|Year : 2017 | Volume
| Issue : 3 | Page : 163-168
Factors affecting the future medical specialty and training location selection
Hemail Mohammed Alsubaie1, Khaled Mohammed Alsubaie2, Khaled Abdullah Alswat3
1 Department of Otolaryngology, King Abdullah Medical City, Makkah, Saudi Arabia
2 Department of General Surgery, King Faisal Medical Complex, Taif, Saudi Arabia
3 Department of Internal Medicine, Taif University, College of Medicine, Taif, Saudi Arabia
|Date of Web Publication||6-Feb-2018|
Dr. Hemail Mohammed Alsubaie
King Abdullah Medical City, Makkah
Source of Support: None, Conflict of Interest: None
Introduction: Medical specialty selection for senior students and interns in Saudi Arabia is the most important issue during their modules and hospital training. Many factors affect this process, so the primary aim of this study is to assess participants' preferred specialty, location, and other factors influencing their choices. Materials and Methods: This cross-sectional study involved interns and 6th-year students from the medical schools in Saudi Arabia, conducted from October to November 2015. A self-reported questionnaire assessed baseline characteristics, specialties of interest, location, and psychological aspects of their preferences. Results: A response rate of 25.1% (540 participants) out of 2150 surveyed students and interns. About 70.2% were interns, 52.2% were male, with a mean grade point average of 3.75/5.0, and predominantly from Taif University. Nearly 58.3% were interested in local training programs. The National Guard Hospital was the most desired hospital while Riyadh was the preferred city for training. The preferred medical specialties were internal medicine and pediatrics, yet 5.9% were undecided about their future specialty. The most important factor in choosing a specialty is a student's personal interest while a training program's quality is also a compelling reason for a certain training site. Furthermore, 81.8% of those who chose international training programs preferred North America, those were more likely to have the required qualifications (P = 0.039) and more likely to be interested in academic positions (P = 0.007). Conclusion: Almost 70.2% of the participants are interns, 58.3% are interested in the local training programs, and the most desired specialty is internal medicine. The National Guard Hospital was considered as the best training location. Those selecting international residency programs were more likely to be interested in academic careers.
Keywords: Choose, contributing factors, Saudi universities, specialty
|How to cite this article:|
Alsubaie HM, Alsubaie KM, Alswat KA. Factors affecting the future medical specialty and training location selection. Saudi J Health Sci 2017;6:163-8
| Introduction|| |
Currently, there are around 30 medical schools in Saudi Arabia, which are mainly governmentally run, but some are private: both are supervised by the Ministry of Education. These medical schools are located in 13 regions, over 2,150,000 km2 in the Arabian Peninsula. After 12 years of education, students graduating from high school can apply to university to pursue undergraduate education. The road to medical school is long and competitive: enrolled students are required to finish 6 years, plus a year of a compulsory internship before earning a medical degree.
Medical school starts with the health science preparatory year, in which outstanding students compete with each other to enter one of the health-related schools (including the School of Health and Allied Science, the School of Pharmacy, the School of Medicine, and the Dental School). School selection after the preparatory year is based on personal preference and a student's grade point average (GPA) as they play a major role in selection. Usually, those with high GPA scores compete for a spot in medical school. Students who get to medical school will do an additional 5 years, with the 1st 3 years mainly focused on the basic sciences and the last 2 years focused on the clinical sciences. Most medical schools in Saudi Arabia use integrated modules in their curriculum so that students will have fewer clinically related lectures, sessions, and hospital visits in the early stages while studying the basic sciences.
After that, each student will do the 7th year of a compulsory internship, in which they perform tasks similar to those of a junior resident, with supervision from the hospital staff. The internship is mandatory and considered a full-time, paid job. The year is divided into rotations: 2 months for each of the major specialties, which include internal medicine, general surgery, pediatrics, and obstetrics and gynecology, with an additional 2 months in an elective rotation and 1 month each of family medicine and emergency medicine. Each student must complete the Saudi Medical License Examination during the internship to apply for the training program. The Saudi Commission for Health Specialties (SCHS) was established in 1993 to approve and organize residency and fellowship training. One of the objectives of the SCHS is to guide and supervise, with the ultimate goal of graduating qualified and certified physicians in different medical and surgical specialties. The SCHS is supervising 51 specialty and subspecialty training programs, with about 950 training sites in 13 regions. Most sites are located in Riyadh, the capital of Saudi Arabia.
There are limited data about the factors affecting the future trainee specialties and training location selections nationally. The primary aim of this study is to assess participants' preferred specialty and location. Furthermore, we will evaluate the factors influencing their choices.
| Materials and Methods|| |
A cross-sectional study from October to November 2015 was completed for senior medical students coming from all medical schools. We published a similar study design, but it was only limited to Taif University students and interns. We then decided to do it on a national level, so we invited all Saudi medical school students and interns to participate in our online survey.
An online questionnaire was available for online medical groups, 6th-year medical students, and interns, all of whom were invited to participate in the study. We included interns and 6th-year medical students, with both genders included in the final analysis. We excluded residents and all medical students except for those in their 6th year. Respondents who did not complete the questionnaire and demographic data were also excluded from the study.
There were 540 interns and students participating in the study from a number of universities in Saudi Arabia. Using an Arabic questionnaire, we assessed a participant's knowledge (that could influence future medical career choices). The questionnaire included 31 questions, 30 being multiple-choice and 1 being an open-ended question about GPAs. The first four questions involved demographic data, including the level of training, gender, college location, and GPA. Five questions concerned a student's social status, for example, marital status, and how marriage affects the choice of specialty, the father's level of education, and either of the parents being a physician and then the impact of a composite of these factors.
The questionnaire also includes the future desired specialty, factors guiding that interest, the location of the program (local or international), the preferred training sponsor, and the impact of previous research or summer training. There are five questions that assess the preferred training site, the region, a civilian or military lifestyle, and the facility's name; this includes questions to assess preparation and participant knowledge about requirements for acceptance; moreover, advantages and disadvantages of that specialty were also collected.
Data were collected with Excel and analyzed with the Statistical Package for the Social Sciences (SPSS) SPSS Inc. Chicago, Ill., USA version 20. The mean and standard deviation (SD) were expressed scale data while frequency and percentage were presented as category data. Chi-square test was used to assess the relationship between variables, and we considered a P = 0.05 or less as significant. This study has been approved by the Research Ethics Committee at Taif University.
| Results|| |
A total of 2150 potential students and interns surveyed with a response rate of 25.1% (540 interns and 6th-year medical students) from 21 universities in Saudi Arabia were included in the study. The majority of respondents were interns, with both genders equally represented in the study. Most respondents graduated from university in the western region of Saudi Arabia [Table 1]. The mean GPA was 3.75 out of 5.0 (SD 0.629), 10.9% were married, more than half of them had parents with a bachelor's degree or higher, while 6.7% came from a family of physicians, with one or both parents in the field [Table 2]. The majority of participants (58.3%) are interested in local programs, with two-thirds preferring Riyadh and Jeddah City, followed by 21% interested in the western region [Figure 1].
|Figure 1: The most desired training city region for those interested in the local training programs|
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|Table 1: Participants' distribution according to their medical school locations|
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Approximately one-third prefer North American programs while 6.7% are interested in training in Europe. The majority are interested in working for the government sector versus the private sector, which represents <2% of participants. The highest-ranked hospitals (as training centers) are the National Guard Hospitals (36%), followed by the Ministry of Health Hospitals (30%) and the King Faisal Specialist Hospital and Research Center (19%). Approximately 17.4% of male participants are interested in becoming physicians with the military [Table 2]. The factor that most influenced trainee choice for location was the quality of the program, followed by its reputation for having a friendly work environment [Table 3]. Accessibility of the training program was the least influential factor. To reiterate, the most desired specialty is internal medicine (12.7% of those selecting local programs, compared to 12% selecting international programs), with the 2nd most chosen field being pediatrics (11.8% of those chose local programs, vs. 7.6% who chose international programs) [Figure 2]. These are followed by ophthalmology and psychiatry. However, 5.4% of those interested in local programs and 6.2% of those interested in international programs are still undecided about their future specialties.
More than two-thirds of participants are influenced by their mentors and feel qualified for the desired specialty. Sixty-one percent of participants feel confident about the positives and negatives of a specialty. A high percentage of participants are advised by those in the field (or they consult an expert about their chosen specialty and learn more about the importance of research experience). Those deciding on international programs are significantly more likely to be interested in an academic career versus those interested in local programs (P = 0.007) [Table 4]. Personal interest in student teaching and research are the main reasons to pursue an academic career. Factors affecting trainee choices are social life and gender, followed by faculty staff influence. The availability of local training programs in their region, as well as marital status, plays a minor role. Failure also negatively influences training choices.
|Table 4: Groups' characteristics based on the desired residency training country|
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| Discussion|| |
The decision about the optimal field of medicine begins during the clinical years as a student or intern. Many factors affect recent medical graduates a preferred specialty and training facility. After graduation, the second important phase includes the student's specialty, which forms the basis of their professional career. This study shows that the majority of respondents prefer local training programs. The best-regarded location was Riyadh City while the National Guard Hospital was still the most preferred training institution. The sought-after specialties continue in internal medicine and pediatrics, with <6% undecided about the desired specialty. The program's quality plus a friendly training environment are the most influential factors in training location. Previous studies show that factors such as the medical school's GPA criteria, examination scores, research activities, the training facility's reputation, duration of training, workload and job responsibilities, and training environment – all play a major role in program selection.,
Our study indicates that personal interest plus workload and lifestyle, respectively, are the most influential factors in selecting a specialty while income was among the least important [Figure 3]; similarly, a study done in 1997 showed personal interest to be the most influencing factor for choosing a specialty  while a research conducted in 2014 at Dammam University found that the lifestyle of the physician is more important than personal interest and workload. Specialty choice might differ from time to time and from place to another, for example, our study showed that most participants chose internal medicine as their priority followed by pediatrics, and another research done in Saudi Arabia in 2013 at King Saud University in Riyadh found general surgery then otolaryngology and ophthalmology then internal medicine. A physician's monthly income in Saudi Arabia is not a major factor as it does not differ between specialties; most board-certified physicians work for the government, where salary scales are based on the number of boards and certificates one has, including years of experience versus the type of specialty. North American training programs are considered a goal for many medical school graduates. In our study, 81.8% of those who decided on an international training program preferred those programs, with the quality of training the most influential factor. Given the North American training sites' reputation and their international rank, the combination of resident autonomy with optimal supervision (and many research opportunities) had a major role in the pursuit of training. In a study on trainee perception of a resident in Saudi and the US, it was found that Saudi residents responded less positively about board examination preparation, access to educational resources, and weekly academic activities, especially those working in the emergency room. Another study found that Saudi trainees (on the number of patients seen per hour) felt less competent to handle less common procedures, compared to the US trainees. There is a preference for orthopedic specialties (for those who select local vs. international sites). It was also shown that orthopedic Saudi trainees are more likely to report an inadequate level of training versus Canadian trainees.
|Figure 3: The most influential factor in choosing future training specialty|
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Our study indicates that those interested in international programs are more likely to pursue academic positions, versus those in local programs. For these reasons, many of the leading Saudi government and private hospitals seek those who completed postgraduate training in North America. The majority of universities in Saudi Arabia require foreign training to be considered for a medical academic position.
Whether they are interested in local or international programs, we show that half of the study participants participated in research activities. This reflected the new requirements for SCHS; this led to an additional 20 points (out of 100, points toward competing for Saudi residency programs) and 2 points for their 2015 residency application (along with 4 points for work in two research activities). Another study showed that participating in research during medical school allows the student to similarly engage in more research during residency, postgraduate, and academic positions. This is a critical factor in resident confidence and doing relevant research.
Our study limitations include limited response rate, and one-third of the respondents were from Taif University. Our strengths include surveying all medical schools in Saudi and comprehensive baseline characteristics.
| Conclusion|| |
The most preferred specialty is general medicine, with a candidate's personal interest as the most influential factor. Riyadh City is the most preferred site for residency training. Thus, compared to those selecting local programs, participants who chose international programs were more likely to be interested in academic careers and more likely to feel confident about their required qualifications.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Alsubaie K, Alsubaie H, Alswat K. The contributing factors affecting Taif university medical students and interns in choosing their future specialty. Int J Healthc Pharm Res 2016;5:031-5.
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.
Al-Jarallah KF, Moussa MA. Specialty choices of Kuwaiti medical graduates during the last three decades. J Contin Educ Health Prof 2003;23:94-100.
Muula AS, Komolafe OO. Specialisation patterns of medical graduates, University of Malawi College of Medicine, Blantyre. Cent Afr J Med 2002;48:14-7.
al-Faris E, Kalantan K, al-Rowais N, al-Mahdi Balla al-Nour M, al-Umran K, Kabraah MT, et al.
Career choices among Saudi medical students. Acad Med 1997;72:65-7.
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.
Abdulghani HM, Al-Shaikh G, Alhujayri AK, Alohaideb NS, Alsaeed HA, Alshohayeb IS, et al.
What determines the selection of undergraduate medical students to the specialty of their future careers? Med Teach 2013;35 Suppl 1:S25-30.
Alghamdi K, Alburaih A, Wagner MJ. A comparison between emergency medicine residency training programs in the United States and Saudi Arabia from the residents' perception. Emerg Med Int 2014;2014:362624.
Al-Ahaideb A, Alrabai HM, Alrehaili OA, Aljurayyan AN, Alsaif RM, Algarni N, et al.
Evaluation of the orthopedic residency training program in Saudi Arabia and comparison with a selected Canadian residency program. Adv Med Educ Pract 2014;5:315-21.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]