Saudi medical students' views on obstetrics and gynecology as a future career specialty.

BACKGROUND: The specialty of obstetrics and gynecology is showing a widening gap between the vacant positions and the number of applicants as reported by the Saudi Commission for Health Specialties (SCFHS). This study was conducted to explore the medical students' views on obstetrics and gynecology as a future career and identify factors influencing these views.
METHODS: An observational survey was conducted on 148 medical students in years 5 and 6 at Jazan University between June 2019 and July 2019. Participants completed a self-report online questionnaire covering their sociodemographic details, interest in obstetrics and gynecology, and views on the specialty.
RESULTS: Overall, obstetrics and gynecology was selected as the first specialty choice by 8.8% and second choice by 17.6%. Intention to take a career in obstetrics and gynecology was associated with female sex (P = 0.01). While over half of the participants emphasized the merits of obstetrics and gynecology as exciting, interesting, and challenging, over 40% viewed the specialty as stressful, over one-third described it as demanding, and over one-quarter appreciated its riskiness.
CONCLUSION: This study showed that 8.8% of the respondents chose obstetrics and gynecology as their first career choice. Sex was the only factor influencing the views of medical students on the specialty, with more females favoring the specialty than males. To improve its appeal, students should be supplied with more information about the specialty and its training opportunities, as well as exposure to areas of special interest. Copyright: © Journal of Family Medicine and Primary Care.

Introduction

Obstetrics and gynecology is one of the major medical specialties that medical graduates can take as a future career and it is one of the least attractive specialties to medical students. Some authors suggest that the specialty is facing a recruitment crisis given the decreasing numbers of medical graduates expressing an interest in the specialty.[1] In 2006, Turner et al.[2] reported that obstetrics and gynecology was not as appealing and popular career choice for medical graduates as it has been. They conducted a large survey in London including 24, 623 young graduates between 1974 and 2002 and found a large fall in interest in obstetrics and gynecology. In a longitudinal cohort study conducted by the British Medical Association, 5% of doctors planned to specialize in obstetrics and gynecology, but this had fallen to only 1% by 2002.[3] A similar trend has been observed in the United States of America,[4] Oman,[5] and the Kingdome of Saudi Arabia (KSA).[6]

The 2008–2009 report from the Saudi Commission for Health Specialties (SCFHS) showed a widening gap between the vacant positions in obstetrics and gynecology and the number of applicants for the specialty.[7] Therefore, an alarming disparity has emerged between the demand for obstetricians and gynecologists and the number of applicants, which may lead to underachievement and reduced quality of care provided by overwhelmed physicians in the field. As a result, this may lead to patient dissatisfaction, increased rates of complications, and medico-legal actions.[6]

Several studies have been concerned with the medical students’ perceptions of obstetrics and gynecology as a future career and factors influencing their interest in the specialty.[2356891011] Morgan[12] surveyed medical students and junior staff in London to explore their aspirations for a career in obstetrics and gynecology. He found that students who were interested and remained committed to obstetrics and gynecology perceived the specialty as “exciting,” “rewarding,” combining “surgery and medicine,” and “cross-disciplinary.” These students “enjoyed rotation” in obstetrics and gynecology and perceived the learning environment as “good teaching” and “involved.” The reasons for a future change of mind about taking a career in obstetrics and gynecology were fear of litigation, the implications for family life, and being on call. Other studies found those interested in obstetrics and gynecology were more likely to select it as their first choice at an early stage, to be females, and to aim for a narrow scope of practice.[10]

College of medicine at Jazan University is one of the main teaching institutions in the KSA, with around 90 medical graduates every year. Finishing two teaching blocks in obstetrics and gynecology is mandatory, with the blocks taking place in the fifth and sixth years of medical school. We conducted a survey of all fifth and sixth-year medical students at Jazan University to explore their views on obstetrics and gynecology as a future career and identify factors influencing these views. The findings of this survey can help improve the curriculums for medical education, planning the objective of delivering adequate demand and supply of physicians in the field, and determining learning priorities.

Materials and Methods

In this observational survey, fifth and sixth-year undergraduate medical students who finished core learning blocks in Obstetrics and Gynecology I and II were invited to complete a structured questionnaire formulated on a previous study with similar objectives.[11] All students were sent a link to an online survey from June 2019 to July 2019. Participation was only allowed after providing written consent. The questionnaire included sociodemographic characteristics (5 items), perception of obstetrics and gynecology as a future specialty (1 item), and views on the specialty's merits (5 items) and demerits (5 items). Views were assessed using a 5-point Likert scale, with one indicating “too bad,” five indicating “too good,” and 3 indicating “neither bad nor good.” The online questionnaire was available for one month; thereafter, students’ responses were collected and prepared for statistical analysis.

The mean and standard deviation was calculated for continuous variables. Categorical variables were presented as frequencies and percentages. The Chi-square was used for comparison between the sociodemographic data and students’ views. Differences were considered significant if P < 0.05. Data were analyzed using the Statistical Package of Social Sciences (SPSS) Version 20 (SPSS Inc., Chicago, IL).

Results

The study involved a total of 148 participants from years 5 (54.7%) and 6 (45.3%); 52% of them were males. The mean age of respondents was 23.1 years (SD 1.4 years). Sociodemographic features of the study population are shown in Table 1.

Table 1

Sociodemographic features of the study population

Variables	n	%
Age (years)	23.1 (1.4)*
Sex
Male	77	52.0
Female	71	48.0
Year of study
5th	81	54.7
6th	67	45.3
Marital status
Single	136	91.9
Married	12	8.1
Economic status
More than enough	71	48.0
Enough	65	43.9
Less than enough	12	8.1

*These values are presented as mean (standard deviation)

Table 2 summarizes the respondents’ interests in obstetrics and gynecology as a future career and factors likely to influence these interests. A total of 8.8% expressed their strong interest in obstetrics and gynecology as their career choice, while 17.6% would consider it as a second specialty of choice. Females were more likely than males to consider a career in obstetrics and gynecology (P = 0.01). The perception of opportunities to train in obstetrics and gynecology, attitudes toward a split between obstetrics and gynecology, and the effect of such a split on career interests are shown in Table 2. Over two-thirds (68.2%) of participants were not sure about their opportunities to secure a training position in obstetrics and gynecology and 16.9% perceived the current positions as limited, while only 14.9% viewed opportunities to train in the specialty as good. While 58.1% of participants disagreed with splitting obstetrics and gynecology, a considerable proportion (31.1%) agreed and 10.8% were not sure. Over one-quarter (25.7%) wanted to focus on obstetrics, 16.9% wanted to focus on gynecology, and 41.9% wanted to have both in their future careers [Table 2].

Table 2

Respondents’ interests in obstetrics and gynecology as a future career and factors influencing these interests

Perceptions	n	%
Career intentions regarding obstetrics and gynecology
First choice*	13	8.8
Second choice	26	17.6
Not interested	109	73.6
Opportunities to train in obstetrics and gynecology
Good	22	14.9
Limited	25	16.9
Not sure	101	68.2
Attitudes toward splitting of obstetrics and gynecology
Agree	46	31.1
Do not agree	86	58.1
Not sure	16	10.8
Effect of split on attractiveness of the specialty
Yes, as I would like to concentrate on obstetrics	38	25.7
Yes, as I would like to concentrate on gynecology	25	16.9
No, as I would like a bit of each	62	41.9
No, as I do not like it any way	23	15.5

*Significantly associated with sex (Pearson Chi-Square=8.807; P=0.01)

As shown in Table 3, the majority (73.6%) of students were not interested in obstetrics and gynecology as a future career. Further analysis revealed that 58.1% were attracted to other specialties, 6.1% chose to pursue primary care, and 9.4% were undecided.

Table 3

Career choice of respondents who were not interested in obstetrics and gynecology

Choice*	n	%
Other specialties	86	58.1
Working as a GP	9	6.1
Undecided	14	9.4

GP: General practitioner. *Calculated for those who were not interested in obstetrics and gynecology (n=109)

Table 4 shows that over half of the participants expressed their agreement with the advantages of obstetrics and gynecology as exciting, interesting, and challenging. On the contrary, over 40% viewed the specialty as stressful, over one-third described it as demanding, and over one-quarter appreciated its riskiness [Table 5].

Table 4

Respondents’ views on the suggested merits of obstetrics and gynecology as a future career

Merit	1 (too bad) %	2 (bad) %	3 (neither bad nor good) %	4 (good) %	5 (too good) %
Exciting	5.4	23.0	17.6	33.8	20.3
Interesting	6.8	23.0	14.9	35.8	19.6
Fulfilling	7.4	24.3	30.4	28.4	9.5
Rewarding	6.1	12.8	35.1	27.0	18.9
Challenging	11.5	23.0	10.1	42.6	12.8

Table 5

Respondents’ views on the suggested demerits of obstetrics and gynecology as a future career

Demerit	1 (too bad) %	2 (bad) %	3 (neither bad nor good) %	4 (good) %	5 (too good) %
Demanding	12.8	29.1	24.3	23.6	10.1
Boring	2.7	24.3	37.2	30.4	5.4
Stressful	10.1	20.3	27.7	30.4	11.5
Incompatible with family life	4.1	27.0	44.6	14.9	9.5
Risky	22.3	30.4	18.9	23.6	4.7

Discussion

The main objective of the present survey was to explore the views of medical students on obstetrics and gynecology as a future career specialty. A key finding of this study is that 8.8% of the respondents chose obstetrics and gynecology as their career choice. This confirms the previous results that only a low percentage of medical students considered obstetrics and gynecology as the first specialty choice.[2511] A similar percentage (9.7%) was reported in central KSA.[6] The finding that 17.6% of the respondents indicated that they would select the specialty as a second choice is lower than what was reported by Ismail and Kevelighan in the United Kingdome.[11] However, these findings collectively show that students can be persuaded to reconsider obstetrics and gynecology as a future career. Identifying potential factors that influence the career choice among medical students and their perception of obstetrics and gynecology is one important way to popularize the specialty and improve its appeal.[1011]

In agreement with the previous research findings,[11131415] the analysis showed that students who were interested in taking a career in obstetrics and gynecology were more likely to be female (P = 0.01, as shown in [Table 2]). In the KSA, only one study addressed factors affecting the medical students’ intentions regarding obstetrics and gynecology as a future career and showed no sex difference, though the percentage of females who were interested in the specialty was slightly more than the percentage of males.[6] Al-Faris et al.[16] reported that men were more likely to choose surgery and women were more likely to choose obstetrics and gynecology and ophthalmology. Factors that influenced the students’ career choices were “personal interest,” “availability of postgraduate training,” “a chance to help people,” “a chance to help people,” and “prestige.”

Interestingly, over two-thirds of the respondents were unaware of their opportunities to secure a training position in obstetrics and gynecology and 16.9% perceived their opportunities as limited. These findings are in line with what was found by the previous research.[11] Newton et al.[17] demonstrated that awareness of the opportunities of specialization and training have a significant influence on graduate students. Therefore, these findings open the door for interventions aiming at improving the appeal of the specialty among medical students. Such interventions may include orientation workshops, lectures, or brochures, although the effectiveness of these interventions has not yet been established.

It is encouraging that over half of the participants perceived obstetrics and gynecology as exciting, interesting, and challenging. Attempts to increase exposure to the specialty would further reinforce this positive perception among medical undergraduates.[11] It is also noteworthy that over one-third viewed the specialty as stressful, demanding, and over one-quarter perceived it as risky. Such negative views can be addressed with the aforementioned methods of intervention.

It is noteworthy that that over half of our respondents (58.1%) expressed their interests in specialties other than obstetrics and gynecology, which is in accordance with the reported preference to specialize among Saudi medical students.[181920] Ashour et al.[21] conducted a study of career preferences among medical students and interns at King Abdulaziz University, KSA and found that 9.1% were undecided about their specialty of choice, which supports our finding that 9.4% of Saudi medical students were not sure whether they would like to pursue a particular specialty or continue to work as generalists. A new finding this study presented was that 6.1% of the surveyed students chose a career in general practice. Despite the shortage of general practitioners, the proportion of physicians interested in primary care has been decreasing both in developing and developed countries.[2223] These findings warrant further investigation to explore what pushes medical students away from the practice of primary care. Such studies may address adverse views of the field and help conducting structured interventions aiming at improving the position of primary care among young doctors.

This study has explored the medical students’ views of obstetrics and gynecology as a future specialty and factors influencing these views for the first time in the Jazan region and provided a body of information that could be used to improve the appeal of the specialty. However, the findings of this survey should be interpreted with caution and considered within its limitations. The survey included only students of one academic year in one medical school, thus the findings may not generalize to all Saudi medical students. Studies designed as interviews or focus groups may give more information and further explore the findings of this study.

Conclusions

This study showed that 8.8% of the respondents chose obstetrics and gynecology as their first career choice. Sex was the only factor influencing the views of medical students on the specialty, with more females favoring the specialty than males. Both positive and negative views reported in this study could be used to improve the appeal of obstetrics and gynecology as a future career. In addition, students should be supplied with more information about the specialty and its training opportunities, as well as exposure to areas of special interest.

Declaration of patient consent

The authors certify that they have obtained all appropriate participant consent forms. In the form, the participants have given their consent for their images and other clinical information to be reported in the journal. The participants understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity was guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.