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ORIGINAL ARTICLE
Year : 2019  |  Volume : 33  |  Issue : 2  |  Page : 81-85

Subject preference for specialization and factors influencing it among medical graduates of Regional Institute Of Medical Sciences, Imphal


Department of Community Medicine, RIMS, Imphal, Manipur, India

Date of Submission08-Mar-2019
Date of Acceptance22-Sep-2019
Date of Web Publication11-Feb-2020

Correspondence Address:
Jalina Laishram
Department of Community Medicine, RIMS, Imphal, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jms.jms_51_19

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  Abstract 


Background: Deciding what to do after MBBS is a tough decision for a medical graduate. It is perceived that postgraduate specialization is essential, and there is tough competition for postgraduate seats in the country. In Manipur, apart from a few assumptions based on individual and personal experiences, there are no significant data available regarding the perspective of medical graduates toward postgraduation (PG).
Objectives: The objectives of this study are to determine the specialty preferences of medical graduates working as interns and house officers in the Regional Institute of Medical Sciences, Imphal, Manipur, India, and to determine the factors influencing them.
Materials and Methods: This was a cross-sectional study. The data were collected using a self-administered questionnaire. Descriptive statistics such as mean, median, standard deviation, and percentages were used. The Chi-square test and Fisher's exact test were used to determine the association. Data analysis was performed using the SPSS IBM version 21.
Results: Overall response rate was 93.6%. Of 147 respondents, 110 were interns and 37 were house officers. The mean age of the participants was 24.56 ± 1.97 years. More than half of the participants were female. Medicine and pediatrics were the two subjects preferred by most medical graduates. Females had more intention to do PG.
Conclusion: Majority of the participants were inclined toward pursuing PG in the clinical subjects. Interest in the subject and love for patients were the two major reasons for subject preference.

Keywords: Medical graduates, postgraduation, subject preference


How to cite this article:
Laishram J, Agui RS, Laishram S, Akoijam BS. Subject preference for specialization and factors influencing it among medical graduates of Regional Institute Of Medical Sciences, Imphal. J Med Soc 2019;33:81-5

How to cite this URL:
Laishram J, Agui RS, Laishram S, Akoijam BS. Subject preference for specialization and factors influencing it among medical graduates of Regional Institute Of Medical Sciences, Imphal. J Med Soc [serial online] 2019 [cited 2020 Feb 29];33:81-5. Available from: http://www.jmedsoc.org/text.asp?2019/33/2/81/278102




  Introduction Top


Medical profession has been the choice of best minds from the various family backgrounds as it offers an acclaimed and financially secure career. Choosing what to do after MBBS is a tough decision for a medical graduate.[1] Postgraduate medical education is increasingly being recognized as a necessary qualification needed to practice specialty medicine in India. Today's medical graduates are under greater pressure, facing stiff competition at the level of PG entrance examinations.[2]

Health system needs to have a balanced specialty distribution to meet the needs of the population. Understanding of factors that influence career decisions may help in workforce planning to avoid over- or under-supply of doctors in different specialties.[3],[4],[5] Maldistribution has adverse implications for availability and affordability of comprehensive health services and may create barriers to access specialist care.[6],[7],[8],[9]

In Manipur, apart from a few assumptions based on individual and personal experiences, there are no significant data available regarding the perspective of medical graduates toward postgraduation (PG). Hence, this study was conducted to determine the specialty preferences of medical graduates working as interns and house officers in the Regional Institute of Medical Sciences (RIMS), Imphal, and to determine the factors influencing them.


  Materials and Methods Top


A cross-sectional study was conducted among the medical graduates who were working as interns and house officers in RIMS, Imphal, between 1st and 26th October, 2018. RIMS is one of the two teaching medical colleges in Manipur. It has a yearly intake of 100 students for the MBBS course and 147 seats for the postgraduate course. Students come from the different parts of the country, but the majority are from Northeast India. All interns and house officers in RIMS were included in the study. There were 118 interns and 39 house officers working at RIMS during our study. Those who refused to participate and those who could not be contacted after three visits were excluded from the study. Self-administered questionnaire was used for the data collection. It consisted of two sections: Section-I consisted of sociodemographic profile and Section-II consisted of 12 questions on subject preference. After explaining the purpose of the study, informed verbal consent was obtained from the participants. Participants were reassured about their anonymity and confidentiality. The questionnaire was explained and administered. After collecting, questionnaires were checked for completeness and consistency.

Age (in completed years), gender, current work status, college of passing MBBS, parents' education, parents' occupation, and having a doctor in the family were the independent variables for our study, and subject preference for specialization and intention to do PG were the outcome variables. In our study, preclinical subjects consisted of anatomy, biochemistry, and physiology. Paraclinical subjects included microbiology, pathology, forensic medicine, and pharmacology. Clinical subjects comprised community medicine, ophthalmology, otorhinolaryngology, medicine, pediatrics, obstetrics and gynecology, surgery, orthopedics, physical medicine and rehabilitation, psychiatry, radiodiagnosis, radiotherapy, respiratory medicine, transfusion medicine, and anesthesia. An end subject, in the study, refers to a subject that does not require superspecialization such as biochemistry, forensic medicine, psychiatry, dermatology, and radiodiagnosis.

Data collected were analysed using appropriate statistical tool. Descriptive statistics such as mean, median, SD, and percentages were used for age, gender, current work status, and college of passing MBBS. The Chi-square and Fisher's exact tests were used for determining the association between variables. P< 0.05 was considered statistically significant. Approval was sought from the Research Ethics Board, RIMS, Imphal. Verbal informed consent was obtained from the participants. Participants were assured that the data collected will not be linked to identify the individual in any way or the process of data collection will not harm the participants in any way. Confidentiality was maintained by limiting the access of data only among the investigators.


  Results Top


Of 157 interns and house officers, 147 participated in our study (eight interns could not be contacted and two house officers refused to participate). Hence, the response rate was 93.6%. The mean age of the participants was 24.56 ± 1.97 years. The median age was 24 years. Nearly 60% of the respondents were <24 years. [Table 1] shows the sociodemographic characteristics of the study participants.
Table 1: Sociodemographic characteristics of the respondents (n=147)

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Nearly one-third of the participants (32%) had doctors in their family, and of them, the most common relations were siblings, cousins, and parents. Most of the participants (83.7%) had opted the medical profession on their own choice. Among those 16.3% of the participants who did not opt medical course on their own choice, majority studied MBBS because of family pressure (87%). A very few did so as they could not get into their desired course (13%).

Majority of the participants (133; 91.2%) have an intention to do PG in the medical profession. The most common reasons were to learn more (74%), because specialization being a trend at present (12.2%), better job opportunity and security (5.3%), desirable by society (4.6%), to be more confident in treating patients (2.3%), and to serve the people better (1.5%). Three respondents (2%) did not intend to do PG because they found it boring and taxing. Among those who have not yet decided to go for PG (11; 6.8%), majority said that they needed more time to decide (40%). Other reasons included wanting to earn and save money and to get married before going for PG.

Of the 133 participants who wanted to go for PG, majority (92.5%) of the participants were inclined to do PG in clinical subjects. Only 1.5% wanted to do PG in para-clinical subjects and 6% have not decided which subject to go for. Medicine was preferred by the majority of the students (26.1%), followed by pediatrics (17.9%), surgery (13.4%), dermatology (11.9%), obstetrics and gynecology (7.5%), etc., in the order indicated in [Table 2]. Personal interest in the subject, love for children/patients, no emergency duty and less workload, want to become more skillful in the subject, because it is an end subject, etc., were the main reasons for choosing a particular subject.
Table 2: Preferred subject for postgraduation (n=133)

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More than one-fourth (27.2%) of the participants reported to have changed their subject of preference for PG from MBBS days to internship/housemanship days. However, there was no change in the proportion of graduates who wanted to do PG in clinical subject from MBBS to internship/housemanship days.

About 58.5% have received advice to choose a specialty from more than one person, and they include faculties and senior doctors (60.5%), family (57.0%), friends (57.0%), and relatives (33.7%). Of the total 147 participants, 42.9% of the participants wanted to pursue superspecialty. Endocrinology (14.3%) and cardiology (12.7%) were the superspecialties of choice. More than half of the participants (52.4%) wanted to work in the government sector and only 4.1% wanted to work in rural areas.

More than two-third of the participants are of the opinion that career counseling will be helpful in choosing a specialty, and 99% of those who thought career counseling will be helpful said that they would like to have career counseling sessions in their institute. More than one-fourth of the participants (26.5%) have thought of changing their profession. The reasons given by the students for wanting to change their profession after joining medical course were that they were more interested in other professions (51.3%), less power and respect for a doctor (15.4%), want to earn lots of money (7.7%), too much work pressure, stress, and competition in medical profession (7.7%), etc.

[Table 3] shows that medical graduates aged 24 years and below had more intention to do PG as compared to those aged >24 years, and this association was found to be statistically significant (P = 0.034). Females had more intention to do PG as compared to males, and this association was found to be statistically significant (P = 0.000).
Table 3: Association between the sociodemographic characteristics and intention to do postgraduation (n=147)

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  Discussion Top


This study provides an insight into the current trend of medical graduates preferring to do PG in clinical subjects. Majority of the participants (92.5%) in our study were also inclined to do PG in clinical subjects. Only 1.5% preferred preclinical/paraclinical subjects. Similar results were seen in studies conducted in other parts of India[1],[2],[10] and other countries.[9],[11] This may be because they are not fully aware that preclinical/paraclinical subjects are parallel to clinical subjects in importance. This indicates a great need for career counseling in medical institutes for the students to give equal emphasis to all the medical subjects for PG. The comparatively low number of graduates choosing preclinical and paraclinical specialties is a worrisome fact, as it may result in a serious deficit of faculty in these fields in future.[12]

The five most common specialties chosen were medicine, pediatrics, surgery, dermatology, and obstetrics and gynecology. This is very similar to the findings of Saoji et al.[10] in Nagpur and Aslam et al.[12] in Karachi, Pakistan. Gender played a role in choosing specialty in our study with more males opting for surgery and orthopedics and more females opting for medicine, pediatrics, dermatology, and obstetrics and gynecology. Similar findings were also reported by Saoji et al.[10] and Madu et al.[11] Men prefer surgery due to the prestige and career opportunities associated with it, whereas female graduates show a lower preference for it due to the workload and uncontrollable lifestyle.[13],[14] The present study showed that the most common factors influencing choice of specialty were interest in the subject, love for patient or children, less workload, and an end subject. Similar findings were found in other studies too.[2],[9]

More than half (52.4%) of the participants would like to work in the government sector in future and 10.2% want to work in the private sector. A similar finding was also reported by Singh and Singh.[1]

In the current study, 34.7% of the participants chose to work in an urban location, and only 4.1% chose to work in a rural location which is contradictory to the findings of the study conducted by Sapkota and Amatya[15] in Nepal where around an equal number of respondents had chosen the urban (49.2%) and rural (50.8%) location for future practice. However, Sapkota's study was conducted among medical graduates who had rural place of birth, rural place of rearing, and rural permanent address.

A fairly good number of the medical graduates in our study have received advice/information to choose a specialty from senior doctors (60.5%), family (57%), friends (57%), and relatives (33.7%), which is similar to the findings of Jackson et al.,[16] and in contrast to the finding of Mehmood et al.[17] in Saudi Arabia, where only a small proportion of the respondents (7%) had received career advice from their family and friends and only 17% by senior doctors.


  Conclusion Top


Majority of medical graduates had intention to pursue PG in clinical subjects. Medicine, pediatrics, and surgery were the subjects preferred by majority of them. Interest in the subject, love for children or patients, less emergency duties, and less workload were the main factors influencing their subject choices. Qualitative studies among newly qualified doctors are recommended.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Singh MK, Singh AK. What to do after MBBS? An analysis of MBBS students career aspiration and their determinants. Indian J Prev Soc Med 2012;43:134-40.  Back to cited text no. 1
    
2.
Babu TA, Joseph NM, Sharmila V, Satish B. Speciality preference of Indian medical graduates and factor influencing them. Res J Pharm Biol Chem Sci 2012;3:263-70.  Back to cited text no. 2
    
3.
Ranta M, Hussain SS, Gardiner Q. Factors that inform the career choice of medical students: Implications for otolaryngology. J Laryngol Otol 2002;116:839-41.  Back to cited text no. 3
    
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.  Back to cited text no. 4
    
5.
Soethout MB, Heymans MW, ten Cate OJ. Career preference and medical students' biographical characteristics and academic achievements. Med Teach 2008;30:15-22.  Back to cited text no. 5
    
6.
Petrides KV, McManus IC. Mapping medical careers: Questionnaire assessment of career preferences in medical school applicants and final-year students. BMC Med Educ 2004;4:18.  Back to cited text no. 6
    
7.
Holland JL. Making Vocational Choices: A Theory of Careers. New York: Prentice Hall; 1973.  Back to cited text no. 7
    
8.
Dryler H. Parental role models, gender and educational choice. Br J Sociol 1998;49:375-98.  Back to cited text no. 8
    
9.
Eze BI, Okoye OI, Maduka-Okafor FC, Aguwa EN. Factors influencing choice of medical specialty of preresidency medical graduates in Southeastern Nigeria. J Grad Med Educ 2011;3:367-71.  Back to cited text no. 9
    
10.
Saoji A, Deoke A, Kasturwar N, Mitra A, Saoji P. Feedback concerning compulsory rotatory internship programme (CRIP) and specialty preference among medical interns. J Educ Technol Health Sci 2016;3:50-3.  Back to cited text no. 10
    
11.
Madu A, Ubesie A, Madu K, Nonyelu C, Ibegbulam O. Medical specialist preferences and reasons among fresh Nigerian interns. Ann Med Health Sci Res 2014;4:S223-7.  Back to cited text no. 11
    
12.
Aslam M, Ali A, Taj T, Badar N, Mirza W, Ammar A, et al. Specialty choices of medical students and house officers in Karachi, Pakistan. East Mediterr Health J 2011;17:74-9.  Back to cited text no. 12
    
13.
Gjerberg E. Gender similarities in doctors' preferences – And gender differences in final specialisation. Soc Sci Med 2002;54:591-605.  Back to cited text no. 13
    
14.
Dorsey ER, Jarjoura D, Rutecki GW. The influence of controllable lifestyle and sex on the specialty choices of graduating U.S. Medical students, 1996-2003. Acad Med 2005;80:791-6.  Back to cited text no. 14
    
15.
Sapkota BP, Amatya A. What factors influence the choice of urban or rural location for future practice of Nepalese medical students? A cross-sectional descriptive study. Hum Resour Health 2015;13:84.  Back to cited text no. 15
    
16.
Jackson C, Ball JE, Hirsh W, Kidd JM. Informing Choices: The Need for Career Advice in Medical Training. Cambridge: National Institute for Careers Education and Counselling; 2003.  Back to cited text no. 16
    
17.
Mehmood SI, Norcini JJ, Borleffs JC. Newly qualified doctors' views on the significance and accessibility of career advice during medical training in Saudi Arabia. Medical Teacher 2013;35 (Sup 1):S20-4.  Back to cited text no. 17
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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