Specialty career preferences among fifth year medical students in the school of medicine, Makerere University College of health sciencess

Abstract

Introduction: Uganda has a high disease burden yet a low doctor to patient ratio at 1:28,202. In addition there is an imbalanced distribution of the health workforce which may be influenced by the specialty career preferences of medical students. Studies have shown that students tend to select the well-established disciplines in their countries. However there is inadequate literature concerning the factors influencing specialty career preferences. Objectives: The aim of this study was to determine the specialty career preferences and the factors influencing the preferences among fifth year medical students in the School of Medicine, Makerere University College of Health Sciences. Methods: A sequential explanatory mixed study design with a descriptive cross-sectional study followed by a qualitative study was used. 135 eligible fifth year students in MAKCHS were recruited using consecutive sampling and given a self-administered questionnaires. Three focus group discussions were also conducted to obtain information concerning factors influencing the specialty career preferences using a guide. The quantitative data was entered into EpiData v.7 and analysed using Stata v.13 while the qualitative recordings were transcribed and content analysis done using Nvivo v.12. Results: 135 students were recruited for the quantitative arm between April 2019 and May 2019. Of these students 91(67.4%) were males and 44(32.6%) were females with ages ranging between 21 years and 47 years. As a first choice, the most preferred specialty career was obstetrics and gynecology (25.2%) and was followed by surgery (20%), pediatrics (13.3%) and internal medicine (12.6%). Specialties like anesthesia and ENT were not selected as a first choice by any student. There was a significant difference between groups in the way the students select their career xii preferences for the following variables; sex (p = 0.04), marital status (p < 0.01), having children (p < 0.01) and sponsorship (p = 0.04). During the focus group discussions students highlighted a number of facilitators for the career preferences including controlled lifestyle, assurance of a good life and inspirational specialists. A number of barriers were also pointed out including bad experience during the clinical rotations, lack of guidance and perceived poor and miserable specialists. Conclusion: Most students are drawn towards the established disciplines including obstetrics and gynecology, surgery, internal medicine and pediatrics while some fields have very few or no specialists. This is due to various factors including gender, assurance of a good life and proper guidance. The findings of this study may have several implications on proper distributions of specialists across disciplines. Therefore, there is a need to formulate career guidance and mentorship programs, so as to attract students to the neglected disciplines. There is also a need for further research in form of implementation science projects or follow-up studies to determine eventual choices of students at postgraduate level.