Factors influencing the selection of medicine as a course of study: a survey of undergraduate medical students at the University of Namibia

¹School of Medicine, Hage Geingob Campus, University of Namibia, Windhoek, Namibia, ²Department of Surgical Sciences, Hage Geingob Campus, University of Namibia, Windhoek, Namibia, ³Department of Family Medicine, Hage Geingob Campus, University of Namibia, Windhoek, Namibia

^&Corresponding author
Kingsley Ufuoma Tobi, Department of Surgical Sciences, Hage Geingob Campus, University of Namibia, Windhoek, Namibia

Introduction    

The University of Namibia's admission board report indicates a significant influx of applications for the study of medicine during the 2023 academic session, with over 1,500 prospective students vying for limited spots within the School of Medicine. This surge in interest among high school graduates reflects a growing trend in recent years toward pursuing careers in medicine. Understanding the factors driving this heightened interest is essential for the university to effectively tailor its recruitment strategies and support services. One prominent factor influencing students' decision to pursue medicine is their interest and passion for the profession. A study by Cleland et al. underscores the pivotal role of passion in motivating students to choose medicine as their academic path [1]. This inclination towards medicine often stems from a genuine desire to alleviate suffering and make a positive impact on the lives of others. Furthermore, exposure to healthcare professionals through prior interactions can significantly contribute to developing interest in medicine among prospective students [2]. Levaillant and colleagues in their study to determine factors that influenced the choice of medical specialization by medical students also collaborated with the above [3]. Goncalves et al. and Hojat et al. highlighted the significance of altruistic motives, compassion, and empathy towards patients as significant factors influencing the choice of medicine as a course of study [4,5]. The ability to understand and share the feelings of others, is often linked to intrinsic motivation for choosing a career in medicine. Many medical students cite a desire to help others and make a positive impact on patients' lives as primary reasons for their career choice. However, some studies have shown that the level of empathy displayed by medical students decline during the course of their studies. It is crucial therefore to ensure that the factors such as empathy that influenced the initial decision to study medicine is not lost. The inherent job security and stability associated with the medical profession further enhance its appeal, particularly in comparison to other fields where employment prospects may be less certain. With notably low unemployment rates in the medical sector, the assurance of a stable livelihood post-graduation is a significant driving force behind students' decision to pursue medicine. The combination of financial stability, long-term employment prospects, professional prestige, geographical mobility, and diverse career opportunities contributes to the attractiveness of medicine as a secure and rewarding profession [6].

Family background, particularly having relatives or friends in the medical profession, significantly influences students' career choices. Ibrahim et al. [7] while studying the factors which influenced Sudanese students to choose Medicine as a course of study reported that having close relatives as doctors played a significant role in this regard. Exposure to medical professionals within familial circles provides insights into the challenges and rewards associated with medicine, thus shaping students' perceptions and aspirations. Individuals from families with medical backgrounds may be particularly influenced by familial ties and the perceived prestige of the profession, further shaping their career aspirations. Students' socioeconomic status is pivotal in their decision to study medicine. The desire to improve their socioeconomic status vis-à-vis financial standing is a significant factor influencing medical students' decision to study medicine. The prospect of financial stability and the ability to support their families are some compelling reasons for students to pursue a medical career [8]. While some students from lower socioeconomic backgrounds may view medicine as a means to improve economic status and support their families, others from privileged backgrounds may be driven by a sense of social responsibility and a desire to address healthcare disparities.

Medicine has been considered a noble profession in the society. The societal prestige and privilege, associated with being a doctor, exert considerable influence on students' career choices. Studies have reported how perceptions of medicine as a prestigious profession contribute to societal pressure and influence students' decisions [9,10]. Medical professionals are often regarded highly and accorded certain privileges and respect, being used as examples to young people. This invariably seems to impact positively on the decision to study medicine by high school graduates. Given the limited annual admissions to the University of Namibia's School of Medicine, the majority of applicants inevitably face disappointment. Therefore, this research explored the multifaceted factors underpinning the decision-making process of students aspiring to pursue medicine as their academic and professional trajectories. By comprehensively understanding these influences, the university can better cater to the needs and aspirations of prospective medical students, ultimately fostering a well-equipped and motivated cohort of future healthcare professionals. Understanding the diverse factors influencing students' decisions to study medicine is paramount for universities in tailoring recruitment strategies and support programs. Institutions can better guide prospective medical students toward fulfilling and sustainable careers by addressing personal motivations, familial influences, socioeconomic backgrounds, job security concerns, societal expectations, and academic prerequisites.

Methods     

Study design: the study employed a mixed-methods approach, integrating quantitative and qualitative data collection methods to comprehensively explore the factors influencing the decision-making process of first-year students aspiring to pursue medicine as a course of study at the University of Namibia. The research unfolded in three distinct phases.

Setting: phase 1: quantitative data collection: quantitative data was collected through an online survey targeting first-year students enrolled in the MBChB program. The survey, designed with Likert scale questions, aimed to identify and quantify the factors influencing students' choice of medicine as their academic pursuit. Participants' responses were analyzed using statistical software to gauge the relative importance of each factor.

Phase 2: qualitative data collection: qualitative insights were garnered through individual interviews with a subset of participants selected via stratified sampling. These interviews delved deeper into validating the findings from the quantitative phase and uncovering the key factors driving students' decision to study medicine. An interview guide ensured consistency while allowing flexibility for participants to share personal perspectives and experiences.

Phase 3: integration of qualitative and quantitative data: the qualitative data underwent thematic analysis to identify recurring themes and insights, while the quantitative data was subjected to descriptive statistical analysis to determine the significance of each factor. Integrating both datasets through a triangulation approach provided a comprehensive understanding of the factors influencing students' decisions.

Study participants: the research participants comprised first-year students enrolled in the MBChB program at the University of Namibia for the academic year 2023.

Sample and sampling method: with 71 students enrolled in the MBChB program, a census approach was initially considered for the online survey. However, practical constraints led to a smaller sample size of 17 students selected for qualitative interviews through stratified sampling. Inclusion criteria encompassed all first-year medical students at the University of Namibia, ensuring representation across diverse demographic backgrounds.

Variable outcomes: qualitative data was collected through semi-structured individual interviews, while quantitative data was gathered via an online questionnaire.

Data collection method: individual interviews were conducted to explore participants' motivations, experiences, and challenges related to their decision to pursue medicine. The online survey questionnaire covered demographic information, career preferences, influential factors, and perceptions of the medical profession, utilizing Likert scales for quantitative analysis.

Data analysis: thematic analysis was employed for qualitative data obtained from interviews, while descriptive statistics facilitated quantitative analysis of survey responses. Integration of both datasets through triangulation validated the findings and provided a holistic understanding of the factors influencing students' decisions.

Validity and reliability: the study upheld research protocols to ensure validity and reliability, utilizing multiple methods and sources, transparent presentation of findings, and adherence to ethical guidelines.

Results     

Participants: the online survey attracted 56 respondents out of the total population of 71, revealing a significant gender disparity. 71.43% (40) of participants identified as female, while 28.57% (16) identified as male, indicating a predominant representation of female participants. Regarding age distribution, an overwhelming majority (98.21%) fell between 18 and 24 years old, reflecting the youthfulness of the sample, typical of first-year medical students. Only 1.79% (1) of participants were under 18, with no representation in older age categories.

Descriptive: representation across Namibian regions was broad, with 13 out of 14 regions being represented. Oshana emerged as the most represented region, constituting 17.86% (10) of the participants, followed closely by Omusati and Khomas. Lower representation was observed in regions such as Kavango and Zambezi, ranging from 1.79% to 5.36%. Additionally, 7.14% (4) of participants identified as foreigners, contributing to the diversity of the sample. Various secondary schools were represented, with notable proportions from institutions like St Boniface College (17.86%), Oshigambo High School (8.93%), and Onawa Secondary School (7.14%). Several other schools showed modest representation ranging from 3% to 5%, while a long tail of schools had one or two participants, reflecting the diversity of educational backgrounds.

Main results: most participants expressed a strong desire to positively impact others' lives, highlighting the altruistic nature of medicine as a career. Many participants cited a genuine interest in medicine as a primary motivator, underscoring the importance of personal passion and curiosity. Additionally, some participants considered a medical career's stability and financial rewards as influential factors. Table 1 provides an overview of the frequency of factors influencing the choice to study medicine.

The results, based on 56 respondents, revealed a diverse range of opinions concerning the importance of different factors in the decision to study medicine. The average Likert scale score across all responses, including the frequency and degree of importance, is summarised in (Table 2). When queried about their confidence in choosing to study medicine, participants generally expressed a moderate to high level of assurance in their decision, as evidenced by an average Likert scale score of 4.14. None of the participants (0%) deemed the decision to study medicine as "not important," indicating unanimous agreement on the significance of this career choice. However, a small but noteworthy portion of participants 3 (5.36%) considered the decision to study medicine as only "slightly important." Approximately one-fifth of participants 12 (21.43%) regarded the decision as "moderately important," while a substantial number 15 (26.79%) deemed it "very important." A significant percentage of respondents 26 (46.43%) perceived the decision to study medicine as "extremely important." Participants highlighted key challenges encountered when selecting medicine as a career path. When prompted to identify challenges applicable to themselves, a considerable majority 33 (62.50%) cited financial constraints as a significant hurdle. Additionally, academic challenges 33 (58.93%), personal or family obligations 13 (23.21%), and discrimination or bias 3 (5.36%) were reported as significant obstacles. In the "other" category, 10.71% of participants reported facing challenges not covered in the provided options. A small proportion of participants 2 (3.57%) struggled with time management and self-regulation challenges.

Furthermore, a minority, each representing 1 (1.79%), disclosed grappling with imposter syndrome, reflecting feelings of inadequacy or self-doubt, and cited mental health challenges. Analysis of participants' responses regarding whether they believed the current state of the healthcare system influenced their decision to study medicine revealed diverse perceptions. A minority 10 (17.86%) indicated that the state of the healthcare system had not influenced their career choice, while 15 (26.79%) remained unsure. The majority 31 (55.36%) affirmed that the current state of the healthcare system had influenced their decision to pursue medicine. Additionally, the results showed that most (67.86%) participants did not have parents or relatives who studied medicine. However, among those with medical backgrounds in their families, a notable percentage (17.86%) acknowledged familial influence in their decision to pursue medicine. While most participants expressed confidence in choosing medicine, the results revealed diverse alternative career paths participants would have pursued if not admitted into medicine. The distribution across different secondary career options is presented in Table 3. Participants were queried about the advice they would offer to individuals contemplating studying medicine, yielding several discernible themes. Notably, 75.00% of respondents emphasized the importance of passion and motivation, while 44.64% stressed the necessity of hard work and discipline. Additionally, 25.00% highlighted the significance of self-reflection and confidence, with 14.29% offering advice on studying and planning, and 12.50% referencing the role of God and faith in their advice (Table 4).

Results for individual interviews: the study population exhibited a balanced gender distribution, with 8 (47.06%) male participants and 9 (52.94%) female participants. Regarding age distribution, diversity was evident, with the majority (58.82%) falling into the 19-year-old bracket. Other age groups included two individuals (11.76%) aged 18 and one individual each (5.88%) at ages 17, 20, 21, 23, and 24.

Motivation to study medicine: based on responses from 17 participants, several themes emerged. Passion for medicine and community service, academic challenge, academic excellence, family influence, and choices due to circumstances were observed, accounting for 23.53%, 5.88%, 52.94%, 5.88%, and 11.76%, respectively.

Academic factors: various academic interests were explored, with "strong background in science subjects" being the most prevalent theme, cited by 52.94% of participants. Additionally, four participants (23.53%) expressed a strong interest in human physiology and disease prevention, while a few mentioned interests derived from medical television shows (11.76%), community service and discipline (5.88%), and hard work and passion for learning (5.88%).

Influence of teachers, parents, and mentors: participants noted the influence of teachers, parents, and school mentors on their decision to study medicine. Specifically, 52.94% were influenced by specific teachers, while 11.76% generally indicated parents and teachers. Additionally, 35.29% had no specific influence from teachers or parents.

Personal, university, peer, and social career aspirations factors: all interviews revealed various factors influencing their decision to study medicine. Table 2 summarizes different factors and themes noted from the interviews

Challenges and decision-making process: most participants (58.82%) highlighted academic doubts and rejections as their primary concern when contemplating medicine. A significant portion (35.29%) expressed personal doubts and fears as significant hurdles during decision-making. Only 1 (5.88%) encountered a career choice dilemma, while an equal percentage 1 (5.88%) reported experiencing no doubts or difficulties. Participants were further asked about how they overcame these challenges. Over a third cited self-encouragement and spiritual support (35.29%), while approximately 5 (29.41%) emphasized persistence and continuous effort. A moderate number of participants mentioned information gathering and research, as well as private decision-making, accounting for 3 (17.65%) and 2 (11.76%), respectively. Guidance and support from others emerged as a minority theme, constituting 1 (5.88%).

Discussion     

The demographics from the online survey and interviews depict a nuanced representation of participants. The online survey predominantly consisted of young female respondents, aligning with the typical profile of first-year medical students. Conversely, the interview cohort displayed a balanced gender distribution, ensuring diverse perspectives. Additionally, including participants from various Namibian regions and other countries enhances the study's richness and generalizability. The factors influencing the decision to study medicine underscore a blend of altruism, personal interest, and practical considerations. The prevalence of a desire to help others emphasizes the humanitarian aspect of the medical field. In a qualitative study by Hojat et al. participants expressed a strong inclination toward medicine due to their compassion and empathy for patients, which they believed would be fulfilled through a medical career [5]. Our study also revealed that the desire to help others was one of the driving factors for the majority of the students interviewed.

Moreover, personal interest and practical considerations such as job security and financial stability are pivotal in career decision-making. The Likert scale analysis reveals high importance attributed to factors such as the profession's prestige, research opportunities, and university reputation, indicating a multifaceted approach to decision-making. According to Woodward and coworkers [6], students were drawn to medicine due to its potential for job stability, financial security, and career growth. Medicine as a profession offers various career opportunities, such as clinical practice, research, and academia. Therefore, students who desire a stable and lucrative career may choose to study medicine.

Our study has collaborated with the findings of Ibrahim et al. [7] who noted that exposure to family members in the medical field positively influenced students' perceptions of medicine as a career option. Moreover, these familial influences provided insights into the challenges and rewards associated with a medical career, shaping the students' career aspirations. Students whose immediate relatives are doctors are more prone to choose medicine as a career. Whether this influence stems from the positive impact of their relatives and overt or covert pressures from them remains to be elucidated. A positive influence will most likely bear a more lasting and rewarding motivation to pursue medicine not just as a course of study but also as a career of pursuit.

Challenges in choosing medicine encompass financial constraints, academic hurdles, and personal/family obligations. These findings underscore the multifaceted nature of obstacles faced by aspiring medical professionals. The varied responses regarding the influence of the healthcare system highlight the intricate relationship between societal factors and individual career choices. Despite expressing confidence in their choice of medicine, participants displayed diverse interests in alternative career paths. From mathematical sciences to business and finance, these alternative options reflect the multidimensional talents and aspirations of the surveyed individuals. The themes identified in individual interviews provide nuanced insights into motivation, including a passion for medicine, academic excellence, family influence, and circumstances-related choices. These factors underscore the complexity of individual motivations. Academic solid backgrounds, specific interests in science subjects, and influences from teachers and parents emerged as influential factors shaping participants' paths to medicine. The competitiveness of the admissions process can be a significant factor in the choice of medicine as a course of study in the University. Cleland et al. [1] found that students who had achieved high grades in the sciences and mathematics were more likely to choose medicine as a course of study. In addition, the requirements for high grades as a prerequisite for admission to the school of medicine could serve as a motivation for students who desire to choose medicine to study hard for their examinations.

Limitations: the reliance on a specific cohort of first-year medical students at one university limits the generalizability of the findings to a broader population. Additionally, the self-report nature of the data, particularly in qualitative responses, introduces the possibility of response bias and social desirability bias.

Conclusion     

This research offers valuable insights into the factors shaping the career choices of first-year medical students at the University of Namibia. While these findings are informative, they should be interpreted within the context of their limitations. Future research endeavours may benefit from addressing these constraints to gain a more comprehensive understanding of the subject. Overall, the study underscores the importance of understanding the motivations and challenges of aspiring medical professionals to foster a supportive educational environment and shape future healthcare leaders.

Competing interests     

The authors declare no competing interests.

Authors' contributions     

Mbatjandangi Katjinaani: writing and conducting the entire study. Kingsley Tobi and Dr Felicia Christians: supervision. All the authors have read and agreed to the final manuscript.

Acknowledgments     

Professor Kingsley Tobi for his guidance and expertise in shaping the trajectory of this research. His invaluable insights and unwavering support have significantly enriched the depth and quality of our study. Dr. Felicia Christians, for her contributions to the research process and co-supervising my research. Miss Tinashe for her dedicated efforts and assistance throughout the data collection and analysis phases. Her meticulous approach and commitment have been integral to the success of this study.

Tables     

Table 1: main factors that influenced the decision to study medicine in first-year medical students at the University of Namibia 2023

Table 2: the importance of different factors on the choice to study medicine in first-year medical students at the University of Namibia 2023

Table 3: second career options of current first-year medical students at the University of Namibia if not admitted into the course

Table 4: factors influencing the choice to study medicine in first-year medical students at the University of Namibia 2023

References