciality

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Results also showed that amongst the 232 respondents, 103 (44.4%) chose to pursue studies abroad, amongst which were 54 females and 49 males. Their decision to study abroad was not affected by their GPA, gender, level of education or their speciality choice, P = 0.916, 0.607, 0.075 and 0.349, respectively [Table 4]. [Figure 5] shows the reasons why they chose to pursue their studies abroad. Top reason was shown to be for better learning (47.4%), followed by experiencing other culture (34.1%) and different healthcare system (31.0%).
Table 4: Taking of board abroad or locally

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Figure 5: Reasons for choosing to take their board abroad

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As to the level of security, using the Chi-square test, it was found that gender and level of education do not have significant differences; however, there was a significant difference when it came to the choice of speciality, P = 0.022. Specifically, level of security significantly differed to those who chose Internal Medicine, Family Medicine, Obstetrics and Gynaecology and Orthopaedics [Table 5]. Furthermore, it was found that the choice of speciality was not affected by family expectation, level of competition or financial causes. This was the same across gender, GPA and level of education.
Table 5: Level of security vis-à-vis gender, level of education and speciality choice

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  Discussion Top


Various studies aiming at apprehending the speciality selection of medical students have been administered in Saudi Arabia as well as other countries.[10],[11],[12],[13],[14] It was observed that influencing factors in speciality selection included cultural, social, personal and financial circumstances.[15],[16],[17] Moreover, Mehmood et al., stated that experiences also play a major role in career or speciality choice for medical students.[18] Furthermore, Alshahrani et al.,[19] stated that Saudi medical students considered lifestyle as the most dominant and imperative aspect in choosing their area of specialisation.

This study showed that most of the interns and 6th year medical students chose Internal Medicine to be their future career speciality. This finding is in accordance with the studies conducted by Ai-Faris et al., and Alshahrani et al.[19],[20] While in a study conducted by Abdulghani et al.,[15] General Surgery, ENT, Opthalmology and Internal Medicine were the most preferred specialities by the medical students. With regard to Orthopaedics, it ranked fifth among preferences. This is nearly the same findings as of Mehmood et al.,[18] wherein Orthopaedics was ranked sixth as the most sought speciality.

Orthopaedics according to the Saudi Commission of Health Specialities is the most dynamic and hectic profession in any hospital because of its huge turnout.[21] Johnson et al.,[22] also state that Orthopaedic Surgery is the most popular profession by students, even before entering medical school. Even if it is very likely that doctors specialising in this area detach themselves from their social life, leaving them very little time to devote with their family, with proper management they could get over this dilemma.[21] In addition, this specialisation is the most appreciated amongst the hospital staff and patients.[21]

The most important factor that influenced their choice of speciality was personal interest. This is in conformity with the findings of Abdulghani et al., and Ai-Faris et al.[15],[20] However, it is believed that personal interest is not perpetual and could change later in life while the person is exposed to different factors such as experiences as well as environmental factors.

Positive experiences during undergraduate elective rotation were found to be a second factor. This may imply that the internship year does not add any difference to those who do not decide their speciality in the clinical years. This is in agreement with the findings of Ko et al.,[16] in a study conducted with medical students of University of British Columbia. However, some studies found that intellectual content of speciality,[13] financial opportunities,[23] prestige [23],[24] and career opportunities [24] were contemplated to be the greatest influencing factors. Positive experiences are an important factor as it presents the students or interns with a practical feel of how the career life is going to shape if they chose that speciality as their future career. In addition, in a study conducted by Kawamoto et al.,[25] their female respondents considered memorable experiences in class or clinical rotation as one of the important motivational factors in their speciality choice. Regarding the internship year, this gives more exposure to the speciality than during the undergraduate years since they will be more acquainted to on-call duty and lots of other responsibilities related to the field.

The most excluded speciality by the students was Obstetrics and Gynaecology, which is remarkably in contrast to the findings of other studies here and abroad.[13],[20],[26] As for the interns, it was General Surgery, which is again in contrast to that of the findings of Abdulghani et al.[15] The most frequent factor chosen that led to these exclusions were the poor quality of life and heavy workload. This is understandable taking into consideration the findings of several studies where their respondents considered quality of life and controllable working hours to be important factors in choosing a speciality.[27],[28],[29],[30] Moreover, this study found that 93.1% of the students who chose their speciality during their basic years changed their speciality during their clinical years. This could be due to the exposure to different specialities through the different rotations in which the interns and students rotate through the different specialities with different teams. This is reiterated by Abdulghani et al.,[15] when they stated in their study that clinical rotation has an impact on the speciality selection of the students. Moreover, it was also found that most of the male students and interns wanted to have their postgraduate education abroad. This is in accordance with the findings of Ai-Faris et al.,[20] who stated that a significantly higher number of their male respondents chose or preferred to pursue postgraduate studies in the United States.

To recap, KAU medical students were not so different from those in other parts of the world, considering the similarities of our findings on the factors they considered while choosing their specialities. It is noteworthy to state that this paved the way for the comprehension of how students and interns are choosing their speciality and the factors that influence their choices. Thus, these findings can be utilised to improve the methods of their selection which can be of help in addressing the job market needs of the Kingdom.


  Conclusion and Recommendation Top


Upon scrutinising the results of this study, we therefore conclude that the speciality choice of the respondents did not lean or was not affected by fixed factors which include their GPA, level of education or their gender. Instead, their choice of speciality was greatly affected by their personal interest which was considered to be subjective by nature. To improve results of future studies, the researchers recommend that more definite epidemiology of the demographics should be included.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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