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ORIGINAL ARTICLE
Year : 2020  |  Volume : 22  |  Issue : 2  |  Page : 141-146

Perception and career choice of otorhinolaryngology among final year medical students: a two centre survey in a developing country


1 Department of Otorhinolaryngology, Benue State University, Makurdi, Benue State
2 Department of Ear, Nose and Throat Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakiliki, Ebonyi State
3 Department of Ear, Nose and Throat Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State
4 Department of Ear, Nose and Throat Surgery, Irrua Specialist Hospital, Irrua, Edo State
5 Department of Ear, Nose and Throat Surgery, Jos University Teaching Hospital, Jos, Plateau State
6 Department of Ear, Nose, and Throat Surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu, Enugu State

Date of Submission17-Apr-2020
Date of Decision05-Jun-2020
Date of Acceptance16-Jun-2020
Date of Web Publication11-Sep-2020

Correspondence Address:
A Adekwu
Department of Otorhinolaryngology, Benue State University, Makurdi, Benue State
Benue State
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jomt.jomt_17_20

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  Abstract 


Background: Otorhinolaryngology (ORL) cares for pathologies involving the ear, nose, throat, however in the developing countries, it does not attract much patronage from young doctors thereby resulting in shortage of manpower in the subspecialty. This study was to assess the perception of otorhinolaryngology as a career and establish the factors involved in career choice among final year medical students in two universities in a developing country. Methods: A cross-sectional descriptive study undertaken using a self-administered questionnaire designed to assess the perception and determinants of career choice in ORL which was distributed to consenting final year medical students of the Benue State University (BSU), Makurdi and University of Nigeria (UNN), Enugu Campus. Results: A total of 122 questionnaires with complete data were analysed. Males constituted 65.6% while ages of participants were 21 to 37 years. BSU and UNN had 40 and 82 respondents respectively. Surgical specialties were the most preferred choice in 76 (62.3%) then Internal Medicine in 15 (12.3%). Otorhinolaryngology at 11 (14.5%) was the third preferred surgical specialty. Personal interest (78.4%), mentor influence (7.4%) and financial gain (7.4%) were the main determinants of specialty choice. Majority of the respondents 78 (63.9%) viewed Otorhinolaryngology as important and interesting. Modern teaching aids 24 (19.7%), increase in duration of posting 19 (15.6%), mentorship 15 (12.3%) were top suggestions that may attract interest in ORL. Conclusion: This study found that otorhinolaryngology was the third most preferred surgical subspecialty. Personal interest was the overriding reason for career choice among these medical students.

Keywords: Career choice, developing country, medical students, otorhinolaryngology, perception


How to cite this article:
Adekwu A, Ibiam F A, Obasikene G, Agbonifo M, Unogwu S O, Ezeanolue B C. Perception and career choice of otorhinolaryngology among final year medical students: a two centre survey in a developing country. J Med Trop 2020;22:141-6

How to cite this URL:
Adekwu A, Ibiam F A, Obasikene G, Agbonifo M, Unogwu S O, Ezeanolue B C. Perception and career choice of otorhinolaryngology among final year medical students: a two centre survey in a developing country. J Med Trop [serial online] 2020 [cited 2020 Sep 20];22:141-6. Available from: http://www.jmedtropics.org/text.asp?2020/22/2/141/294814




  Introduction Top


Otorhinolaryngology (ORL) is a subspecialty of surgery that is concerned principally with the management of pathologies involving the ear, nose, throat, head and neck. These pathologies include many surgical and non-surgical disease spectrum such as audiology, allergy, speech and voice disorders among others. Otorhinolaryngology has a wide range of clientele from neonates with airway challenges to elderly patients with head and neck tumours.[1] The knowledge of career choice among medical students and young medical graduates is important in every country’s national health and economic planning so that there will be fairly even distribution of human resources to cater for the populace. Specialties that lack adequate manpower need to be incentivized.

Whereas in the developed world, subspecialties of cardiology, ophthalmology and ORL are highly competitive with low success rate for the candidates, in developing countries such as Nigeria, ORL is poorly developed with only very few trained manpower to cater for their teeming populations.[2],[3] For instance, in Canada, there are approximately 715 ORL Surgeons, reflecting 2.1 Surgeons per 100,000 people[4],[5] and in Nigeria, there are still less than 200 trained otorhinolaryngology specialists caring for its estimated 200 million people. Many factors may be responsible for the poor development of this subspecialty such as, inadequate funding of the health sector by successive administrations at various levels, coupled with lack of interest in the choice of ORL in residency training premised on the long duration of training program, perceived ‘hard to understand’ notion by young doctors and inadequate exposure during undergraduate training. [2],[6]

There are several other determinants that affect choice of specialty by medical students such as interest, mentor relationship, financial gain, life style/flexible work schedule, good lecture delivery and good presentation that gives the student an indebt understanding of overview of the specialty.[7] Most medical schools have rotations for their undergraduate students which spans between 3 and 8 weeks which certainly do not accord them enough time to appreciate the specialty. Furthermore, during internship in many centres, the Interns barely have more than a week of rotation in ORL. It was in the light of these challenges that we set out to undertake this study with a view to determining the perception and factors that influence career choice of ORL and how to improve the choice of Otorhinolaryngology among final year medical students of Benue State University, Makurdi (BSU) and University of Nigeria, Enugu Campus (UNN) who have completed their rotations in Otorhinolaryngology. Whereas BSU is a relatively new Medical School (have produced only seven consecutive sets of graduates), UNN on the other hand is a first generation Medical training institution in Nigeria.


  Materials and methods Top


University of Nigeria Medical School (UNMS) is in the South Eastern part of Nigeria and had Medical and Dental Council of Nigeria (MDCN) admission quota of 200 for the studied final year class but the class had student population of 126 students. It also had eight consultant Otorhinolaryngologists. The Benue State University Medical School (BSUMS) is a state-owned institution in the North Central region of the country, with an MDCN approved admission quota of 75 but the study final year class had student population of 44 students. The Medical school had one consultant Otorhinolaryngologist on its staff.

This cross-sectional descriptive study population was all the 170 final year medical students of both medical schools. The students were counselled of the study aim, objectives and methods and their individual consent sought. Participation was voluntary, anonymous and confidentiality assured. The study was approved by the Human Research Ethics Committee of Benue State University Teaching Hospital, Makurdi before the commencement of the study. Informed consent was also obtained from the respondents.

The questionnaire had the following parts namely (A) Demography/Work Experience/University Name (B) Specialty of choice which included Community Medicine, Family Medicine, Internal Medicine, Obstetrics/Gynaecology, Paediatrics, Pathology and Surgical Specialties, (C) Reason for the choice of specialty whether interest, financial gain, peer group influence, parental influence, mentor influence, life style/flexible work schedule and others and (D) if your choice is surgical specialties, which would that be among Anaesthesia, Cardiothoracic Surgery, General Surgery, Neurosurgery, Ophthalmology, Orthopaedic Surgery, Otorhinolaryngology (Ear, Nose and Throat Surgery), Paediatric Surgery, Plastic Surgery and Urology. The final part evaluated the student’s perceptions about Otorhinolaryngology as a specialty (exploring student’s view) whether it is important and interesting, interesting but not important, boring, and difficult to understand and students’ perceptions about Otorhinolaryngology (exploring students’ expectations and thoughts) what they thought could be done to attract interest in the specialty and improvement they would like to see in ORL teaching.

Data were collated on Excel® spread sheet and analysed using Statistical Package for the Social Sciences version 16.0 for Windows (SPSS Inc., Chicago, IL, US) and the results were presented as tables and charts.


  Results Top


All the study population of 170 students were eligible for the study, however, only 150 consented to participate in the study. Of the 150 distributed questionnaires, 122 questionnaires, were correctly filled and returned corresponding to 81% response rate and were subsequently analysed. There were 82 and 40 respondents from UNMS and BSUMS respectively. They were 80 (65.6%) males and 42 (34.4%) females giving a ratio of 1.9:1 while age of participants ranged from 21 years to 37 years [Table 1]. The medical school course, was the first undergraduate experience for 103 (84.4%) of the respondents while 19 (15.6%) of them had either attended or graduated from a tertiary institution prior to entering medical school. Thirty-five (28.7%) of the participants had previous work experience elsewhere before admission into Medical School while 87(71.3%) did not.
Table 1: Age, sex and specialty choice distribution of respondents (n = 122)

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Surgical specialties were the most preferred choice in 76 (62.3%) of the participants, followed by Internal Medicine in 15 (12.3%). Of the 76 that chose surgical specialty, 19 (25%), 12 (15.8%) and 11 (14.5%) of them preferred General Surgery, Ophthalmology and Otorhinolaryngology respectively [Figure 1]. Personal interest was reason for the specialty choice in the majority of the students accounting for 96 (78.7%) while mentor influence and financial gain were responsible in 9 (7.4%) each [Figure 2]. Majority of the respondents; 78 (63.9%) viewed Otorhinolaryngology as important and interesting, however 21 (17.2%) and 17 (13.9%) said it was difficult to understand and boring respectively [Figure 3].
Figure 1: Choice of surgical subspecialty

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Figure 2: Factors influencing choice of specialty

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Figure 3: Perception of respondent on Otorhinolaryngology

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Several suggestions that will attract interest in ORL were made such as use of modern teaching aids (mannequins, diagrams, audio-visual aids) by 24 (19.7%), increase in duration of posting by 19 (15.6%), mentorship by 15 (12.3%), and good concise lecture notes/delivery by 11(9.0%). Hands-on practical exposure, creating awareness and the provision of undergraduate specific textbooks each were suggested by nine (7.4%) students. Other suggestions included video-assisted surgical procedures (6.6%), more incentives (4.1%), more accredited residency training centres (2.4%), ORL topics should be taken during the major surgery postings (2.4%) and reduced duration of residency training (0.8%).


  Discussion Top


The response rate in this study was 81% with majority (44.3%) of them in the age range of 24-27 years. Eke et al.[8] in their study of Surgery as career choice among Interns in Makurdi, had 84% response rate, and largest age distribution in the 30–34 years age range. However, our majority age range agrees with the findings of similar studies from Thailand, Brazil, and Saudi Arabia with mean ages of 26.2, 25.4 and 22.8 years respectively but differs from that of Canada where most of them were older at 30­±2 years.[5],[9] These differences in age may be due to the fact that in the low- and medium-income countries, medical schools degrees are done as undergraduate courses where students attend at an early age while in the high income country, it is a graduate course where obtaining a Premed degree is a prerequisite.

Surgical specialties, Internal Medicine, Obstetrics/Gynaecology and Community Medicine at 62.3%, 12.3%, 7.4% and 7.4% respectively were the top three most preferred specialties by these students in this study while Pathology (4.1%), Paediatrics (3.3%) and Family Medicine (2.5%) have the least attraction. This is in tandem with earlier studies in Nigeria[10],[11],[12] but differs with regards to paediatrics as it has always been among the most preferred specialty.

When surgical specialties were considered on their own, General Surgery (25.0%), Ophthalmology (15.8%), Otorhinolaryngology (14.5%) and Paediatric Surgery (13.2%) were the commonly preferred specialties in that order while Cardiothoracic Surgery (5.3%), Urology (3.9%), Anaesthesia (3.9%) and Plastic Surgery(1.3%) were the least favoured. This is in agreement with the report of Ossai et al.[12]in South Eastern Nigeria where respondents interests in the clinical specialties was mainly surgery at 24.0% but differs sharply where ORL at 0.2% was the least preferred. Similarly, Akpayak et al.[2]in Jos, North Central Nigeria, reported a preference for General Surgery with ORL being among the not frequently chosen career leading to shortage of such specialists. This they attributed to the very short period of rotation by the students which in most cases is less than 4 weeks which do not accord them enough time to appreciate the specialty and make an informed decision on career choice in the affected discipline. Our study group had their postings for 8 to 10 weeks.

Studies from other parts of the world reported more preference to career choice in ORL. Alamri et al.[9]in a large cohort study in Saudi Arabia involving 1516 medical students from different universities, found 27% of their respondents preferring ORL as their future specialty as compared to 24.6% and 41.6% from single institution studies in the same country by Abdulgani et al.[13]and Qorban et al.[14]. Also in Kenya, Dossajee et al.[15] found only 9% of their studied final year medical students to be interested in ORL based on various factors. Alamri[9] and Abdulgani[13]believed that students make better career choices when they have ‘greater exposure, more knowledge, and proper insight’. They therefore, advocated for increase in the time allotted for the subspecialty rotation. Qorban et al.[14] observed that complex factors come into play in career selection by the students and recommended career education for proper guidance. Since many factors come into play in career choice among medical students, we tend to agree with increase in duration of rotation and career counselling to these undergraduates preferably in their final year for proper career guidance.

This study found personal interest to be the overriding reason for career choice among this set of medical students, followed by financial gain and mentor influence. This agrees with findings of Yang et al.[16]in their systematic review and meta-analysis of factors influencing subspecialty choice among medical students, where interest at ‘effect of their influence’(EOI) of 75.29% and income (EOI of 34.70%) were the main facilitators in determining subspecialty choice. Likewise Madu et al.[17]in Eastern Nigeria found interest (78.9%), and Odusanya and Nwawolo[18] in Lagos established that interest at 72.9% and job satisfaction(69.0%) were the predominant determinants. The study in Jos, North Central Nigeria by Akpayak[2] found personal interest, possibility of job satisfaction, financial reward and societal perception among medical students as the dominant reasons for selecting career which was corroborated by Eke et al.[8] in their recent work on interns from the same region of Nigeria. However, our findings contrast sharply with Ossai et al.[12]in South Eastern Nigeria where respondents’ personal interest in specialty constituted the second determinant at 19.7% of specialty choice. Other studies that disagreed with ours include Alamri et al.[9] in Saudi Arabia, McCaffrey[7] and Newton et al.[19]in USA, and Wright et al.[20]in Canada which found lifestyle and income to be the main factors that influenced career choice by medical students. Mwachaka and colleagues [21] in Kenya cited role model in the specialty, job opportunities and financial reward, and intellectual challenge as some of the strong determinants of career choice while Qorban and colleagues[14] observed “secured and respected job, opportunity to meet patients of different age groups, appreciative patients, versatile, challenging work, and long-term doctor-patient relationships” as the main factors outlined by their respondents. The implication of our finding is that the uneven distribution of clinicians in the various subspecialties is not dependent on increase wages alone but on their personal interests among others, hence concerted efforts should be made to identify and stimulate the students’ professional interest which may help to improve the imbalance in the medical workforce. There is the possibility that when personal interest is the overriding determinant of career choice, the chances of discouragement and depression in the individual is minimised when work pressure increases.

Otorhinolaryngology was perceived as important and interesting by 63.9% of the respondents but difficult to understand (17.2%), boring (13.9%) and interesting but not important (4.9%). This agrees with the finding of Qorban et al.[14] who in Saudi Arabia reported that 68% of their respondents disagreed that ORL was less important than other specialties. There is no doubt that ear, nose, throat, head and neck play significant role in everyone’s health as alluded to by Hauer et al.[22] who recorded that 95% of their studied population were of this opinion. Based on our finding, it is necessary to build on the assertion by these students, hence it becomes important to seek to attract their interests in this subspecialty. To achieve this, the use of modern teaching aids, increase in duration of posting, mentorship, concise lecture notes, hands-on practical exposure and provision of undergraduate specific textbooks were the main suggestions by this group of students. Yang et al.[16] observed that competences acquired by students during their undergraduate training was the second determining factor in subspecialty choice and advocated that “medical education should focus more on enhancing students’ personal competences alongside their academic interests”. The dearth of specialists currently being experienced in ORL will increase workload leading to less attention to teaching or poor lecture delivery and absence of mentoring which will discourage students from choosing this subspecialty thereby worsening the disparity in the medical workforce. The effect of mentoring relationship was reported by Alamri et al.[9] where 30% of their respondents stated that it influenced their preference of otolaryngology. In the light of these, we advocate that some of these highlighted suggestions by the respondents’ be looked into by the trainers with a view to improving on the lecture delivery and better understanding of the subspecialty. This becomes imperative when we consider the 17.2% and 13.9% of the respondents’ in this study who viewed ORL as difficult to understand and boring respectively.

This study found that otorhinolaryngology was the third most preferred surgical subspecialty which is quite encouraging. Personal interest is the overriding reason for career choice among these set of medical students. Although majority of these students perceived ORL as important and interesting, we recommend that they be encouraged and attention be given to their suggestions of improved teaching methods and developing harmonised exciting course content for every medical school, in order to attract them to the subspecialty. Based on the varied reasons for career choice we also advocate the introduction of career guidance and counselling at a stage in medical school training for career direction.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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