|ORIGINAL RESEARCH ARTICLE
|Year : 2016 | Volume
| Issue : 3 | Page : 231-243
Specialty preferences and motivating factors: A national survey on medical students from five uae medical schools
Mahera Abdulrahman1, Maryam Makki2, Sami Shaaban3, Maryam Al Shamsi3, Manda Venkatramana4, Nabil Sulaiman5, Manal M Sami6, Dima K Abdelmannan7, AbdulJabbar M.A Salih7, Laila AlShaer8
1 Department of Medical Education, Dubai Health Authority, United Arab Emirates
2 Department of Surgery, Dubai Health Authority, United Arab Emirates
3 Department of Medical Education, Faculty of Medicine, UAE University, Al Ain, United Arab Emirates
4 Department of Surgery, Gulf Medical University, Ajman, United Arab Emirates
5 Department of Family and Community Medicine and Behavioral Sciences, University of Sharjah, Sharjah, United Arab Emirates
6 Department of Pathology, Ras al-Khaimah Medical and Health Sciences University, Ras al-Khaimah, United Arab Emirates
7 Department of Internal Medicine, Dubai Medical College, Dubai, United Arab Emirates
8 Department of Hematology, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
|Date of Web Publication||11-Apr-2017|
Department of Medical Education, Dubai Health Authority, P.O. Box: 88905, Dubai
United Arab Emirates
Source of Support: None, Conflict of Interest: None
Background: Workforce planning is critical for being able to deliver appropriate health service and thus is relevant to medical education. It is, therefore, important to understand medical students' future specialty choices and the factors that influence them. This study was conducted to identify, explore, and analyze the factors influencing specialty preferences among medical students of the United Arab Emirates (UAE). Methods: A multiyear, multicenter survey of medical student career choice was conducted with all five UAE medical schools. The questionnaire consisted of five sections. Chi-squared tests, regression analysis, and stepwise logistic regression were performed. Results: The overall response rate was 46% (956/2079). Factors that students reported to be extremely important when considering their future career preferences were intellectual satisfaction (87%), work–life balance (71%), having the required talent (70%), and having a stable and secure future (69%). The majority of students (60%) preferred internal medicine, surgery, emergency medicine, or family Medicine. The most common reason given for choosing a particular specialty was personal interest (21%), followed by flexibility of working hours (17%). Discussion: The data show that a variety of factors inspires medical students in the UAE in their choice of a future medical specialty. These factors can be used by health policymakers, university mentors, and directors of residency training programs to motivate students to choose specialties that are scarce in the UAE and therefore better serve the health-care system and the national community.
Keywords: Career choice, medical students, specialty preference
|How to cite this article:|
Abdulrahman M, Makki M, Shaaban S, Al Shamsi M, Venkatramana M, Sulaiman N, Sami MM, Abdelmannan DK, Salih AM, AlShaer L. Specialty preferences and motivating factors: A national survey on medical students from five uae medical schools. Educ Health 2016;29:231-43
|How to cite this URL:|
Abdulrahman M, Makki M, Shaaban S, Al Shamsi M, Venkatramana M, Sulaiman N, Sami MM, Abdelmannan DK, Salih AM, AlShaer L. Specialty preferences and motivating factors: A national survey on medical students from five uae medical schools. Educ Health [serial online] 2016 [cited 2022 Jan 19];29:231-43. Available from: https://www.educationforhealth.net/text.asp?2016/29/3/231/204225
| Background|| |
Several factors have been reported to influence specialty choices among medical students. Medical students might choose a specific specialty due to a genuine interest in the field, advice from friends or family, and admiration of a certain mentor.,,, Medical career preferences are also linked to the possibility of private practice, attractiveness of the specialty, an interest in research and teaching or perceived benefits of particular specialties,,,,,, lifestyle choices,,,, and even demographic factors such as gender.,, Factors associated with curriculum of medical schools also play a role in career choice.,,,
The United Arab Emirates (UAE) has five medical schools: Faculty of Medicine in UAE University (UAEU, Governmental, established in 1986), Dubai Medical College ([DMC] Private, established in 1985), Gulf Medical University ([GMU] Private, established in 1998), Sharjah University (SHMC, Private, established since 2004), and Ras al-Khaimah Medical and Health Science University (RAKMC, Private, established in 2006). Three of these medical schools have 5-year curricula and the other two have 6-year curricula (e.g., UAEU and SHMC). The curricula of all five schools are delivered in English according to the regulations of the Ministry of Higher Education and Scientific Research, and students earn the MBBS (e.g., Bachelor of Medicine/Bachelor of Surgery) degree, which is recognized by the Ministry of Health, UAE. Applicants to medical school in the UAE tend to study medicine as an undergraduate degree, progressing directly from high school to medical school. All schools are open to both male and female students, except for DMC which is exclusively for females. After graduation, one year of internship is required, per the guidelines of the Ministry of Health, to practice medicine in the UAE. The five medical schools have their own curriculum.
The main purpose of studying the career preferences among UAE medical students is to understand current students' views about their future specialties and practice locations to be able to anticipate whether those views fit the expected demand for health-care services. A declining number of applicants to some residency specialties, including pediatrics and obstetrics and gynecology, have been observed in the UAE, whereas the number of applicants to family medicine residencies is growing. In a literature review, we found no previous reports from the UAE on this critical subject. Most research into career preferences in medicine has been carried out in the US, Canada, and the UK,,,,,, with some studies carried out in the Middle East.,,, We can find no such studies with medical students of the UAE.
Studies in a varied health-care system would add different insight into specialty preference. Each country has its own needs and health-care demands, for example, the demanding role in time-compressed practice makes primary care less attractive as a career for future doctors in the USA,, whereas good hours and working condition of General Practice in the UK influence the career choice of medical graduates. The reasons of medical students make various career choices can be expected to vary across countries, which differ in their health-care systems and practice situations, thus policymakers and educators in the UAE cannot depend entirely on studies from other countries.
| Methods|| |
Setting and background population
As part of multiyear, multicenter investigation into medical student career choice, a survey on student career aspirations of all five UAE medical schools, which together have approximately 2079 students. The UAE medical schools differ in their admissions processes in terms of the relative weightings given to grade point averages, interview performance, and Test of English as a Foreign Language/The International English Language Testing System requirements. The five schools in the study also differ in various important aspects including curricula (e.g., problem-based, case-based or traditional, lecture-based learning), student intake (ranging from 65 to 120 per year), geographical location that varies from a large, heavily populated city to a relatively rural and coastal town, and school age (from 10 to 30 years). Fees also differ for these five medical schools, with UAEU being fully governmental and free-of-charge and the other four schools charging between 90,000 and 110,000 AED per year (24,000 and 30,000 US$).
All undergraduate students at the five UAE medical schools were approached in this study.
Procedure and instrument
The six-page survey instrument consisted of five sections [Appendix 1 [Additional file 1]]. Questions asked student demographic information, socioeconomic backgrounds, and age, which was categorized into 17–20 years and ≥21 years. Question 17 asked about factors that students perceived which affected their choice of studying medicine at the undergraduate level. Five questions asked about which medical school students had applied to and examinations they have completed before entering medical school. Four questions queried students' intention on continuing their internship and specialty in the UAE. In a single question, the students were asked to choose, in order of preference, up to three specialties that they would like to pursue as a long-term career. Career and specialty choices were selected that were felt would be clear and distinct for students in their first few months of medical studies. A final set of questions asked about factors that students perceived to influence their career choice.
The questionnaire was designed by the authors with reference to an advisory panel of undergraduate and postgraduate faculty staff as well as the current literature on career choice and preference [Appendix 1]. The variables presented were chosen based on a literature review and discussions with medical students, residents, and educational leaders. The survey was then subjected to a validation process which included giving the questionnaire to medical students, residents, physicians, and experts to check for item appropriateness and comprehensiveness (content validity). Variables listed in the questionnaire were modified based on this review and more questions on pre-entry tests for students were added. An initial version of the questionnaire was tested with the DMC students on October 2014.
The questionnaire was distributed to the five medical schools between October 2014 and February 2015. Paper questionnaires were distributed at prearranged sessions in each school. Students were asked to complete the questionnaire and return it to school administrative offices. A cover page was provided which contained a description of the project and informed consent checkbox. A hard copy of the survey was sent to the five UAE medical schools, and for each school, a faculty member was chosen to coordinate the distribution of the survey among the medical students. Completed surveys were collected, and data were entered into an Excel sheet manually.
Data were carefully reviewed in Excel, and data analysis was performed using SPSS version 15 (SPSS Inc. Chicago, IL, USA). Descriptive analysis was used to present student career interest on entry to medical school. Chi-squared tests (bivariate analysis) were used to identify significant differences among groups (gender, age group, country of birth, socioeconomic status [SES], medical school, factors influencing career choice, and specialty choice).
Students were segregated into groups according to the year of the study. Students' specialty of choice was described, and significant group differences were assessed using Chi-square tests. Significant variables found through Chi-square tests were included in subsequent step-wise regression analyses.
Finally, a step-wise logistic regression was performed using career choice as the criterion (dependent variable), and the factors (predictor variables) were age groups, gender, nationality (UAE vs. non-UAE), place of birth, upbringing, place of students earned their high school degree, marital status, if the spouse is a doctor, number of children, place where the student completed high school, university, year of study, and sponsorship. All variables were treated as continuous data with the exception of gender, nationality, age groups, place where high school was completed, and marital status, which were considered categorical. Variables were entered into the model if the associated significance was P< 0.05. The only variable that was accepted into the model is university (P < 0.001) which gave a Nagelkerke Pseudo R2 = 0.077.
Ethical approval for this study was granted by the Faculty of Medicine and Health Sciences in UAE University and Sharjah University. These permissions were accepted as proof of review by other medical schools.
| Results|| |
A cohort of 956 medical students enrolled in the five schools responded to the survey on career choice. The overall response rate was 46% (956/2079), and the students' distribution was almost even between all years within each school. Return rates differed significantly by school (χ2 = 100.9, df = 16, P< 0.001): GMU (78.4%), DMC (54%), and RAKMC (47.5%) gave higher response rates than SHMC (35%) and UAEU (30.6%).
Over half of the students were females (530, 55.4%), and the gender difference was statistically significant between the five medical schools (P < 0.001) with DMC having only females, whereas GMC and SHMC having predominantly male students.
Most students (513, 54%) were within the age group of 17–20 years. While all UAEU students were UAE nationals, the majority of the students in other four medical schools was non-UAE nationals (730, 76%, P< 0.001) and were born outside the UAE (545, 57%, P< 0.001). The great majority of the respondent students were single (914, 96%, P = 0.015), and out of 42 married students, 22 (52.4%) of their spouse were perusing medical career.
There were no significant differences among students of the five schools in terms of the occupation of primary earner in the parental household, total family income, fathers education, and SES [Table 1]. All students were from SES Groups I and II with the majority of (83.4%) their primary earner having managerial and professional occupation, and half of (54.4%) their family income were more than 30,000 AED (~8000 US$). However, there was a significant difference (P < 0.001) between tuition fees payment: all UAEU students paid no tuition, whereas at most 10% of students in other four medical schools paid no tuition.
|Table 1: Demographics characteristics, socioeconomic background, and factors influencing medical career choice of the undergraduate medical students in UAE|
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Choice of medical school and factors influencing
Students provided up to three factors they felt influenced their career choice to study medicine. The two leading factors where having a parent/relative as doctor and parent/teacher advice; the next leading factor was having high scores in high school/liking science [Table 1].
Future career plans
Students were asked if they planned to do their internship training in the UAE and just over half (490, 51%) responded that they would. Of the 573 students (60%) who stated that they planned to work abroad after their graduation, two-third (363/573, 63%) stated that this would be only temporarily. Most (405/557, 73%) of the students who planned to work abroad stated that this would be for their specialty training. When the students were asked whether they intended to undertake residency training, the vast majority (847/956, 89%; P = 0.0034) answered positively; however, most had not yet chosen a specialty (394/956, 41%). Most students had not yet received career guidance from their schools (517/956, 54%; P< 0.05).
Medical students were asked to indicate the importance of certain job-related factors when considering their future career preferences. The following factors were rated highest using the weighted average of responses (scale of 0–3 with 3 being extremely important and 0 being not at all important). Factors being extremely important by the majority of students were: intellectual satisfaction (87%, 2.86), work–life balance (71%, 2.69), having the required talent (70%, 2.58), stable and secure future (69%, 2.57), location of work (56%, 2.43), easier to find a resident position (60%, 2.36), length of training (57%, 2.31), and location of work (56%, 2.43) career responsibilities (59%, 2.27) [Table 2]. The Kendall's W-test for concordance (n = 822, coefficient of concordance = 0.243, df = 12, P< 0.001) indicates that these factors are significantly different in their importance from each other.
|Table 2: Factors influencing future career options. Listed from most important to least important based on the weighted average (0-3 with 3 being extremely important and 0 being not at all important)|
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Students were asked to provide their top three specialty choices, and their responses were categorized according to the year of the study [Table 3]. Internal medicine (20%), surgery (19%), emergency medicine (12%), and family medicine (8.9%) were most frequently mentioned as top choices [Table 3]. The proportions of students prioritizing obstetrics and gynecology, diagnostics: pathology/radiology, and hospital management/health management varied significantly across students of various years (P = 0.026, P = 0.031, P = 0.004 respectively).
|Table 3: Specialty choice preference based on study year from first to final year|
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The principal motives medical students reported for a preferred specialty were as follows matching personal interest (21%), hours of practice/work pressure/on-call schedule/flexibility of specialty (17%), and interest in long-term relations with patients/diversity of patients/physician–patient interaction (12%) [Table 4]. There was no association between reasons for choosing preferred specialty and year of undergraduate study.
|Table 4: The reason behind choosing preferred specialty in different undergraduate level students in UAE|
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The majority of the students (621, 66%; P = 0.048) planned to work in the government, whereas 203 (21%) favored the private sector and 123 (13%) chose to work in a clinic they would own. When the students were asked if they believe doctors are paid more in the public sector or private sector, most (643, 70%) stated that private sector doctors are paid more. In addition, most students (498, 53%) indicated that they are considering working part time. When asked which of several professions had a higher salary/income: a strong majority (775, 82%) of the students believed a chief executive officer (CEO) earns most, then beauty salon owner (83, 9%), banker (49, 5%), and finally doctors (38, 4%).
| Discussion|| |
UAE is a relatively young country with a population of 9.2 million, of which 1.4 (15%) million are UAE national citizens. New governmental policies encourage UAE nationals to pursue a career in medicine to ensure that in the future, the health sector is run and managed by UAE national doctors. However, although there is an increase in a number of UAE nationals entering medical schools, there remains a lack of UAE national physicians in some specialties including obstetrics and gynecology and pediatrics. In contrast, there are an increasing number of UAE national female physicians choosing family medicine (unpublished data from Dubai residency training program). The future career specialties preferred and the factors involved in making these choices by medical students are of great importance to ensuring a balanced distribution of doctors in different specialties. The factors influencing students of the UAE to choose one specialty over another is unknown.
According to new rules of the Dubai Health Authority, doctors need to begin their residency training after they complete internship with no more than a 4-year hiatus. This recent rule gives newly graduated doctors less time to make their career decisions based on what they have learned in practice than current graduates.
It is not known whether students in the UAE are guided toward a career in medicine and then later to a specific specialty through career counseling, personal research into options, through job fairs, or by guided by the people around them such as family members and mentors. The goal of this study was to further explore undergraduate medical students' career interests and the factors they feel influence these preferences, using a questionnaire.
Apart from the known 100% female composition of the DMC and 100% UAE national student body of the government-run UAEU, this study finds that medical school students were relatively homogeneous across schools in their sociodemographics.
This study also finds that the majority (63%) of medical students in the UAE report that they chose to pursue medicine as a career because of either having a parent–doctor, doctor in the extended family, school teacher advice, or because they like science and got a high score in school [Table 1]. However, while all (100%) of students in UAEU were accepted into their university of choice, this frequency was 43% for students in RAKMU; and this difference was statistically significant. The explanation could be that RAKMU is a new university compared to the other four medical schools; thus, students may not be identifying it as a first choice for the study.
The majority (60%) of the students in this study identified a specialty preference for internal medicine, surgery, emergency medicine, and family medicine, in descending order. This is similar to the findings of studies from Saudi, Kuwait, UK, Canada, Japan, Jordan, Sudan, and Greece.,,,,,,, Thus, it appears that UAE medical students are like other medical students worldwide in their specialty choices. In addition, an alternate reason could be that these specialties are the most common clinical areas that the students are exposed to on a daily basis during their hospital rotations in clinical years. Mentors and role models also influence the student's decision. This theme of students choosing to specialize in fields, in which they can see doctors already practicing is seen repeatedly in the literature. The theme of “role models” is cited frequently in literature on student career choices.,,
From conversations, we have had with deans of five UAE medical schools, none offer career guidance; therefore, students might not be made aware of the different specialties available for them. This study raises the importance of having career guidance early in the medical school experience in the UAE to introduce different specialties to the students in the early phase of their undergraduate study.
The most common reason for choosing a specialty reported by medical students in this study was “personal interest” (21%), followed by flexibility of working hours (17%), physician–patient interaction (12%), and advice from a relative or a practicing physician (11%), similar to studies in Saudi Arabia, Iraq, Pakistan, Taiwan, the UK, and Sudan.,,,,, The second most important factor that students felt influenced by their specialty choice was hours of practice/work, pressure/on-call, and schedule/flexibility of specialty (17%). This is in line with recent studies showing that medical students choose specialties that enable them to have control over their work schedule.,,
Further investigation is required to identify the reasons for possible differences in the specialty choices of students of the five UAE schools. It might be that a better or stronger curriculum in specific specialties or stronger “role models” among the faculty of some departments influences the students of one school or another.
Economic and social incentives are well known to be vital determinants in choosing a career. In a study undertaken in Turkey, the financial aspects and prestige were the driving factors for choosing a specialty. Surprisingly, in the present study, only 10% of students stated that having a high monthly income was important. Interestingly, when questioned, the majority (96%) of students identified that CEOs, bankers, and beauty salon owners earn more than doctors. These results indicate that most students in the UAE did not choose medicine for prestige or high income; instead, they felt that they were focusing on the intellectual satisfaction offered by the field and that it matched their interests. The majority of the students in our study (66%) preferred to work in the governmental sector even though most (70%) believed that physicians in the private sector have higher salaries. This might be explained by the secure nature of jobs in the governmental sector in the UAE compared to the private sector. In addition, 53% of these students were considering working part time, which may be due to the importance of work–life balance in the Eastern culture and how part-time allows physicians to also manage family duties, which is especially important for female doctors. Female physicians who choose to be family physicians mention that the main reason for their decision is the work–family balance; they can get through this specialty: family physicians currently do not work night shifts in the government sector.
To conclude, this study has revealed several factors that medical students feel affects their choice of specialties. It will be important to offer UAE students career advisors and career counseling starting from their early years of study and increasing as they near graduation, when they must make choices. Future studies should assess why some specialties, such as internal medicine, surgery, emergency medicine, and family medicine, are preferred by students over other specialties. Further investigations are also required into the differences in specialty preferences among students of the various medical schools. Furthermore, having job fairs in high schools in association with medical schools can also help students have a better understanding from the very start of medicine as a career.
Strengths and Limitations
The strengths of this study lie in its broad scope and applicability to the medical community in the UAE. The authors believe this study to be the first of its kind to comprehensively evaluate the career intentions of the current cohort of medical students studying in the UAE five medical schools and their underlying motivating factors.
One of the limitations of this study is the response rate (46%, 956/2079). This may have allowed self-selection bias among participants. Another limitation of this study is that it relies solely on what students say influences their careers. People are not fully aware of the factors that influence their choices or truly how much they are influenced by each factor.
| Conclusion|| |
This study is the first report from the UAE analyzing the links between undergraduate student characteristics and career intentions. It presents how both nonmodifiable (age, gender, nationality, place of birth, and upbringing) and modifiable factors (medical school, specialty preference, influential factors such as family, career guidance, and charismatic role models) can influence specialty career choices. The data suggest that a variety of factors inspire medical students in the UAE to choose a future medical specialty. These factors can be used by policymakers, university mentors, and directors of residency training programs to motivate students to choose specialties that are scarce in the UAE and therefore better serve the health-care system and the national community.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]