Career choices of the first year students of Madha Medical College

INTRODUCTION

It is not clear about what influences the medical students to prefer one speciality to the other. The factors considered were personality, demographic characteristics and attitudes about the specialties themselves, with the latter apparently being the most important factor.¹ Career choices are influenced both by the graduate’s inclination before starting medical school as well as exposure during training in medical school.² Other factors that have been suggested to play a role include the characteristics of the medical college, lifestyle preferences, prestige, job opportunities, expected income, longitudinal care, preclinical and clinical experiences, and role models.^3–5 Material rewards, societal appreciation of the speciality and pressure from the parents also have a role in choosing a particular speciality.⁵

This study was conducted in Madha Medical College, a private college established in 2011. Medical education system in this part of the country includes a traditional way of teaching pattern which is lecture-based, teacher-centered, discipline-based, examination-driven, and hospital-oriented. Medical curriculum is divided into basic sciences, paraclinical and clinical sciences. The Bachelor of Medicine and Bachelor of Surgery degree is a four and half year’s program followed by a 1-year internship period.** In our college we are trying to make the curriculum in such a way that it is integrated, problem based learning. Students are exposed to a defined community from the 1^st year itself under the department of Community Medicine where they spend time with the families in imparting knowledge regarding basic hygiene, balanced diet, vaccination etc.

Various studies carried out in Asia had shown that medical students were interested in hospital-based clinical specialties and they prefer to practice in main cites.^6-12 A study conducted among students, interns, and house officers in Nepal found that half of the participants of this study wished to migrate to a developed country after graduation.¹³ The reasons quoted were comparatively less remuneration, quality of training, and the working atmosphere of their home country.¹⁴ The objective of our present study was to assess the First year Medical Students attitudes towards their choice of the Post Graduate Subjects and the factors influencing them.

The present study would serve as a baseline to identify the career preferences of the students and the factors that influenced them. These findings can help determine the current status and the future directions of the curriculum.

METHODS

We did a cross sectional questionnaire based study on the first semester medical students in September 2013. Out of a total of 150 students, 141 were present on the day of the administration of the questionnaire in the Community Medicine theory class.

After ethical clearance from the Institutional Ethics Committee- Human Research, medical students of the first semester (at that time) were requested to self-administer the questionnaire. Participation was voluntary and applied only to the students who were present in class on that day. The questionnaire requested socio demo-graphic detail, awareness of the subjects taught, and their preference of specialty on that day and the factors influencing it.

The data was analysed using SPSS version 17.

RESULTS

The total number of students present on that day was 141. All of them successfully completed and returned the questionnaire.

The demographic and other characteristics are depicted in Table 1. The mean age in years of the first semester students was 17.8 with a standard deviation of 0.6. About 54% of the students were females. Most of the students 67% were from urban areas. The number of students having a doctor in the family was 27%. The number of students who joined the MBBS course out of personal interest was about 82%.

Knowledge regarding MBBS and PG courses is depicted in Table 2. None of the students were aware of the number of subjects taught in MBBS course. Less than half of the students (45%) were aware of the number of years of specialization. About 91% of the students were interested to pursue the specialization.

Table 3 shows that less than one fourth of the students were interested to pursue in preclinical subjects (anatomy, biochemistry, physiology), only 1% were interested in para clinical subjects (Pathology, Pharmacology, Community Medicine, Forensic Medicine) and most of the students 71% were interested to pursue in the clinical subjects (Surgery, Medicine, Gynecology, Pediatrics, Orthopedics, Radio diagnosis, Skin & STD, ophthalmology, ENT).

Table 4 shows that a sizable proportion that is around 9% of the students was not interested in pursuing the PG course. Some of the students 5% of them were interested to pursue their career in civil services, around 1% was interested to join the management course, less than 1% does not want to do any specialization, and around 1% is undecided about what to do with their career.

Table 5 shows the factors influencing their career choice. Around 80% of the students said that it was their ambition to pursue their career in a particular subject, 6% of the students want to pursue their career in a particular subject because their parents want them to do so and around 13% of the students want to pursue their career in a particular subject to earn money.

Table 6: Distribution of students according to the place they want to serve after completion.

Table 6 shows the area where the students want to serve after completion of their education. Equal number of students that is around 45% of the students wants to serve in urban area and 45% of them in rural area and around 11% of them have no particular preference for any area.

Table 7 shows where the students want to settle down after the completion of education. About 87% of the students want to settle down in India and 13% of them want to make their career abroad.

Table 7 shows the choice of work of the students after completing their education. Majority of the students 46% of them want to settle down in the Corporate Hospital, 37% want to settle down as private practitioners, only 6% of them want to join a teaching college, around 1.4% of them want to do both teaching and private practice, 2.1% of them want to do private practice and also be attached to a corporate hospital, 1.4% of them want to do teaching, private practice and be attached to a corporate hospital and some of the students 2.8% are undecided.

Table 8 shows about the opinion of the students whether one year is sufficient for the basic sciences. More than half of the students 53.9% felt that more than one year is required to complete the basic sciences.

DISCUSSION

In our study we found that the mean age of the first semester students was 17.8 years with a standard deviation of 0.6. Girl students were more in our study participants. Most of the students 67% were from urban areas. The number of students having a doctor in the family was 27%.Though most of the students joined MBBS course out of personal interest, there were 18% of them who joined because their parents had forced them to do so. The parents should not force their children to pursue what they themselves wished for then these future doctors eventually fail to accomplish and become an uninterested doctor who may ultimately affect the society too. It is always better that parents and children should decide together on the career they would pursue.

The discrimination for para clinical and preclinical subjects from clinical subjects starts from the time they join medical profession. They underestimate the pre and para clinical fields as they think that clinical field is more challenging, more lucrative and with more job satisfaction as there is interaction with patients and the practical aspects of medical profession. Other reasons for discrimination could be that clinicians earn more, have more prestige and status among the people, more productive, intelligent which is the major driver of student behavior. Though the basic subjects form the foundation of the clinical subjects they are labeled as the revenue “loss leader” rather than as a core function or even producer of downstream revenue. This income disparity explains much of the difficulty in achieving the balance in specialty and geographic physician distribution and will continue to inhibit achieving the workforce needed for better quality, efficiency and equity.

Our study also shows that Post-graduation in clinical subjects is preferred over basic sciences. Some subjects like Pathology and Microbiology have no takers and it may show a long term effect on the health system.

A small proportion (8%) of students did not plan to pursue a postgraduate course. The reasons for not doing so were that they wanted to move to the civil services or management fields. The failure of students to continue in the Medical profession represents a waste of resources. While a trained medical person may be an asset in the Civil services, it does deplete the pool of already scarce healthcare providers. Some of the other reasons relate to dissatisfaction with the system of postgraduate medical education in India. The expectation of bottlenecks in the postgraduate training programmes makes some students consider careers outside the medical profession.¹⁵

Our study shows that 6.4% of the students had to choose a career option which their parents wished for. Parents play an important role in building as well as diminishing the career of their children. The children should be given the wings to choose what they wish to do for their career atleast after MBBS because during their MBBS career they would have decided what interests them.

Our study shows that 12.8% of the students want to settle outside India. This is a huge loss to the Government because it incurs an expenditure of about Rs 25 lakh on every medical student by allotting seats at subsidised fees in government colleges and government seats in private medical colleges.

Very few students (6.4%) have opted to work in Medical Colleges. Most of the students (46.1%) had opted to work in a corporate set up. Till now government run medical colleges with teaching staff is considered the best in the world in terms of training the students as well as patient care. But now slowly medicine has entered a new era and corporate set up is playing an important role in the delivery of good quality health care. Doctors are satisfied in the corporate set up because there is a scope for continuing medical education, conferences, drug and device development, research funding and personalised health care and good pay. Patients are satisfied because of personalized health care while getting the best of treatments.¹⁶

Our study shows that (46.1%) of the students felt that one year is adequate for the basic sciences that are Anatomy, Physiology and Biochemistry. Rest of the students felt it difficult to cope up with the basic subjects in one year. Though the total duration of the course has remained the same that is 5 ½ years. The course has been restructured by the MCI so that the students would be more participatory and competent. It has been divided into 2 months foundation course 12 months for 1^st MBBS, 12 months for 2^nd MBBS 28 months for Final MBBS and one year internship.

CONCLUSION

In our study it is seen that the choice of subjects as their career preference has been biased against the clinical subjects who in the long run may affect the health system. Some of the students do not want to pursue their career in medicine and enter the civil services which are a huge loss for the Government as well as the society. Some of the students want to pursue their career abroad. This study helps us to understand the choice of their career and their location of placement. This requires a solution which should involve the students, universities and the Government.

ACKNOWLEDGEMENTS

The authors would like to thank the students for their cooperation.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Furnham A. Career attitudes of preclinical medical students to the medical specialities. Med Educ. 1986;20:286-300.
2. 2. Newton D.A., Grayson, M.S. & Thompson, L.F. (2005). The variable influence of lifestyle and income on medical students’ career specialty choices: data from two US medical schools 1998 – 2004. Acad Med. 2005;80:809-14.
3. 3. Mutha S, Takayama JI, O’Neil EH. Insights into medical students’ career choices based on third- and fourth-year students’ focus-group discussions. Acad Med. 1997;72:635-40.
4. 4. Fincher RM, Lewis LA, Rogers LQ. Classification model that predicts medical students’ choices of primary care or non-primary care specialties. Acad Med. 1992;67:324-7.
5. 5. Kassebaum DG, Szenas PL, Schuchert MK. Determinants of the generalist career intentions of 1995 graduating medical students. Acad Med. 1996;71:198–209.
6. 6. Zulkifli A, Rogayah J. Career preferences of male and female medical students in Malaysia. Med J Malaysia. 1997;52(1):76–81.
7. 7. Shahabuddin SH. Career choice of final-year female medical students at Universiti Kebangsaan Malaysia (UKM). Med J Malaysia. 1986;41(4):327–30.
8. 8. Razali SM. Medical school entrance and career plans of Malaysian medical students. Med Educ. 1996;30(6):418–23.
9. 9. Huda N, Yousuf S. Career preference of final year medical students of Ziauddin Medical University. Educ Health (Abingdon). 2006;19(3):345–53.
10. 10. Al-Faris E, Kalantan K, Al-Rowais N, et al. Career choices among Saudi medical students. Acad Med. 1997;72(1):65–7.
11. 11. Karalliedde LD, Senanayake N, Aluwihare AP. Career preferences of the 1984 medical graduates of Sri Lanka. Med Educ. 1986;20(1):64–8.
12. 12. Majumder MAA, Rahim AFA, Rogayah J, et al. Career choices of the 2003 medical graduates of Universiti Sains Malaysia. Proceedings of 8th National Conference on Medical Sciences, 2003 May 8–9, Universiti Sains Malaysia, Kelantan, Malaysia. Malaysian J Med Sci. 2003;10(2):164.
13. 13. Lakhey M, Lakhey S, Niraula SR, Jha D, Pant R. Comparative attitude and plans of the medical students and young Nepalese doctors. Kathmandu Univ Med J (KUMJ). 2009;7(26):177-82.
14. 14. Syed NA, Khimani F, Andrades M, Ali SK, Paul R. Reasons for migration among medical students from Karachi. Med Educ. 2008;42(1):61–8.
15. 15. Ranta M Hussain SS, Gardiner Q. Factors that inform the career choice of medical students: Implications for otolaryngology. J Laryngol Otol. 2002:166:838-41
16. 16. Murali Poduval, Jayita Poduval. Medicine as a Corporate Enterprise: A Welcome Step? Mens Sana Monography. 2008;6(1):157-74.