Exploring Specialty Selection and Inuencing Factors among Medical Students and Postgraduates: An Observational Study

How to Cite: Arif, M. M., Nisar , W. ., Agha , K. ., Qureshi, M. G. ., Mansoor, A. ., Malik, A. U. ., Khokhar, M. S. ., Awan, F. ., Khwaja, S. I. ., & Parveen, A. . (2023). Exploring Specialty Selection and In uencing Factors among M e d i c a l S t u d e n t s a n d P o s t g r a d u a t e s : A n Observational Study: Specialty Selection and In uencing Factors among Medical Students. Pakistan Journal of Health Sciences, 4(06). https://doi.org/10.54393/pjhs.v4i06.803


I N T R O D U C T I O N
Medical students are driven by interest and in uenced by factors like early exposure, training, environment, teaching, role models, rewards, appreciation, patient feedback, and mentorship. Gender also impacts specialty choices. Students' career choices shape the future workforce. Objective: To explore interests and factors in uencing specialty choice among post graduate trainees and nal year students, aiming to guide informed career decisions and address inadequate recruitment in specialties. Methods: This study was an observational crosssectional study conducted at Fatima Memorial Hospital and college. Data were collected from 163 participants via online questionnaire using non-convenience sampling. Analysis was conducted using SPSS software, including frequencies, percentages, averages and t-test to assess statistical signi cances. Results: Study nds strong preference for clinical subjects among nal year and postgraduate students. Divergence among specialty selection was seen as nal year students favor general surgery, while postgraduate trainees lean towards pediatrics medicine. Prestige and social responsibility were common in uential key factors, with salary bene ts impacting more the nal year students and specialty prestige, social responsibility and research opportunities weighing on postgraduate trainees were seen. The research also explores that family in uence for nal year students and teachers and senior doctors for postgraduate trainees in specialty selection. Conclusions: In conclusion, nal year and postgraduate trainees prefer clinical specialties like general surgery and pediatrics, driven by considerations of future salary, working hours, and social responsibility. Family, teachers, and senior colleagues play crucial roles in specialty selection decisions. postgraduates to invest their time, training, and nancial resources effectively. On the other hand, making an uninformed decision can result in wasted time, resources, decreased motivation, frequent specialty changes, and even individuals leaving the medical profession altogether. A thoughtful choice ensures a better utilization of human potential and leads to long-term success [3]. Medical specialization choices are in uenced by various factors, including personal preferences. Younger individuals tend to be more optimistic. They have more time to dedicate to their careers. In contrast, older individuals may have various responsibilities and other familial obligations that can impact their specialization choices [4]. Gender norms in Pakistan limit women's professional lives, leading many to become housewives. This greatly impacts medical specialization choices, with men favoring demanding surgical careers and women seeking specialties with fewer duty hours and lighter workloads [5]. Personality in uences career choices. Those who have a natural a nity for children may lean towards becoming pediatricians instead of surgeons. Some individuals may be inspired by a psychiatry professor and choose psychiatry as their role model. Others may be impressed by gures like Sigmund Freud and opt for neurology [6]. Income is another important factor; some people choose a nancially highly paid specialty rather than taking care of if they can perform well and can commit to the hard work required along [7]. Undergraduate curriculum, house job experiences, job availability, parental in uence, and prestige are key factors guiding medical specialization choices for Pakistani students and postgraduates [8]. Personal health is a crucial factor in uencing the choice of medical specialization for postgraduate residents (PGRs). Specialties like gynecology, with high job pressure, may not be suitable for individuals with health concerns. Dermatology and radiology, which typically involve less work burden, offer better opportunities for maintaining a satisfying family life [9]. In different regions of a country, the effects of various factors are different depending on the employment opportunities and speci c mindsets and requirements [10]. In resource-poor settings with a low doctor-to-population ratio, achieving an equitable distribution of the healthcare workforce is crucial [11]. Similarly, becoming pro cient and skilled in a particular medical specialty requires a substantial investment of time, effort, and nancial resources. Consequently, the effectiveness of the selection process becomes crucial [12]. Matching inclination and true passion prevent premature career termination, provides guidance to students and young doctors, aligns aspirations with societal needs. Improper selection leads to specialty changes, dropouts, and career abandonment [13].

M E T H O D S
Motivations and experiences, both before and during medical school, shape career decisions [14]. Residents often enter medical school with a speci c interest in a medical eld. However, imbalances in specialist numbers can pose challenges. Medical educators should educate and motivate students about specialty choices. Postgraduate specialization is crucial for success due to competition for seats worldwide. Fresh graduates are versatile, but specialization makes them specialized. Students typically choose specialties before graduation with limited knowledge [15]. Students choose specialties based on various factors like working hours, passion, family responsibilities, income, and job prospects. In India, a study revealed that medicine and pediatrics are popular choices due to their higher pay. Several factors, including gender, working hours, cultural and social beliefs, in uence students' career decisions [3]. We choose this topic to know about the interests, search the factors that in uence the choice of specialty and to nd out why some specialties are preferred over others by the postgraduate trainees and nal year students. Certain important specialties fail to recruit a suitable number of postgraduate trainees and also alter the balanced distribution of seats. This can cause them to perform inadequately, and impact the favorable patient outcome and the future of that specialty as well. This study will also enable in development of interest in medical students about future choices and perhaps the guidance about the specialty they choose.
The study design employed in this research was an observational cross-sectional study. It took place at Fatima Memorial Hospital and its a liated institution, FMH College of Medicine and Dentistry. The study spanned approximately two months, during which data were collected and analyzed. As this study targeted a speci c medical college, the population selected was from the FMH College of Medicine and Dentistry, Lahore which included Final year medical students and Postgraduates for year 2020. The estimated sample size for this study was 163 participants (95% CI and 6% ME). A non-convenient sampling technique was employed. The collection of data were conducted through an online questionnaire. The study included all eligible students and postgraduates who willingly participated and provided their consent. However, individuals who did not participate, give consent, or were affected by any mental ailment were excluded from the study. The data analysis was conducted using SPSS version 21.0. For qualitative variables such as gender and locality, frequencies and percentages were employed to present the data. Meanwhile, quantitative variables like age were analyzed by calculating averages and mean deviations to provide a comprehensive understanding of the data distribution. To determine the statistical signi cance of the results, p-values were calculated using t-tests. These tests of signi cance helped to assess the strength of the associations and identify any meaningful relationships within the data. Ethical approval was taken from the institutional research board of FMH College of Medicine and Dentistry with IRB # FMH-09-2020-IRB-787-M, dated 16-09-2020.

R E S U L T S
Factors favoring specialty choice included prestige/ status, potential for administration, salary bene ts, research opportunities, social responsibilities, better working hours, opportunities in rural areas, and foreign job prospects. The main in uences were family and role models, while friends, books, television, and media had less impact (Table 3). The study included 75 nal year students. Findings showed that most students preferred clinical subjects (70) over basic subjects (5). The male-to-female ratio was nearly equal (37:38). A majority came from middle-class families (68), while 7 were from upper-class families. Out of the 75 students, 44 were not from Lahore (Table 1).  (11), gynecology (7, all female), Cardiothoracic surgery (5), pediatrics (5), psychiatry (4), cardiology (3), gastroenterology (2), nephrology (2), neurosurgery (2), dermatology (1), ENT (1), urology (1), neurology (1), orthopedics (1), rheumatology (1), and 2 students did not respond (Table 2).  According to the research, data were collected for 88 postgraduates. Most of them specialized in clinical subjects over basic subjects. There were more females than males, with a ratio of 42 to 46. Out of the total, 60 were from Lahore and 28 were not. The socioeconomic distribution was 8 from the upper class, 79 from the middle class, and 1 from a low socioeconomic background (Table  4). were satis ed with their specialty choice, indicating a high percentage (84%) of happiness and satisfaction in their chosen eld (Table 6). In terms of specialty choices, the data showed that 4 people chose anesthesia, 1 person chose cardiology, 1 person chose dermatology, 2 people chose ENT, 1 person chose eye, 1 person chose family medicine, 1 person chose gastroenterology, 9 people chose general medicine, 7 p e o p l e c h o s e g e n e r a l s u rg e r y, 9 p e o p l e c h o s e gynecology/obstetrics, 1 person chose nephrology, no one chose neurology, 1 person chose neurosurgery, no one chose nuclear medicine, 1 person chose orthopedics, 10 people chose pediatrics medicine, 1 person chose pediatrics surgery, 2 people chose plastic surgery, 2 people chose psychiatry, no one chose pulmonology, 1 person chose radiology, 1 person chose rheumatology, no one chose cardiothoracic surgery, no one chose urology, and 6 people did not answer (Table 5).  The research highlighted that factor such as specialty prestige and potential for administration greatly in uenced students' choice of specialty. Medicine is considered a noble profession, and despite challenges in Pakistan's healthcare system, individuals still pursue it for the respect and status associated with it. Female individuals may be drawn to medicine due to the unmatched respect and prestige it offers compared to other professions. Research opportunities and salary packages were also attractive factors, particularly in gynecology and pediatrics, which have high patient demand and facilitate data collection. Additionally, better working hours and social responsibility were signi cant factors guiding specialty decisions. Students passionate about their chosen specialty and eager to serve their community viewed social responsibility as their primary motivation. Role models, such as teachers and senior doctors, greatly in uenced students' choices, while the impact of television, books, and media was relatively low. The research suggests a need for more accessible platforms, such as blogs, online resources, and television programs, to aid students in making informed decisions about medical specialties. Foreign job opportunities were not a signi cant factor, but serving in rural or underserved areas held importance. This nding underscores the focus on pursuing a passion for serving humanity and gaining experience in order to contribute meaningfully to society (Table 7). in England on postgraduate trainees shows that the students prefer microbiology followed by molecular biology and pharmacology as basic medical sciences subject [20]. This research shows that trainees selected anatomy followed by community medicine and behavioral sciences as their basic medical sciences subject. It can be seen that postgraduate trainees in developing and developed countries often have divergent career preferences and choices. Researchers extensively studied the factors in uencing the selection of medical specialties among nal year medical students in developed countries. They utilized renowned databases like MEDLINE/PubMed and EBSCOhost for their research. The results of the study revealed that the primary reasons behind choosing speci c specialization subjects were increased research opportunities, a sense of social responsibility, and the chance to serve in underdeveloped areas [21]. This conducted research reveals that factors such as the prestige or status associated with a specialty, the salary package offered, the sense of social responsibility involved, and the prospect of better working hours play a signi cant role in their decision-making process of nal year students. As far as post graduate trainees are concerned, research conducted among postgraduate trainees in California revealed their priorities when selecting their specialization eld. The ndings indicated that these trainees primarily considered research opportunities, followed by factors like social responsibility and working hours [22]. Furthermore, this research emphasizes the signi cance of various factors that in uence postgraduate trainees, such as specialty prestige, research opportunities, and potential for administration.
As far as statistical tests are concerned, comparisons were made for choice of specialties and factors affecting choice of s p e c i a l t i e s b et we e n n a l ye a r st u d e n t s a n d postgraduates. The results showed that there was a statistical signi cance (P=0.015) for choice of specialties in basics sciences between nal year students and postgraduates whereas no statistical signi cance (P=0.622) for choice of specialties in clinical sciences and factors affecting specialty choices (P=0.107) between nal year students and postgraduates (Table 8). Similar results were observed in this conducted research with general surgery and general medicine as preferred clinical subjects, while Behavioral Sciences and Oncology were popular choices for basic subjects. A study at the U n i ve r s i t y o f N a i r o b i , Ke n y a , s u r veye d fe m a l e postgraduate trainees to understand their medical specialization preferences. Results showed that they were less likely to choose obstetrics/gynecology and basic medical sciences. Instead, they preferred surgery, internal medicine, and pediatrics. Their reasons included higher income potential, increased patient-physician interaction, and a personal interest in research [17]. A similar study conducted in Pakistan revealed that females exhibited a pronounced inclination towards obstetrics and gynecology, along with a strong interest in basic medical sciences such as behavioral sciences, public health, and pathology. They chose these clinical and behavioral science subjects because they wanted to nd a good balance between their work and family life. Additionally, they have faced gender discrimination and bias in their experiences [18]. This study was also conducted among Pakistani post graduate trainees reveals that females preferred gynecology and obstetrician. This difference might indicate that, in Pakistan, females choose Specialization choices differ in developing and developed countries. Developed countries prioritize research and serving underserved areas, while developing countries focus on higher pay and shorter duty hours due to limited mentorship, competition, and gender bias. To improve the situation, medical schools should implement tailored mentoring programs, collaborate with professional organizations, provide internship opportunities, and introduce policies promoting work-life balance.