Perceptions of medical students regarding medical profession: Is there a change during graduation course?

Priyanka; Manish Kumar Goel; Sanjeev Kumar Rasania

doi:10.4103/ijcfm.ijcfm_21_21

ORIGINAL ARTICLE

Year : 2021 | Volume : 7 | Issue : 2 | Page : 100-104

Perceptions of medical students regarding medical profession: Is there a change during graduation course?

Priyanka, Manish Kumar Goel, Sanjeev Kumar Rasania
Department of Community Medicine, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India

Date of Submission	11-Mar-2021
Date of Acceptance	29-Jul-2021
Date of Web Publication	24-Dec-2021

Correspondence Address:
Dr. Priyanka
Department of Community Medicine, Lady Hardinge Medical College and Associated Hospitals, New Delhi - 110 001
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijcfm.ijcfm_21_21

Abstract

Introduction: Medical students enter this profession with a set of perceptions toward the practice of medicine. The study of these factors becomes important as it may provide an insight into the perceptions of doctors toward medical profession to maintain a high standard of professionalism among medical practitioners.
Material & Methods: This study was conducted by the department of community medicine of a premier medical institute of Delhi and involved the analysis of 457 feedback forms filled by medical students about their perceptions regarding medical profession at the time of entry and at the end of graduation. The responses were read several times and categorized into similar thematic areas.
Results: At the time of choosing profession, 74.8% mentioned the reasons as, its respectable status in the society, 71.8% mentioned their interest to serve people, 26.9% the possibility of huge financial earning, and 21.2% the ease of getting employment. At the end of graduation, 312 (68.3%) considered ease of getting a job and 251 (54.9%) high paying capacity. The proportion of participants mentioning the profession to be prestigious and respectful (50.1%) and intention to serve people (51.2%) considerably declined. Regarding the reasons for change, majority (74.6%) mentioned stress, 66.7% felt it less rewarding, and 54.2% mentioned difficulty to maintain work-life balance.
Conclusion: There was a change in students' perceptions at the end of graduation as compared to the time of entry. Their focus shifted from being in a respectful profession and serving community to getting jobs and earning money.

Keywords: Change, medical profession, perceptions

How to cite this article:
Priyanka, Goel MK, Rasania SK. Perceptions of medical students regarding medical profession: Is there a change during graduation course?. Indian J Community Fam Med 2021;7:100-4

How to cite this URL:
Priyanka, Goel MK, Rasania SK. Perceptions of medical students regarding medical profession: Is there a change during graduation course?. Indian J Community Fam Med [serial online] 2021 [cited 2022 Jul 4];7:100-4. Available from: https://www.ijcfm.org/text.asp?2021/7/2/100/333662

Introduction

Medicine at its core is a human service profession. Medical students enter this profession with a set of perceptions toward the practice of medicine.^[1] However, some studies have shown that students tend to lose their idealistic perceptions during the course of medical graduation.^{[2],[3],[4],[5]} Recently, there have been changes in medical curriculum also to support the maintenance and advancement of desirable attitudes among medical professionals.^[6]

Several factors motivate a student to join medical career while there may be other factors that may influence the motivations of students later on during the years of graduation that may influence their practices and professional satisfaction. The study of these factors becomes important as it may provide an insight into the perceptions of doctors toward medical profession. Furthermore, if we know whether there is a change in their perception later on and the reasons for this change, it can provide an opportunity to address these issues to maintain a high standard of professionalism among them. There is a dearth of research in this area, especially among Indian medical students. Hence, the present study was planned and conducted.

Material & Methods

This study was conducted by the department of community medicine of a premier medical institute of New Delhi. The department coordinates the internship training of medical students. The students who pass their final professional examinations and are about to start their compulsory internship are routinely invited to give a feedback about their perceptions and experiences about medical graduation. We analyzed 457 feedback forms filled by the students of last three consecutive batches.

A self-designed semistructured questionnaire enquired about the demographic profile of students. It contained open-ended questions regarding their perceptions about medical profession at the time of entry and at the end of graduation. If there was a change in their perception during medical graduation, the reasons for change were also asked. The questionnaire was pretested on a group of students who were pursuing internship at the time of development of questionnaire. Their responses were not included in the final data analysis. The students were informed that their participation is completely voluntary and they could opt out if they felt so. The form was self-administered and filled anonymously. One student representative from each batch was responsible for collecting the filled forms and handing them over to one of the investigators.

The participants had filled the responses to open-ended questions in one or more sentences. Their responses were in their own verbatim , coding was initially done by two investigators independently. Any discrepancy or disagreement was resolved by discussion and mutual consensus was obtained for identification of themes. Subthemes were identified by examining persistently repetitive words and depicting the idea represented by them. After further discussion and mutual consent, less relevant areas were eliminated and synonymous ones were merged and data were finally categorized into similar thematic areas.

All the data were kept completely anonymous with no personal identifier. The confidentiality was strictly maintained. As this study involved retrospective analysis of anonymous data, the permission to do so was obtained from the Institutional Ethics Committee along with a waiver of written consent.

Results

The study questionnaire was distributed to 502 students, out of which complete responses were obtained from 457 participants who were included in the final data analysis. Thus, the response rate came out to be 90.9%.The mean age of the participants was 22.8 ± 0.76 years (range 21–25). The majority of respondents (87.7%) belonged to the urban areas. As far as education of parents is concerned, 91.1% fathers and 71.1% mothers of respondents were graduates and above. Fourteen percent students had at least one parent who was doctor [Table 1]. The students were asked about their perceptions regarding medical profession at the time of choosing the profession. Four main themes emerged from data analysis:

Table 1: Demographic profile of medical students (n=457)

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Prestigious and respectful status in society
Meant for serving people
Capable of huge financial earning
Ease of getting an employment.

Almost three-fourth (74.8%) mentioned that the profession is very respectable in the society, 71.8% mentioned their interest to serve people, 26.9% said there is possibility of huge financial earning, and 21.2% the ease of getting employment. When asked about their perceptions regarding the same after completing final MBBS examination, there focus now seemed to shift more toward employment and earnings. Three hundred and twelve (68.3%) considered ease of getting a job and 251 (54.9%) mentioned high paying capacity. The proportion of participants mentioning the profession to be prestigious and respectful (50.1%) and intention to serve people (51.2%) considerably declined as compared to what it was at the time of entry to the profession [Table 2].

Table 2: Perceptions of students regarding medical profession at the time of entry and at the end of graduation

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Similar perceptions were also highlighted when the students were enquired about their intentions for specialty choice. The students were asked whether or not they were interested in pursuing postgraduation and all of them mentioned that they were interested in doing so. Regarding the factors they would consider while choosing a specialty for postgraduation, a high demand in job market (72.3%) and high paying capacity (57.4%) were mentioned by a maximum proportion of respondents. A considerable proportion of study subjects (39.9%) wanted to choose a branch that is considered desirable and high rated by their peers while 133 (29.1%) preferred choosing a specialty with less hectic work hours.

When asked about the reasons for change in their perceptions about medical profession after clearing final professional MBBS examinations, five main areas were found. Maximum number of students (74.6%) mentioned that it is a stressful profession. Almost two third (66.7%) students described the profession as very demanding but comparatively less rewarding. The other perceptions about medical profession were, challenging and prestigious (55.4%), difficult to maintain work-life balance (54.2%) and takes a long time to settle in life (15.8%) [Table 3].

Table 3: Reasons for change in perceptions about medical profession during graduation

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Discussion

The present study tried to find out if there is any change in the perceptions of medical students regarding medical profession at the end of graduation than at the time of entry to the profession. Being a respectable profession in the society (74.8%) and intention to serve people (71.8%) were cited as the most common perceptions at the time of joining medical profession by the students. High earning capacity was cited as important factor by approximately one fourth of subjects. This reflects that students enter medical profession primarily because of the nobility of the profession and with intention to serve the community. Another study by Morley et al. also shows that ability to make a difference in others' lives and serving community are the major reasons for choosing career in medicine.^[2] A desire to help others is cited as the most important factor considered while entering medical profession by studies conducted by Gazibara et al. as well as by Scheffer et al.^[7],[8] Our finding are in accordance with those of Saad et al. showing that financial gain was not a major consideration for joining medical profession.^[9] Although Heikkilä et al. have reported that good salary was cited by almost 50% participants as the reason for joining the profession.^[10] Finding similar to ours has been documented by other researchers as well.^{[11],[12],[13],[14],[15],[16],[17],[18]}

After clearing final MBBS examinations, the students' perceptions about medical profession seemed to differ than what they were at the time of entry. The proportion of students considering it a respectable profession was almost 50% which was earlier cited as the most common reason for entering medical career by a majority of students (74.8%). Similarly, the proportion of students considering that medical profession is meant to serve people also dropped to almost 50% from the earlier level of 71.8% at the stage of entry. A study by Morley et al. also shows that there is a decline of medical student idealism later during medical training as compared to time of entry.^[2] Ease of getting a job (68.3%) and high financial earning (54.9%) were mentioned by a significant proportion of students. Thus, at the end of graduation, students had become more concerned about jobs and earnings as compared to when they entered medical profession. These two factors were also the most important ones mentioned by respondents for choosing a specialty. Mirvis has also reported that medical students prefer to choose a specialty which is high paying.^[19] Good earning capacity is mentioned as an important factor while choosing postgraduation by many other authors.^{[1],[2],[7],[8],[10],[15],[17],[20]}

All of the study participants showed interest in pursuing postgraduation. This may be a reflection that just MBBS is not a desirable qualification for a doctor nowdays and every doctor wants to become a specialist. A study from the United States reports that medical students think that primary care doctors are poorly valued by the rest of the medical profession.^[2] Moreover, prestige and status issues for certain specialties also seem to make them more preferable, thereby indicating that doctors are concerned that they should have a desirable and high rated status. Other studies have mentioned that 6%–22% students reported to choose a branch for postgraduation based on its high reputation.^{[8],[11],[20]}

Regarding the reasons for change in their perceptions toward medical profession, almost three-fourth students were concerned about the mental stress associated with the profession while almost two-third considered it less rewarding. Similar results have been shown by other studies where students have also emphasized that there should be regular workshops for stress management for medical students.^[21] A similar research from Pakistan found that students feel that doctors have excessive working hours and medical training is very difficult and prolonged.^[14] Narayanasamy et al. in their study on Indian medical students have reported that students felt that doctors work for long hours with comparatively less salaries.^[1] Our results also show that the students were now more concerned about maintaining a balance between personal and professional life, which was not their concern when they entered this profession. This may be the reason that many of them wanted to choose a specialty which has a less hectic lifestyle. These findings are in accordance with another study from Siberia which mentions that final year medical students are more concerned about comfortable work hours and balancing work life with family responsibilities as compared to 1^st year students.^[7] Jennet et al. have found that almost one fourth medical professionals report major changes in medical career because of general dissatisfaction with the profession and lack of life style compatibility.^[12] A small proportion (15.8%) also mentioned about the long time it takes to settle in medical profession which is in accordance with the results of another study.^[9] This may be an indication that young doctors do not consider the profession very rewarding and they have concerns over lifestyle, family life, and money.

Medical students were more idealistic in their approach at the time of entering the profession which declined later on. There is a need to look into the challenges faced by students which led to this decline so that the nobility of this profession can be maintained. It is high time to take remedial measures so that the medical doctors, who choose the profession primarily because of its respectful status and with intention to serve community, continue to work with the same principles throughout their professional lives.

Limitations

We used semi-structured questionnaire for obtaining the responses. Focus group discussion and in-depth interviews may be a better method for getting a deeper insight into the students' perceptions. It may have also resulted in reducing nonresponse rate, which was approximately 10% in this study because of incomplete responses.

Conclusion

The present study shows that a majority of students enter medical profession primarily because of respectful image of this profession in society and to serve the community while after clearing MBBS final exams, they seem to be more concerned about getting an employment and earning money. Thus, near the end of graduation, they worried about stress and challenges associated with medical profession. Furthermore, their priorities changed to having a stable less hectic job and work-life balance which were not their main focus while choosing medical career.

Recommendations

The authors are of the opinion that there should be more focus on extracurricular activities in medical institutes and mandatory organization of sports, yoga, and cultural events along with medical curriculum. Further, students should be encouraged to nurture their hobbies and interests so that they do not feel overburdened by their vast curriculum and it will help in coping up with stress. Setting up of a separate Indian Medical Services cadre will help the doctors regain the prestige for this noble profession as well as will be beneficial for uplifting the health status of population. Steps to improve doctor-population ratio and fixing the maximum number of work hours per day should be taken. Adequate efforts for providing job security to the doctors along with good salary at par with other reputed professionals can help.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Narayanasamy M, Ruban A, Sankaran PS. Factors influencing to study medicine: A survey of first-year medical students from India. Korean J Med Educ 2019;31:61-71.
2.	Morley CP, Roseamelia C, Smith JA, Villarreal AL. Decline of medical student idealism in the first and second year of medical school: A survey of pre-clinical medical students at one institution. Med Educ Online 2013;18:21194.
3.	Woloschuk W, Harasym PH, Temple W. Attitude change during medical school: A cohort study. Med Educ 2004;38:522-34.
4.	Griffith CH, Wilson JF. The loss of idealism throughout internship. Eval Health Prof 2003;26:415-26.
5.	Hojat M, Vergare MJ, Maxwell K, Brainard G, Herrine SK, Isenberg GA, et al. The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Acad Med 2009;84:1182-91.
6.	Medical Council of India. AETCOM- Attitude, Ethics & Communication [Internet]. New Delhi: Medical Council of India; Available from: https://www.nmc.org.in/wp-content/uploads/2020/01/AETCOM_book.pdf. [cited 2021 May 13].
7.	Gazibara T, Kurtagić I, Marić G, Kovačević N, Nurković S, Kisić-Tepavčević D, et al. Perception of first-year versus sixth-year medical students in Serbia on studying medicine and postgraduate career. Acta Clin Croat 2019;58:371-8.
8.	Scheffer MC, Guilloux AG, Poz MR, Schraiber LB. Reasons for choosing the profession and profile of newly qualified physicians in Brazil. Rev Assoc Med Bras 2016;62:853-61.
9.	Saad SM, Fatima SS, Faruqi AA. Students' views regarding selecting medicine as a profession. J Pak Med Assoc 2011;61:832-6.
10.	Heikkilä TJ, Hyppölä H, Vänskä J, Aine T, Halila H, Kujala S, et al. Factors important in the choice of a medical career: A Finnish national study. BMC Med Educ 2015;15:169.
11.	Compton MT, Frank E, Elon L, Carrera J. Changes in U.S. medical students' specialty interests over the course of medical school. J Gen Intern Med 2008;23:1095-100.
12.	Jennett PA, Kishinevsky M, Bryant H, Hunter KL. Major changes in medical careers following medical school graduation: When, how often, and why. Acad Med 1990;65:48-9.
13.	Diwan V, Minj C, Chhari N, De Costa A. Indian medical students in public and private sector medical schools: Are motivations and career aspirations different? – Studies from Madhya Pradesh, India. BMC Med Educ 2013;13:127.
14.	Creed PA, Searle J, Rogers ME. Medical specialty prestige and lifestyle preferences for medical students. Soc Sci Med 2010;71:1084-8.
15.	Labiris G, Vamvakerou V, Tsolakaki O, Giarmoukakis A, Sideroudi H, Kozobolis V. Perceptions of Greek medical students regarding medical profession and the specialty selection process during the economic crisis years. Health Policy 2014;117:203-9.
16.	McManus IC, Livingston G, Katona C. The attractions of medicine: The generic motivations of medical school applicants in relation to demography, personality and achievement. BMC Med Educ 2006;6:11.
17.	Leserman J. The professional values and expectations of medical students. J Med Educ 1978;53:330-6.
18.	Millan LR, Azevedo RS, Rossi E, De Marco OL, Millan MP, de Arruda PC. What is behind a student's choice for becoming a doctor? Clinics (Sao Paulo) 2005;60:143-50.
19.	Mirvis DM. Choosing a medical specialty: The difference between what students want and what society needs. Isr J Health Policy Res 2013;2:18.
20.	Zia S, Abbas M, Sulaiman M, Sheikh SM. Career choices of medical doctors at graduate level – A multicenter study. Pak J Med Sci 2017;33:1086-90.
21.	Pruthi S, Pandey R, Singh S, Aggarwal A, Ramavat A, Goel A. Why does an undergraduate student choose medicine as a career. Natl Med J India 2013;26:147-9.