|Year : 2018 | Volume
| Issue : 4 | Page : 141-145
Factors influencing decision of medical students in choosing a surgical specialty: A cross-sectional study
Hesham Fouad Barradah1, Mohammed Ridha Algethami1, Jehad Basem Bambi1, Mazin Abdul Manan Alsayed1, Nabeel Ghazwan Mahmalji1, Mahmoud Fakiha2, Hisham Rizk2
1 Department of Surgery, King Abdulaziz University, Faculty of Medicine, Jeddah, Saudi Arabia
2 Department of Surgery, Jeddah University, Jeddah, Saudi Arabia
|Date of Web Publication||13-Dec-2018|
Dr. Hesham Fouad Barradah
Faculty of Medicine, King Abdulaziz University, Jeddah
Source of Support: None, Conflict of Interest: None
Introduction: It has been noticed that the surgical field has been facing shortage in the workforce in many countries. This study aimed to take a closer look on the possible factors influencing medical students' decision in choosing surgical specialty. These factors include the gender, nationality, living conditions, the effect of the mentors during medical school years, and satisfaction with the training programs. We aim to assess different factors that affect the decision-making of medical students in Saudi Arabia when choosing a surgical specialty.
Methodology: (a) A cross-sectional study was conducted at King Abdulaziz University in Jeddah. Participants were from King Abdulaziz university medical students, from preclinical years (2nd and 3rd), and clinical years (4th, 5th, and 6th). Students from other colleges and universities were excluded from the study. A questionnaire utilizing the fivepoint Likert Scale ranging from 1 (strongly disagree) to 5 (strongly agree) was used when asking students about their opinion in choosing a surgical career.
Results: A total of 329 medical students completed the questionnaire. Significant demographical differences were found regarding housing and physical training (P = 0.006 and P = 0.004). Fifty-two (15.8%) and 61 (18.2%) participants showed interest in general surgery and cardiothoracic surgery, respectively. Females were mostly interested in cardiothoracic surgery (18.9%), with significant difference (P = 0.007).
Conclusion: The majority of medical students are willing to pursue a surgical career and most of them believe that overseas have a good surgical training program. Based on our result, we recommend that more lectures, campaigns, and workshops should target medical students to increase their knowledge about these potential factors that could alter their decision when choosing a surgical career.
Keywords: Cross-section, medical education, medical students, surgery, survey
|How to cite this article:|
Barradah HF, Algethami MR, Bambi JB, Alsayed MA, Mahmalji NG, Fakiha M, Rizk H. Factors influencing decision of medical students in choosing a surgical specialty: A cross-sectional study. Saudi Surg J 2018;6:141-5
|How to cite this URL:|
Barradah HF, Algethami MR, Bambi JB, Alsayed MA, Mahmalji NG, Fakiha M, Rizk H. Factors influencing decision of medical students in choosing a surgical specialty: A cross-sectional study. Saudi Surg J [serial online] 2018 [cited 2019 Jan 18];6:141-5. Available from: http://www.saudisurgj.org/text.asp?2018/6/4/141/247416
| Introduction|| |
It is of great importance to understand the factors that influence medical students when they come to choosing a medical specialty. In the future, surgery will face shortage in the workforce. The high demand for general surgeons in the United States of America insufficiently met by only 84.8% of residency positions filled, which resulted in dependence on the International Medical Graduate. Many factors play a role in specialty choice for medical students, ranging from personality type of students to the relationship with the surgery mentor during medical school years or others. Mentors affected the majority of students who choose surgery as a career during college years and the research opportunities their mentors provided.,, Other factors can either attract medical students to join a specific specialty such as the social standing or the salary, while other factors might avert them such as long-working hours. Another study found that student evaded surgical specialties because of high workload and poor balance between life and career. Fear of lack of respect for the upcoming surgical resident was also one of the factors concerning medical students when choosing the surgical specialty.,, Moreover, previous researchers founded that gender status as well as the undesirable lifestyle of the surgeon influenced student's choices. A study in Germany showed that female physicians prefer more family-friendly specialties, with only 5.6% of female medical students choosing surgery as a career compared to 15.2% of the opposite gender, and while 70% of medical students are female that might avert them from choosing a surgical career.,,, In many cases, the availability of the specialty plays a stronger factor than passion when it comes to choosing. Satisfaction with the training programs can also be an important factor in choosing a surgical residency program. A study in Saudi Arabia found that surgical residents are dissatisfied with their current training programs.,
There are insufficient studies done in Saudi Arabia to understand the influencing factors on medical students when they come to choosing a surgical career in the future, and we aimed to study the different factors that affect the decision-making of medical students in Saudi Arabia when selecting a surgical specialty.
| Methodology|| |
The ethical committee of the university hospital approved an institutional-based cross-sectional study conducted at King Abdulaziz University in Jeddah.
Participants were from King Abdulaziz university medical students, from preclinical years (2nd and 3rd) and clinical years (4th, 5th, and 6th). Students from other colleges and universities were excluded from the study.
The questionnaire we used was quoted from another study and edited based on our culture and practice. The questionnaires were designed using Google forms and distributed among all the students using their university E-mails. The data were collected and entered into the Microsoft Excel with confidentiality and anonymity. Data were collected from October 29 to November 29, 2017. Demographic data obtained first in the questionnaire.
The five-point Likert Scale ranging from 1 (strongly disagree) to 5 (strongly agree) used when asking students about their opinion in choosing a surgical career, as well as their feelings toward the current standard of surgical training in Saudi Arabia compared to overseas. In addition, closed-ended and multiple-choice questions were asked students about any previous surgical exposure, their surgical specialty interest, as well as what they think to be the most significant positive and negative factors to pursuing a surgical career.
The variables were analyzed using Statistical Package for the Social Sciences (SPSS) version 24 (IBM Corp., New York, USA), with either Pearson's Chi-square test or Fisher's exact test utilized for categorical data analysis. P ≤ 0.05 was considered as statistically significant.
| Results|| |
A total of 329 medical students completed the questionnaire. Males comprised 50.2% (n = 165), and the mean age of all respondents was 21.0 years (range: 18–25 years). The majority were Saudis 96.0% (n = 316), lived in Jeddah 94.8% (n = 312) and 97% (n = 319) were single. About 86% had married parents (n = 283), 94.5% (n = 311) lived with their parents in childhood years, and 87.2% reported no chronic illness (n = 287).
About 67% (n = 221) reported monthly income >15,000 Saudi riyals, 77.2% had own house (n = 254), and 82.4% were nonsmokers (n = 271).
Almost half of the 49.2% had normal weight (n = 162) and the mean body mass index of all respondents (n = 329) was 24.4 (range: 15.4–50.5).
[Table 1] illustrates demographic data of respondents between each year of study. Significant demographical differences were found regarding housing and physical training (P = 0.006 and P = 0.004), while no significant demographical differences were found regarding gender, nationality, marital status, chronic illness, income, and smoking.
|Table 1: Demographical data of respondents in each year of the study (n=329)|
Click here to view
[Figure 1] shows participant interest in various surgical specialties. The majority of participants were undecided. A total of 52 (15.8%) participants were not interested in surgery, while 52 (15.8%) and 61 (18.2%) participants showed interest in general surgery and cardiothoracic surgery, respectively. Females (n = 164) were mostly interested in cardiothoracic surgery (18.9%), general surgery (16.5%), and neurosurgery (12.8%), while males (n = 165) were mostly interested in ophthalmology (9.7%), orthopedics (7.3%), and plastics (9.1%), with significant difference (P = 0.007). On the other hand, there was no significant difference regarding the demographic variables.
Only 59 (17.9%) students had been exposed to medicine and surgery before their undergraduate medical training. No significant correlation was found between the said exposure and an interest in surgery (Pearson's Chi-square = 3.022; P = 0.107). Moreover, 284 (86.3%) participants reported not having parents in the medical profession. Similarly, no significant correlation was established between these participants and an interest in surgery (Pearson's Chi-square = 6.607; P = 0.158).
The most commonly stated barriers to pursue a career in surgery, as depicted in [Figure 2], were “lifestyle (on call/dealing with trauma patients) as reported by 133 (40.4%) participants,” and “working hours” in 90 (27.4%) participants. Although both males and females stated these barriers to be most significant, 12 (75%) females from 16 participants reported “female unfriendly.” There was no significant difference regarding all demographic data.
|Figure 2: The most significant barriers to pursue a career in surgery regarding gender|
Click here to view
As displayed in [Figure 3], the most significant motivators to pursue a career in surgery were “hands-on work” and “immediate improvement of patient condition after surgery,” which were reported by 91 (27.7%) and 74 (22.5%) participants, respectively. Academic interest was stated by 45 (13.7%) participants. There was no significant difference regarding all demographic data.
| Discussion|| |
Factors affecting the students' decisions regarding their specialty are quite essential to encourage students to pursue a career compatible with his/her personality and expectations, yet these studies are scarce.,
The majority of students participated in our study showed high interest in pursuing a career in surgery; this is consistent with many studies done in the Middle East, North America, Europe, and Africa.,,,,, On the other hand, there was a good percentage of students who neither agreed nor disagreed to pursue a career in surgery, probably due to limited exposure of students to clinical practice, especially in the early academic years of medical college.,
Interestingly, we found out that females expressed slightly higher interest in surgery than males (50.8%); this had matched A J Scott results and contrary to other studies.,,,,
Cardiothoracic surgery was the most chosen specialty, followed by general surgery, in contrast, A J Scott reported that general surgeries followed by cardiothoracic surgery were the most preferred surgical specialties.
There were significant differences in subspecialty choices among gender, as males favored ophthalmology, orthopedics, and plastics. A J Scott showed that males are mainly interested in general surgery, cardiothoracic surgery, and neurosurgery, while orthopedics was the most reported by Mehmood et al.,
In our study, females preferred cardiothoracic surgery, general surgery, and neurosurgery. Many studies reported orthopedics and OB/GYN as the preferred specialty; we found quite the opposite as female preferred orthopedics and OB/GYN the least.,,
In general, the most significant factors favoring to pursue a career in surgery were “hands-on work” followed by “immediate improvement of patient condition after surgery,” this is similar to what A J Scott reported in his study.
Males considered “salary” factor more important than females did, on the other hand, females considered “academic interest” factor more important than males did. A study done in Kuwait showed that student considered observation good treatment outcomes for patients as the most important factor, also, Anthony P reported technical skills and salary as the most important factors.,
Only a few number of students in this study showed prior exposure to medicine or surgery. On the contrary, in South Africa, the majority were exposed. However, this difference in exposure did not show any effect on specialty decision in both studies.
Based on our study, lifestyle is the most influential factor for medical students to choose surgical specialties by both males and females, followed by “working hours.” This was similar to what Alshahrani found in his research, which concluded that lifestyle is the most important factor in specialty choosing. Likewise, A J Scott who revealed that lifestyle was one of the most important barriers to pursuing a surgical specialty in addition to “length of training” and “working hours.” While according to Ian M. Scott research lifestyle is a less important factor In influencing the choice of specialty.,,
In this study, the least significant barrier is “arrogance/attitude of surgeons,” and some participants (male and female) report that “female unfriendly” is the barrier, and A J Scott study also had “female unfriendly” as a barrier reported only by female participants.
| Conclusion|| |
Our study concludes based on the previous result that the majority of medical students are willing to pursue a surgical career and most of them believe that overseas have a good surgical training program. The decision of these students affected by four significant factors such as “hands-on work” and “immediate improvement of patient condition after surgery” as motivational factors and “lifestyle (on call/dealing with trauma patients)” and “working hours” as a significant barrier. Based on our results, we recommend that more lectures, campaigns, and workshops should target medical students to increase their knowledge about these potential factors that could alter their decision when choosing a surgical career.
The lack of monitoring the changes in the students' preferences as they pass through clinical years was a major limitation in this cross-sectional study. Although the response rate was good, higher number of responses would have been preferred. Another limitation is the restriction of the participant in this research to the students of King Abdulaziz University; it would have been appreciated if we included student from other universities across the country.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Terhune KP, Zaydfudim V, Abumrad NN. International medical graduates in general surgery: Increasing needs, decreasing numbers. J Am Coll Surg 2010;210:990-6.
Mehmood SI, Khan MA, Walsh KM, Borleffs JC. Personality types and specialist choices in medical students. Med Teach 2013;35:63-8.
Berger AP, Giacalone JC, Barlow P, Kapadia MR, Keith JN. Choosing surgery as a career: Early results of a longitudinal study of medical students. Surgery 2017;161:1683-9.
Pointer DT Jr., Freeman MD, Korndorffer JR Jr., Meade PC, Jaffe BM, Slakey DP, et al.
Choosing surgery: Identifying factors leading to increased general surgery matriculation rate. Am Surg 2017;83:290-5.
Kiker BF, Zeh M. Relative income expectations, expected malpractice premium costs, and other determinants of physician specialty choice. J Health Soc Behav 1998;39:152-67.
Kleinert R, Fuchs C, Romotzky V, Knepper L, Wasilewski ML, Schröder W, et al.
Generation Y and surgical residency – Passing the baton or the end of the world as we know it? Results from a survey among medical students in Germany. PLoS One 2017;12:e0188114.
Sanfey HA, Saalwachter-Schulman AR, Nyhof-Young JM, Eidelson B, Mann BD. Influences on medical student career choice: Gender or generation? Arch Surg 2006;141:1086-94.
Mehmood SI, Kumar A, Al-Binali A, Borleffs JC. Specialty preferences: Trends and perceptions among Saudi undergraduate medical students. Med Teach 2012;34 Suppl 1:S51-60.
Minor S, Poenaru D, Park J. A study of career choice patterns among Canadian medical students. Am J Surg 2003;186:182-8.
Gensch K. Occupational decisions of young physicians and possible future consequences for the provision of medical care. Results of an anonymous questionnaire. Gesundheitswesen 2007;69:359-70.
Thiele K, Matziolis D, Perka C. Lack of new trainees in trauma surgery and orthopedics. An approach to a solution. Unfallchirurg 2010;113:1053-6.
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]
Al Shanafey S, Alzahrani A, AlBallaa A, Alballaa A. Surgical resident satisfaction with the current surgical training program in the Riyadh area. Ann Saudi Med 2009;29:388-92.
Scott AJ, Kahn D. Factors influencing medical students in pursuing a career in surgery: A cross-sectional survey. S Afr J Surg 2017;55:24-30.
Scott IM, Matejcek AN, Gowans MC, Wright BJ, Brenneis FR. Choosing a career in surgery: Factors that influence Canadian medical students' interest in pursuing a surgical career. Can J Surg 2008;51:371-7.
Hoffmann H, Dell-Kuster S, Rosenthal R. Medical students' career expectations and interest in opting for a surgical career. Swiss Med Wkly 2014;144:w13932.
Hochberg MS, Billig J, Berman RS, Kalet AL, Zabar SR, Fox JR, et al.
When surgeons decide to become surgeons: New opportunities for surgical education. Am J Surg 2014;207:194-200.
Sutton PA, Mason J, Vimalachandran D, McNally S. Attitudes, motivators, and barriers to a career in surgery: A national study of U.K. undergraduate medical students. J Surg Educ 2014;71:662-7.
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;17:19587.
Alshahrani M, Dhafery B, Al Mulhim M, Alkhadra F, Al Bagshi D, Bukhamsin N, et al.
Factors influencing Saudi medical students and interns' choice of future specialty: A self-administered questionnaire. Adv Med Educ Pract 2014;5:397-402.
[Figure 1], [Figure 2], [Figure 3]