Specialty career preferences among final year medical students at the school of medicine, Makerere University College of health sciences, Uganda

Job Kuteesa, Mulago National Referral Hospital, Uganda
Victor Musiime, Makerere University College of Health Sciences, Uganda
Ian Munabi, Makerere University, Uganda
Aloysius Mubuuke, Makerere University, Uganda
Robert Opoka, Aga Khan University
David Mukunya, Makerere University, Uganda
Sarah Kiguli, Makerere University, Uganda

This work was published before the author joined Aga Khan University.


Background: Uganda has an imbalanced distribution of the health workforce, which may be inuenced by the specialty career preferences of medical students. In spite of this, there is inadequate literature concerning the factors inuencing specialty career preferences. We aimed to determine the specialty career preferences and the factors inuencing the preferences among fth year medical students in the School of Medicine, Makerere University College of Health Sciences (MakCHS).

Methods: A sequential explanatory mixed methods study design with a descriptive cross-sectional study followed by a qualitative study was used. A total of 135 nal year medical students in MakCHS were recruited using consecutive sampling. Self-administered questionnaires and three focus group discussions were conducted. Quantitative data was analysed in STATA version 13 (StataCorp, College Station, Tx, USA) using descriptive statistics, chi-square tests and logistic regression. Qualitative data was analysed in NVIVO version 12 (QRS International, Cambridge, MA) using content analysis.

Results: Of 135 students 91 (67.4%) were male and their median age was 24 years (IQR: 24, 26). As a rst choice, the most preferred specialty career was obstetrics and gynecology (34/135, 25.2%), followed by surgery (27/135, 20.0%), pediatrics (18/135, 13.3%) and internal medicine (17/135, 12.6%). Nonestablished specialties such as anesthesia and Ear Nose and Throat (ENT) were not selected as a rst choice by any student. Female students had 63% less odds of selecting surgical related specialties compared to males (aOR=0.37, 95%CI: 0.17-0.84). The focus group discussions highlighted controlled lifestyle, assurance of a good life through better nancial remuneration and inspirational specialists as facilitators for specialty preference. Bad experience during the clinical rotations, lack of career guidance plus perceived poor and miserable specialists were highlighted as barriers to specialty preference.

Conclusion: Obstetrics and Gynecology, Surgery, Pediatrics and Internal Medicine are well-established disciplines, which were dominantly preferred. Females were less likely to select surgical disciplines given the perceived effects on lifestyle by these disciplines for example interruption of family life. Therefore, a need to formulate career guidance and mentorship programs is required, to attract students to the neglected disciplines.