ORIGINAL ARTICLE

Specialty Choice Of Medical GraduatesT P Lam*, MBBS, M Fam Med, FRACGP, FHKAM(Family Medicine)

General Practice UnitDepartment of Medicine

The University of Hong Kong

Summary

Objective: To investigate the specialty choice of Hong Kong medical graduates. Design: Mailed questionnairesurvey. Subjects: A total of 139 students who attended the General Practice Unit of the University of Hong Kongfor their general practice teaching during 1993 were surveyed in the second half of 1995 i.e. approximately 12months after graduation. Complete data were collected for 88 (63.5%) of the graduates after four rounds ofmailing. Results: General Medicine was the most popular with 48 (54.5%) graduates selecting it as one of theircombined top three choices, followed by Accident & Emergency (A&E) (36 graduates, 40.9%) and General Practice(35 graduates, 39.8%). Male and female graduates showed similar patterns except towards Surgical specialties andObstetrics and Gynaecology (O&G). Conclusions: These results provide indication on the competitiveness ofspecialty choices and the need for specialty counselling for junior doctors. It also reveals the possibility of anundecided stage towards specialty choice at the end of internship and raises the need for general rotation duringearly postgraduate years. (HKPract 1996; 18: 504-512)

Keywords: Specialty choice, medical graduates, Hong Kong

Introduction

Over 300 medical graduates areproduced in Hong Kong each year,at great costs to the community.However, it is now well recognizedworld wide that undifferentiateddoctors are produced at the end oftheir undergraduate training.1-2

Further specialty training isessential to equip junior doctorswith the appropriate expertise toserve the community. It is thereforeimportant for medical graduates to

have the information on thespecialty choices of other graduatesso that they know the competi-tiveness of their getting into theirspecialties of choice. It also allowsthe senior doctors to counsel juniordoctors on their career choices. Themedical profession and thecommunity at large will also get thebenefits by ensuring the specialtychoices of the young graduates arematching the needs of thecommunity. Literature on specialtychoices of Hong Kong medical

graduates is scarce3 while suchinformation is widely available inother countries.4"7

The objective of this study wastherefore to examine the specialtychoice of junior medical graduatesat the University of Hong Kong.

Methods

Medical students at theUniversity of Hong Kong attend a

(Continued on page 506)

* Address for correspondence: Dr TP Lam, Lecturer, General Practice Unit (HKU), 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Hong.

Specialty Choice of Graduates

ORIGINAL ARTICLE

General Practice clerkship at theGeneral Practice Unit either duringthe second half of Fourth year or thefirst half of Fifth year. Thosestudents who attended their GeneralPractice clerkship during 1993 wereinvited to provide their contactaddresses so that a questionnairecould be sent to them in future.They were encouraged to provideaddresses which they thought wouldbe more permanent e.g. theirparents' addresses instead of theaddresses of their universityaccommodation colleges. Thesubjects of the questionnaire werenot disclosed to the students.

This study was part of the projectwhich examined medical graduates'attitudes towards the generalpractice clerkship and their specialtychoice. A questionnaire was sent tothese medical graduates during thesecond half of 1995 which wasapproximately twelve months aftergraduation for most of therespondents.

Four rounds of mailing werenecessary to achieve a satisfactoryresponse rate of 63.5%. Thereminders were sent 6-8 weeksapart.

The results were analyzed usingSPSS software.

The distribution of months ofclinical experience is shown inTable 2. About 17% of therespondents were still in their internyear, most likely to be due to needto sit for supplementary finalexaminations.

The rank order of the first sixmost popular first specialty choicesis shown in Table 3. GeneralMedicine was by far the mostpopular choice for all graduates.General Surgery and Obstetrics &Gynaecology (O&G) were thesecond most popular among maleand female graduates respectively,however the differences in their firstspecialty choices between the twosexes did not reach statistical

significance (chi-square=6.93; df=5;0.50>p>0.10).

The rank order of the first sixcombined first, second and thirdspecialty choices of all graduates isshown in Table 4. General

Medicine was again the mostpopular choices. However, Accident& Emergency (A&E), and GeneralPractice became the next mostpopular choices. There were alsodifferent trends between male(Table 5) and female graduates(Table 6) in their combined first,second and third specialty choicesbut they did not reach statisticalsignificance (chi-square=5.28; df=5;0.50>p>0.10).

Table 1: A{

Age

23

24

25

26

27

Total

;e and sex distribution of respondents

Female

0

5

11

1

0

17

Male

1

13

40

13

4

71

Results

The age and sex distribution ofthe respondents is shown in Table 1.Over 80% of the respondents weremale graduates and all of therespondents were within the narrowage range of 23 to 27.

Table 2: Distribution of duration of clinical experience

Months of clinical experience

Less than 12 months

More than 12 months

Number

15

73

fiflfi

Hong Kong Practitioner 18 (10) October 1996

ORIGINAL ARTICLE

Table 3: Rank order of first six most popular first specialty choices

Rank Specialty choice

1 General Medicine2 General Surgery3 Obstetrics & Gynaecology4 Accident & Emergency5 Paediatrics6 Orthopaedics

Female (%)

5 (29.4)1 (5.9)

4(23.5)1 (5.9)

2(11.8)0

Male (%)

23 (32.4)12(16.9)5 (7.0)6 (8.5)4 (5.6)5 (7.0)

Total (%)

28(31.8)13(14.8)9(10.3)7(8.0)6 (6.8)5 (5.7)

Table 4: Rank order of the first six combined first, second and third specialty choices of all graduates

Rank

1

23456

Specialty choice

General Medicine

Accident & EmergencyGeneral PracticeGeneral SurgeryObstetrics & GynaecologyPaediatrics

Total no. of graduates

48

3635312319

Table 5: Rank order of the first six combined first, second and third specialty choices of male graduates

Rank

12

3456

Specialty choice

General Medicine

Accident & EmergencyGeneral PracticeGeneral SurgeryPaediatricsObstetrics & Gynaecology

Total no. of male graduates

41

3128241615

Table 6: Rank order of the first six combined first, second and third specialty choices of femalegraduates

Rank

123456

Specialty choice

Obstetrics & Gynaecology

General PracticeGeneral MedicineGeneral SurgeryAccident & EmergencyPaediatrics

Total no. of female graduates

(Continued on page 511)

Hong Kong Practitioner 18 (10) October 1996

ORIGINAL ARTICLE

Key messages

* The specialties which medical undergraduates and interns have more exposure e,g. General Medicine,General Surgery and Obstetrics and Gynaecology are the most popular first specialty choices.

* General Medicine, Accident & Emergency, General Practice and General Surgery are the most popularcombined first, second and third specialty choices.

* The study shows that Accident & Emergency is particularly popular among junior doctors and it raisesthe possibility of a need to introduce general rotations in early post-internship years.

Discussion

The aim of this study was to

examine the specialty choices ofmedical graduates of the University

of Hong Kong (HKU). It can be

seen that the HKU medical

graduates come from a very narrow

age range and there are more malethan female graduates.

The results of the presentresearch indicate that the specialties

which undergraduates and interns

get most exposure are more popular

among medical graduates. For

instance, General Medicine is the

most popular first and combinedfirst, second and third specialtychoices whereas General Surgeryand O&G are the second and third

most popular first choices respec-

tively. It is hardly surprising to findjunior medical graduates to select

specialties to which they have had

more exposure.7"10 However, animportant question to ask is, "Does

the community need such a largenumber of Internist or Surgeons or

O&G specialists?" Furthermore,

the junior doctors also need to bemade aware of the fact that they will

face stiff competition if they want to

be trained in the popular disciplines.

Another result worthy of special

consideration is the fact that A&E

is the second most popular of thecombined first, second and thirdspecialty choices of all juniordoctors. Although A&E is now an

established specialty of its own, it is

still very surprising to find it being

so popular as most junior doctors

would have had relatively little

exposure to it. It is possibly a

reflection of the state of uncertaintytowards specialty choice amongjunior doctors since a period ofgeneral rotational training is not

available to most graduates after

their internships, except probablyGeneral Practice trainees. Furtherresearch is needed to confirm this

hypothesis and if it is confirmed,

general rotations in early post-internship years should then be

introduced in all major hospitals. Itwill allow junior doctors moreexposure to various disciplines and

in the mean time to consider their

life long career choice. It would bea lot more worthwhile for these

junior doctors to rotate through

such a general training than to

embark upon a specialty training

prematurely only to discover that

a wrong decision has been made.

In conclusion, this study

provides up-to-date information onthe specialty choices of the medicalgraduates of the University of Hong

Kong and the likely competition of

getting into these disciplines. Italso raises the need to introduce a

general rotation period in the early

postgraduate years to allow ourjunior doctors more varied exposure

to different disciplines and moretime to consider their choices of lifelong medical career. |

References

1. General Medical Council. Recommenda-

tions on basic medical education. London:

GMC Education Committee, 1980.

511

Specialty Choice of Graduates

ORIGINAL ARTICLE

Kamien M. Academic General Practice inAustralian Medical Schools. AustralianAssociation for Academic General Practice.Sydney 1990.Masarei JRL. Career Preferences of HongKong Interns, 1991. (Letter) J of HongKong Med Assoc 1993; 45(4): 326.Medical specialty choice: A selectedbibliography with abstracts. Acad Med1993; 68: 391-436.Kassebaum DG & Szenas PL. Factorsinfluencing the specialty choices of 1993

medical school graduates. Acad Med1994; 69: 164-170.Gorenflo DW, Ruffin MT & Sheets KJ. Amultivariate model for specialty preferenceby medical students. J Fam Pract 1994;39: 570-576.Kassebaum DG, Szenas PL & SchuchertMK. Determinants of the generalist careerintentions of 1995 graduating medicalstudents. Acad Med 1996; 71: 197-209.Paiva REA & Verhulst SJ. The effects ofclinical experiences in medical school on

specialty choice decisions. J Med Educ

1982; 57: 666-674.

9. Duerson MC, Crandall LA & Dwyer JW.

Impact of a required fami ly medicine

clerkship on medical students attitudes

about primary care. Acad Med 1989;

(64): 546-548.

10. Erney SL, Allen DL & Siska KF. Effect of

a Year-long primary care clerkship on

graduates selection of family practice

residencies. Acad Med 1991; 66: 234-236.

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