Factors influencing medical students' choice of specialization: A gender based systematic review

Abstract

Background: Students' choice of medical specialties has evolved throughout year, with a growing interest in quality of life and in technological specialties. We investigated the repartition of such choices in the world and its influencing factors with a focus on the gender's influence, for helping policy-makers to deal with medical shortage and territorial to specialty disconnect.

Methods: A systematic search was conducted on MEDLINE and Scopus from January 2010 to January 2020. Data extraction and analysis followed JBI and PRISMA recommendations. The selected articles had to focus on medical students, detail their choice of specialty, and look for factors influencing their choice. Articles were excluded if they only assessed the attractiveness of a specialty, or evaluated a public policy. This review was registered on PROSPERO, CRD 42020169227.

Findings: 751 studies were screened, and fifty-four were included. Surgery and internal medicine were the most wanted specialties, both in occidental and non-occidental countries. The main factors influencing the choice of specialty were lifestyle, work-life balance and discipline interest, with variation across different countries. Gender clearly affected this choice with 63.7% of men willing radiology and 14.7% of men in obstetrics and gynecology.

Interpretation: Influential factors vary with specialty and are affected by the country of residence. Gender has a great impact in students' willingness to work in specific specialties. Policymakers should adapt their appealing strategies according to the country and the medical discipline concerned.

Funding: The authors have no support or funding to report.

Keywords: Gender study; Medical specialties; Public policy.

Fig. 1

Flowchart.

Fig. 2

Proportion of articles in which each influence factor was founded significantly associated to the choice of a specialty, sorted by occidental and non-occidental countries. Each percentage is referring to the number of the article quoting the studied factor as influencing the students’ choice, either in occidental or non-occidental countries.

Fig. 3

Graphic representation of the specialty of interest and the men percentage among all countries. Above the abscissa axis are represented the men percentage and proportion of medical students’ interests among occidental countries. Below the axis, the same data are provided for non-occidental countries. Abscissa axis represents the percentage of men among each specialty. The size of each bubble reflects the relative proportion of medical students’ interest in a specialty. The bubbles have been vertically distributed to allow a better readability, without another meaning of the ordinate axis. For example, radiology interested 0.7% of medical students’, and mostly men (above70% men percentage) in occidental countries, and 2.5% in non-occidental countries, with less men interested (between 60% and 65% men percentage). ER: Emergency Room, ICU: Intensive Care Unit, O&G: Obstetrics and Gynaecology.

Fig. 4

Graphic representation of the specialties wanted by medical students’, according to their gender and the country they completed their studies. Percentages lower than 1% are not reported on the graph. ICU: Intensive Care Unit, O&G: Obstetrics and Gynaecology, ENT: Ear, Nose, Throat.