Assessment of factors influencing the choice of ophthalmology as a post-graduation speciality among medical undergraduates

 

 

Abstract               Background: Selection of post-graduation speciality is very critical and crucial decision for medical students and it is influenced by intrinsic and extrinsic factors. Ophthalmology is very important part of primary care in India. Aim: To determine factors associated with preference of Ophthalmology as post-graduation speciality. Material and Methods: Descriptive cross-sectional questionnaire based study conducted on 247 medical undergraduates in private medical college in India. Results: Age range of students and interns was 22 to 25 years with mean age of 23.5 years. Female (47.7%) to Male (52.3%) ratio was 1:1.09. Out of total 247 students and interns, 28% were willing to take ophthalmology, 29% were not willing to take ophthalmology and rest 43% students and interns were not sure about their preference. Interest in ophthalmology and surgical branches, no emergency, influence of teacher, good life-work balance and new techniques were commonest reasons for preference while commonest reasons given by them for non-preference were dislike for surgical branch, saturation in field and expensive equipment. Income potential and investment requirement were two important pull factors. Conclusion: Interest in ophthalmology being a surgical branch, influence of role models, good work-life balance and opportunities to learn newer techniques were major attractive factors but saturation, return on investment, need of super-speciality education were some repelling factors. So this study will help the Medical Education and Ophthalmology experts to modify the system to persuade more students so that they will contribute to the enhancement of the field.

Keywords: Medical education, Ophthalmologist, Post graduation studies, NEET PG, Stress

 

INTRODUCTION

India has a total of 479 medical colleges with an annual intake of 67,218 MBBS students.¹At present, there are over 23,000 post-graduation seats per year in government and private medical colleges across India.² Selection of post-graduation speciality is very critical and crucial decision for medical students and this is ongoing process throughout their MBBS education period. The decision largely depends upon performance in entrance examination but the preferences for speciality are influenced by intrinsic (personal attributes, gender and preferences) and extrinsic factors (Patient load, emergencies, lifestyle and flexibility of the speciality and work environment).^3-6 Ophthalmology is very important part of primary care in India. The role of an ophthalmologist is very important in National Program for Control of Blindness (NPCB), vision 2020 especially at the level of sub-district hospital and above.^7,8 But, there are deficiencies of ophthalmologists at this-levels.^9,10 Ophthalmology is a unique field of combination of surgery and medicine speciality. There are many attractive factors for preference towards ophthalmology as post-graduation subject but there are factors like extensive investment, return on that investment and other factors which may alter these preference. Therefore, knowing the details of these factors that influence medical graduates decisions regarding ophthalmology as their post-graduation speciality can help in taking suitable measures in due course of time. So this study was conducted on medical students to determine factors associated with preference of Ophthalmology as post-graduation speciality in medical college in India.

 

MATERIAL AND METHODS

An observational descriptive cross-sectional study was conducted in a private medical college in Maharashtra, India on medical students and interns from July 2019 to December 2019. The aim of the study was to find out factors influencing preference of medical students and interns towards ophthalmology as post-graduation speciality. Medical students and interns of both genders who were willing to participate were included in study. Total 250 medical students (final year) and interns were enrolled but out of that 3 interns did not submit responses. Institutional Ethics Committee (IEC) permission was taken before commencement of data collection. Standard operating protocol and definitions were formulated at the beginning and followed throughout the study period. Written informed consent was taken from each participant after explaining study procedure in details. Confidentiality of identity of study participants was maintained. Information was collected through pretested and structured questionnaire. Information was collected using google forms having details like age, gender, preference of speciality subjects, reasons for opting in/ opting out Ophthalmology as speciality subjects etc. Collected information was then compiled in Microsoft Excel 2013 and analysed with SPSS v.16. Multiple responses were segregated and arranged in informative manner. Descriptive statistics like frequency, proportion, range and mean were used while Chi-square test used to draw inference (p<0.05). Tables and graphs used at appropriate places to present data.

 

RESULTS

TABLES AND FIGURES

Table 1: Do you want to take up ophthalmology for your post graduate studies? (n=247)

Responses	Male		Female		Total
	Frequency	%	Frequency	%	Frequency	%
Yes	28	40.57	41	59.43	69	100
No	43	59.72	29	40.28	72	100
May be	58	54.71	48	45.29	106	100
Total	129	52.3	118	47.7	247	100
Chi-square test value=5.636; p=0.059; Not significant

 


Figure 1: Do you want to take up ophthalmology for your post graduate studies?- YES (n=69)


Figure 2: Do you want to take up ophthalmology for your post graduate studies?- No (n=72)

Table 2: Do you want to take up ophthalmology for your post graduate studies?- May be (n=106)

Reasons		Frequency	%
Yes	Interest in the subject	18	16.98
	Like a surgical branch	38	35.85
	Like a relatively non-emergency branch	30	28.30
	Influenced by your teachers	11	10.38
	Good work life balance	23	21.70
	Like to learn and practice new technology	7	6.60
	It is a clean branch	6	5.66
	Small set up is enough	10	9.43
	ICU X ray and Blood bank support not required	1	0.94
	No risk of contracting serious infection from patients	2	1.89
	Do not want indoor patients	3	2.83
No	Do not want a surgical branch	3	2.83
	High level of skill required	8	7.55
	Learning curve is steep	5	4.72
	Expensive equipment is required	20	18.87
	Earning is less compared to other surgical branches	9	8.49
	Saturation in the field	9	8.49
	Lot of charitable work involved	4	3.77
	Less patient availability because of national programme	8	7.55
	Super speciality is desirable	6	5.66

DISCUSSION

Selection of post-graduation speciality in entrance examination is largely dependent on performance in examination but it also depends on choice or preferences of medical graduates. These preferences largely depend upon prestige of speciality, career opportunities, potential of income generation, work-life balance, preference towards surgical branches, hospital set-up cost, risk involved, patient satisfaction etc. A cross sectional study was conducted on medical students and interns to know their preference towards opting ophthalmology as post graduation study. In present study, female to male ratio was 1:1.09. Female students and interns were more interested in ophthalmology subject as compared to male students and interns. Percentage of male students and interns (54.71%) who were not sure about ophthalmology as post graduation subject was more than female students and interns (45.29%). This difference was found to be statistically not significant (p>0.05). Study done by Abdullah et al.¹¹ on 275 medical students and interns, shows that ophthalmology was first choice for 28 students and interns. Among them 23 were male and 5 were female. This finding is contradictory to current study finding which showed more females were interested in ophthalmology. Study done by Subba et al.¹² reported similar findings with 52.1% females and 47.9% males willing to take up ophthalmology as post graduate subjects. Hussein et al.¹³ also reported similar trend in their study. Anand et al.¹⁴ reported similar findings in their study. The influence of gender on subject preferences also resembled the findings available in the previous literature.^15-17 Good work-life balance was important factor among female students and interns. In current study, interest in ophthalmology and surgical branches were most common reasons for preference. Other common reasons were no emergency, influence of teacher, good work life balance and new techniques etc. Abdullah et al.¹¹ reported reasons for attraction of ophthalmology in their post-graduation study, which were high income (54%), private sector opportunities (40%), opportunities for part time job (40%) and free time for work (34%) and others. Subba et al.¹² reported influencing factors among students which were interest in subjects, job security, job satisfaction, employment scope, prestige and parental coercion. Previous study conducted in Alfaisal University¹⁸ reported, high income generation as common cause for preference. A study conducted on medical students in Jordan reported that income generation is most common factor behind selection of post-graduation study.³ Private sector opportunities in context of more income generation as well as lifestyle improvement were also important push factors in some studies.^19,20 In current study, it was highlighted by reason like good work life balance in 15.94% participants which considered lifestyle, income and free time after work. Similar findings were reported by other studies.^4,6,21 Patino et al.²² reported greater amount of patient satisfaction in ophthalmology as important factor for opting this subject. In current study, learning new things and facing challenges of surgical branches were common reasons for preference to ophthalmology. Similar findings were reported by previous studies.^21,23 Role or influence of teachers was highlighted in many studies.^16-18,23 In current study, influence of teachers was responsible in 17.39% students and interns for giving preference to ophthalmology. Abdullah et al.¹¹ reported reasons for non-attraction of ophthalmology in their post-graduation study, were difficulty in getting ophthalmology in entrance exam, unsatisfied patients, degree of stress, less opportunities to perform procedures etc. In current study, commonest reasons given by participants were dislike surgical branch (30.56%), saturation in field (25%) and expensive equipment (13.89%) etc. Low income generation due to availability of many charitable organizations and presence of National program for control of blindness in India⁷ reduces number of patients. Also costly equipment and set-up were major pull factors. The influence of motivational factors on subject preferences also matched the reports available in the literature.²⁴ Some studies in different countries have focussed different factors like intellectual content or challenge of the specialty.^3,4.23 which was similar to current study findings. Years of training and need of super-speciality after post graduation were important factors in current study. Income potential and investment requirement were two important pull factors in current study like other similar studies in literature.^21-23 Other factors that have been discussed in present study and also noted by previous studies were influence of role models, risk assessment and direct patient contact.^17,18

 

CONCLUSION

This study has been conducted at a very crucial period of medical education process as at this level medical undergraduate has insight of all subjects, especially ophthalmology. So he/she can make better choice at this level. Interest in ophthalmology being a surgical branch, influence of role models, good work-life balance and opportunities to learn newer techniques were major attractive factors but saturation, return on investment, need of super-speciality education were some repelling factors. So this study will help the Medical Education and Ophthalmology experts to modify the system to persuade more students so that they will contribute to the enhancement of the field.

 

  

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