preferences among medical students in a Kenyan university
Maseghe Mwachaka1,&, Eric Thuo Mbugua1
of Medicine, University of Nairobi, Kenya
Maseghe Mwachaka, Department of Human Anatomy, University of Nairobi, P.O. Box
30197 - 00100 GPO, Mobile: +254723353913, Nairobi, Kenya
countries especially in Sub Saharan Africa are faced with a critical shortage
of skilled health personnel. Kenya is ranked as one of the countries with
poorest doctor to patient ratio ranging between 1:25,000 in Nairobi (capital
city) and 1:308,878 in rural areas [1,2].
A survey done showed that specialized medical personnel, such as physicians,
surgeons, obstetric gynecologists, pediatricians, anesthetists and
ophthalmologists, represent a mere 5% of total health workforce .
This clearly depicts a deficiency of medical specialists in Kenya.
of the measures taken by the government to address this shortage was to train
more medical personnel. According to an economic survey by the Kenya Bureau of
Statistics 2007, the total number of medical students training to be doctors in
2000 was 1355 and increased to 2,098 in 2006 [2,3]. In this survey, there was a noted increase in the number
female students training, from 488 in 2000 to 984 in 2006. In spite of this drastic increase in number of
female medical students, specialist distribution in the country continues to
exhibit gender disparities .
order to correct the maldistribution of doctors by specialty, factors
influencing choice and preference of specialty by doctors and medical students
should be identified . Although several studies have
been done to assess the factors that influence career choices among medical
students [5-9] there is scarcity of data from countries in
Sub Saharan Africa. These studies are based on developed countries whose health
care demands differ from developing countries. This study aimed at determining
specialty preferences and factors influencing these choices among medical
students in Kenya.
Setting and participants: University of Nairobi is
the largest and oldest university in Kenya. Its College of Health Sciences
based at Kenyatta National Teaching and Referral Hospital offers a five year
undergraduate degree in medicine and surgery. Students in this program chose of
medicine in their final year of high school or immediately after high school.
With the increasing demand for doctors, the number of students admitted to this
program has also been increasing. In the 2008/09 academic year, there were
1557(874 male and 683 female) students. For this study we enrolled 450
students, ninety per year of study. The survey was conducted between September
and October 2009, coinciding with the last quarter of the 2008/09 academic
year. All participants were informed of the aim of the study and that their
involvement was voluntary. This survey did not require ethical approval because
the data collection was anonymous.
and Measures: Self administered questionnaires (printed) were disseminated and
collected in classrooms for 1st to 5th year students. The
survey took approximately 10 minutes to complete. Information collected
included: gender, marital status, year of study, the specialty they are
interested in, factors that influenced this choice, and timing of specialty
choice. The participants were offered the following list of possible
specialties: surgery, internal medicine, pediatrics, obstetrics and gynecology,
public health, psychiatry, radiology, anesthesiology, pathology, microbiology,
anatomy, physiology, biochemistry, ophthalmology, immunology and other (a write
in option). Option for ‘not yet decided’ was also included. These
specialties were preselected as it was felt they would be clear and distinct
for most students. The participants were allowed to choose only one specialty.
the factors influencing choice of the specialties, the students responded to
the question “Did this factor influence your choice of the specialty?” The
response was either “yes” or “no” to a list that included: encouragement by
teaching or clinical staff, role model in the specialty, job opportunities and
financial rewards, prestige of the specialty, academic and research
opportunities, intellectual challenge in the specialty, lifestyle of practice,
gender distribution in the specialty, ease of raising up a family, ease of
entry into residency, length of residency, lifestyle during residency, and
further training required after residency. These factors were based on similar
published studies [5-9].
Data collected were analyzed using Statistical Package for Social Sciences
version 17.0. We used the modified Schwartz et al 
method to classify the specialties as having either a controllable or
uncontrollable lifestyle. Specialties with uncontrollable lifestyles included
surgery, pediatrics, internal medicine, and obstetrics and gynecology. The
remaining medical specialties were grouped into controllable lifestyle careers.
Chi square test was used to evaluate gender differences as well as compare
between factors influencing choice of controllable and uncontrollable lifestyle
careers. A p-value≤0.05 was considered statistically significant.
the 450 questionnaires administered, 385 (85.6%) were completed and returned.
Male respondents were 217 (56.4%) while females were 168 (43.6%). The response
according to year of study is summarized in Table 1. Sixteen (0.042%) students
were married while the rest were single.
preferences of medical students
Table 2 illustrates the specialty preferences among the students as well as the
actual distribution of specialists in Kenya. Most students, 319(82.8%),
preferred a medical specialty while 8(2.1%) selected non medical careers. The
non medical specialties chosen were business (5 students), law (2 students) and
music (1 student). Fifty eight (15.1%) students were undecided on their future
specialties. Specialties more popular among male students were surgery
76(40.6%) and internal medicine 29(15.5%). Female students were more interested
in pediatrics 40(28.6%) followed by surgery 29(20.7%).
gender differences were observed in the choice of surgery and pediatrics
(p<0.001). Male students had a double-fold likelihood of choosing surgery,
while female students had a five-fold chance of choosing pediatrics. There was
also an increased likelihood of female students preferring controllable
lifestyle specialties such as ophthalmology (odds ratio 3.13), pathology (odds
ratio 2.70), radiology (odds ratio 1.82), microbiology (odds ratio 1.41) and
physiology (odds ratio 1.41). These specialty preferences among male and female
students mirrored the actual gender distribution of specialists in Kenya (Table 2).
influencing specialty preferences
preferences among both male and female students was mainly influenced by
presence of a role model in specialty, job opportunities and financial rewards,
intellectual challenge in the specialty, and research opportunities in the
specialty of choice (Table 3). In addition, compared to female students, male
students selected specialties mainly because of prestige of specialty
(p=0.006). Female students on the other hand mostly considered ease of raising
a family (p<0.001), and gender distribution in the specialty (p<0.001).
Table 3 also illustrates the factors influencing choice of controllable and
uncontrollable lifestyle specialties. Female students significantly preferred
controllable lifestyle careers than males because of ease of raising a family
(p<0.001) and gender distribution in these specialties (p=0.023).
Preference of uncontrollable lifestyle among male students was largely due to
prestige of the specialty (p=0.006), while among female students was
mainly due to length of residency (p=0.010) and gender distribution in
the specialty (p<0.001).
a career is a complex process and may be influenced by several factors. This
study aimed at determining specialty preferences and factors influencing these
choices among male and female medical students in Kenya. We found significant
gender differences in the choice of surgery and pediatrics. Male students had a
special liking for surgery while their female counterparts preferred
pediatrics. Previous studies in other countries have also reported similar
gender differences in doctors’ and medical students’ specialty choices and
preferences [5-8,10]. Some factors
such as control of lifestyle and work balance have been identified as been
related to women’s specialty preferences and choices [9-11].
though in our study most students, both male and female, preferred
uncontrollable lifestyle specialties, there was a higher likelihood female
students selecting a controllable lifestyle specialty. Controllable lifestyle
careers have been defined as those that allow more personal time free of
practice requirements for leisure, family, and control of total weekly hours
spent on professional responsibilities [7,9].
Studies have further shown that women are more likely to integrate family
responsibilities with a career, and therefore they consider flexibility of work
and opportunity for part time working in their choice of careers [11-14]. In agreement with these authors, female students in
the current study significantly considered specialty’s lifestyle of practice
and easy of raising a family.
models especially of the same gender have been reported as a key factor in
career choice [11,12]. Female
students are discouraged from specialties such as surgery as there are few
female surgeons to look up to as role models [15,16]. Consequently these students turn to other specialties
that have more female representation such as pediatrics .
This explains the observed high preference of pediatrics among female students
in the current study. These students significantly considered specialty’s
gender distribution. Studies have also shown that women suffer more gender
discrimination than males in male dominated specialties, and this has been
reported to deter their choice of these specialties [18,19].
though pediatrics was the most popular area amongst female students, surgery
was the second most popular with up to two fifths of the female students
selecting it. The popularly held notion that surgery is ‘men only club’ [15,16] may become history if more
females take up surgical careers. It is possible that with the increasing
number of female medical graduates some venture in previously male dominated
areas and provide role models for those still training. Factors driving women
to previously male dominated specialties appear to be similar to the ones
driving men to the same specialties. These include job opportunities and
financial gains, intellectual challenge, and availability of academic and
results of this study should be viewed in the context of the following
limitations. Firstly we measured specialty preference at one point in time. It
is known from literature that specialty choice does not remain stable over the
course of medical education. Students tend to use their clinical years as well
as internship period to refine their specialty preferences. Secondly, the study
was only conducted in one medical school. Thus, the results may not be
generalized to the entire country. However this study serves as a pilot for
future, more comprehensive cohort studies following up the students from the
early years in medical school to the actual time they choose the specialties.
also dichotomized selected specialties into controllable or uncontrollable
lifestyle. This classification is an oversimplification as lifestyle among and
within the specialties is variable. Other ways of classifying specialties have
been introduced such as technique oriented versus person oriented, and primary
care versus non primary care specialties [20,21]. However, these classifications also have their own
limitations. Even though classifying specialties according to lifestyle is
subjective, multiple studies have validated this designation used by Schwartz
and colleagues [5,7,9,11,12,22].
study has revealed similarities and differences in specialty preferences and
factors influencing these choices among male and female students in Kenya.
Specialty preference among the students is corresponds to the specialist doctor
distribution in Kenya. Enthusiasm and encouragement
from a role model has the ability to give students the necessary conviction
that they can succeed in any discipline. Thus, barriers caused by a lack of
same sex role models in certain specialties must be recognized and addressed.
There is also need for more career education in order to match the
career preferences of students with the demands of the labor market.
authors declared they have no conflicts on interests
Literature review, Data collection, Data analysis, Manuscript write up, EM:
Research question, Data collection, Data analysis, Manuscript write up.
Table 1: Response rate according to the year of study
Table 2: Specialty preferences among students and specialist distribution in Kenya
Table 3: Factors influencing specialty preferences
authors would like to acknowledge all medical students at the University
of Nairobi-Kenya who took part in the study.
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