SPECIALTY PREFERENCES AMONG MEDICAL STUDENTS IN RIYADH CITY

Dr. Khalid Al Qumaizi 1 , Abdullah Muqrin Al Muqrin 2 , Rakan Mohammed Khawaji 2 , Abderrahman Mamoun Khalaf 2 , Abdullah Dhafer Algarni 2 and Suliman Muhammed Al TERIQI2. 1. Dean, College Of Medicine at Al-Imam Muhammad Ibn Saud Islamic University Consultant and Assistant Professor of Family Medicine. 2. Medical student, Al Imam Mohammad Ibn Saud Islamic University (IMSIU). ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

Strong motivation is an essential requirement for the medical students to maintain patience and achieve professional success. Preference for a set ofspecialties isoften a strong motivationto pursue medicine. Many other factors, including demographic characteristics, medical school ethos and curriculum, as well as students' perceptions, attitudes and values, potentially influence the medical students' career plans regarding specialties [2][3][4][5][6].Their decision may also be influencedby suggestions from their peers, perception about competitionin the field, job opportunities, family expectations, marital status, and prospects for teaching and research in medical colleges, and the opportunity to practice overseas.
So far,there have been only a few systematic studies on the medical students' preferences for specialties and the motivational factors underlying them. Information from such studies can help the students make optimal choices and prepare for the expected career transitions. These studies can also yield important data regarding training and manpower requirement across medical specialties. No prior study has investigated these aspects of medical education in theRiyadh city;hence, the present study attempts to fill in this gap.

Methods:-
We performed a cross-sectional study on 387 medical students from three Medical Colleges (College of Medicine Al Imam Mohammad Ibn Saud Islamic University, College of Medicine King Saud University and College of Medicine Al Maarefa Colleges for Science & Technology), during the monthsof April and June 2014.The students' participation was solicited via e-mail, and they were administered a validated structured questionnaire using online survey and a maintenance platform called SurveyMonkey. We calculated the sample size from 2507 undergraduate students by using survey system website with a confidence level of95%and confidence interval of5. The questionnaire included items on demographic data and sought students' preferences from a list of 13 specialties, such asCardiology, Dermatology, Ear, Nose & Throat (ENT), Emergency Medicine (ER), Family Medicine, Internal Medicine, Neurology, Ophthalmology, Orthopedics, Pediatrics, Psychiatry, Radiology, and Surgery. The respondents were instructed to write down their preference if it was not listed among the options. Students also indicated the degree to which 19 statements (developed after extensive literature review and interviews with medical students, interns, residents and educational experts) influenced their first preference. The students scored the responses on a 5-point Likert scale (ranging from 1, strongly disagree to 5, strongly agree).

Data analysis:-
We analyzed the data using IBM SPSS 22.0 (IBM, Chicago, IL, USA). Descriptive statistics and bar charts were used to represent data, and the Chi-square test was used to examine the relationship between categorical variables. Dimensions of Likert-type responses to statements were evaluated using the t-test. The values of p less than 0.05 were considered significant, and a confidence interval of 95% was calculated for each test.

Results:-Demographic findings:-
The demographic and academic data of the participants are presented in Table 1. A total of 387 students (233 females and 154 males) were included in the study. A majority of the participants (236; 61%) were aged between 20 to 22 years of age,and only 2.
Participants(0.5%) were aged 25 years or older. The mean age of the participants in the study was 22 years. Of the respondents, 113 (29.2%) were first-year students, followed by 84 (21.7%) participantsin the third year. Regarding the marital status, a majority of the participants (347; 89.7%) were single and lived with their family while only 8 (2.1%) participants were married. The assessment of the GPA scores revealed that 195 (50.4%) participants had scored 4.5 or higher, followed by 115 (29.7%) who had GPAscores between 4-4.5.Only 17 (4.4%) participants had GPA scores less than 3. With respect to the specialty preferences of the participants (Table 2),it was found that Surgery was the most preferred specialty among the participants (90; 23.3%), followed by Internal Medicinethat was opted by 49 (12.7%) students. The least preferred specialty was Radiology as only 10 (2.6%) participants opted for it. Next, we investigated whether the students' preferences were influenced by their pre-medical academic performance using a non-parametric Chi-square test with cross-tabulation of the two attributes. The results of this analysis are presented in Table 3. We found a significant association between the student's earlier academic preference and their specialty preference (Chi-square, 66.84 and p<0.01).
2078 We also investigated the gender influences on the choice of academic specialty by the participants. Table 4 depicts the findings from this evaluation. Theanalysis using Pearson Chi-Square test revealed no significant influence of gender on specialty preference among the participants (Chi-square, 19.1; p > 0.05). Furthermore, we evaluated the students' responses to 19 categories of influencing factors, as the driving factor for their specialty preference. The responses to each criterion on a Likert scale from 1 to 5 were recorded, and the mean scores were calculated. A summary of the findings from this comparison is presented in Table 5.
2079  As depicted inTable 6, the mean scores for the criteria except 'Personal interest', 'Desire to practice abroad', 'Research opportunities in medical college', 'Previous rotation in the specialty', 'Role models', 'Desire to serve people', and 'High income potential' were less than the neutral value of 3.
We also recorded whether the students had a neutral response to the criteria mentioned. In cases where the response was not neutral, it wasevaluatedwhether they agreed or disagreed with the statement, using t-test. The results ofthis analysis are presented in Table 7.

Discussion:-
The paper describes the results of a cross-sectional study on the preferenceof specialization of medical students in Riyadh city and the factors influencing them.
All students in our study wereclear about their preferences for their future specialty. This is in contrast to the findings of several studies thatreported students' indecision regarding the specialization for future practice [7][8][9].However, our findings are in agreement with the study by Gasiorowski, et al. [10].
Surgery, internal medicine, and cardiology were the three most preferred specialties according toour study, with 23.3%, 12.7% and 9.8% students, respectively, opting for them. This agrees with the findings of several earlier studies [9,11,12]. Only less than 5% of the respondents expressed a desire to pursue aspecializationin ENT, ER, family medicine, orthopedics, psychiatry, and radiology. Khader et al. [4] had earlier reported thatvery fewmedical students preferred tospecialize in orthopedics and dermatology.
Our findings revealed a significant influence of earlier academic performance on the choice of specialization taken up by a student(Chi-square, 66.84; p < 0.01). Surgery, internal medicine, and cardiology were the top three preferences among students with GPAs ranging from 4.00-4.50 while surgery, pediatrics, and family medicine were the most preferredchoices of those with GPAs less than 3 (Table 3). This seems to be in agreement with the findings of Khader, et al. [4].  -14] suggested gender influences on the career choices of medical students. However, there were no major differences in the preference of specialization subject of the male and female students in our study. This is in consonance with the findings of Dorsey et al. [15] who investigated the career preferences of medical students in the U.S.
'Personal interests', 'desire to serve people', and 'future job opportunities' ranked high as the major influences on career preferences among our students, which is in congruence with the findings from similar studies in other countries [10,[16][17][18][19][20]. This was followed by criteria like the 'potential for high income', 'earlier rotation in the specialty', and 'desire to practice abroad'.Alshahrani et al. [8], in a study on 379 medical students and interns in University of Dammam, Kingdom of Saudi Arabia, identified lifestyle, and not personal interests, had a greater impact on the students' choice of subject specialization.
Individual evaluation of responses scoring less than the neutral value of 3 (using t-test) revealed no significant influence by 'research opportunities in medical colleges', 'role models', and 'high-income potential' on the choice of specialty. Students' lack of interest in research and the lack of inspirational role models are points of concern raised by our study participants that warrant further attention. We observed that lifestyle was not a significant factor 2082 in the choice of a specialty by the medical students, which is in contrast with earlier reports of Newton et al. and Dorsey et al. [2,15].
In our study, the prestige and social acceptability of the stream of specialization and shorter periods of training had a significant influence on the students' choices. This seems to be in agreement with the earlier reports by Dikici et al., Khader et al. and Mehmood et al. [4,11,21].
A significant number of our study participants belonged to the early years of medical education, with insufficient experience of the specialties, which might have influenced the overall results. We suggest that in future, studies shouldbe conducted with a larger number of final-year students, interns and residents to gain more accurate insights.
Overall, the findings from our study seem to agree with the reports from most other countriesthatsurgery, internal medicine, and cardiology arethe highly preferred specialties. The scarcity of inspirational role models in medical education and low levels of student interest in medical research also need further investigation.