Abstract
Context:
The number of Saudi psychiatrists in Saudi Arabia is not sufficient to keep up with the increasing need.[1] Approximately out of 6873 physicians, only 148 are psychiatrists, which is barely 2.1%.[2] Despite the high number of medical students graduating each year and the high demand for psychiatry physicians, only few medical graduates choose psychiatry as a career option.[3]
Aims:
To investigate the profile of final year medical students of both sexes at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia. In terms of their decisions regarding specialization, this study aimed to identify the motivators and deterrents that impact the choice of psychiatry as specialty.
Subjects and Methods:
Students filled in a self-reported questionnaire focusing on the several factors that act as motivators, deterrents, or have no impact on psychiatry career choice.
Statistical Analysis Used:
Statistical analysis was done using Statistical Package for Social Sciences (SPSS)® version 20. Different factors were expressed in terms of numbers and percentages. Chi-square test was used to compare responses to the questionnaire between male and female students and whether the GPA had an effect on their choice. P value less than 0.05 was considered significant.
Results:
It was noted that 85% did not choose psychiatry, with the most important deterrent being “Family member is psychologically ill” and “Available job position” being the most common motivator for choosing a specialty.
Conclusion:
In conclusion, there are many factors that play an important role in career choice. No difference was found among male and female students, and no effect was identified while comparing GPA with career choice.
Keywords: Career, medical students, psychiatry
Introduction
During their clinical years, students gain vast amount of knowledge about medicine and receive training on real patients in an authentic learning environment. This training in real settings with real patients may help students in their career selection. They get to identify their limitations and develop interest in the field of their choice.[4]
The choice of a specialty is a challenge that all students face in their clinical years of medical education, particularly during their internship years. Different factors play a role in selection as reported in a study conducted in family medicine that identified various factors that have an impact on the career choice among students. The most commonly reported factors are social status, ability to help others, availability of position, personal interest, and financial benefits.[4] In the last 10 years, many medical colleges have been established in Saudi Arabia, and approximately 9,210 students graduate from 32 medical colleges in the country every year. The Ministry of Health (MOH) in its report published in 2017 stated that the number of Saudi physicians in Riyadh region till date is approximately 6873, of which only 148 are Saudi psychiatrists, which barely reaches 2.1%; moreover, there is a shortage of doctors in many specialties including psychiatry.[2]
Psychiatry as a career choice is still not popular among students due to its negative impact and the associated stigma.[5] To elucidate this concept is the need of the hour is that can be improved and strengthened through lectures, during clerkship in psychiatry units, as well as conferences on psychiatry.[6] A qualitative study assessed the impact of psychiatry training and identified the positive impact of psychiatric clerkship on students’ career choice. In addition, this study reported that integration of psychiatry with teaching medical sciences and awareness at the secondary school level may have a positive impact on the attitude of medical students toward psychiatry as a career choice.[7]
Although psychiatry has been given due importance, there are reports on the weakness in the mental health services in Saudi Arabia.[1,8] A previous study done in Jazan in 2016 showed that the preferred specialties were surgery, pediatrics, and internal medicine. Psychiatry was also frequently chosen as a specialty by students. Very few students chose community medicine and public health and gynecology.[3]
Different factors influenced these choices such as the possibility of a foreign scholarship, opportunity for helping people, and challenging the nature of the field.[3] Choices like these affect the health sector by over supplying or creating shortages in some specialties, e.g., the only 121 psychiatrists out of 5,821 physicians in Riyadh (MOH 2017). Another established factor is the short duration of exposure during the clinical years of medical school.[9] Stigmatization toward psychiatric patients has also been attributed to affect the choice of psychiatry as a speciality.[8]
To the best of authors’ knowledge, only few studies have been done on this subject, but no study has been conducted on elucidating the contributing factors in the selection of psychiatry as a career choice. Thus, study on the decision of psychiatry as a specialty chosen among medical students in KSAU-HS will be done with an objective to assess the factors that play a role in this choice. The result will provide better insights and help stakeholders in the planning of psychiatry teaching with medical sciences and in raising awareness.
Subjects and Methods
The study was a cross-sectional survey conducted among last year students in KSAU-HS. A purposive sampling method was used. A total of 81 students responded to the questionnaire administered to final year medical students (157 students), with a response rate of 51.5%. All students were in the last year of their study. Participation in the study was voluntary, and an informed consent form was also administered along with the questionnaire.
The questionnaire was composed of two parts. The first part dealt with the demographic details, and if they considered psychiatry as the first career choice [Table 1], while the second part was a two-point questionnaire which had 23 factors marking each factor as a motivator or nonimpactful\deterrent evaluating student's perceptions regarding the factors influencing the specialty choices according to their own perception [Table 2]. These factors included community need, lifestyle, available job position, available scholarship, psychologically ill family member, prestige, high income, program length, geographic location, service–training balance, research opportunities, formal mentorship, elective opportunities, benefits, emphasis on psychotherapy, job market for psychiatry, concerns regarding personal safety, stigma maong students, emphasis on neuroscience, limited treatments, and outreach opportunities.
Table 1.
Demographics of students
| Variables | n | Percentage |
|---|---|---|
| Gender | ||
| Male | 71 | 88 |
| Female | 10 | 12 |
| GPA | ||
| ≤4.0 | 13 | 21 |
| >4.0-4.5 | 19 | 31 |
| >4.5 | 29 | 48 |
| Family (parent) income | ||
| <10,000 | 6 | 8 |
| 10,000-20,000 | 12 | 16 |
| 20,000-30,000 | 16 | 21 |
| 30,000 above | 42 | 55 |
| Father’s education level | ||
| PhD | 21 | 26 |
| Masters | 17 | 21 |
| Bachelor | 32 | 40 |
| High school | 6 | 7 |
| Intermediate school | 3 | 4 |
| Primary school | 2 | 3 |
| Mother’s education level | ||
| PhD | 9 | 11 |
| Masters | 6 | 7 |
| Bachelor | 38 | 47 |
| High school | 18 | 22 |
| Intermediate school | 3 | 4 |
| Primary school | 6 | 7 |
| Any parent is a medical doctor | ||
| Mother: No | 81 | 100 |
| Father: Yes | 65 | 80 |
| Marital Status | ||
| Single | 76 | 94 |
| Married | 5 | 6 |
| Do you want to choose psychiatry as a future career | ||
| No | 69 | 85 |
| Yes | 12 | 15 |
Table 2.
Responses of students on different items with high percentage
| Items | Motivator | No Impact | Deterrent |
|---|---|---|---|
| Available job position | 72% | 19% | 4% |
| Lifestyle | 69% | 21% | 3% |
| Salary or benefits | 67% | 22% | 5% |
| High financial income | 63% | 27% | 3% |
| Community need | 62% | 29% | 2% |
| Program flexibility | 60% | 30% | 2% |
| Geographic location | 60% | 25% | 7% |
| Available scholarship | 59% | 30% | 3% |
| Service-training balance | 48% | 38% | 4% |
| Elective opportunities | 44% | 42% | 3% |
| Research opportunities | 42% | 40% | 6% |
| Prestige | 40% | 39% | 9% |
| Formal mentorship | 36% | 48% | 4% |
| Concerns regarding personal safety | 33% | 40% | 14% |
| Job market for psychiatry | 27% | 51% | 8% |
| Outreach opportunities | 27% | 48% | 11% |
| Emphasis on psychotherapy | 26% | 51% | 9% |
| Limited treatments | 23% | 39% | 23% |
| Program length (too long) | 19% | 49% | 17% |
| Emphasis on neuroscience | 19% | 48% | 18% |
| Family member is psychologically ill | 11% | 63% | 9% |
| Stigma among students | 10% | 60% | 13% |
Statistical analysis was done using Statistical Package for Social Sciences (SPSS)® version 20. Different factors were expressed in terms of numbers and percentages. Chisquare test was used to compare responses to the questionnaire between male and female students and whether the GPA had an effect. P value less than 0.05 was considered significant.
Results
A total of 81 responses were obtained (71 males and 10 females). Only 15% chose psychiatry as a career choice whereas 86% did not. Overall, 72% of the students found “available job position” to be one of the main factors that motivated them to a specialty followed by “lifestyle” among 69%, as having lesser night duties and nature of workload led to choosing a specialty suitable for them.
Approximately 67% of the students considered “benefits” and 63% considered “high financial income” as important motivators to consider, keeping in mind that 55% of the students have an income of 30,000 and above.
On the other hand, 88.9% mentioned that “family member is psychologically ill” to be the most nonimpactful\deterrent to choose a specialty, whereas the “stigma among students” was considered to be a deterrent in 60%, and “program length” was considered by 49%, as the students divided with duration of the postgraduate studies length.
Analyzing the difference in the response to the questionnaire, gender and GPA showed no significant difference. Different genders showed no significant difference in influencing factors (Chi-square, 0.23; P value, 0.64), as well as GPA (Chi-square, 0.03; P value, 0.99). [Table 3]
Table 3.
Gender and GPA wise comparison with career choice
| Variable | Chi-square | df | P |
|---|---|---|---|
| Gender | 0.23 | 1 | 0.64 |
| GPA | 0.03 | 1 | 0.99 |
According to these results, students were more concerned with lifestyle and availability of positions.[7]
Discussion
This study was conducted with an objective to identify the motivators and deterrents for choosing psychiatry as a specialty. A total of 81 students participated in the study. Among them 85% of the final-year students preferred other specialties over psychiatry (Need of MOH). The choice was influenced by several factors, with availability of job positions and lifestyle being the most important motivating factors having a strong influence on students’ specialty choice. Surprisingly, having a family member who is psychologically ill was a deterring factor [Table 4].
Table 4.
Factor-wise comparison of student career choice
| Factors | Motivators | No impact/Deterrent | Chi-square | df | P |
|---|---|---|---|---|---|
| Lifestyle (Less number of night duties, nature of workload) | 56 (70%) | 24 (30%) | 3.16 | 1 | 0.096 |
| Family member is psychologically ill | 9 (11%) | 72 (88.9%) | 13.31 | 1 | 0.003 |
Another study conducted in London conducted among psychiatry trainees showed that early exposure and a positive role model were very influential factors.[7] Moreover, availability of posts after graduation was very valuable. It was suggested that raising awareness in secondary schools, challenging the stigma among medical educators, and promoting more integration within the medical specialities improves medical attitude and promotes enrolment into psychiatry.
Another study conducted in Riyadh investigated the career preferences of 109 first-year medical students (57 females and 53 males), and showed that the top speciality choices were general surgery (23%), pediatrics (18%), and dermatology (15%). Important factors affecting these choices included primary aptitude, advice of peers, reputation, financial rewards, and the challenges involved.[10]
In a cross-sectional online study done among 502 students in Singapore[11] showed that several factors categorized as non-medical factors influenced choosing psychiatry as a career choice, i.e., preschool influence, interest in the field, and having a family member or close contact with psychiatric illness. Among medical factors, i.e., attending psychiatry health club and having an optional elective course in the speciality were significant factors for choosing to enrol in psychiatry. Having a negative attitude toward psychiatry, being uninterested, and prior training with some level of responsibility on psychiatric patients were strong deterrents for choosing psychiatry.
In a 20-country study involving 2198 students conducted to determine the factors influencing their choice of psychiatry,[12] only 4.5% of students reported psychiatry as their first choice as a career specialty. Female gender along with a personal experience of psychiatric illness and media portrayal of doctors were associated with positive choices of psychiatry. In the study, males were less likely to choose psychiatry than females as (16% vs. 21%) unlike our study which showed no gender difference.
Conclusion/Recommendation
This study concluded that several factors played an important rule in the career choice such as available job positions and lifestyle. GPA and gender did not have any impact on the decision regarding career choice. The study had some limitations which need to be addressed to generalize the results on a broader level. Our first limitation is that the study was done only in one medical college and with one batch of final-year medical students. It is imperative to expand it to other universities and internship students. The second limitation was the duration and time of the study. The study was conducted when many students were busy in their midterm examination and data were collected in a month, which might be the reason for low response rate, especially from female students. More research is recommended on a larger scale. It is recommended that psychiatry teaching should be improved by adopting a longitudinal approach with other medical sciences field. Ministry of Health in Saudi Arabia and medical colleges should develop programs to raise awareness.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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