School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia.
IMU Centre for Education, International Medical University, Kuala Lumpur, Malaysia.
BMC Med Educ. 2022 Nov 16;22(1):796. doi: 10.1186/s12909-022-03845-2.
Shortage and maldistribution of medical specialists hamper healthcare quality. The specialist career choices of house officers determines the future composition of healthcare systems. We studied house officers'' specialist career choices and motivators for their choice.
We conducted online in-depth interviews among seven house officers using an interview guide developed based on a literature review. The transcripts were analyzed. Major themes were identified. A 33-item questionnaire was developed, and the main and sub-themes were identified as motivators for specialist career choice. An online survey was done among 185 house officers. Content validation of motivators for specialist choice was done using exploratory factor analysis. First, second and third choices for a specialist career were identified. Multinomial logistic regression analyses were done to determine the socio-demographic factors and motivators associated with the first choice.
HOs perceived that specialist training opportunities provide a wide range of clinical competencies through well-structured, comprehensive training programs under existing specialist training pathways. Main challenges were limited local specialist training opportunities and hurdles for 'on-contract' HO to pursue specialist training. Motivators for first-choice specialty were related to 'work schedule', 'patient care characteristics', 'specialty characteristics', 'personal factors', 'past work experience', 'training factors', and 'career prospects.' House officers' first choices were specialties related to medicine (40.5%), surgery (31.5%), primary care (14.6%), and acute care (13.5%). On multivariate analysis, "younger age", "health professional in the family", "work schedule and personal factors", "career prospects" and "specialty characteristics" were associated with the first choice.
Medical and surgical disciplines were the most preferred disciplines and their motivators varied by individual discipline. Overall work experiences and career prospects were the most important motivators for the first-choice specialty. The information about motivational factors is helpful to develop policies to encourage more doctors to choose specialties with a shortage of doctors and to provide career specialty guidance.
医学专家的短缺和分布不均影响医疗质量。住院医师的专科职业选择决定了未来医疗体系的构成。我们研究了住院医师的专科职业选择及其选择的动机。
我们使用基于文献回顾制定的访谈指南，对 7 名住院医师进行了在线深入访谈。对转录本进行了分析。确定了主要主题。制定了一份 33 项的问卷，确定了主要和次要主题作为选择专科职业的动机。对 185 名住院医师进行了在线调查。使用探索性因素分析对专科选择动机进行了内容验证。确定了专科职业的首选、第二选择和第三选择。进行了多项逻辑回归分析，以确定与首选相关的社会人口学因素和动机。
住院医师认为专科培训机会通过现有专科培训途径下的结构化、全面的培训计划提供了广泛的临床能力。主要挑战是本地专科培训机会有限，以及“在合同上”的住院医师在追求专科培训方面的障碍。第一选择专业的动机与“工作时间”、“患者护理特点”、“专业特点”、“个人因素”、“过去工作经验”、“培训因素”和“职业前景”有关。住院医师的首选专业是与医学（40.5%）、外科（31.5%）、初级保健（14.6%）和急症护理（13.5%）相关的专业。在多变量分析中，“年龄较小”、“家庭中有卫生专业人员”、“工作时间和个人因素”、“职业前景”和“专业特点”与首选相关。
医学和外科学科是最受欢迎的学科，其动机因学科而异。整体工作经验和职业前景是首选专业的最重要动机。关于激励因素的信息有助于制定政策，鼓励更多医生选择医生短缺的专业，并提供职业专业指导。
