preliminary report phoonyathorn phatthanathitikarn, md prawit kittidumrongsuk, md chulalongkorn...

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Factors Influencing orthopedic Resident's Decisions for subspecialty training in Thailand ปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปป ปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปปป Preliminary report Phoonyathorn Phatthanathitikarn, MD Prawit Kittidumrongsuk, MD Chulalongkorn hospital

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Factors Influencing orthopedic Resident's Decisions for subspecialty training in

Thailand

ป�จจ�ยท��ม�ผลในการเล�อกเร�ยนต�อแพทย�ประจ�าบ�านต�อยอดของแพทย�ประจ�าบ�านออร�โธป"ด#กส�

Preliminary report

Phoonyathorn Phatthanathitikarn, MD

Prawit Kittidumrongsuk, MD

Chulalongkorn hospital

Introduction There has been much focus on factors

influencing residents’ final subspecialty choice in aboard sufficient future workforce a cultural shift in values and priorities.

Once in a Thailand residency little data on factors influencing residents’ final

subspecialty choice.

Method A cross-sectional survey was developed and

content validated The questionnaire was distributed The study group included 2nd, 3rd and 4th year

orthopedic resident is four institutions

Questionnaire

 ° µ¤� � � � Á¦ºÉ°� ´ ¥ ɤ ¨Ä µ¦Áº° Á¦¥ n°Â¡ ¥r¦³ εoµ n°¥° ° ¡ ¥r¦³ εoµ°°¦rà · · r� � � � � � � � � � � � � � � � � � � � � � � � � � � � ε ÊÂ� � � � : æ� � Ä®oo°¤¼Åªoµ¤ ªµ¤ÁÈ ¦·� � � � � � � Ã¥ µ¦Áº° εÁ¦ºÉ° ®¤µ¥� � � � � � ³Á·¤ 뵀 n° ªnµ Éε® Ūo� � � � � � � � � �

1. o°¤¼ nª » ¨� � � � � 1.1. Á¡« [ ] µ¥� [ ]® ·� � 1.2. °µ¥» ………¸� 1.3. µ ³£µ¡� � [ ] à � [ ] ¤¦ [ ]®¥nµ [ ] ®¤oµ¥ 1.4. ε ª »¦ ɤ� � � � � � [ ]¤ εª� � � .............. [ ]Ťn¤� � 1.5. £¼¤·ÎµÁµ ®ª� � � � ________________________________________(æ ¦³ »� � � ) 1.6. ¡ ¥r«µ ¦rµ µ ´� � � � � � � � � __________________________________________________ (æ ¦³ »� � � ) 1.7. ¡ ¥r¦³ εoµ� � � � � °°¦rà · · rÊ� � � � � � ¸É� � [ ] 2 [ ] 3 [ ] 4

¡ ¥rÄo»°°¦rà · · rʸÉ� � � � � � � � � � � � [ ] 2 [ ] 3 [ ] 4 [ ] 5 1.8. µ É� � �  ¹° ¦¤Ä ´ »� � � � � � � � __________________________________________________ (æ ¦³ »� � � ) 1.9. o ´ ´� � � � �

1.9.1. [ ] ¦´ µ µ ´� � � � � /¦¡.________________________________________________ (æ ¦³ »� � � ) 1.9.2. [ ] °ºÉÇ� Án¦¡� � .Á°� � � ________________________________________________ (æ ¦³ »� � � ) 1.9.3. [ ] °· ¦³Å¤n¤ o ´ ´� � � � �

2. æ Ä®oÎʵ®´� � � � � ´ ¥ ɤ ¨ n° µ¦ ´ ·Ä ° nµ� � � � � � � � � � � � � � � ®µ nµÁº°  ¹° ¦¤Á¡·É¤Á·¤ÁÈ� � � � � � � � � fellow ship ( ε ÊÂ� � � � 1= Ťn ε ´� � , 2= ε ´ o°¥� � � , 3= ε ´ µ ¨µ� � � � � � , 4= ε ´¤µ� � � , 5= ε ´¤µ É »� � � � � )

 ° µ¤� � � � Á¦ºÉ°� ´ ¥ ɤ ¨Ä µ¦Áº° Á¦¥ n°Â¡ ¥r¦³ εoµ n°¥° ° ¡ ¥r¦³ εoµ°°¦rà · · r� � � � � � � � � � � � � � � � � � � � � � � � � � � � ε ÊÂ� � � � : æ� � Ä®oo°¤¼Åªoµ¤ ªµ¤ÁÈ ¦·� � � � � � � Ã¥ µ¦Áº° εÁ¦ºÉ° ®¤µ¥� � � � � � ³Á·¤ 뵀 n° ªnµ Éε® Ūo� � � � � � � � � �

1. o°¤¼ nª » ¨� � � � � 1.1. Á¡« [ ] µ¥� [ ]® ·� � 1.2. °µ¥» ………¸� 1.3. µ ³£µ¡� � [ ] à � [ ] ¤¦ [ ]®¥nµ [ ] ®¤oµ¥ 1.4. εª »¦ ɤ� � � � � � [ ]¤ εª� � � .............. [ ]Ťn¤� � 1.5. £¼¤·ÎµÁµ ®ª� � � � ________________________________________(æ ¦³ »� � � ) 1.6. ¡ ¥r«µ ¦rµ µ ´� � � � � � � � � __________________________________________________ (æ ¦³ »� � � ) 1.7. ¡ ¥r¦³ εoµ� � � � � °°¦rà · · rÊ� � � � � � ¸É� � [ ] 2 [ ] 3 [ ] 4

¡ ¥rÄo»°°¦rà · · rʸÉ� � � � � � � � � � � � [ ] 2 [ ] 3 [ ] 4 [ ] 5 1.8. µ É� � �  ¹° ¦¤Ä ´ »� � � � � � � � __________________________________________________ (æ ¦³ »� � � ) 1.9. o ´ ´� � � � �

1.9.1. [ ] ¦´ µ µ ´� � � � � /¦¡.________________________________________________ (æ ¦³ »� � � ) 1.9.2. [ ] °ºÉÇ� Án¦¡� � .Á°� � � ________________________________________________ (æ ¦³ »� � � ) 1.9.3. [ ] °· ¦³Å¤n¤ o ´ ´� � � � �

2. æ Ä®oÎʵ®´� � � � � ´ ¥ ɤ ¨ n° µ¦ ´ ·Ä ° nµ� � � � � � � � � � � � � � � ®µ nµÁº°  ¹° ¦¤Á¡·É¤Á·¤ÁÈ� � � � � � � � � fellow ship ( ε ÊÂ� � � � 1= Ťn ε ´� � , 2= ε´ o°¥� � � , 3= ε´ µ µ� � � � � � , 4= ε´¤µ� � � , 5= ε ´¤µ É »� � � � � )

´ ¥ ɤ ¨ n° µ¦ ´ ·ÄÁº° ° » µµ� � � � � � � � � � � � � � Ťn ε´� � -----> ε ´� � ¤µ� É »� �1. ¤case emergency o°¥� 1 2 3 4 5

2. ¤ case Éo°� � � nµ´ ° ¨µ º� � � � � � � � � o°¥� 1 2 3 4 5

3. µ¤µ¦ ε®� � � � µ¦µ µ¦ εµ� � � � � � ³ nµ´� � � ÁÈÁª µ� � Åonµ¥� � 1 2 3 4 5

4. ¤Áª µ nª ª¤µ� � � 1 2 3 4 5

5. ¤ ªµ¤� Ä� � Disease/procedure/technique ° ° » µµ Ê� � � � � � ÁÈ¡·Á«¬� � 1 2 3 4 5

6. ¤ ªµ¤� ¦³ ´Ä� � � � µ� � µ¦Åo ¤ � � � ´ µÄ� � � � � field ÊÇ° ÁÈ� � � � � � resident 1 2 3 4 5

7. ¤ ªµ¤ oµµ¥� � � Ä µ¦ ε� � � procedure/technique ( Án¥µ ®¦º°¤ ªµ¤� � � �®µ®µ¥� )

1 2 3 4 5

8. ·ªnµ³ ε� � � � procedure/techniqueÅo� � nµ¥� 宦´ Á°� � � � 1 2 3 4 5

9. ¤¦³¥³Áª µ° µ¦ nµ´� � � � � � (operative time) ÄÂn³� � ¦µ¥ Ê� 1 2 3 4 5

1. o° µ¦� � � learning curve Ä µ¦ εµ� � � � � o°¥� 1 2 3 4 5

2. ¨ µ¦¦´¬µ� � � ¤ ÁÈÅ µ¤ É� � � � � � µ®ª� � � Ūo( ¼onª¥¤ ªµ¤¡¹¡°Ä¤µ¦´¬µÂoª� � � � � � �°µµ¦ ¹Ê¤µÃ° µ ·¡¨µ ¨Â¦ o° o°¥� � � � � � � � � � � � � � � )

1 2 3 4 5

3. ´ ¥� � � » ¤ ·®¦º°� � � � ¨� ¬� ³� ¼o� nª¥Â³ µ ·� � (Ánµ�³� »�£µ¡Â�È�¦�� � � � � � � � �°µ¡² ²� )

1 2 3 4 5

4. ¤ ªµ¤ µ®ª ° ¼onª¥Â³ µ ·� � � � � � � � � � o°¥� 1 2 3 4 5

5. ¤ ªµ¤ oµª®oµÄª·µ¡� � � � � � ¤µ ªnµ� � General orthopedic (¤¦µ¥ÅoÁ¡·É¤Á·� � �ÁºÉ° ε®n¤ ªµ¤ µ¤µ¦ Ä µ¦ ε� � � � � � � � � operation¤µ ¹Ê� � � )

1 2 3 4 5

6. ·ªnµ¤� � ¦µ¥Åo� Ã¥¦ª¤¤µ� � (>150,000 µ� � n°Áº°� � � ) 1 2 3 4 5

7. ·ªnµ� � ¤ ¨ ¦³Ã¥ rµ°o°¤¤µ� � � � � � � ( ¼µ nµ ¦³Á«² ²� � � � � � � ) 1 2 3 4 5

8. ¤ » nµ� � � µ ·Ä³ ªµ¤£µ£¼¤·Ä� � � � � � � � 1 2 3 4 5

9. ¤°´¦µµ¦Ân´ Îɵ� � � � � � � ³ ªµ¤ o° µ¦Â¡ ¥r° » µµoµ ÊÇ ¼Ä° µ� � � � � � � � � � � � � � � �(Án� � ¼onª¥� � Á¥°³®¦º°¤Â¡ ¥roµ Êo°¥� � � � � � )

1 2 3 4 5

10. µ¤µ¦ Áº°� � ÁoµÎµµ®¦º°¥oµ¥� � � � µ Éεµ� � � � � � Åonµ¥� � 1 2 3 4 5

11. ¦¡. Énµ o° µ¦ εµ� � � � � � � � � µÂ¡ ¥roµ Ê°¥¼n� � � � � � � 1 2 3 4 5

12. µ¤µ¦ Áº°� � µ É� � �  ¹ ° ¦¤� � Åo� nµ¥� 1 2 3 4 5

13. ¤Ã° µ Åoε� � � ª·¥� 1 2 3 4 5

14. ¤Ã° µ Åo� � °� «¹¬µ®¦º°� � � resident 1 2 3 4 5

15. ¤°µµ¦¥r� fellow ®¦º° ¼o°ºÉ� � Ä®oo°¤¼Ã¥ ¦� � � � ³ 宦º° ´ ª� � � � � � Ä®oÁ¦¥� 1 2 3 4 5

16. ¤Â °¥nµ� � � (role model) µ� � fellow ®¦º°°µµ¦¥r®nª¥ ÊÇ� � � � oµ ¦·¥ ¦¦¤� � � � 1 2 3 4 5

17. ¤Â °¥nµ� � � (role model) µ� � fellow ®¦º°°µµ¦¥r®nª¥ ÊÇ� � � � oµ� � ¦µ¥Åo� 1 2 3 4 5

18. ¤Â °¥nµ� � � (role model) µ� � fellow ®¦º°°µµ¦¥r®nª¥ ÊÇ� � � � oµ� � Á¥¦ ·¥«� �ºÉ°Á ¥� �

1 2 3 4 5

19.  °¥nµ� � � (role model) µ� � fellow ®¦º°°µµ¦¥r®nª¥ ÊÇ� � � � ÄÁ¦ºÉ°� � ¨´¬ ³� �· ¥�

1 2 3 4 5

1. ´ » nµ ·ªnµ³Áº°  ¹° ¦¤ n°Ä° » µµÄ� � � � � � � � � � � � � � � � � � (æ� � εÁ¦ºÉ° ®¤µ¥� � � Ä®ª o° Énµ Áº°� � � � � � ) 1.1. µµ Éo° µ¦Á¦¥� � � � � �

1.1.1. [ ]. ŤnÁ¦¥� ®¦º°¥Å¤nÂnÄÃ¥ · ·µÁÈ� � � � � � � � � � � � General Ortho 1.1.2. [ ]. Á¦¥� Ân° µµÃ¦ Á¦¥ ε ´� � � � � � � � � ______________________________(Áº° Á¡¥ ° µµ� � � � )

A.¥Å¤nÅo ·Ä� � � � � � B.Trauma C.Arthroplasty D.Sport E.Hand F.Ped G.Tumor H.Spine 1.2. nµ ·ªnµo°Á ¥� � � � � Ä� µµ� Énµ Áº°� � � � ° ´ É®¹É� � � � � � ®¦º°Å¤nÁ¦¥ n°� � fellow ship º°�

( ε ÊÂ� � � � 1= ŤnÁ®È oª¥� � , 2=Á®È oª¥o°¥� � � , 3=Á®È oª¥ µ ¨µ� � � � � � , 4=Á®È oª¥¤µ� � � , 5= Á®È oª¥¤µ É »� � � � � )

o°Á ¥ ° ° » µµÉnµ Áº°� � � � � � � � � ŤnÁ®È oª¥� � ------>Á®È oª¥ É »� � � �

1. ¦ ª µ¦Äoª· ¦³ εª� � � � � � � � � � ®¦º°case emergency ¤µ� 1 2 3 4 5

2. ¦µ¥ÅoÃ¥¦ª¤ o°¥� � � (< 150,000 µ� � n°Áº°� � � ) 1 2 3 4 5

3. ¤Â¡ ¥rµ oµ ʤµ° ¦µµ¦Ân ¼� � � � � � � � � � � � � � 1 2 3 4 5

4. ®µ µ ÉεµÅo¥µ� � � � � � � � 1 2 3 4 5

5. ¨ µ¦¦´¬µÅ¤nÁÈÅ� � � � � � µ¤� ɵ®ª� � � � (Án¤ ªµ¤¡¹¡°Ä o°¥¤Ã° µ � � � � � � �·¡¨µ ¼Á¡¥ Ân¦¦ÁµÃ¦ Ân¦´¬µÅ¤n®µ¥� � � � � � � � � � � )

1 2 3 4 5

6. ªµ¤ µ®ª n° µ¦¦´¬µ� � � � � � � µ ¼onª¥Â³ µ ·� � � � � � ¼� 1 2 3 4 5

7. o°� � Äo� learning curve ¥µª µ� � 1 2 3 4 5

8. o° °µ«¥°» ¦ rÁ¦ºÉ° ¤º°Â³ » µ¦Ä µ¦¦´¬µ� � � � � � � � � � � � � / nµ ¤µ� � � � 1 2 3 4 5

9. ÁÈ µµÉ¤� � � � ° ¦µ� µ¦¢o° ¦o°� � � ¼� 1 2 3 4 5

10. ªµ¤oµª®oµÄª·µ¡ o°¥� � � � � � � (Ťn¤Á·Á¡·É¤Á·¤Åo¦´ µ¦¥°¤¦´ o°¥� � � � � � � � ) 1 2 3 4 5

1.3. µ ´ Énµ o° µ¦¦´ µ¦ ¹° ¦ ÁÈ¡ ¥r¦³ εoµ n°¥° º°� � � � � � � � � � � � � � � � � � � � � � � � � ________________________(æ ¦³ »� � � ) 1.4. ¦µ¥ÅoÄ° µ Énµ o° µ¦®´ µ¦ ¹° ¦¤� � � � � � � � � � � � � � � � �

[ ] <100,000 µ� � n°Áº°� � � [ ] 1-150,000 µ� � n°Áº°� � � [ ] 1.5-200,000 µ� � n°Áº°� � � [ ] 2-300,000 µ n°Áº°� � � � � [ ] >300,000 µ n°Áº°� � � � �

1.5. ¦µ¥Åo¦µ¥ÅoÄ° µ Énµ o° µ¦Ä¦³¥³¥µª� � � � � � � � � � � � � (æ ¦³ »� � � )__________________________ µ n°Áº°� � � � � 1.6. ¨´¬ ³� � ®nª¥µ Énµ o° µ¦ ε� � � � � � � � � � µ� � (Áº° Á¡¥ o°Á¥ª� � � � )

[ ] ¦¡. ®ª ®¦º°¦¡� � � .«¼¥r° ¦´� � � � [ ] ¦¦.¡ ¥r� µ  ¹° ¦¤Â¡ ¥r� � � � � � [ ] ¦¡.Á°� � � ®¦º°®nª¥µÁ°� � � � � � [ ] ÉÄ ÈÅo� � � �

° ° » ÉÄ®oªµ¤¦nª¤¤º°Ä µ¦ °  ° µ¤� � � � � � � � � � � � � � �

Results

Demographic Characteristics of Respondents

    n %

Sex Male59

90.77

Female6

9.23

Marital Single55

84.62

Married10

15.38

Address BKK and suburb22

33.85

Other parts in Thailand43

66.15

ScholarshipGovernment scholarship

4163.08

Free training24

36.92

Resident Year 2nd 21

32.31

3rd 23

35.38

4th 21

32.31

N = 112, Response 65 residents (58%)

Subspecialty selected by respondents

Specialty N %

No train/ unsure 3756.9

0%

Arthroplasty 710.8

0%

Spine 710.8

0%

Undecide 57.70

%

Sport 46.20

%

Hand 23.10

%

Trauma 11.50

%

Other 11.50

%

No response 11.50

%

Ped 00.00

%

Tumor 00.00

%

56.90%

10.80%

10.80%

7.70%

6.20%

3.10% 1.50% 1.50%1.50%

No train/ unsure Arthroplasty Spine

Undecide Sport Hand

Trauma Other No response

Year of training

2nd 3rd 4th0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%61.90%

65.20%

42.90%

No train/ Unsure

Factor influence

Mean ค�าเฉล��ย 4.21-5.00 = ส�าค�ญมากท��ส(ด Most importantMean ค�าเฉล��ย 3.41-4.20 = ส�าค�ญมาก Very importantMean ค�าเฉล��ย 2.61-3.40 = ส�าค�ญปานกลางModerate importantMean ค�าเฉล��ย 1.81-2.60 = ส�าค�ญน�อย Little importantMean ค�าเฉล��ย 1.00-1.80 = ไม�ส�าค�ญ No important

Procedure & Technical

Interesting

Impressi

ng

Challenging

Easy

Short

Op-Time

Short

learning Curve1.00

1.80

2.60

3.40

4.20

5.004.40 4.29

3.97 3.85

2.77 2.63

Mean

Income & Pride

¤ ªµ¤ µ®ª ° ¼onª¥Â³ µ ·� � � � � � � � � � o°¥� 1 2 3 4 5

¤ ªµ¤ oµª®oµÄª·µ¡� � � � � � ¤µ ªnµ� � General orthopedic (¤¦µ¥ÅoÁ¡·É¤Á·� � �ÁºÉ° ε®n¤ ªµ¤ µ¤µ¦ Ä µ¦ ε� � � � � � � � � operation¤µ ¹Ê� � � )

1 2 3 4 5

·ªnµ¤� � ¦µ¥Åo� Ã¥¦ª¤¤µ� � (>150,000 µ� � n°Áº°� � � ) 1 2 3 4 5

·ªnµ� � ¤ ¨ ¦³Ã¥ rµ°o°¤¤µ� � � � � � � ( ¼µ nµ ¦³Á«² ²� � � � � � � ) 1 2 3 4 5

¤ » nµ� � � µ ·Ä³ ªµ¤£µ£¼¤·Ä� � � � � � � � 1 2 3 4 5

Income IndirectIncome Pride Progression of life1.00

1.80

2.60

3.40

4.20

5.00

3.262.60

4.153.67

Mean

Mean

Mentor

¤°µµ¦¥r� fellow ®¦º° ¼o°ºÉ� � Ä®oo°¤¼Ã¥ ¦� � � � ³ 宦º° ´ ª� � � � � � Ä®oÁ¦¥� 1 2 3 4 5

¤Â °¥nµ� � � (role model) µ� � fellow ®¦º°°µµ¦¥r®nª¥ ÊÇ� � � � oµ ¦·¥ ¦¦¤� � � � 1 2 3 4 5

¤Â °¥nµ� � � (role model) µ� � fellow ®¦º°°µµ¦¥r®nª¥ ÊÇ� � � � oµ� � ¦µ¥Åo� 1 2 3 4 5

¤Â °¥nµ� � � (role model) µ� � fellow ®¦º°°µµ¦¥r®nª¥ ÊÇ� � � � oµ� � Á¥¦ ·¥«� �ºÉ°Á ¥� �

1 2 3 4 5

 °¥nµ� � � (role model) µ� � fellow ®¦º°°µµ¦¥r®nª¥ ÊÇ� � � � ÄÁ¦ºÉ°� � ¨´¬ ³� �· ¥�

1 2 3 4 5

Invite

by

som

eone

Mor

ale

Inco

me

Reput

atio

n

Chara

cter

istic

1.00

2.60

4.20 3.18 3.602.94 3.45 3.62

Mean

Result Operation & Patient characteristic and Expectation

ResultOp Patient Expectation1.00

1.80

2.60

3.40

4.20

5.00

3.78

2.89 2.77

Mean

 ° µ¤� � � � Á¦ºÉ°� ´ ¥ ɤ ¨Ä µ¦Áº° Á¦¥ n°Â¡ ¥r¦³ εoµ n°¥° ° ¡ ¥r¦³ εoµ°°¦rà · · r� � � � � � � � � � � � � � � � � � � � � � � � � � � � ε ÊÂ� � � � : æ� � Ä®oo°¤¼Åªoµ¤ ªµ¤ÁÈ ¦·� � � � � � � Ã¥ µ¦Áº° εÁ¦ºÉ° ®¤µ¥� � � � � � ³Á·¤ 뵀 n° ªnµ Éε® Ūo� � � � � � � � � �

1. o°¤¼ nª » ¨� � � � � 1.1. Á¡« [ ] µ¥� [ ]® ·� � 1.2. °µ¥» ………¸� 1.3. µ ³£µ¡� � [ ] à � [ ] ¤¦ [ ]®¥nµ [ ] ®¤oµ¥ 1.4. εª »¦ ɤ� � � � � � [ ]¤ εª� � � .............. [ ]Ťn¤� � 1.5. £¼¤·ÎµÁµ ®ª� � � � ________________________________________(æ ¦³ »� � � ) 1.6. ¡ ¥r«µ ¦rµ µ ´� � � � � � � � � __________________________________________________ (æ ¦³ »� � � ) 1.7. ¡ ¥r¦³ εoµ� � � � � °°¦rà · · rÊ� � � � � � ¸É� � [ ] 2 [ ] 3 [ ] 4

¡ ¥rÄo»°°¦rà · · rʸÉ� � � � � � � � � � � � [ ] 2 [ ] 3 [ ] 4 [ ] 5 1.8. µ É� � �  ¹° ¦¤Ä ´ »� � � � � � � � __________________________________________________ (æ ¦³ »� � � ) 1.9. o ´ ´� � � � �

1.9.1. [ ] ¦´ µ µ ´� � � � � /¦¡.________________________________________________ (æ ¦³ »� � � ) 1.9.2. [ ] °ºÉÇ� Án¦¡� � .Á°� � � ________________________________________________ (æ ¦³ »� � � ) 1.9.3. [ ] °· ¦³Å¤n¤ o ´ ´� � � � �

2. æ Ä®oÎʵ®´� � � � � ´ ¥ ɤ ¨ n° µ¦ ´ ·Ä ° nµ� � � � � � � � � � � � � � � ®µ nµÁº°  ¹° ¦¤Á¡·É¤Á·¤ÁÈ� � � � � � � � � fellow ship ( ε ÊÂ� � � � 1= Ťn ε ´� � , 2= ε ´ o°¥� � � , 3= ε ´ µ ¨µ� � � � � � , 4= ε ´¤µ� � � , 5= ε ´¤µ É »� � � � � )

´ ¥ ɤ ¨ n° µ¦ ´ ·ÄÁº° ° » µµ� � � � � � � � � � � � � � Ťn ε´� � -----> ε ´� � ¤µ� É »� �

2. ¨ µ¦¦´¬µ� � � ¤ ÁÈÅ µ¤ É� � � � � � µ®ª� � � Ūo( ¼onª¥¤ ªµ¤¡¹¡°Ä¤µ¦´¬µÂoª� � � � � � �°µµ¦ ¹Ê¤µÃ° µ ·¡ µ ¨Â¦ o° o°¥� � � � � � � � � � � � � � � )

3. ´ ¥� � � » ¤ ·®¦º°� � � � ¨� ¬� ³� ¼o� nª¥Â³ µ ·� � (Ánµ�³� »�£µ¡Â�È�¦�� � � � � � � � �°µ¡² ²� )

4. ¤ ªµ¤ µ®ª ° ¼onª¥Â³ µ ·� � � � � � � � � � o°¥�

Work & Training Place

 ° µ¤� � � � Á¦ºÉ°� ´ ¥ ɤ ¨Ä µ¦Áº° Á¦¥ n°Â¡ ¥r¦³ εoµ n°¥° ° ¡ ¥r¦³ εoµ°°¦rà · · r� � � � � � � � � � � � � � � � � � � � � � � � � � � � ε ÊÂ� � � � : æ� � Ä®oo°¤¼Åªoµ¤ ªµ¤ÁÈ ¦·� � � � � � � Ã¥ µ¦Áº° εÁ¦ºÉ° ®¤µ¥� � � � � � ³Á·¤ 뵀 n° ªnµ Éε® Ūo� � � � � � � � � �

1. o°¤¼ nª » ¨� � � � � 1.1. Á¡« [ ] µ¥� [ ]® ·� � 1.2. °µ¥» ………¸� 1.3. µ ³£µ¡� � [ ] à � [ ] ¤¦ [ ]®¥nµ [ ] ®¤oµ¥ 1.4. εª »¦ ɤ� � � � � � [ ]¤ εª� � � .............. [ ]Ťn¤� � 1.5. £¼¤·ÎµÁµ ®ª� � � � ________________________________________(æ ¦³ »� � � ) 1.6. ¡ ¥r«µ ¦rµ µ ´� � � � � � � � � __________________________________________________ (æ ¦³ »� � � ) 1.7. ¡ ¥r¦³ εoµ� � � � � °°¦rà · · rÊ� � � � � � ¸É� � [ ] 2 [ ] 3 [ ] 4

¡ ¥rÄo»°°¦rà · · rʸÉ� � � � � � � � � � � � [ ] 2 [ ] 3 [ ] 4 [ ] 5 1.8. µ É� � �  ¹° ¦¤Ä ´ »� � � � � � � � __________________________________________________ (æ ¦³ »� � � ) 1.9. o ´ ´� � � � �

1.9.1. [ ] ¦´ µ µ ´� � � � � /¦¡.________________________________________________ (æ ¦³ »� � � ) 1.9.2. [ ] °ºÉÇ� Án¦¡� � .Á°� � � ________________________________________________ (æ ¦³ »� � � ) 1.9.3. [ ] °· ¦³Å¤n¤ o ´ ´� � � � �

2. æ Ä®oÎʵ®´� � � � � ´ ¥ ɤ ¨ n° µ¦ ´ ·Ä ° nµ� � � � � � � � � � � � � � � ®µ nµÁº°  ¹° ¦¤Á¡·É¤Á·¤ÁÈ� � � � � � � � � fellow ship ( ε ÊÂ� � � � 1= Ťn ε ´� � , 2= ε ´ o°¥� � � , 3= ε ´ µ ¨µ� � � � � � , 4= ε ´¤µ� � � , 5= ε ´¤µ É »� � � � � )

´ ¥ ɤ ¨ n° µ¦ ´ ·ÄÁº° ° » µµ� � � � � � � � � � � � � �

9. ¤°´¦µµ¦Ân´ Îɵ� � � � � � � ³ ªµ¤ o° µ¦Â¡ ¥r° » µµoµ ÊÇ ¼Ä° µ� � � � � � � � � � � � � � � �(Án� � ¼onª¥� � Á¥°³®¦º°¤Â¡ ¥roµ Êo°¥� � � � � � )

1 2 3 4 5

10. µ¤µ¦ Áº°� � ÁoµÎµµ®¦º°¥oµ¥� � � � µ Éεµ� � � � � � Åonµ¥� � 1 2 3 4 5

11. ¦¡. Énµ o° µ¦ εµ� � � � � � � � � µÂ¡ ¥roµ Ê°¥¼n� � � � � � � 1 2 3 4 5

12. µ¤µ¦ Áº°� � µ É� � �  ¹ ° ¦¤� � Åo� nµ¥� 1 2 3 4 5

13. ¤Ã° µ Åoε� � � ª·¥� 1 2 3 4 5

Competition for job

Work Place Wanted by hospital

Trainning Place

1.00

1.80

2.60

3.40

4.20

5.00

2.953.28 3.45

3.02

Mean

Life schedule control

CaseEmer OpNight HobbyTime1.00

1.80

2.60

3.40

4.20

5.00

2.69 2.66

3.34

 ° µ¤� � � � Á¦ºÉ°� ´ ¥ ɤ ¨Ä µ¦Áº° Á¦¥ n°Â¡ ¥r¦³ εoµ n°¥° ° ¡ ¥r¦³ εoµ°°¦rà · · r� � � � � � � � � � � � � � � � � � � � � � � � � � � � ε ÊÂ� � � � : æ� � Ä®oo°¤¼Åªoµ¤ ªµ¤ÁÈ ¦·� � � � � � � Ã¥ µ¦Áº° εÁ¦ºÉ° ®¤µ¥� � � � � � ³Á·¤ 뵀 n° ªnµ Éε® Ūo� � � � � � � � � �

1. o°¤¼ nª » ¨� � � � � 1.1. Á¡« [ ] µ¥� [ ]® ·� � 1.2. °µ¥» ………¸� 1.3. µ ³£µ¡� � [ ] à � [ ] ¤¦ [ ]®¥nµ [ ] ®¤oµ¥ 1.4. εª »¦ ɤ� � � � � � [ ]¤ εª� � � .............. [ ]Ťn¤� � 1.5. £¼¤·ÎµÁµ ®ª� � � � ________________________________________(æ ¦³ »� � � ) 1.6. ¡ ¥r«µ ¦rµ µ ´� � � � � � � � � __________________________________________________ (æ ¦³ »� � � ) 1.7. ¡ ¥r¦³ εoµ� � � � � °°¦rà · · rÊ� � � � � � ¸É� � [ ] 2 [ ] 3 [ ] 4

¡ ¥rÄo»°°¦rà · · rʸÉ� � � � � � � � � � � � [ ] 2 [ ] 3 [ ] 4 [ ] 5 1.8. µ É� � �  ¹° ¦¤Ä ´ »� � � � � � � � __________________________________________________ (æ ¦³ »� � � ) 1.9. o ´ ´� � � � �

1.9.1. [ ] ¦´ µ µ ´� � � � � /¦¡.________________________________________________ (æ ¦³ »� � � ) 1.9.2. [ ] °ºÉÇ� Án¦¡� � .Á°� � � ________________________________________________ (æ ¦³ »� � � ) 1.9.3. [ ] °· ¦³Å¤n¤ o ´ ´� � � � �

2. æ Ä®oÎʵ®´� � � � � ´ ¥ ɤ ¨ n° µ¦ ´ ·Ä ° nµ� � � � � � � � � � � � � � � ®µ nµÁº°  ¹° ¦¤Á¡·É¤Á·¤ÁÈ� � � � � � � � � fellow ship ( ε ÊÂ� � � � 1= Ťn ε ´� � , 2= ε ´ o°¥� � � , 3= ε ´ µ ¨µ� � � � � � , 4= ε ´¤µ� � � , 5= ε ´¤µ É »� � � � � )

´ ¥ ɤ ¨ n° µ¦ ´ ·ÄÁº° ° » µµ� � � � � � � � � � � � � �¤case emergency o°¥�

¤ case Éo°� � � nµ´ ° ¨µ º� � � � � � � � � o°¥�

 ° µ¤� � � � Á¦ºÉ°� ´ ¥ ɤ ¨Ä µ¦Áº° Á¦¥ n°Â¡ ¥r¦³ εoµ n°¥° ° ¡ ¥r¦³ εoµ°°¦rà · · r� � � � � � � � � � � � � � � � � � � � � � � � � � � � ε ÊÂ� � � � : æ� � Ä®oo°¤¼Åªoµ¤ ªµ¤ÁÈ ¦·� � � � � � � Ã¥ µ¦Áº° εÁ¦ºÉ° ®¤µ¥� � � � � � ³Á·¤ 뵀 n° ªnµ Éε® Ūo� � � � � � � � � �

1. o°¤¼ nª » ¨� � � � � 1.1. Á¡« [ ] µ¥� [ ]® ·� � 1.2. °µ¥» ………¸� 1.3. µ ³£µ¡� � [ ] à � [ ] ¤¦ [ ]®¥nµ [ ] ®¤oµ¥ 1.4. εª »¦ ɤ� � � � � � [ ]¤ εª� � � .............. [ ]Ťn¤� � 1.5. £¼¤·ÎµÁµ ®ª� � � � ________________________________________(æ ¦³ »� � � ) 1.6. ¡ ¥r«µ ¦rµ µ ´� � � � � � � � � __________________________________________________ (æ ¦³ »� � � ) 1.7. ¡ ¥r¦³ εoµ� � � � � °°¦rà · · rÊ� � � � � � ¸É� � [ ] 2 [ ] 3 [ ] 4

¡ ¥rÄo»°°¦rà · · rʸÉ� � � � � � � � � � � � [ ] 2 [ ] 3 [ ] 4 [ ] 5 1.8. µ É� � �  ¹° ¦¤Ä ´ »� � � � � � � � __________________________________________________ (æ ¦³ »� � � ) 1.9. o ´ ´� � � � �

1.9.1. [ ] ¦´ µ µ ´� � � � � /¦¡.________________________________________________ (æ ¦³ »� � � ) 1.9.2. [ ] °ºÉÇ� Án¦¡� � .Á°� � � ________________________________________________ (æ ¦³ »� � � ) 1.9.3. [ ] °· ¦³Å¤n¤ o ´ ´� � � � �

2. æ Ä®oÎʵ®´� � � � � ´ ¥ ɤ ¨ n° µ¦ ´ ·Ä ° nµ� � � � � � � � � � � � � � � ®µ nµÁº°  ¹° ¦¤Á¡·É¤Á·¤ÁÈ� � � � � � � � � fellow ship ( ε ÊÂ� � � � 1= Ťn ε ´� � , 2= ε ´ o°¥� � � , 3= ε ´ µ ¨µ� � � � � � , 4= ε ´¤µ� � � , 5= ε ´¤µ É »� � � � � )

µ¤µ¦ ε®� � � � µ¦µ µ¦ εµ� � � � � � ³ nµ´� � � ÁÈÁª µ� � Åonµ¥� �

¤Áª µ nª ª¤µ� � � ¤ ªµ¤� Ä� � Disease/procedure/technique ° ° » µµ Ê� � � � � � ÁÈ¡·Á«¬� �

Research & Teaching opportunity

ResearchOpp TechingOpp1.00

1.80

2.60

3.40

4.20

5.00

2.432.78

Mean

Expectation

The training place

92.3% expect the same institution for subspecialty training

The type of workplace

50.8

1.6

14.3

33.3Work place type %

Government hospital 50.8

Anywhere 33.3

Medical school 14.3

Private hospital 1.61.1. ¨´¬ ³� � ®nª¥µ Énµ o° µ¦ ε� � � � � � � � � � µ� � (Áº° Á¡¥ o°Á¥ª� � � � )

[ ] ¦¡. ®ª ®¦º°¦¡� � � .«¼¥r° ¦´� � � � [ ] ¦¦.¡ ¥r� µ  ¹° ¦¤Â¡ ¥r� � � � � � [ ] ¦¡.Á°� � � ®¦º°®nª¥µÁ°� � � � � � [ ] ÉÄ ÈÅo� � � �

The income

Income (bath/month) n %

<100k 69.37

5

100-150k 2843.7

5

150-200k 1218.7

5

200-300k 8 12.5

>300k 1015.6

25

<100k 100-150k 150-200k 200-300k >300k

0

5

10

15

20

25

30

35

40

45

9.375

43.75

18.75

12.5 15.625

Discussion

Discussion Arthroplasty and spine are the most

popular subspecialties. The lowest popular specialties are pediatric

and tumor. Procedure & Technic group is the first

concern as other researches. Mentor factor concern are morality,

characteristic and reputation not income. Result of operation is also very important

Discussion In our research is different from others

research about Work Place concern that relatively very important.

Life style control is not affected the decision for choosing subspecialtly but very important for arthroplasty about Hobby time topic is very important

for No training /uncertain group Income topic is just moderate

important in all groups.

Conclusion

Conclusion The majority of residents has no plan for

subspecialize training. Multiple factors influencing subspecialty

training similar to other research are Procedure&Technical and Mentor factor.

Result of the operation is very important differ from other researches

Very important factor

1.00

1.80

2.60

3.40

4.20

5.004.40 4.29

3.97 3.85 3.78 3.674.15

3.45 3.60 3.45 3.62

Conclusion Life style control is not so important

Relative to low important factor

CaseE

mer

OpNig

ht

Indi

rect

Inco

me

Resea

rchO

pp

Tech

ingO

p1.00

1.80

2.60

3.40

4.20

5.00

2.69 2.66 2.60 2.432.78

Thank you

The end