Who Wants to be a Surgeon? A Survey of Medical Students at the University of Nairobi, Kenya
Mwachaka P.M. BSc, Mbugua E. BSc Saidi H. Bsc, MbChB, MMed, FACS, Affiliation: School of Medicine, University of Nairobi, Kenya.
Dr. Philip Maseghe Mwachaka, P.O Box 30197-00100, Nairobi, Email: firstname.lastname@example.org
Background: In Sub Saharan Africa, surgical conditions account for a significant disease burden. Surgical workforce is however inadequate, and thus strategies such as attracting medical students to surgical specialties could avert the situation. This study determined the proportion of students interested in pursuing surgical career and factors that influence choice of this specialty.
Methodology: Four hundred and fifty medical students, from first to fifth year of study at the University of Nairobi, were each issued a self administered questionnaire designed to assess their specialty preferences, and factors influencing these choices.
Results: The response rate was 385/450(85.6%). Surgery was the most popular specialty with 105(27.3%) students. Majority, 60(57%), of those who preferred surgery were in the preclinical years. Male students had a two-fold likelihood of selecting a surgical career compared to females. Significant factors that attracted students to surgery instead of non surgical careers were prestige of the specialty (p<0.001), presence of a role model (p=0.002), and intellectual challenge (p=0.005). Main deterring factors were ease of raising a family (p<0.001), length of residency (p<0.001) and lifestyle of practice (p=0.020).
Conclusion: Although surgery is the most preferred specialty among medical students at the University of Nairobi, there appears to be a declining interest among the clinical students. In order to attract and maintain student interest in the specialty, there is need for early and active mentoring.
In Sub Saharan Africa, a significant proportion of disease burden is associated with surgical conditions (1,2). The estimate of 38 DALYs (disability adjusted life years) lost per one thousand people in Sub Saharan Africa due to surgical conditions is the highest compared to other regions of the world (2,3). The main cause of this burden is inadequate surgical work force (3). Africa has 24% of the global health burden but only 3% of the global health workforce whereas United States of America has 10% of the global health burden and 37% of the global health work force (3). Improving the recruitment of surgical trainees, through encouraging more medical students to pursue surgical careers, may help alleviate this shortage (4-6).
Undergraduate medical education has largely been ignored in Africa. There is paucity of published data on medical student career preferences, as opposed to Western countries here data on career trends can readily be accessed (7,8). In these countries, where declining student interest in surgical careers have been observed, active and early mentoring has been widely promoted as an important avenue for addressing the trend (7-9). Understanding medical students’ career preferences and the factors influencing these choices helps surgical educators devise strategies aimed at attracting and maintaining student interest in surgical careers (5-9). Our study, aimed at determining medical student’s interest in surgery at the University of Nairobi, Kenya, and the factors influencing choice of this specialty.
Materials and Methods
Setting and participants: This study enrolled medical students at the University of Nairobi in Kenya, which runs a five year undergraduate degree program in medicine. In this study, students in all five years of study were enrolled. The survey was conducted between September and October 2009, coinciding with the last quarter of the 2008/09 academic year. In the 2008/09 academic year, there were 1557(874 male and 683 female) students. For this study we enrolled 450 students, ninety per year of study. All participants were informed of the aim of the study and that their involvement was voluntary.
Procedure and Measures: Self administered questionnaires (printed) were disseminated and collected in classrooms for 1st to 5th year students. The survey took approximately 10 minutes to complete. Information collected included: gender, marital status, year of study, their preferred specialty, factors that influenced the choice, and timing of specialty choice. The participants were offered the following list of possible specialties: surgery, internal medicine, pediatrics, obstetrics and gynecology, public health, psychiatry, radiology, anesthesiology, pathology, microbiology, anatomy, physiology, biochemistry, ophthalmology, immunology and other (a write in option).
Option for ‘not yet decided’ was also included. These specialties were preselected as it was felt they would be clear and distinct for most students. The participants were allowed to choose only one specialty. Regarding the factors influencing choice of the specialties, the students responded to the question “Did this factor influence your choice of the specialty?” The response was either ‘yes’ or ‘no’ to a list that included: encouragement by teaching or clinical staff, role model in the specialty, job opportunities and financial rewards, prestige of the specialty, academic and research opportunities, intellectual challenge in the specialty, lifestyle of practice, gender distribution in the specialty, ease of raising up a family, ease of entry into residency, length of residency, lifestyle during residency, and further training required after residency. These factors were based on similar published studies (6-9).
Analysis: Data collected were analyzed using Statistical Package for Social Sciences version 17.0. Chi square test was used to evaluate gender differences as well compare those who chose surgery to those who chose other careers. In cases where the expected value of any cell was less than 5, the two-tailed Fisher’s exact test was performed. A p-value≤0.05 was considered statistically significant.
Of the 450 questionnaires administered, 385 (85.6%) were returned. Male respondents were 217 (56.4%). The response according to year of study is summarized in Table 1. Only 58 (15.1%) students had not yet decided on their future careers.
Choice of surgery
Surgery was the most preferred specialty (27.3%)(Figure 1). It was the most popular specialty among male students 76(35%), and the second most preferred choice among the female students 29(17.3%).Majority, 60(57%), of those who preferred surgery were in the preclinical years, before surgery clerkship rotation (Figure 2).