Perception of Senior Medical Students in Taif University towards Family Medicine Specialty as a Future Career

Research Article

J Fam Med. 2018; 5(5): 1152.

Perception of Senior Medical Students in Taif University towards Family Medicine Specialty as a Future Career

Al-Thagafi SD1* and Zughbi JP2

¹Family Medicine Resident, Prince Mansour Community Military Hospital, Saudi Arabia

²Family Medicine Consultant, Prince Mansour Community Military Hospital, Saudi Arabia

*Corresponding author: Saja Dhafer Al-Thagafi, Prince Mansour Community Military Hospital, Airport Road, Al Faisaliyyah, At Taif 26526, Saudi Arabia

Received: October 03, 2018; Accepted: November 02, 2018; Published: November 09, 2018

Abstract

Background: The family medicine specialty is faced by a number of challenges; the concept of family medicine is still confusing and probably irrelevant to most physicians in other specialties.

Objectives: To explore the perceptions of senior medical students (both genders) in Taif University to family medicine as a chosen future career.

Subjects and Methods: This cross-sectional study was conducted at Taif University in Taif city, Saudi Arabia. It included students of medicine levels 4 to 6 (male and female sections). A self-administered, anonymous English questionnaire was utilized for data collection. It is composed of two main parts. The first part includes the socio-demographic characteristics of the participants and awareness about the scope of family medicine as a clinical specialty and sources of that awareness, if any. The second part includes the original version of the Valuation of Attitudes towards and Knowledge of Family Medicine Questionnaire (CAMF).

Results: The study included 574 medical students. Their age ranged between 20 and 28 years (22.8±1.1 years). More than half of the students were males (57.5%). Majority of the senior medical students (91.5%) were aware of family medicine scope as a clinical specialty. Preclinical training (53.8%), friends and relatives (47.9%) and private reading/internet (35.9%) were the main source of awareness among them. The overall family medicine perception score ranged between 44 and 92 with a mean of 75.3±6.7, out of a possible 102. Older, female, sixth year students, those whose fathers were retired, whose mothers were working and higher educated expressed higher perception of family medicine than others. Awareness of the scope of family medicine through preclinical training, friends and relatives improved perception of family medicine while awareness through private reading and internet had a bad influence on perception of family medicine.

Conclusion: A although, a considerable proportion of senior medical students agreed that family medicine is highly valued in the medical school, and they would like to be family physicians in the future, some negative points towards family medicine were raised by the students.

Keywords: Family Medicine; Taif University; Questionnaire

Abbreviations

FM: Family Medicine; PC: Primary Care; USA: United States of America; CAMF: Valuation of Attitudes towards and Knowledge of Family Medicine Questionnaire; χ2: Chi-square; SPSS: Statistical Package for Social Sciences

Introduction

Background

Choosing a future career is a special moment in any students’ life as it will affect the personal development, and satisfaction level throughout life [1].

The specialty of family medicine (FM) is a demanding one that requires a great experience and knowledge [2]. Family medicine is the cornerstone of the health care system [3] since family physicians screen everyone seeking help, regardless of his/her characteristics [4,5].

The family physician was described by the World Organization of Family Doctors (Wonca, 1991) as “the physician who is primarily responsible for providing comprehensive health care to every individual seeking medical care, and arranging for other health personnel to provide services when necessary [6].

There is an obvious need of family physicians in Saudi Arabia. During the residency family medicine program which extends to 4 years, residents are exposed to thirteen different specialties. They spend most of that period rotating in training centers at different hospitals [7,8].

Family medicine as a specialty is more preferred by females than males in Saudi Arabia. In a relatively recent study carried out in Saudi Arabia (2014) [9], the second choice for female students was family medicine. They reported that family medicine practice in Saudi Arabia is attractive to females as they work less hours, as family physicians are underutilized by the general public in Saudi Arabia, which leads to a large number of unnecessary visits of less urgent cases to emergency departments. In North America [10], family physicians have a heavy workload with great public awareness and utilization.

Third year and fourth year medical students in USA were allowed to share clinical experience with family physicians. This proved to improve students` attitude towards family medicine [11] and at the same time strongly affect their decision to choose family medicine as a future career [12].

The family medicine specialty is faced by a number of challenges; the concept of family medicine is still confusing and probably irrelevant to most physicians in other specialties; relatively few family physicians are being graduated; family physicians working in Ministry of health face many problems related to shortage of staff, services and infrastructure, which could have a role in choosing family medicine as a future carrier [13].

The limited attraction of family physicians specialty to medical students is influenced by several factors including personal characteristics of students, educational environment and the perception of its professional practice [14-18].

A recent study done in Sao Paulo, Brazil revealed that having a course in primary care for medical students not only improves students’ knowledge of family medicine and helps them to develop a more positive attitude towards it, but also would lead to more favorable attitudes to be more likely to choose this specialty in the future [19].

Rationale

• Low attitude towards family medicine among medical students could formulate a barrier against choosing family medicine as a future career.

• Shortage of primary care physicians is a prominent problem worldwide, which contributes to suboptimal care, inappropriate use of specialists and less concentration on preventive activities.

• Up to our knowledge, no similar study has been done in this vital area in Taif.

• The results of this study would contribute to the development of the undergraduate programme for senior medical students.

Aim of the study

The aim of this study is to explore the perceptions of senior medical students (both genders) in Taif University to family medicine as a chosen future career.

Objectives

• To investigate the awareness and perception of senior medical students (fourth year to sixth year) in Taif University towards family medicine as a future career.

• To compare between male and female students in this regard.

• To identify socio-demographic factors that may be associated with perception of family medicine as a future career.

Literature Review

Some similar studies were cited, majority of them were conducted abroad with only one recent published study carried out locally.

Alyousefi (2017) carried out a qualitative study to evaluate knowledge and attitude of undergraduate Saudi medical students at King Saud University, Riyadh towards family medicine as a future career. The results indicated that the family medicine clinical course has a significant influence on medical students’ career decisions, and it was beneficial in improving students’ knowledge of family medicine. Many of the students have chosen family medicine as a career after acquiring extensive knowledge on the subject. Majority of them believe that family medicine is an integral part of the healthcare system in Saudi Arabia. The main reasons for choosing family medicine as a future career were observations of the physician-patient interaction in this specialty; the faculty staff’s attitudes, interests and compassion; and the enjoyment of the family medicine rotation [20].

In USA, Phillips and Charnley (2015) implemented a study to evaluate third-year medical students’ attitudes toward family medicine before and after a family medicine clerkship as well as to compare these findings to the same students’ attitudes toward family medicine in the fourth year. At least 92 students completed participation at each time point. Approximately, (27%) of students initially unlikely to choose family medicine as a career became interested after the clerkship and 90% of those interested in family medicine maintained their interest. Attitudes toward lifestyle and compensation, family medicine’s role in research, and family physician expertise significantly improved after the clerkship. However, some of these areas deteriorated in the fourth year [21].

In Tajikistan (2014), Kadirova et al carried out a cross-sectional study among medical undergraduate students (first, fourth and sixth grades) and teaching staff to explore the perceptions and determinants (socio-demographic and clinical teaching) of family medicine. In total more than 2500 students and more than 350 staff of Tajik State Medical University were included in the study. Students were mostly interested in working in surgery, obstetrics and gynecology more than family medicine. Prestige, working abroad and very high salary were the commonest motivators. Students and staff agreed that working as a family physician is not very attractive in Tajikistan. Most students, as well as teaching staff, do not actually know what is family medicine in reality. Furthermore, students viewed that society and other medical professionals have a low perception of family medicine. However, they agreed that everyone should receive training in family medicine, no matter what specialty they choose later. Students supported the idea that family medicine should have the same prestige as any other specialty. However, students and teaching staff did not agree that family doctors should receive higher salaries than narrow specialists [22].

In Ghana (2013), Essuman and his colleagues carried out a descriptive study among first clinical year medical students (92 students) to explore their perceptions about family medicine with regard to knowledge, specialty preferences and relevance. Level of awareness of FM was high among the students (88.0%). Rotations and information from friends were the major sources of awareness. More than half of the students (54.4%) perceived that family physicians are capable of providing total health care for majority of patients and majority of them (79.8%) believed that family physicians can reduce overall cost of health care. Despite that, only 2.4% were considering postgraduate training in family medicine. The major factor for specialty choice was personal interest (75.6%) and the main reason for not choosing family medicine was inadequate understanding of the specialty (79.3%) [23].

Innocent, 2013 carried out a cross-sectional study (qualitative and quantitative through focus group discussion) to explore the knowledge and establish the perceptions of family medicine discipline among final year medical students and estimate the proportion of final year medical students that would consider family medicine as a future career. Most of the students seventy one (78%) of 91 respondents knew Family Medicine as a specialty, 67 (73.7%) reported that family physicians need specialized training and knew the principles and core values of Family Medicine. Forty-six (45.1%) of students strongly disagreed that their exposure to Family Medicine was not adequate but few students would be satisfied as family physicians with only 3 (3.3%) of respondents claimed that they would consider Family Medicine as first career choice. Forty-seven (52.2%) of the students were not sure whether to choose Family Medicine as a future career [24].

Zurro et al (2012) implemented a study to explore the perception of medical students first, third and fifth-year students in 22 participated medical schools in Spain regarding family medicine (the total number was 5299 students). Majority of the students (89.8%) considered the social role of FM to be essential, while only 20% have seen the specialty as well respected within the medical professions. The acceptance of family medicine increased with years of study, independent of student characteristics or medical school attended [25].

Olid et al (2012) systematically reviewed published articles regarding medical students’ attitudes and perceptions towards family practice and concluded that although some students found family medicine appealing, it is regarded as a career of low interest and prestige [26].

In Poland, (2007) Pawelczyk and his colleagues analyzed the literature on primary care (PC) specialty choice to explore factors that affect medical students' specialty selection decisions for primary care. They also analyzed personality profiles of physicians, and the influence of communication skills and knowledge of social psychology on his/ her work. There was a negative perception of family medicine among Polish students and doctors because of its long work hours and less time for family, insufficient diagnostic possibilities and monotony. It was chosen because of lack of other possibilities, difficulties in employment and opportunity to become 'a specialist' in short time [27].

Methodology

Study area

This study was conducted at Taif University in Taif city, which is located in the Mecca Province of Saudi Arabia at the West of Saudi Arabia in an elevation of 1700 meters on the slopes of the Al-Sarawat Mountains. It has a population of 1,281,613 (2011 census) [28]. Taif University consists of twenty colleges including 38,047 regular students (15,539 males and 22,508 females) [29]. The study was conducted at the college of medicine levels 4 to 6 (male and female sections).

Study period

Preparatory period (4-8 weeks):

• Selecting the title and doing the literatures review

• Securing the required permissions

• Preparing the questionnaire

• Pilot study

Field work (4-6 weeks):

• Data collection

• Data entry and analysis

Writing the report (2-4 weeks)

Study design

A cross-sectional study was implemented.

Study population

Fourth-year medical students (104 males and 100 females), fifth-year medical students (118 males and 74 females) and six-year medical students (106 males and 69 females) enrolled throughout the academic year 1438 H.

Sample size/technique

All senior students (n=574); fourth-year medical students (n=206), fifth-year medical students (n=191) and six-year (n=177) were invited to participate in the study by filling in the study questionnaire.

Data collection tool

A self-administered, anonymous English questionnaire was utilized for data collection. It is composed of two main parts. The first part includes the socio-demographic characteristics of the participants (age, gender, academic level, Fathers` and mothers` occupation and education), and awareness about the scope of family medicine as a clinical specialty and sources of that awareness, if any. The second part includes the original version of the Valuation of Attitudes towards and Knowledge of Family Medicine Questionnaire (CAMF). It has been proved to be valid and reliable and composed of 34 close-ended questions [30]. Permission to use the questionnaire was requested through an e-mail communication with the corresponding author.

Scoring system

The overall score of the questionnaire was calculated, giving the following values: “disagree”: 1; “neutral” 2; “agree”: 3. In order to make the “1” value always correspond to the most unfavorable option regarding family medicine and the value “3” to the most favorable, the responses to items 15, 22, 23, 25 and 26 were reversed. The minimum possible score was 34 and the maximum one was 102.

Data collection technique

The researcher distributed the self administered questionnaire during the studying hours; care was taken to not disturb the students. Trained medical colleague helped in collecting data from the male faculty of medicine. The researcher and her colleague were available to clarify any issue and the questionnaires were collected in the same day. The researcher and her colleague repeated this over one week period to include as many as students. The data were verified by hand then coded and entered to a personal computer.

Data entry and analysis

Statistical analyses were conducted with the SPSS version 22.0 for Windows (SPSS Inc., Chicago, IL, USA). Data were shown as number and percents. Perception of family medicine total score was utilized for comparisons. Since, it was abnormally distributed (significant K-S test). Non-parametric statistical tests were applied. Mann-Whitney test was utilized for comparison of two groups and Kruskal-Wallis test for comparison of more than two groups. P = 0.05 was accepted as statistically significant.

Pilot study

It was conducted over 10 male medical students and 10 female medical students results were included in the final research as they were not significantly differ from the final results. It helped in adaptation of the study.

Ethical consideration

• Approval of the Regional Research and Ethics committee at Al-Hada Armed Forces Hospital was requested.

• Permission from Dean of medical college at Taif University (male and female sectors) was obtained.

• The purpose of the study was explained to students.

• It was also explained to the participants that the data would be used solely for the purpose of the study, and that their privacy and anonymity would be fully protected.

• All participants completed the questionnaire in the college, anonymously after obtaining verbal consent.

Results

The study included 574 medical students. The youngest age was 20 years while the oldest one was 28 years. The mean±SD age was 22.8±1.1 years. More than half of the students were males (57.5%). More than one third of them (35.9%) were enrolled in the fourth year whereas 33.3% and 30.8% were enrolled in the fifth and sixth years, respectively. Fathers of 23.3% of the students were retired whereas those of 21.4% were professionals. Mothers of 59.6% of the students were working. Exactly half and 48.1% of fathers and mothers respectively were university or above graduated (Table 1).