Medical Education, 1976, 10, 284-289
Career decisions by medical students: a profile from India T. V . RAO Indian Institute of Management, Ahmrdabad, India
Key words : *STUDENTS, MEDICAL; *CAREER CHOICE; MOTIVATION; SOCIOECONOMIC FACTORS; EDUCATIONAL STATUS ; OCCUPATIONS ;FAMILY CHARACTERISTICS ; STUDENT DROPOUTS; SPECIALTIES, MEDICAL; INDIA Introduction Several studies have been conducted in countries like the United States on the career decisions of medical students (Williams, 1949; Thelens, 1957; Gregg, 1955; Rogoff, 1957; Kendall & Selvin, 1957; Severinghans, 1959; Becker et al., 1961; Bloom, 1963, 1965,1971 ;de Goes & de Castro, 1966; Lyden et al., 1968). The process by which the doctors in India come to choose their profession, and their future aspirations in terms of their specialities and practice, seem to be a less attractive area of study for social scientists in India. A review of the social science researches reveals that there is little study in this area. The present study reports the process of career choice and social background factors of medical students from seven medical colleges of India. Social background factors analysed include age, sex, father’s education, mother’s education, father’s occupation, mother’s occupation, and monthly average per capita income of the family. Factors relating to career choice include age at which the student thought for the first time to study medicine, age at which firm decision was made rethinking about the career, problems faced during medical college years, factors influencing the decisions to study medicine, and subjects preferred for specialization after MB BS (the first degree in medicine).
graphic zones of India (South, North, Central and West) were chosen for this study. The colleges from the eastern region could not be approached due to student disturbances at that time. There were approximately 800 students in all doing their final MBBS in these seven colleges. The number of students in each college is more or less uniform, ranging from 100 to 120. Of the 800, only 466 students could be contacted. A questionnaire was used to collect data The questionnaire was administered and received back by the author personally in small groups. In one college it was handed over individually and collected back. As some students did not respond to some questions, the number of students on whom the observations are based is always less than 466. The sample size is indicated in each table separately. Age
Age distribution of the sample is given in Table 1. A majority of the respondents (86%) were in the age range of 20-23 years and only 2% of them were above 26 years. TABLE 1. Age distribution of the respondents ( n = 357) Age (years) 26 and
Percentage ofstudents
Below 19
20-21
22-23
24-25
above
0.2
54.0
32.0
12.5
2.3
Sex
The sample studied consisted of about 60% male students and 40% females. A great variation was observed in the male-female ratio of the students of the seven colleges. In one college there were as many men as there were women whereas in another only 9% were women.
Sample
Seven medical colleges distributed over four geoCorrespondence: Dr T. V. Rao, lndian Institute of Management, Ahmedabad, Vastrapur 380 015, India.
284
Career decisions by Indian medical students
Parental education
Educational levels of the parents of the sample studied are given in Table 2. Unlike the Kansas sample of Becker et al. (1961) more of Indian medical students seem to come from well-educated homes. Fathers of about 62.4% of the Indian students are either graduates or post-graduates (it was only 45% in Kansas sample). Only 3% of the fathers did not have any education. A majority of the mothers of these students also have had 'some schooling or college education (about 24% being graduates). Taking into consideration the rather low literacy levels in the country it is clear that Indian medical students come from rather well educated families. Parental occupation
Distribution of the parental occupations of the sample are presented in Table 3. Fathers of a majority of the students are government servants and office workers, some of them occupying administrative positions. 11% of fathers are in business; parents in business can afford to pay the high costs involved in medical education. About 10% of the fathers are doctors. Engineers and lawyers seem to be less interested in sending their children into medicine, or it could be due to the lower number of high earning engineers and lawyers in this country. These results also indicate that a majority of Indian medical
285
students come from middle class families as in other countries. Economic status
Monthly average per capita income of the family was calculated by dividing the total monthly income of the family by the total number of persons in the family. The income distribution is presented in Table 4. The table reveals that only in about 31% of the cases the per member family income is less than Rs.100/-. This provides further support for the assumption that a majority of the students come from middle class families. Even a per capita income of Rs.100/- is sufficient to elevate a student from a poor family and categorize him in the lower middle class in view of the low income index of India. Thus these results are closer to the observations made by Hall (1948), Johnson (1965) and Bloom (1971) on American students. First thoughts of medicine as a career
Responses of the students to the question 'At what age did you first think of becoming a doctor?' are given in Table 5. About 21.5% of the sample reported to have had first thoughts of studying medicine as early as when they were below 10 years of age. These results are highly similar to those observed by
TABLE 2. Parental education of the students (n =372 for fathers and 325 for mothers) ~~
Level of education
Percentage of fathers Percentage of mothers
No education
u p to primary school
u p to high school
u p to graduation*
u p to post-graduation/ professional deareet
3.0 16.3
6.4 17.8
28.2 42.2
25.0 15.7
37.4 8 .O
* BA, BSc, BCom, degree holders. t Masters degree holders or above: professional degrees include BE, MB BS, etc., which is considered as higher
education.
TABLE 3. Parental occupation of the students (n=369 for fathers and 329 for mothers)
Occupation ~~
Percentage of fathers Percentage of mothers
Retired, no occupation, etc./housewife
Agriculture/ labourer
Business
Lawyer
Engineer/ technician
7.3
11.4
23.8
5.7
0.6
0 .o
87.5
4.3
Teacher
Doctor
Other administrative service, etc.
3.8
7.0
10.0
30.9
0.3
4.3
2.7
0.3
286
T. V. Rao TABLE 4. Per capita monthly income of the student’s family (n=360) Income (rupees) 100 or
Percentage of students in the income group
below
101-200
201-300
301-400
30.8
34.4
14.7
6.4
Rogoff (1957). In Rogoff’s study 20% of the students reported to have thought of studying medicine by 10 years or less, and 27% between 10 and 13 years, making a total of 47 % planning to study by 13 years of age. This percentage comes up to 51% in the present sample. In their sample about 18% considered the study of medicine between 14 and 15 years as compared to 22 % in the present study, and about 17% between 16 and 17 years as compared to 21.5 % in the present study. We also find here about 1 in 100 who never thought of becoming a doctor. They have entered the college by chance or due to external forces like parental pressures.
401-500
501-1000
Above 1000
4.2
3.1
6.4
Preferences for other professions In their answers to the question whether they preferred other professions before they decided to study medicine, 40% of the students (n = 168) reported that they did prefer, and 60% (n = 250) reported that they never preferred any other professions to medicine. In Thelens’ (1957) study about 64% of the students reported that medicine was the only career for them as compared to the 30% of law students who reported so. The results of this study are similar to those obtained by Thelens. Changing profession during college years
Firm decisions Details of the age at which these students firmly decide to choose medicine are presented in Table 6. Although about 21.5% of students reported to have thought of studying medicine as early as before 10 years of age, only about 4% of them seem to make firm decisions at such an early age. Only about 14% report to have made firm decisions at their 13th year or earlier. About 21% make their decisions between 14 and 15 and about 63%, the majority of the students, make firm decisions between 16 and 19. It may be recalled that in Rogoff’s sample about 67% of students made firm decisions between 16 and 20 years and the present results approach this figure.
In their answers to the question on whether they wanted to change their profession after joining the medical college, 33% (n = 104) reported that they wanted to change their profession and 77% (n = 353) did not think of changing. Severinghans (1959) observed that about 33% of students do show concern due to the difficulties they face in the beginning of their courses and start thinking whether they made the right choice. Such difficulties experienced may be the reason for the preferences expressed by 33% of students here for other professions. In order to go a step further in this study the students reporting that they wanted to change their profession were asked to mention the reasons for such a change. The results are presented in Table 7.
Age at which the students first thought of becoming d x t o r s (n=404)
TABLE 5.
Age (years)
Percentage reporting
TABLE 6.
Below 10
10-11
12-13
14-15
16-17
above
Never thought
21.5
9.9
19.6
22.3
21.5
5.9
1.2
18 and
Age at which firm decision was made to study medicine (n=411) Age (years)
Below Percentage reporting
10
10-11
12-13
14-15
16-17
18-19
20and above
Never thought
4.4
I .7
8.8
20-7
47.7
15.6
0.2
1 .o
281
Career decisions by Indian medical students TABLE 7. Reasons for deciding to change profession (n = 104 who wanted to change their profession after joining the college) Percentage of students
Reason 1. Personal/financial 2. Curricular, length of course, difficulty, poor marks, etc. 3. Teachers, favouritism, lack of interest, etc. 4. Examination system 5. Poor college atmosphere 6. Professional apprehensions of future 7. Liking for other professions 8. Others: e.g. student disturbances, college policies, etc. 9. No reason
21.1 34.6 16.3 10.6 8.7 13.5 18.3
Persons influencing the decisions to study medicine
3.8 14.4
Reasons for changing profession
The reasons given by the students for wanting to change their profession after joining the college were analysed into eight categories. These categories are mutually exclusive and the same student was classified into more than one category whenever he mentioned a number of reasons. A majority of the students (35%) who desired to change their profession were disturbed by the curricular problems such as the length of the course, difficulty of the course and poor marks they obtained during the first year of the college. Also about 16% were upset by the lack of concern from the teachers towards the students, favouritism shown by the teachers, lack of personal attention, interest and guidance from teachers, and poor teaching and so on. About 11% were disturbed by the examination system. About 21% seem to have financial problems which formed a major part of the first category. The word ‘personal’ was added for a few of the students who mentioned lack of adjustTABLE
ment to the college, hostel, food, etc. Such disappointments about examinations, about teaching and difficulty of the courses in the beginning students were found in a number of studies including those by Becker et al. (1961) and Bloom (1971).
In order to study the relative influence exerted by different people in the decisions to study medicine, the students were given nine possible categories and were asked to rank them in order of their influence (on the students) in their choice of this profession. The results are presented in Table 8. Following Hall (1948) and Katz & Lazarsfeld’s (1955) theories of the role played by the significant others in the person’s environment and assuming that the significant others could be arranged in a continuum as father, mother, brothers/sisters/relatives,friends, teachers, doctors known and others, we may expect that the amount of influence exerted by these agents on the students’ decision would be in the same order. Also following the thesis of Gregg (1955) that students make their career choices as responsible personal decisions, we may also expect the self-interest of the student to play a major role than the others. In fact, that is revealed in Table 8. A majority of the students (83%) report that their own interest played a great role in their decisions to study medicine, followed by fathers, mothers, relatives and brothers, friends, teachers and doctors known to them. However, at least in 14%, of cases self-interest does not seem to have played any role and in 23-24% of cases at least one of the parents does not seem to have played any role in the choice of medicine.
8. Role played by different agents in influencing the students’ decisions to study medicine. Percentage of the influencing agents and the amount of influence they had on the students’ decisions as indicated by the ranks. Percentage mentioning the source of influence
Rank
Self
Father
Mother
Teachers
Friends
Brothers/ sisters/ relatives
Doctors known
1* 2
55.0
28.1 31.7
10.8
3
10.0 1.8 1.3
19.3 23. I
I .5 3.5 8.1
7.5
11.4
2.9 1.8 0.2 0.2 34.3
6.2 3.3 2.9
3.5 2.9 6.6 9.2 8.4 5.3 1.8 0.2 64.4
5.9 5.7 6.6 9.2 6.8 5.7 4.0 0.2 77.8
0.9 2.9 3.7 5.3 4.0 4.6 4.8 1.8 72.1
4 5
6 7 8 N o role
18.0
0.4
0 .o
0.2 13.6
12.5
2.4 I .8 0.4 0.2 0.2 22.6
0.4
62.6
Others I
.o
1.5
0.2 0.8 0.8 0.6 2.0 7.3 85.5
Total number of first ranks exceeds the total number of subjects because subjects had liberty to give the same rank to more than one influencing persons i n case of equal influences.
288
T. V. Rao
Difficulty of the course and problems in college About 58% of the students mentioned that they felt at one time or the other that medicine is a difficult course of study, and 42% report that they never felt it as a difficult course of study (n = 407). Since the earlier question dealt with the reasons given by only those students who wanted to change profession, in order to get the views of the total sample they were asked to mention the problems that disturbed them during the college.* Responses were analysed into the same categories used in Table 7. Results are presented in Table 9. The percentage mentioning personal and financial problems shoots up and those mentioning curricular problems has come down. Among the personal problems, a few students (about 2%) also mentioned love affairs as a problem. The majority were financial problems and a few were problems of concentration in studies. Teachers and examination system seem to be disturbing at least a quarter of them. In the study by Becker et al. (1961) 60% reported their strong disappointment with examinations. TABLE 9. Problems that disturbed the students in college Problem Personal/financial Curricular/length of course/difficulty, etc. Teachers/favouritism, lack of interest, etc. Examination systems Poor college atmosphere 6. Professional apprehensions of future 7. Others 8. No problem
1. 2. 3. 4. 5.
Percentage of students mentioning it 49.0 28.5 27.2 24.7 23.4 5.8 6.1 41.3
Tendencies towards specialization
A total of 222 students from three colleges were studied for this part of the study.? In an answer to the question about their decisions for specialization, 47% of the students (i.e. 104 out of 222) reported that they also thought of specialization when they first thought of entering medical profession. Different specialities and the number of students preferring
* The dropout rate of medical students in India is extremely low. Once a student gets admitted, it is rare that he leaves the medical college. Hence the possibility of this being a select group surviving the difficulties is rather low; almost everyone completes. t This study was conducted as a part of a larger study on professional socialization of medical students. As the questionnaire used was felt lengthy by the students this part of the questionnaire was not administered in the rest of the four colleges.
each of them are presented in Table 10. Surgery was preferred by a majority of the students (about 32%) followed by medicine, gynaecology, paediatrics, opthalmology, etc., in the order indicated in Table 10 TABLE 10. Number of students preferring each speciality when they first decided to enter the medical profession Speciality
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.
Surgery Medicine Gynaecology Paediatrics Opthalmology Cardiology Neurology Pathology Cancer Skin and V D ENT Forensic medicine Psychiatry Total
No. of students preferring 33 22 14 11 7 5
3 3 2 1 I 1
1 104
As Becker et al. (1961) have observed, students seem to develop certain stereotypes about specialities In this study students choosing surgery reported to have chosen it for reasons such as that it is an interesting field (19), respected speciality (4), gives scope to do something great (3), gives an opportunity to serve people (3), gives an opportunity to earn money (2), and has bright future (2). Five of them mentioned that their parents and friends advised them to be surgeons. Those choosing medicine gave reasons such as interesting area (6), can serve people ( 5 ) easy to do research (3), paying (2), enjoys respect (2) can treat many common diseases (2), and has future prospects (3). Students choosing gynaecology mention the reasons such as interesting field (7), can earn money (2), and easy (2). Students preferring paediatrics talk of it as interesting (6), has future prospects (2), gives opportunity to serve people (I), and one can treat many common diseases (5). Some of these reasons given by them are similar to the stereotypes found in Becker’s subjects. Only eighty-one of the 104 students answered the item about their change in decision with regard to the speciality. Of them nineteen (nearly 25%) changed their speciality preferences during their stay in the college. Of these nineteen, twelve started preferring other subjects like gynaecology, paediatrics and medicine to surgery. Two changed their preferences from opthalmology, two from neurology, and one each from cancer, paediatrics and medicine
Career decisions by Indian medical students
Different reasons were given for such change in preferences. These include reasons such as the increasing awareness of the importance of originally non-preferred subjects like gynaecology, paediatrics, and medicine, awareness of ones own limitations in skills required, and also the awareness of the health needs and demands by the society. Thus this provides a broad survey of the personal background factors and career choices of medical students. This brief survey and comparisons reveal that the medical student in India is comparable in many aspects with those in other countries, especially the American medical student. They have a lot to share in common in terms of the process by which they choose to study medicine, influencing sources for the decision, difficulties and problems faced in the college during first few years, attitudes towards examinations, expectations from teachers and views about specialities. Perhaps medical students form a student society where the least amount of personal and environmental variations could be found. This may be due to the uniform organizational structures of the medical schools and colleges in different parts of the world. Similar studies from other countries are required to get more insight into the sociology of medical education. References BECKER, H.S., GEER,B., HUGHES, E.C. & STRAUSS, A. (1961) Boys in White: Student Culture in Medical School. University of Chicago Press.
289
BLOOM,S.W. (1963) The process of becoming a physician. Annals of the American Academy of Political and Social Sciences, 346, 77. BLOOM,S.W. (1965) Sociology of medical education. Some comments on the state of the field. Milbank Memorial Fund Quarterly, 42, 143. BLOOM,S.W. (1971) The medical school as a social system. A case study of faculty-student relations. Milbank Memorial Fund Quarterly, 49, 196. DE GOES,P. & DE CASTRO, C.L.M. (1966) Social characteristics of medical students and their appraisal of medical education. Milbank Memorial Fund Quarterly, 44, 131. GREGG,A. (1955) Our anabasis. The Phares of Alpha, Omega, Alpha, 18. 18. HALL, 0. (1948) The stages of medical career. American Journal of Sociology, 53, 329. JOHNSON, L. (1965) The variety of value structures of medical colleges. Doctoral dissertations in Psychology, Columbia University Library. KATZ, E. & LAZARFELD, P.F. (1955) Personal Influence: Glencoes III. The Free Press. KENDALL, P.L. & SELVIN,H.E. (1957) Tendencies towards specialization in medical training. The Student Physician (ed. by R. K. Merton, G . G. Reader and P. L. Kendall), pp. 153-174. Harvard University Press, Cambridge. LYDEN, F., GEIGER,H.J. & PETERSON, O.L. (1968) The Training of Good Physicians: Critical Factors in Career Choices. Harvard University Press, Cambridge. ROGOFF,N. (1957) The decision to study medicine. The Student Physician (ed. by R. K. Merton, G . G. Reader and P. L. Kendall), pp. 109-129. Harvard University Press, Cambridge. A.E. (1959) The medical student. Journal of SEVERINGHANS, Medical Education, 34, 21 5 . THELENS, W. (1957) Some comparisons of entrants to medical and law school. The Student Physician (ed. by R. K. Merton, G . G. Reader and P. L. Kendall), pp. 109-129. Harvard University Press, Cambridge. WILLIAMS,J. (1949) The professional status of women physicians. Doctoral dissertation, University of Chicago.
Career decisions by medical students: a profile from India T. V . RAO Indian Institute of Management, Ahmrdabad, India
Key words : *STUDENTS, MEDICAL; *CAREER CHOICE; MOTIVATION; SOCIOECONOMIC FACTORS; EDUCATIONAL STATUS ; OCCUPATIONS ;FAMILY CHARACTERISTICS ; STUDENT DROPOUTS; SPECIALTIES, MEDICAL; INDIA Introduction Several studies have been conducted in countries like the United States on the career decisions of medical students (Williams, 1949; Thelens, 1957; Gregg, 1955; Rogoff, 1957; Kendall & Selvin, 1957; Severinghans, 1959; Becker et al., 1961; Bloom, 1963, 1965,1971 ;de Goes & de Castro, 1966; Lyden et al., 1968). The process by which the doctors in India come to choose their profession, and their future aspirations in terms of their specialities and practice, seem to be a less attractive area of study for social scientists in India. A review of the social science researches reveals that there is little study in this area. The present study reports the process of career choice and social background factors of medical students from seven medical colleges of India. Social background factors analysed include age, sex, father’s education, mother’s education, father’s occupation, mother’s occupation, and monthly average per capita income of the family. Factors relating to career choice include age at which the student thought for the first time to study medicine, age at which firm decision was made rethinking about the career, problems faced during medical college years, factors influencing the decisions to study medicine, and subjects preferred for specialization after MB BS (the first degree in medicine).
graphic zones of India (South, North, Central and West) were chosen for this study. The colleges from the eastern region could not be approached due to student disturbances at that time. There were approximately 800 students in all doing their final MBBS in these seven colleges. The number of students in each college is more or less uniform, ranging from 100 to 120. Of the 800, only 466 students could be contacted. A questionnaire was used to collect data The questionnaire was administered and received back by the author personally in small groups. In one college it was handed over individually and collected back. As some students did not respond to some questions, the number of students on whom the observations are based is always less than 466. The sample size is indicated in each table separately. Age
Age distribution of the sample is given in Table 1. A majority of the respondents (86%) were in the age range of 20-23 years and only 2% of them were above 26 years. TABLE 1. Age distribution of the respondents ( n = 357) Age (years) 26 and
Percentage ofstudents
Below 19
20-21
22-23
24-25
above
0.2
54.0
32.0
12.5
2.3
Sex
The sample studied consisted of about 60% male students and 40% females. A great variation was observed in the male-female ratio of the students of the seven colleges. In one college there were as many men as there were women whereas in another only 9% were women.
Sample
Seven medical colleges distributed over four geoCorrespondence: Dr T. V. Rao, lndian Institute of Management, Ahmedabad, Vastrapur 380 015, India.
284
Career decisions by Indian medical students
Parental education
Educational levels of the parents of the sample studied are given in Table 2. Unlike the Kansas sample of Becker et al. (1961) more of Indian medical students seem to come from well-educated homes. Fathers of about 62.4% of the Indian students are either graduates or post-graduates (it was only 45% in Kansas sample). Only 3% of the fathers did not have any education. A majority of the mothers of these students also have had 'some schooling or college education (about 24% being graduates). Taking into consideration the rather low literacy levels in the country it is clear that Indian medical students come from rather well educated families. Parental occupation
Distribution of the parental occupations of the sample are presented in Table 3. Fathers of a majority of the students are government servants and office workers, some of them occupying administrative positions. 11% of fathers are in business; parents in business can afford to pay the high costs involved in medical education. About 10% of the fathers are doctors. Engineers and lawyers seem to be less interested in sending their children into medicine, or it could be due to the lower number of high earning engineers and lawyers in this country. These results also indicate that a majority of Indian medical
285
students come from middle class families as in other countries. Economic status
Monthly average per capita income of the family was calculated by dividing the total monthly income of the family by the total number of persons in the family. The income distribution is presented in Table 4. The table reveals that only in about 31% of the cases the per member family income is less than Rs.100/-. This provides further support for the assumption that a majority of the students come from middle class families. Even a per capita income of Rs.100/- is sufficient to elevate a student from a poor family and categorize him in the lower middle class in view of the low income index of India. Thus these results are closer to the observations made by Hall (1948), Johnson (1965) and Bloom (1971) on American students. First thoughts of medicine as a career
Responses of the students to the question 'At what age did you first think of becoming a doctor?' are given in Table 5. About 21.5% of the sample reported to have had first thoughts of studying medicine as early as when they were below 10 years of age. These results are highly similar to those observed by
TABLE 2. Parental education of the students (n =372 for fathers and 325 for mothers) ~~
Level of education
Percentage of fathers Percentage of mothers
No education
u p to primary school
u p to high school
u p to graduation*
u p to post-graduation/ professional deareet
3.0 16.3
6.4 17.8
28.2 42.2
25.0 15.7
37.4 8 .O
* BA, BSc, BCom, degree holders. t Masters degree holders or above: professional degrees include BE, MB BS, etc., which is considered as higher
education.
TABLE 3. Parental occupation of the students (n=369 for fathers and 329 for mothers)
Occupation ~~
Percentage of fathers Percentage of mothers
Retired, no occupation, etc./housewife
Agriculture/ labourer
Business
Lawyer
Engineer/ technician
7.3
11.4
23.8
5.7
0.6
0 .o
87.5
4.3
Teacher
Doctor
Other administrative service, etc.
3.8
7.0
10.0
30.9
0.3
4.3
2.7
0.3
286
T. V. Rao TABLE 4. Per capita monthly income of the student’s family (n=360) Income (rupees) 100 or
Percentage of students in the income group
below
101-200
201-300
301-400
30.8
34.4
14.7
6.4
Rogoff (1957). In Rogoff’s study 20% of the students reported to have thought of studying medicine by 10 years or less, and 27% between 10 and 13 years, making a total of 47 % planning to study by 13 years of age. This percentage comes up to 51% in the present sample. In their sample about 18% considered the study of medicine between 14 and 15 years as compared to 22 % in the present study, and about 17% between 16 and 17 years as compared to 21.5 % in the present study. We also find here about 1 in 100 who never thought of becoming a doctor. They have entered the college by chance or due to external forces like parental pressures.
401-500
501-1000
Above 1000
4.2
3.1
6.4
Preferences for other professions In their answers to the question whether they preferred other professions before they decided to study medicine, 40% of the students (n = 168) reported that they did prefer, and 60% (n = 250) reported that they never preferred any other professions to medicine. In Thelens’ (1957) study about 64% of the students reported that medicine was the only career for them as compared to the 30% of law students who reported so. The results of this study are similar to those obtained by Thelens. Changing profession during college years
Firm decisions Details of the age at which these students firmly decide to choose medicine are presented in Table 6. Although about 21.5% of students reported to have thought of studying medicine as early as before 10 years of age, only about 4% of them seem to make firm decisions at such an early age. Only about 14% report to have made firm decisions at their 13th year or earlier. About 21% make their decisions between 14 and 15 and about 63%, the majority of the students, make firm decisions between 16 and 19. It may be recalled that in Rogoff’s sample about 67% of students made firm decisions between 16 and 20 years and the present results approach this figure.
In their answers to the question on whether they wanted to change their profession after joining the medical college, 33% (n = 104) reported that they wanted to change their profession and 77% (n = 353) did not think of changing. Severinghans (1959) observed that about 33% of students do show concern due to the difficulties they face in the beginning of their courses and start thinking whether they made the right choice. Such difficulties experienced may be the reason for the preferences expressed by 33% of students here for other professions. In order to go a step further in this study the students reporting that they wanted to change their profession were asked to mention the reasons for such a change. The results are presented in Table 7.
Age at which the students first thought of becoming d x t o r s (n=404)
TABLE 5.
Age (years)
Percentage reporting
TABLE 6.
Below 10
10-11
12-13
14-15
16-17
above
Never thought
21.5
9.9
19.6
22.3
21.5
5.9
1.2
18 and
Age at which firm decision was made to study medicine (n=411) Age (years)
Below Percentage reporting
10
10-11
12-13
14-15
16-17
18-19
20and above
Never thought
4.4
I .7
8.8
20-7
47.7
15.6
0.2
1 .o
281
Career decisions by Indian medical students TABLE 7. Reasons for deciding to change profession (n = 104 who wanted to change their profession after joining the college) Percentage of students
Reason 1. Personal/financial 2. Curricular, length of course, difficulty, poor marks, etc. 3. Teachers, favouritism, lack of interest, etc. 4. Examination system 5. Poor college atmosphere 6. Professional apprehensions of future 7. Liking for other professions 8. Others: e.g. student disturbances, college policies, etc. 9. No reason
21.1 34.6 16.3 10.6 8.7 13.5 18.3
Persons influencing the decisions to study medicine
3.8 14.4
Reasons for changing profession
The reasons given by the students for wanting to change their profession after joining the college were analysed into eight categories. These categories are mutually exclusive and the same student was classified into more than one category whenever he mentioned a number of reasons. A majority of the students (35%) who desired to change their profession were disturbed by the curricular problems such as the length of the course, difficulty of the course and poor marks they obtained during the first year of the college. Also about 16% were upset by the lack of concern from the teachers towards the students, favouritism shown by the teachers, lack of personal attention, interest and guidance from teachers, and poor teaching and so on. About 11% were disturbed by the examination system. About 21% seem to have financial problems which formed a major part of the first category. The word ‘personal’ was added for a few of the students who mentioned lack of adjustTABLE
ment to the college, hostel, food, etc. Such disappointments about examinations, about teaching and difficulty of the courses in the beginning students were found in a number of studies including those by Becker et al. (1961) and Bloom (1971).
In order to study the relative influence exerted by different people in the decisions to study medicine, the students were given nine possible categories and were asked to rank them in order of their influence (on the students) in their choice of this profession. The results are presented in Table 8. Following Hall (1948) and Katz & Lazarsfeld’s (1955) theories of the role played by the significant others in the person’s environment and assuming that the significant others could be arranged in a continuum as father, mother, brothers/sisters/relatives,friends, teachers, doctors known and others, we may expect that the amount of influence exerted by these agents on the students’ decision would be in the same order. Also following the thesis of Gregg (1955) that students make their career choices as responsible personal decisions, we may also expect the self-interest of the student to play a major role than the others. In fact, that is revealed in Table 8. A majority of the students (83%) report that their own interest played a great role in their decisions to study medicine, followed by fathers, mothers, relatives and brothers, friends, teachers and doctors known to them. However, at least in 14%, of cases self-interest does not seem to have played any role and in 23-24% of cases at least one of the parents does not seem to have played any role in the choice of medicine.
8. Role played by different agents in influencing the students’ decisions to study medicine. Percentage of the influencing agents and the amount of influence they had on the students’ decisions as indicated by the ranks. Percentage mentioning the source of influence
Rank
Self
Father
Mother
Teachers
Friends
Brothers/ sisters/ relatives
Doctors known
1* 2
55.0
28.1 31.7
10.8
3
10.0 1.8 1.3
19.3 23. I
I .5 3.5 8.1
7.5
11.4
2.9 1.8 0.2 0.2 34.3
6.2 3.3 2.9
3.5 2.9 6.6 9.2 8.4 5.3 1.8 0.2 64.4
5.9 5.7 6.6 9.2 6.8 5.7 4.0 0.2 77.8
0.9 2.9 3.7 5.3 4.0 4.6 4.8 1.8 72.1
4 5
6 7 8 N o role
18.0
0.4
0 .o
0.2 13.6
12.5
2.4 I .8 0.4 0.2 0.2 22.6
0.4
62.6
Others I
.o
1.5
0.2 0.8 0.8 0.6 2.0 7.3 85.5
Total number of first ranks exceeds the total number of subjects because subjects had liberty to give the same rank to more than one influencing persons i n case of equal influences.
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Difficulty of the course and problems in college About 58% of the students mentioned that they felt at one time or the other that medicine is a difficult course of study, and 42% report that they never felt it as a difficult course of study (n = 407). Since the earlier question dealt with the reasons given by only those students who wanted to change profession, in order to get the views of the total sample they were asked to mention the problems that disturbed them during the college.* Responses were analysed into the same categories used in Table 7. Results are presented in Table 9. The percentage mentioning personal and financial problems shoots up and those mentioning curricular problems has come down. Among the personal problems, a few students (about 2%) also mentioned love affairs as a problem. The majority were financial problems and a few were problems of concentration in studies. Teachers and examination system seem to be disturbing at least a quarter of them. In the study by Becker et al. (1961) 60% reported their strong disappointment with examinations. TABLE 9. Problems that disturbed the students in college Problem Personal/financial Curricular/length of course/difficulty, etc. Teachers/favouritism, lack of interest, etc. Examination systems Poor college atmosphere 6. Professional apprehensions of future 7. Others 8. No problem
1. 2. 3. 4. 5.
Percentage of students mentioning it 49.0 28.5 27.2 24.7 23.4 5.8 6.1 41.3
Tendencies towards specialization
A total of 222 students from three colleges were studied for this part of the study.? In an answer to the question about their decisions for specialization, 47% of the students (i.e. 104 out of 222) reported that they also thought of specialization when they first thought of entering medical profession. Different specialities and the number of students preferring
* The dropout rate of medical students in India is extremely low. Once a student gets admitted, it is rare that he leaves the medical college. Hence the possibility of this being a select group surviving the difficulties is rather low; almost everyone completes. t This study was conducted as a part of a larger study on professional socialization of medical students. As the questionnaire used was felt lengthy by the students this part of the questionnaire was not administered in the rest of the four colleges.
each of them are presented in Table 10. Surgery was preferred by a majority of the students (about 32%) followed by medicine, gynaecology, paediatrics, opthalmology, etc., in the order indicated in Table 10 TABLE 10. Number of students preferring each speciality when they first decided to enter the medical profession Speciality
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.
Surgery Medicine Gynaecology Paediatrics Opthalmology Cardiology Neurology Pathology Cancer Skin and V D ENT Forensic medicine Psychiatry Total
No. of students preferring 33 22 14 11 7 5
3 3 2 1 I 1
1 104
As Becker et al. (1961) have observed, students seem to develop certain stereotypes about specialities In this study students choosing surgery reported to have chosen it for reasons such as that it is an interesting field (19), respected speciality (4), gives scope to do something great (3), gives an opportunity to serve people (3), gives an opportunity to earn money (2), and has bright future (2). Five of them mentioned that their parents and friends advised them to be surgeons. Those choosing medicine gave reasons such as interesting area (6), can serve people ( 5 ) easy to do research (3), paying (2), enjoys respect (2) can treat many common diseases (2), and has future prospects (3). Students choosing gynaecology mention the reasons such as interesting field (7), can earn money (2), and easy (2). Students preferring paediatrics talk of it as interesting (6), has future prospects (2), gives opportunity to serve people (I), and one can treat many common diseases (5). Some of these reasons given by them are similar to the stereotypes found in Becker’s subjects. Only eighty-one of the 104 students answered the item about their change in decision with regard to the speciality. Of them nineteen (nearly 25%) changed their speciality preferences during their stay in the college. Of these nineteen, twelve started preferring other subjects like gynaecology, paediatrics and medicine to surgery. Two changed their preferences from opthalmology, two from neurology, and one each from cancer, paediatrics and medicine
Career decisions by Indian medical students
Different reasons were given for such change in preferences. These include reasons such as the increasing awareness of the importance of originally non-preferred subjects like gynaecology, paediatrics, and medicine, awareness of ones own limitations in skills required, and also the awareness of the health needs and demands by the society. Thus this provides a broad survey of the personal background factors and career choices of medical students. This brief survey and comparisons reveal that the medical student in India is comparable in many aspects with those in other countries, especially the American medical student. They have a lot to share in common in terms of the process by which they choose to study medicine, influencing sources for the decision, difficulties and problems faced in the college during first few years, attitudes towards examinations, expectations from teachers and views about specialities. Perhaps medical students form a student society where the least amount of personal and environmental variations could be found. This may be due to the uniform organizational structures of the medical schools and colleges in different parts of the world. Similar studies from other countries are required to get more insight into the sociology of medical education. References BECKER, H.S., GEER,B., HUGHES, E.C. & STRAUSS, A. (1961) Boys in White: Student Culture in Medical School. University of Chicago Press.
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BLOOM,S.W. (1963) The process of becoming a physician. Annals of the American Academy of Political and Social Sciences, 346, 77. BLOOM,S.W. (1965) Sociology of medical education. Some comments on the state of the field. Milbank Memorial Fund Quarterly, 42, 143. BLOOM,S.W. (1971) The medical school as a social system. A case study of faculty-student relations. Milbank Memorial Fund Quarterly, 49, 196. DE GOES,P. & DE CASTRO, C.L.M. (1966) Social characteristics of medical students and their appraisal of medical education. Milbank Memorial Fund Quarterly, 44, 131. GREGG,A. (1955) Our anabasis. The Phares of Alpha, Omega, Alpha, 18. 18. HALL, 0. (1948) The stages of medical career. American Journal of Sociology, 53, 329. JOHNSON, L. (1965) The variety of value structures of medical colleges. Doctoral dissertations in Psychology, Columbia University Library. KATZ, E. & LAZARFELD, P.F. (1955) Personal Influence: Glencoes III. The Free Press. KENDALL, P.L. & SELVIN,H.E. (1957) Tendencies towards specialization in medical training. The Student Physician (ed. by R. K. Merton, G . G. Reader and P. L. Kendall), pp. 153-174. Harvard University Press, Cambridge. LYDEN, F., GEIGER,H.J. & PETERSON, O.L. (1968) The Training of Good Physicians: Critical Factors in Career Choices. Harvard University Press, Cambridge. ROGOFF,N. (1957) The decision to study medicine. The Student Physician (ed. by R. K. Merton, G . G. Reader and P. L. Kendall), pp. 109-129. Harvard University Press, Cambridge. A.E. (1959) The medical student. Journal of SEVERINGHANS, Medical Education, 34, 21 5 . THELENS, W. (1957) Some comparisons of entrants to medical and law school. The Student Physician (ed. by R. K. Merton, G . G. Reader and P. L. Kendall), pp. 109-129. Harvard University Press, Cambridge. WILLIAMS,J. (1949) The professional status of women physicians. Doctoral dissertation, University of Chicago.
