Medical Students Career

Study of Factors Influencing Medical Students in their Choice of Career Introduction What makes medicine such a sort-after field? Medicine today is a very highly regarded profession which is well compensated, provides excellent job security and has the opportunity to have a positive influence on the lives of many people1. Success in medicine requires hard work and application, both while learning and when entering practice2. However, it brings great rewards in terms of job satisfaction and the range of career opportunities within the profession3. Learning about and practicing medicine is also very pleasing, involving as it does a blend of human interactions and applied science2. The environment in which different types of medicine are practiced is rich and diverse and obviously continually changing, and doctors continue to learn throughout their working lives. That is why the students interested in medicine should have the capacity for, and interest in, a lifetime of learning about this fascinating subject. To get the most out of the course a student need to be a keen scientist, with a sound scientific understanding and determination and also an ability to cope up with the demands and pressures of early clinical training3. But are they actually aware of the high demands of this prestigious professional course?? Do they have a realistic understanding of what a career in medicine will involve? We often wonder, is it the genuine passion for the subject and the genuine interest to be of service to the mankind that make students do medicine or is it just their parents??!!! This study gives us the opportunity to find out the factors that drove students to do medicine. If choosing the medical profession is not hard enough, medical students have an even bigger hurdle ahead of them, which is choosing their line of specialisation. Many factors affect the career choices of graduating medicalstudents. Influences such as strong mentors, formativeacademic and non-academic experiences, and career counselingcan all help aspiring physicians select their particular careers4.Similarly, market trends, self-perception of strengths and weaknesses,and anticipated lifestyle can also affect career choice5. It has often been questioned, is gender really an issue? Does money influence one's decisions? Or is it competition?! A large number of specialising fields and over 50 career options are available in medicine, assuring a medical graduate of finding a profession. But how many medical students are actually aware of these career options? As mentioned earlier, medical profession brings great rewards in terms of job satisfaction and a variety of career opportunities. However, like any job, there are parts of a doctor's work that are frustrating, undesirable, and even repetitive or boring. Studies show that doctors work far more hours than the average U.S. professional and cope with large amounts of stress and pressure6. Managed care has made it more difficult for U.S doctors to practice as they see fit and limit the amount of time that they can spend with patients. In fact, for some doctors, the upsides of the profession aren't worth the sacrifice and hassles of the modern health-care environment4. This has lead to doctors with long and potentially bright careers to hang up their stethoscopes and quit! But is this the case when it comes to medical students in India? What makes them leave medicine despite the fact that there's a shortage of doctors making a ratio of one doctor per 1,634 people in India which is considered to be extremely below the ideal standard of doctor-people ratio?7,8 Medical students' attitude towards various clinical fields and post graduation has been a major focus of study in the U.S as well as in the United Kingdom, yet there have been very few studies and surveys done on the career choices of Indian medical students. Hence, little is known about career intentions or attitudes of medical students in India. This study aims to reporton the career intentions and attitudes of first and second year medical students. It gives us the opportunity to discover the factors that influence the medical students on their career choices. The study also shows how exposure to more clinically oriented medical professions will affect the choice of careers in medical students. Aims and Objectives The study aims to find out factors that influence the choice of career of medical students Objectives

• To find out the reasons for students to take up medicine as a course of further studies.

• To compare career intentions of 1st year medical students, early in their training, with 2nd year medical students of Kasturba Medical College, Mangalore, in relation to various socio-demographic correlates.

• To compare findings from the 2nd year batch with those from a similar survey conducted on the same batch last year.

Methodology  We conducted a survey in the study setting of KMC Mangalore with the total study population of 393 MBBS students, which consisted of 216 1st year and 177 2nd year students. It was a cross sectional study which lasted from the dates of March 7th to March 14th, 2008. Data was collected through a pilot studied semi-structured questionnaire. The outline of the questionnaire was designed after referring to questionnaires used in similar studies like ours. Certain changes such as clearing any non-specific questions and adding more questions which seemed relevant to our study were made. Permission was obtained from the Associate Dean Dr. M.V. Prabhu and respective teachers. Then questionnaires were given out to consenting students. Collected data was tabulated and analyzed by using SPSS version 10 software. Results obtained were presented on tables and graphs wherever appropriate. Lastly the test of significance was carried out using ?2 test on tables in which we thought there would be significant values. Results The total study sample was 393 students, comprising of 216 1st year students and 177 2nd year students. The response rate among the 1st and 2nd year students was 98.18% and 100% respectively.

Gender	1st Year (n=216)	2nd Year (n=177)	Total (n=393)
Male	94 (43.5%)	103 (58.2%)	197 (50.1%)
Female	117 (54.2%)	71 (40.1%)	188 (47.8%)

Table 2: Baseline Characteristics

1st Year (n=216)

2nd Year (n=177)

Total (n=393)

Schooling:

Abroad	30 (13.9%)	43 (24.3%)	73 (18.6%)
In India	170 (78.7%)	121 (68.4%)	291 (74%)
Both	16 (7.4%)	9 (5.1%)	25 (6.4%)

Before MBBS:

School	121 (56%)	95 (50.7%)	216 (55%)
Degree	5 (2.3%)	4 (2.25%)	9 (2.3%)
Dropped	68 (31.5%)	50 (28.2%)	118 (30%)
Others	19 (8.8%)	25 (14.1%)	44 (11.2%)

Majority of the participants have done their schooling solely in India (74%). 55% of the respondents joined directly after school, whereas 30% dropped a year or 2 before joining college. 2.3% of the students had completed a degree prior to joining college. Both 1st year and 2nd year students chose the medical profession because they had a passion for the medical field. It seems that very few 2nd year students were forced by their parents (3.4%) as compared to the 1st year students (4.6%). On the other hand, there are very few students in the 1st year that chose medicine for job security (1.9%) unlike the 2nd year students who had a higher percentage of 15.3%. Job security & parents' insistence were the most unlikely reasons for 1st year & 2nd year students respectively (Table 3). When asked about their future line of plan, had it not been MBBS, more than 100 students who responded in the OTHERS category specified that they would join ONLY MBBS. As expected, most students (37.2%) felt that they would join engineering had they not been in MBBS. This may possibly be due to the fact that Mathematics is a compulsory subject during pre-university college. Paramedical/Allied Health Sciences were the least sought-after fields which were chosen by the 1st & 2nd year students respectively (Table 4). Interestingly, ALL 1st year students wanted to pursue a PG degree while 4% of the 2nd year students DID NOT want to go in for post graduation - perhaps due to the exposure to clinical postings? Both 1st and the 2nd year students seemed widely interested in doing an MD/MS (91.7% & 86.4% respectively), with the next popular choice being MRCP/MRCS with only 7.4% & 6.2% of 1st & 2nd year students considering it . Even with the very little information they have, 86.6% of 1st year students wanted to go in for a clinical field & 12.5% of the students could not decide about their choice of career, whereas 0.93% decided for a non-clinical field. Among the 2nd year students, 84.2% of the students decided for a clinical field, 7.9% having not decided yet & 2.3% for a non-clinical field. This trend of more students opting for a clinical field may be due to the exposure to clinical postings during the 2nd year (Table 5). When asked about going in for super-specialization, 79.6% of 1st year students & 64.4% of 2nd year students answered on the affirmative, 13.4% & 25.4% answered against it while 6.9% & 10.2% said they had not decided yet (Table 6). The general trend among 1st year students is to take up a career in surgery (40.7%) whereas for 2nd year students it is medicine (24.9%). The least sought after fields are Anaesthesiology for 1st year students & ENT for 2nd year students (Table 7). Regarding non-clinical fields, Forensic Medicine is the most preferred non-clinical field among 1st years (5.1%) where as post-graduation research is more popular among 2nd years (2.8%) (Table 8). According to the data, there is no significant difference between male and female students' choice of career with relation to choosing a clinical or a non-clinical field. 90.9% of the males & 88.5% of the females taking the survey thought it would be a clinical field they would like to pursue (Table 9). When asked if there was a chance that the respondents would not be able to pursue the career of their choice, most students felt that Competition remained the major hurdle ahead of them. 27.3% of 1st year students & 29.4% of 2nd year students felt that the stiff competition they face would stop them from going in for the career of their choice (Table 10). Majority of the 1st & 2nd year students prefer to practice medicine in their own countries, rather than in a foreign country. This may possibly be due to the fact that most relatives & kin are in their own country & also, due to the possibility of an already functional medical set-up in the family. 33.3% of 1st year & 26% of 2nd year students prefer to practice abroad, & 5 of 2nd year students said they would leave medicine, but still stay in the country (Tables 11a & 11b). It is seen that among all the respondents, 205 resident Indians, forming 52.16% of the students prefer to practice in their own country, whereas 25 of them (6.36%) preferred to practice abroad. 70 students (17.81% of students) said they had not decided yet & depended on various factors. Among the Malaysians, 18 students (4.58%) prefer their own country, 1 student (0.25%) prefers practising abroad & 8 students had not decided yet. 7 non-resident Indians (1.78%) wanted to practise in their own country, 6 students (1.52%) abroad & 14 students (3.56%) had not decided yet (Table 12). Most students in 1st year (16.7%) & 2nd year (7.3%) feel that if they were to go abroad, it would be due to better prospects available. A better financial reward was the next most popular reason for going abroad, with 10.6% of 1st year & 6.8% of 2nd year students feeling so (Table 13). The current trend seems to be favoring multi-specialty hospitals over government hospitals. 50% of 1st year students & 49.2% of 2nd year students preferred multi-specialty hospitals over other options. The next most sought work setting was Government Hospitals for 1st year students whereas it was private practice among 2nd year students (Table 14). For most students in both 1st year (4.6%) & 2nd year (7.9%), hectic schedules seem to be the main reason for leaving medicine. Family obligations seem to affect the decisions of 1st year students (3.7%) more than that compared to 2nd year students (1.7%). It also seems as though 2nd year MBBS students are much more concerned with the competition in medicine (2.8%) than the 1st year students, perhaps due to more exposure to clinical fields (Table 15). Interestingly, exposure to clinically oriented medical profession has DECREASED the students' interest to pursue further studies as well as choose a clinical field! Whereas 98% of 1st year students wanted to pursue a post-graduation course, only 94.4% of 2nd year students chose to go in for a post-graduation. Also, while 89.9% of 1st year students wanted to go in for a clinical field, only 84.2% of 2nd year students wanted to go in for a career in a clinically oriented field - a very interesting find! (Table 16). There seem to be a dynamic shift in the career choice of the 2nd year MBBS students of the 2006 batch after clinical exposure. About a quarter of the students presently in 2nd year are inclined towards general medicine, compared to just 15.6% of the same students before clinical exposure. On the other hand, figures for a career in surgery have come down from 33.2% to 21.5% after clinics. Interest in pediatrics has also increased almost two-fold after clinical exposure (Table 17).   Table 3:What drove students to choose medicine?  

	1st year	2nd year	Total
Passion for Medical Science	96 (44.4%)	91 (51.4%)	187 (47.6%)
Inspired by Family Members	40 (18.5%)	37 (20.9%)	77 (19.6%)
To help the Community	48 (22.2%)	25 (14.1%)	73 (18.6%)
Forced by Parents	10 (4.6%)	6 (3.4%)	16 (4.1%)
Job Security	4 (1.9%)	27 (15.3%)	31 (7.9%)
Prestigious Profession	36 (16.7%)	30 (16.9%)	66 (16.8%)
Others	8 (3.7%)	13 (7.3%)	21 (5.3%)

Table 4:If not MBBS?

	1st Year (n=216)	2nd Year (n=177)	Total (n=393)
Dental	19 (8.8%)	21 (11.9%)	40 (10.2%)
Paramedical/Allied Health Sciences	11 (5.1%)	7 (4%)	18 (4.6%)
Engineering	84 (38.9%)	62 (35%)	146 (37.2%)
Others	95 (44%)	77 (43.6%)	172 (43.8%)

Table 5: Post-graduation

1st year MBBS

2nd year MBBS

Total

Post-graduation

Yes	214 (99.1%)	167 (94.4%)	381 (96.9%)
No	0 (0%)	7 (4%)	7 (1.8%)

p=0.0034,highly significant

Choice of degree

MD/MS	198 (91.7%)	153 (86.4%)	351 (89.3%)
Diploma	1 (0.46%)	1 (0.56%)	2 (0.51%)
DNB	1 (0.46%)	5 (2.8%)	6 (1.5%)
MRCP/MRCS	16 (7.4%)	11 (6.2%)	27 (6.9%)

?2=3.935, p=0.268

Table 6: Future career intentions

	1st Year (n=216)	2nd Year (n=177)	Total (n=393)
Clinical Field	187 (86.6%)	149 (84.2%)	336 (85.5%)
Non- Clinical Field	2 (0 .93%)	4 (2.3%)	6 (1.5%)
Not Decided	27 (12.5%)	14 (7.9%)	33 (8.4%)

?2=.456, p=0.499, not significant

Super specialization

Yes	172 (79.6%)	114 (64.4%)	286 (72.8%)
No	29 (13.4%)	4 (25.4%)	74 (18.8%)
Not Decided	15 (6.9%)	18 (10.2%)	33 (8.4%)

?2= 13.489, p=0.0012, highly significant

Table 7:Preference for a profession in a CLINICAL Field:

	1st year MBBS	2nd year MBBS	Total
Radiology	27 (12.5%)	17 (9.6%)	44 (11.2%)
Medicine	43 (19.9%)	44 (24.9%)	87 (22.1%)
Orthopedics	14 (6.5%)	15 (8.5%)	29 (7.4%)
Pediatrics	30 (13.9%)	39 (22%)	69 (17.6%)
Dermatology	4 (1.9%)	5 (2.8%)	9 (2.3%)
ENT	3 (1.4%)	2 (1.1%)	5 (1.3%)
OBGYN	23 (10.6%)	13 (7.3%)	36 (9.2%)
Surgery	88 (40.7%)	38 (21.5%)	126 (32.1%)
Community Med		3 (1.7%)	3 (0.76%)
Ophthalmology	4 (1.9%)	4 (2.3%)	8 (2%)
Anesthesiology	1 (0.46%)	4 (2.3%)	5 (1.3%)
Psychiatry	15 (6.9%)	5 (2.8%)	20 (5.1%)

Table 8: Preference for a profession in a NON - CLINICAL Field 

	1st year MBBS	2nd year MBBS	Total
Anatomy	3 (1.4%)		3 (0.76%)
Physiology	1 (0.46%)		1 (0.25%)
Pathology	3 (1.4%)		3 (.76%)
Forensic Med	11 (5.1%)	2 (1.1%)	13 (3.3%)
Hospital M.	5 (2.3%)	4 (2.3%)	9 (2.3%)
Others	14 (6.5%)	3 (1.7%)	17 (4.3%)
Table 8: Preference for a profession in a NON - CLINICAL Field Cont'd Research	4 (1.9%)	5 (2.8%)	9 (2.3%)

Not Yet Though Of	9 (4.2%)	6 (3.4%)	15 (3.8%)
Don't Know	1 (0.46%)	2 (1.1%)	3 (.76%)
Still Undecided	17 (7.9%)	18 (10.2%)	35 (8.9%)

Table 9: Is GENDER really an issue?

	Clinical Field	Non Clinical Field	Not Decided
Male	170 (90.9%)	3 (1.6%)	14 (7.5%)
Female	162 (88.5%)	3 (1.6%)	18 (9.8%)

Table 10: Reasons for NOT pursuing the career of choice:

1st year MBBS

2nd year MBBS

Total

Not Pursuing a career

Yes	70 (32.4%)	84 (47.5%)	154 (39.2%)
No	114 (52.8%)	61 (34.5%)	175 (44.5%)

Reasons for not Pursuing Career

Working Hours	4 (1.9%)	9 (5.1%)	13 (3.3%)
Income	8 (3.7%)	7 (4%)	15 (3.8%)
Competition	59 (27.3%)	52 (29.4%)	111 (28.2%)
Job Security	6 (2.8%)	1 (0.56%)	7 (1.8%)
Lifestyle	11 (5.1%)	10 (5.6%)	21 (5.3%)
Reputation	4 (1.9%)	1 (0.56%)	5 (1.3%)
Others	6 (2.8%)	6 (3.4%)	12 (3.1%)

Table 11 a:What the future holds for a medical student?

1st year MBBS

2nd year MBBS

Total

Practice in Own Country

Yes	129 (59.7%)	118 (66.7%)	247 (62.8%)
No	18 (8.3%)	18 (10.2%)	36 (9.2%)
Not Decided	66 (30.6%)	35 (19.8%)	101 (25.7%)

Table 11 b: What the future holds for a medical student?

	1st year MBBS	2nd year MBBS	Total
Practice Abroad	72 (33.3%)	46 (26%)	118 (30%)
Leaving Medicine & Staying in Country	-	7 (4%)	7 (1.8%)
Not Applicable	68 (31.5%)	42 (23.7%)	110 (28%)

Table 12:Where do students prefer to practice?

	Practice in own country	Practice Abroad	Not Decided
Resident Indians	205 (52.16%)	25 (6.36%)	70 (17.81%)
NRI	7 (1.78%)	6 (1.52%)	14 (3.56%)
Malaysian	18 (4.58%)	1 (0.25%)	8 (2.03%)
US	6 (1.52%)	1 (0.25%)	2 (0.50%)
UK	1 (0.25%)	0 (0%)	1 (0.25%)
Others	8 (2.03%)	3 (0.76%)	4 (1.01%)
Total	245	36	99

?2=10.776, p=0.001, very highly significant

Table 13:Reasons for Going Abroad

	1st year MBBS	2nd year MBBS	Total
Better Quality Life	12 (5.6%)	10 (5.6%)	22 (5.6%)

Financially Rewarding	23 (10.6%)	12 (6.8%)	35 (8.9%)
Job Satisfaction	8 (3.7%)	5 (2.8%)	13 (3.3%)
Better Prospects	36 (16.7%)	13 (7.3%)	49 (12.5%)
Others	5 (1.3%)	5 (2.8%)	10 (2.5%)
Not Applicable	46 (21.3%)	30 (16.9%)	76 (19.3%)

Table 14:Preference of work setting

	1st year MBBS	2nd year MBBS	Total
Private Practice	29 (13.4%)	38 (21.5%)	67 (17.0%)
Multi-Specialty	107 (50%)	87 (49.2%)	194 (49.4%)
Medical College	7 (3.2%)	7 (4%)	14 (3.6%)
Government Hospital	43 (20%)	22 (12.4%)	65 (16.5%)
Others	2 (0.93%)	0 (0%)	2 (0.51%)

?2=7.884, p=.0489, significant

Table 15: What Makes Students Leave Medicine?

1st year MBBS

2nd year MBBS

Total

Reasons for Leaving Medicine:

Bleak Future	3 (1.4%)	3 (1.7%)	6 (1.5%)
Stiff Competition	6 (2.8%)	6 (3.4%)	12 (3.1%)
Hectic Schedule	10 (4.6%)	14 (7.9%)	24 (6.1%)
Table 15: What Makes Students Leave Medicine? Cont'd Family Business	5 (2.3%)	3 (1.7%)	8 (2.0%)
Family Obligations	8 (3.7%)	3 (1.7%)	11 (2.8%)
Others	6 (2.8%)	10 (5.6%)	16 (4.1%)
Not Applicable	110 (50.9%)	67 (37.9%)	177 (45.0%)

Table 16: Influence of exposure to clinically oriented medical profession on the choice of careers of medical students-1

1st year MBBS (2006)

2nd year MBBS (2007)

Total

Post-graduation

Yes	195 (98%)	167 (94.4%)	362 (96.3%)
No	3 (1.5%)	7 (4%)	10 (2.7%)

?2=2.227, p=0.136, not significant

Clinical Field	179 (89.9%)	149 (84.2%)	328 (87.2%)
Non Clinical Field	15 (7.5%)	4 (2.3%)	19 (5.1%)

?2=4.328, p=0.0375, significant

Table 17: Influence of exposure to clinically oriented medical profession on the choice of careers of medical students-2

	1st year MBBS (2006)	2nd year MBBS (2007)	Total
Medicine	31 (15.6%)	44 (24.9%)	75 (19.9%)
Orthopaedics	7 (3.5%)	15 (8.5%)	22 (5.9%)
Paediatrics	23 (11.6%)	39 (22%)	62 (16.5%)
OBGYN	10 (5.0%)	13 (7.3%)	23 (6.1%)
Surgery	66 (33.2%)	38 (21.5%)	104 (27.7%)

?2=16.747, p=0.0022, highly significant

Discussion There were quite interesting findings in our cross sectional study involving 1st and 2nd year students of KMC Mangalore. Our findings this year were compared with a similar survey done last year on the 2006 batch, when they were in their 1st year. We also did a critical analysis and comparison of our data with similar surveys and studies conducted in India as well as in other parts of the world. One of our objectives was to find out what drove students to choose medicine as a further course of study. According to our data, genuine interest and passion for the subject made majority of students, accounting for 83.5%, to choose medicine. In contrast to our findings, a similar cross sectional study by Panna et al among a group of 1st year students in Delhi showed that students' desire to serve the sick in the society made them chose medicine9. However, there were similar findings in both studies, such as parents profession; a majority of students' parents were in to medical profession. Hence, the fact that having parents as doctors influencing students choice to take up a career in medicine can not be ruled out. After completing the basic MBBS degree, students face the bigger hurdle of choosing their line of specialisation. Our data indicated that majority of students (96.9%) wanted to do their post-graduation either in a clinical field (85.5%) or a non-clinical filed (1.5%). 72.8% of the students even wanted to go in to super specialisation. Similarly Panna et al data shows that majority of Delhi students also wanted to pursue a post graduate degree. Studies by Azizzadeh et al and similar studies by Nellens et al regarding future choice of specialty among medical students showed that majority of first year students chose medicine to help the patients 10, 11. A good number chose internal medicine followed by surgery. This is similar to the survey taken by us of the 2nd year students where medicine was the popular choice. Most of the 1st years of KMC Mangalore had chosen surgery over medicine .This difference is probably due to the exposure to clinical postings by the 2nd year students. Our study found out that 32% students overall wanted to do surgery which is consistent with the study done by Tambyraja and co-workers12. Their study was based on attitudes of medical students toward careers in surgery. Career ambitions and reasoning of a group of final year students who completed their general surgery attachment in a UK medical school was assessed through a questionnaire-based survey. 40% students would consider a career in general surgery, and 39% would not; 29% were undecided. The two most popular attractions to general surgery were challenging postgraduate training and highly regarded career esteem. The two most common disincentives were family considerations and the sacrifice of personal time. Thus the percentage of medical students favouring surgery seems to be independent of any socio-demographic differences between India and the UK. Kuhnigk et al studied the attitudes of medical students towards psychiatry and psychotherapy13. The more positive the psychiatry course was rated, the more positive attitudes towards psychiatry were. Female students and students with psychiatry/psychotherapy experience had a significantly more positive attitude towards psychiatry as a subject. Overall 5.8% of all students chose psychiatry as a career choice. The study concluded that a positive education experience as well as personal experience increases the probability of a positive student attitude towards psychiatry. It remains to be investigated, however, whether an improvement in the attitudes of students towards the psychiatry discipline is sufficient to increase the number of students who would like to become psychiatrists or whether other factors are more deciding such as career opportunities, conditions of further education, or income potential. Our study found that 6.1% of students wanted to do psychiatry which is consistent with the above study. Thus the percentage of medical students favoring psychiatry seems to be independent of any socio demographic differences between India and the UK. According to our data, 1.9% of 1st year students wanted to chose ophthalmology where as an increased number of 2nd year students accounting for 2.3% opted for ophthalmology. This increase in number could be explained by the students' increased exposure to different clinical fields and also by an increased awareness of lifestyle advantages with particular benefits. However, the fact that both 1st year and 2nd year students of our sample had not taken ophthalmology postings can not be ruled out. Maybe we would have obtained an entirely different set of responses had they been exposed to at least one of the ophthalmology postings. Hence, it will be interesting to carry out further investigations in our college regarding this particular choice of career. However, Lambert and co-workers conducted an extensive survey which involved medical students from year 1975-200514. The aim was to study the trends of career choices for ophthalmology among UK medical graduates. According to their data ophthalmology was the first choice of long term career for 2.3% of men and 1.5% of women one year after qualification; 2.0% of men and 1.4% of women three years after; and 1.8% of men and 1.2% of women at five years. Comparing early choices with eventual destinations, 64% who chose ophthalmology in year one, 84% in year three, and 92% in year five eventually practiced in the specialty. The concordance between year one choice and eventual destination was higher for ophthalmology than for most other specialties. ‘Enthusiasm for and commitment to the specialty' was the most important single factor in influencing career choice. The prospect of good working hours and conditions was also an important influence: it influenced career choice a great deal for a higher percentage of those who chose ophthalmology (66% in the third year) than those who made other surgical choices (23%). Lambert et al conclude that those choosing ophthalmology show a high level of commitment to it. Their commitment is strengthened by the prospect of attractive hours and working conditions. Many doctors who become ophthalmologists have already made their choice by the end of their first post-qualification year. A study by Sinclair and co-workers showed that females were more positive about a career in general practice15. General practice was the first choice for 13% of students. Those choosing general practice were more likely than those choosing other specialties to be female and to rate their academic abilities lower and their non-academic abilities as average, and have decided on their future career earlier. Reasons for general practice included: working in and being part of a community; continuity of patient contact; variety of illnesses and people encountered; undergraduate teaching experiences; dislike of or disillusionment with hospital medicine; and an increasing awareness of part-time opportunities. Our study however indicates that no students have chosen general practice. This may be explained by the increased exposure to general practitioners and patients in the teaching program and the increasing awareness of lifestyle advantages with the particular benefits of more regular hours and working part time which may come after further clinical exposure as the surveyed students have limited exposure. This is indicated as the above study found an increasing tendency towards this specialty as the students advanced in the course and had more clinical exposure. A study by Dorsey and co-workers,on relationship between specialty choices of clinical and non-clinical fields with controllable life styles and gender in the United States showed that the number of women choosing specialties with controllable life style increased from 18% in 1996 to 36% 20035. Interestingly, the study found out that women are more likely to pursue an uncontrollable lifestyle specialty than men! But according to our survey this was not the case. Our survey covered a similar objective which was whether gender bias is actually a real reason why a medical student chooses a particular medical profession. Our final data showed that 90.9% of males chose a clinical field while only 88.5% of females chose the clinical field. Although, when it came to choosing a non - clinical field both males and females had an equal percentage of responses of 1.6%. There seemed to be slight difference again when it came to males and females being undecided, this is because 7.5% of males were undecided while 9.8% of females were undecided. Hence, our study shows that there is no significant difference between male and female students' choice of career with relation to choosing a clinical filed, which offers more of an uncontrollable lifestyle or a non-clinical field, which comparatively offers a controllable lifestyle. Reason for this observation could be due to the fact that there has been little exposure to clinical fields through postings so far, thus few students in KMC realize the realities in terms of working hours, stress, pressure and challenges, of some clinical fields. Fysh et al, found out that while medicine in general is becoming more female-dominated, women are still under-represented in surgery16. Opinion is divided as to whether this is due to lifestyle considerations, disinterest or perceived discrimination. It is not clear at what stage these careers decisions are made. While men represented only 38% of the student population, they represented over two-thirds of the students wishing to pursue a career in surgery. Women still opt for general practice and pediatrics. Our study however indicates that there is no gender disparity in career choice concerning surgery. This may be because there has been little exposure to surgery so far, thus few students in KMC realize the realities (working hours - so not favored by female students and challenges) of surgery. A similar study by Williams et al17 showed that there was a gender bias when picking certain professions, especially when it came to surgery. The study showed that females actually did not want to choose the profession of surgery due to reasons such as surgical experience in medical school, lack of involvement of teachers and students during postings, and the general arrogant attitude of surgeons. According to the survey, while orthopedics & cardiothoracic show very less representation of women, pediatrics and general practice seemed to be more popular among women. The differences in our study and the surveys conducted previously could have resulted due to the different geographical locations and sample size. Another reason a difference might have arisen in the studies is due to the fact that both studies took two different levels of students. Our study took first and second year MMBS students, who are relatively fresh into the medical field and do not have as much exposure to all the clinically oriented professions. On the other hand the previous surveys took samples that consisted of post graduate students. Since post graduate students had more exposure to all the clinical fields, they seem to know all the difficulties of the profession unlike the 1st and 2nd year students which would affect there choice in choosing the profession. In India, there are 271 medical colleges, out of which 138 are government colleges and remaining 133 are private. They have a cumulative intake capacity of 31,172 seats in the graduate courses whereas nearby 11,005 post-graduate seats are available in various courses of all medical colleges and hospitals per year7,8. According to the Medical Council of India statistics, there are a total number of 675334 allopathic doctors registered in the country up to 31st March 20077. This makes a ratio of one doctor per 1,634 people in India which is extremely below the ideal standard of doctor-people ratio. These data shows that there is a serious shortage problem of legal and recognized medical practitioners nationwide, especially in rural and urban areas. According to the Health Minister Dr Anbumani Ramadoss, to overcome the critical shortage of medical practitioners in India, the government has adopted a quicker but significant step to recognize the postgraduate medical degrees obtained from five English-speaking countries namely, Australia, Canada, New Zealand, the United Kingdom and the United States. Besides this, the government has requested the medical professionals including Non-resident (NRI) and Overseas Indians who are working in those countries to return home and do their practice in India8. Though the government is planning to curb the problem of shortage of doctors by recruiting NRI doctors and recognizing foreign PG degrees, this might not be the case when it comes to a long term solution. Our study shows that, though there is a majority of 62.8% students who wanted to practice in India, there are still a considerable number of students accounting for 30% who wants to go abroad to practice. This does not seem like a good trend, considering the current situation of shortage of doctors in the country. Our study shows that the main reason for students to pursue a career abroad is the fact that there are better prospects (12.5%). 6.8% of students and 5.6% of students thought it is best to practice abroad since it is more financially rewarding and there is a better quality of life respectively. Interestingly our study shows that there is a considerable number of students who wish to leave medicine after finishing the basic MBBS. The main reason for this appeared to be hectic time schedules (6.1%) and other reasons being stiff competition (3.1%) and family obligations (2.8%). On the other hand, when inquired about the preferred practice setting, students of KMC have chosen to work in multi-specialty hospitals where as Delhi College students preferred to practice in a private hospital as opposed to a government hospital9. Recommendations Though our study can not be applied to all the medical students nationwide, due to various demographic changes, our data does give an overall view as to where the problem lies when it comes to graduating medical students leaving the country as well as the profession as a whole. The analysis of the data obtained from the medical students of their career intentions informs the administration of current issues in medical education which would prevent one from taking up a certain specialized field or which would make a medical student leave the country or the profession, and facilitates appropriate action. Trends in career preference can be tracked for many years through studies like ours. Trend analysis of multiple years of data can identify positive and negative trends at medical schools nationwide. This will aid the authorities to come up with long term solutions for various issues including the critical shortage of physicians which the country is experiencing currently. The Association of American Medical Colleges (AAMC) maintains a data bank of ‘Medical School Graduation Questionnaires' (GQ data bank)18. The questions posed by the 2008 GQ focus on issues critical for all medical students and educators, including the questions related to their specialty choices and career aspirations. In contrast there is very less data available on attitude and career intentions as well as other issues concerning the medical students in India. Hence it is advisable to maintain a similar data base for Indian Medical students. The data collected can be used for medical school program evaluation, for priority-setting, for program and policy development as well as for research purposes. Reference 1. Newton, D., Grayson, M., Thompson, L.F., (2005) The variable Influence of Lifestyle & Income on Medical Students' career specialty Choices. Academic Medicine 80; 809-814. 2. University of Cambridge UK (Online) 2008 (cited 2008 March 28); Available from: https://www.ox.ac.uk/admissions/undergraduate_courses/medicine.html 3. University of Cambridge UK (Online) 2008 (cited 2008 March 28); Available from: https://www.cam.ac.uk/admissions/undergraduate/medicine/index.html 4. George, V., Richard, Deanne, M., Nakamoto, Lockwood, J.H., (2007) Medical Career Choices: Traditional and New Possibilities. JAMA 285; 2249-2250. 5. Dorsey, R. E., Jarjoura, D., & Gregory, W. (2005). The influence of controllable life style and sex on the specialty choices of graduating medical students. Academic Medicine 80 (9): 791-796 6. Arenson D. CLL Diary: When leaving Medicine is the best Medicine (Online) 2006 (cited 2008 March 28); Available from: https://clldiary.blogspot.com/2006/04/when-leaving-medicine-is-best-medicine.html 7. News Track India (Online) 2007 (cited 2008 March 28); Available from: https://www.newstrackindia.com/newsdetails/2813 8. Medical Council of India (Online) 2008 (cited 2008 March 28); Available from: www.mciindia.org/tools/ann_reports/index.htm 9. Panna, L., & Chatna, M. Career Aspirations and Apprehensions regarding medical education among 1st year medical students in Delhi. (www.ijcm.org) 10. Azziadesh, et al, Factors influencing career choice among medical students interested in surgery. 11. Nellens, B.S & Hutchinsons, G. Factors affecting future choice of speciality among 1st year students of the University of the West Indies Trinidad. 12. Tambyraja, A.L., McCrea, C.A., Parks, R.W., & Garden, O.J. Attitudes of Medical Students toward Careers in General Surgery. (Department of Clinical & Surgical Sciences (Surgery), School of Clinical Sciences & Community Health, University of Edinburgh). 13. Kuhnigk, O., Strebel, B., Schilauske, J & Jueptner, M. Attitudes of medical students towards psychiatry: effects of training, courses in psychiatry, psychiatric experience and gender. (Prodekanat fuer Lehre, Martinstr. 52, 20246, Hamburg, Germany). 14. Lambert, T. W., Goldacre1, M.J., Anthony, J.B., (2008) Career choices for ophthalmology made by newly qualified doctors in the United Kingdom, 1974-2005. BMC Ophthalmology; 8:3 15. Sinclair, H.K., Ritchie, LD., & Lee, A. J. A. Future career in General Practice. (Department of General Practice and Primary Care, University of Aberdeen, Aberdeen, UK). 16. Fysh, T.H.S., Thomas, G., Ellis, H. (2007) Who wants to be a surgeon? BMC Medical Education 7:2. 17. Williams, C. & Cantillon., P (2000) A surgical career? The views of junior women doctors. Medical Education 34; 602-607. 18. Association of American Medical Colleges: Surveys & Data (Online) 2008 (cited 2008 March 28); Available from: https://www.aamc.org/data/gq/start.htm 19. Rao, N.R, Meinzer, A.E., Manley, M., & Chagwedera, Iris. (1998) International Medical Students' Career Choice, Attitudes toward Psychiatry, and Emigration to the United States. Academic Psychiatry 22; 2 20. Lambert, T., Goldacre, M., Davidson, M., & Parkhouse, J. (2001) Graduate status & age at entry to medical school as predictors of doctors' choice of long term career. Medical education 35; 450-454. 21. Henderson, E., Berline, A., & Fuller, J., (2002) Attitude of medical students towards general practice and general practitioners. British Journal of Medical practice May 22. Fysh, T.H., Thomas & G., Ellis, H. Gender Disparity in Surgery (Department of Surgery, RCHT Treliske, Treliske, Truro, Cornwall, TR1 3LJ, UK)

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