Background: There is a dearth of studies on career intensions of interns in India in general and Ophthalmology in particular. The exposure in ophthalmology as an undergraduate trainee as well as an intern is lesser in comparison with other major subjects like medicine and surgery. As a result their understanding of the specialty as a career option could be inadequate and biased. The results of this study could be used to assess the need of incorporating career guidance in ophthalmology during internship.
Aim: To study the medical interns’ perspective of Ophthalmology as a career and to analyze the factors that might influence their decision.
Methods and Material: All interns undergoing compulsory rotatory internship in a medical college in Dakshina Kannada were included in the prospective, questionnaire based study, conducted from September to December 2010. Summary statistics are generated using MS Excel, and most are presented as frequencies and percentages. Chi square /and Fisher’s exact test of significance was used wherever applicable and the significance is reported at 5% level.
Observation: Most respondents (33.9%) had ophthalmology as their third choice for pursuing post graduation. There was no significant gender preference (p=0.623) for the branch. 41.5% (37) said that they would not take up ophthalmology because they felt they lacked skill / fine motor co-ordination in activities. 57.3% (51) would opt for this specialty because there was scope for more family time.56.1% (50) would not want to take it up because there was a lot of dependence on equipment for diagnosis.
Conclusions: Ophthalmology is amongst the top five preferred branches for specialization. It is most preferred for its perceived controllable lifestyle. Perceived lack of inherent skill was an important deterring factor. Incorporation of career counseling and hand-eye coordination tests during internship will help dispel myths about the speciality and aid decision making .
: Career choices, Ophthalmology, Perceptions, Career counseling
cite this article :
Sheetal Amarnath Savur. CHASING A POSTGRADUATE DEGREE
IN OPHTHALMOLOGY: THE MEDICAL
INTERN’S PERSPECTIVE. Journal of Clinical and Diagnostic Research [serial online] 2012 August [cited: 2013 May 23 ]; 6:1034-1037. Available from http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=August&volume=6&issue=6&page=1034-1037&id=2318
Introduction Pursuing a postgraduate degree in a particular branch in medicine is often influenced by factors other than aptitude and interest. The undergraduate and the internship experience is often inadequate, as the medical college set-up is not necessarily representative of the current advanced practice pattern and hence, a student may not be aware of all the various options that may be available. As a result, the ophthalmology final year student as well the intern is not aware of all the newer innovations and the possible diversifications within the speciality. This can result in a sub-optimal performance or even frustration during the training period and even after that. There has been a sea of change in ophthalmology as a specialty, due to the rapid technological advances and the expanding subspecialties. There have been no studies till date to the best of the author’s knowledge on the intern’s perceptions about ophthalmology as a career option in India. This study was undertaken to study the perceptions of the interns regarding pursuing ophthalmology as a career, the factors which affect their choice and to identify whether there was a need to implement career guidance in ophthalmology, routinely during the internship.
Aim To study the medical intern’s perspectives about ophthalmology as a career and to analyze the factors that might influence their decision.
Material and Methods
A pilot study was conducted, which included the interns who underwent a compulsory rotatory internship in a medical collegein Dakshina Kannada. The study was prospective and questionnaire based in nature. It was conducted from September 2010 to December 2010. Ethical clearance was obtained from the institutional Ethics committee. A written informed consent which stated the willingness to participate in the study and the permission to use the data for publication was obtained from the participants. The questionnaire was semi-structured and pretested among 10 respondents. It was modified to enhance its comprehension and clarity. The interns anonymously completed the questionnaire in one sitting and immediately returned it. The questions which were included, brought to light their perceptions regarding the different aspects of the specialty like, its financial/ earning potential, lifestyle issues which included emergency calls, the importance of the inherent talent, fine motor skill activities and financial investment issues.
Summary statistics are generated by using MS Excel, and most were presented as frequencies and percentages. The Chi square/and the Fisher’s exact tests of significance were used wherever they were applicable and the significance was reported at a 5% level.
Observation Among the 98 interns who underwent compulsory rotatory internship, 3 were away at the time of the study. Among the 95 students who were administered the questionnaire, only 89 completed the questionnaire. The response rate was 93.6% (n=95). There were 38 (42.6%) males and 51(57.3%) females. The mean age of the respondents was 23 years. The preferential order for ophthalmology has been depicted in (Table/Fig 1).
Majority of the respondents 76.4% (68) felt that ophthalmology, as a specialty, had few emergencies. 46% (41) wanted to take it up because they felt that emergencies were few, while 47.1% (42) did not want to take it up because they felt that emergencies were few. The rest (6.7%) did not comment. There was a significant association (p=0.02) between those who felt that ophthalmology had only few emergencies and those who wanted to pursue ophthalmology as their specialty. Though the specialty involved only few emergency calls, there was no significant gender preference (p=0.623) for the branch.
The respondent’s perception on the requirement of fine motor skills and good hand-eye coordination in ophthalmology has been indicated below (Table/Fig 2). 41.5% (37) said that they would not take up ophthalmology because they felt that they lacked skill / fine motor co-ordination in activities like embroidery. 83.1% (74) felt that the specialty might allow them to spend more time with their families. 57.3% (51) said that they would opt for this specialty only because there was scope for more family time. There was no gender preference (females) for this branch on this basis unlike in other studies. 25.8 % (23) felt that ophthalmology was not amongst the most prestigious of specialties. However, 70.7% (63) disagreed. 3.3% (3) did not respond to this question.
60.6% (54) respondents felt that setting up an ophthalmic practice required heavy investment. 31.4% (28) disagreed and 7.8% (7) did not respond to this question. The intern’s view on the income potential of this specialty has been depicted below (Table/Fig 3). 35.9% (32) wanted to take up this specialty because of its earning potential. 71.9% (64) felt that the diagnosis in ophthalmology was becoming more machine dependent.56.1% (50) said that they would not want to take it up because of this reason.
The Professionals with career orientation compatible with their job setting, report a higher degree of satisfaction and a stronger levelof commitment (1). A mismatch between a person’s attributes and those of the environment (2),(3) may cause people to experience anxiety, stress and job dissatisfaction. (1),(2) The reasons for choosing a particular specialty were analysed in a few studies; A Canadian study (4) cited intellectual stimulation as the most important factor on the basis of which a specialty was chosen. A study which was conducted by Trevor et al., in the UK (5) stated that the enthusiasm for and the commitment to the specialty was the single most important influence. Although profit maximization was the most rational economic theory for physician behaviour, some physicians may be satisfied with achieving a minimum “target income”, while balancing their own interests and preferences for their professional lives (6),(7).
An intern spends 10 weeks in ophthalmology as an undergraduate and two weeks as an intern. This duration is far less as compared to the time which was spent in major specialties like medicine, surgery, obstetrics and gynaecology and paediatrics. This brief exposure may not provide a sufficient opportunity to get acquainted with the various aspects of the specialty. Many are drawn to the field of ophthalmology because of its perceived, controllable lifestyle. Today’s doctors are less prepared to work extremely long and irregular hours (8). The concerns about the quality of life issues sometimes make the Doctors abandon their initial career choice, and this particularly applies to the hospital medical specialties (9).
A majority of the respondents in this study (83.1%) perceived that this specialty had scope to spare more time for the family. This may be due to the perceived flexibility of the scheduling; the fewer on-call responsibilities and the lesser number of totals work hours. 57.3% wanted to take up this specialty mainly because of this reason. Our findings were similar to a those of a US studywhich was done in 2003 (10), where the lifestyle considerations were important for those who chose general ophthalmology careers. Choosing ophthalmology as a specialty was influenced by the attractive working hours and good working environment, as was seen in another study (5). However, 47.1% respondents did not want to take up ophthalmology as it involved handling a lesser number of emergencies. The reasons which were quoted were “few emergencies means lesser money earned” and “no thrill without emergencies”.
Our study showed no gender preference (females) for this branch, unlike in other studies, where women were more likely than men to choose this specialty, mainly because of its controllable lifestyle. The enhanced earning potential due to the advancement in the technology and the increased awareness amongst the patients have tremendously increased the demand for this specialty amongst men. Also, with the changing roles and the sharing of the domestic responsibilities in modern nuclear families, the gender bias in choosing this specialty is decreasing.
As high as 47% felt that fine motor skills and good hand eye coordination were the requisites for taking up this specialty. Some even quoted “not good in embroidery and therefore may not be good in fine surgery”, “too delicate a structure and therefore may be very difficult to work” and “don’t have the inherent talent”. Hand eye coordination, no doubt, is required but being adept at skills like embroidery is not a requisite. Undue importance is given to the inherent talent at times, thus underestimating the potential of hard work and good training through which any skill can be acquired. During the undergraduate training and often during the internship, there is no hands-on experience. A short stint of wet lab training during the internship may be useful . An aptitude test which assesses the hand eye coordination may also be offered to them during their internship.
The specialties like orthopaedics, paediatrics and general surgery are generally considered to be more prestigious than others. Some of the reasons which have been quoted for this disparity by some respondents were, “these specialties required top ranks”, “the earnings are more” and “the surgeries are more challenging”. 70.7% of the respondents in this study felt that ophthalmology was as prestigious as the core specialties. Many expressed that expertise, skill and success earned prestige and that it came, irrespective of the specialty. Most of the participants (60.6%) agreed that a basic ophthalmic practice required heavy investment. Unlike many other branches like general medicine, paediatrics and orthopaedics where the diagnosis was mainly clinical and required inexpensive and minimal equipment. This may be an important deterring factor in choosing ophthalmology as a career, especially for those who intended to set up their own practice in rural or urban areas. The various practice options should be made known during the internship, which can help the interns in deciding and choosing the options of their choice.
A large number of respondents (67.4%) felt that the specialty was financially rewarding. 24.7% wanted to take up the specialty because of its better financial prospects. In the Canadian study (4), the earning potential was an important factor for the interns in forming their career choice, in addition to the intellectual stimulation and the flexibility of the employment. As per a study (11) whichwas by Scott JR et al., “women are more influenced than men by both personal and family values and less motivated by financial aspirations ”.
Most of the respondents (71.9%) felt that the diagnosis in ophthalmology is becoming increasingly in ophthalmology is becoming increasingly machine dependent. 56.1% felt that this discouraged them from taking up this specialty. As students and interns, their access to equipments like slit lamps and direct and indirect ophthalmoscopes is limited and it is likely that they may develop inhibitions to their use.
Weaknesses of this study This study was conducted at only one centre. It is very likely that the medical student’s career decisions are subject to an ongoing dynamic process which is influenced by contingencies. Not all the students who are involved would have reflected upon the ideas about their future careers. The study needs to be strengthened by more comparative studies between different batches of interns and also between different universities.
Ophthalmology is amongst the top five preferred branches for specialization. It is preferred mostly for its perceived controllable lifestyle. It has also been perceived to be financially rewarding. However, the perceived lack of inherent skills was an important deterrent amongst many, which needs to be addressed. Heavy investment and a dependency on the equipments were the factors which discouraged them from taking up ophthalmology. The incorporation of career counselling and hand-eye coordination tests during internship will facilitate their decision making.
Key Messages Incorrect perceptions may lead to wrong career choices and may become a source of constant dissatisfaction. It is important to provide interns a platform where they can be exposed to some of the skills that a particular specialty may require. It is also important to guide and help them choose a specialty commensurate with their aptitude, personality and expectation.
Ithank Dr. Uma Kulkarni and Dr. Rashmi Jain for refining the questionnaire and Miss Neevan for her help in the statistical analysis.