RURAL OBSTACLES AND CAREER ANXIETIES: VOCATIONAL CONCERNS AMONG MEDICAL INTERNS

Year 2024, Volume: 9 Issue: 3, 234 - 244, 01.11.2024

Cihad Dündar

https://doi.org/10.35232/estudamhsd.1506603

Abstract

Medical students face a multitude of challenges including rigorous exams, exposure to diseases and death, and the stress and anxiety associated with preparing for the Medical Specialty Exam (MSE). We aimed to determine what are the primary reasons for vocational future concerns among intern doctors, and are there gender differences in the causes and levels of the concerns. This cross-sectional study was conducted at Ondokuz Mayıs University Faculty of Medicine between July 2019 and March 2020, and 148 interns whose informed consent was obtained were included in the study. The data were collected by 5-point Likert type scale for interns' future concerns, consisted of 15 items, and 3 subdimensions. The Cronbach’s alpha coefficient of the scale was 0.89. Of the 148 participants with a mean age of 23.9 years, 43.9% were male, and 56.1% were female. The main reasons for concern were "inability to prepare for the medical specialty exam (68%)" and "failure to pass the MSE (58%)". These had been followed by concerns about “compulsory service in the eastern regions", “dealing with medical emergencies”, and other professional incompetence. Few interns reported that they were worried about being unemployed (13%). We determined that the vocational concerns of the females were significantly higher than the males, especially about working in the eastern regions, medical emergencies, and clinical skills (p<0.05). The fact that interns aspire to become specialists while avoiding the sole responsibility of diagnosis and treatment highlights deficiencies in medical education programs, particularly in the area of practical skills, for cultivating competent and self-confident physicians.

Keywords

Anxiety, future concern, intern, medical education, medical specialty exam

Ethical Statement

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

KIRSAL ENGELLER VE KARİYER KAYGILARI: İNTÖRNLERİN MESLEKİ ENDİŞELERİ

Abstract

Tıp fakültesi öğrencileri, zorlu sınavlar, hastalıklara ve ölüme maruz kalma ve Tıpta Uzmanlık Sınavı'na (TUS) hazırlanmanın getirdiği stres ve kaygı dahil birçok zorlukla karşı karşıya kalmaktadırlar. Bu durum, öğrenciler arasında kaygı ve tükenmişliğin artmasına neden olmaktadır. Bu çalışmada, intern hekimlerin mesleki gelecek endişelerinin başlıca nedenlerini ve nedenler ile endişe düzeylerinde cinsiyete bağlı farklılıkların olup olmadığını belirlemeyi amaçladık. Bu kesitsel çalışma, Ondokuz Mayıs Üniversitesi Tıp Fakültesi'nde Temmuz 2019 - Mart 2020 tarihleri arasında yürütüldü. Bilgilendirilmiş onamı alınan 148 intörn çalışmaya dahil edildi. Gelecek kaygıları, 15 sorudan ve 3 alt boyuttan oluşan 5-li derecelendirmeli İntörn Mesleki Gelecek Endişesi Ölçeği (İMGEÖ) kullanılarak toplandı. Ölçeğin Cronbach Alfa güvenilirlik katsayısı 0,89 olarak hesaplandı. Ortalama yaşı 23,9 olan 148 katılımcının %43,9'u erkek, %56,1'i kadındı. En büyük endişe nedenleri %68 ile“Tıpta Uzmanlık Sınavı'na (TUS) hazırlanamama" ve %58 ile “TUS'ta başarısız olma" idi. Bunları "doğu bölgelerinde zorunlu hizmet", "acil durumlarla başa çıkma" ve diğer mesleki yetersizliklerle ilgili kaygılar takip etti. İşsiz kalma endişesi bildiren intörn sayısı ise azdı (%13). Kadınların mesleki kaygılarının erkeklere göre anlamlı derecede daha yüksek olduğu; özellikle doğu bölgelerinde çalışma, acil durumlar ve klinik becerilerle ilgili endişelerin daha belirgin olduğu saptandı (p<0,05). İntörnlerin uzman olma isteğinin yanı sıra tanı ve tedavi sorumluluğunu tek başına üstlenmekten kaçınmaları, tıp eğitimi programlarının -özellikle uygulama becerileri alanında- yetkin ve kendine güvenen hekim yetiştirme konusunda eksikleri olduğunu göstermektedir.

Keywords

Kaygı, gelecek endişesi, intörn, tıp eğitimi, Tıpta Uzmanlık Sınavı

References

• AlShamlan NA, AlOmar RS, Al Shammari MA, AlShamlan RA, AlShamlan AA, Sebiany AM. Anxiety and Its Association with Preparation for Future Specialty: A Cross-Sectional Study Among Medical Students, Saudi Arabia. Journal of Multidisciplinary Healthcare. 2020;13:581-91. doi:10.2147/JMDH.S259905.
• Kalmbach DA, Fang Y, Arnedt JT, Cochran AL, Deldin PJ, Kaplin AI, et al. Effects of sleep, physical activity, and shift work on daily mood: a prospective mobile monitoring study of medical interns. Journal of general internal medicine. 2018;33(6):914-20. doi:10.1007/s11606-018-4373-
• Kosan A, El T, Korkmaz G, Toraman Ç. Being a Medical Student in Turkey: The Myths, Challenges and Reality. African Educational Research Journal. 2021;9(Special issue 1):1-8.
• Fontana MCP, Generoso IP, Sizilio A, Bivanco-Lima D. Burnout syndrome, extracurricular activities and social support among Brazilian internship medical students: a cross-sectional analysis. BMC medical education. 2020;20(1):1-9. doi:10.1186/s12909-020-01998-6.
• Hansell M, Ungerleider R, Brooks C, Knudson M, Kirk J, Ungerleider J. Temporal trends in medical student burnout. Family Medicine. 2019;51(5):399-404. doi:10.22454/FamMed.2019.270753.
• Gökdemir Ö, Özçakar N. Kırsal Hekimliğin Geleceği. Turkiye Klinikleri J Fam Med-Special Topics. 2018;9(4):320-4.
• Bulut A, Şengül H. Türkiye’de sağlık sisteminin sorunları ve çözüm önerileri. Balıkesir Sağlık Bilimleri Dergisi. 2020;9(1):45-54.
• Ministry of Health, Turkey. Health Statistics Yearbook. Ankara: Ministry of Health of Turkey; 2020. pp. 209-210. Available from: https://dosyasb.saglik.gov.tr/Eklenti/43400,siy2020-eng-26052022pdf.pdf?0
• Kuzukiran Y, Kurtul B, Kurtul B, Tarhan Z, Tas O, Azap A. The Factors Affecting Specialty Preference and Job Satisfaction of Medical Residents. Infectious Diseases and Clinical Microbiology. 2019;1(1):42-7. doi:10.5152/idcm.2019.19006.
• Ataç Ö, Hayran OE, Emreciksin A. Anxiety and depression levels of doctors during studying for examination for specialty in medicine.ESTÜDA Public Health Journal.2019;4(1):35-44. doi:10.35232/estudamhsd.475125.
• Hill MR, Goicochea S, Merlo LJ. In their own words: stressors facing medical students in the millennial generation. Medical education online. 2018;23(1):1530558. doi:10.1080/10872981.2018.1530558.
• Mirza AA, Baig M, Beyari GM, Halawani MA, Mirza AA. Depression and anxiety among medical students: a brief overview. Advances in Medical Education and Practice. 2021;12:393. doi:10.2147/AMEP.S302897.
• Gürü M, Cengiz GF. Depression, Occupational Anxiety, and Related Factors in Medical Students. Archives of Current Medical Research. 2021;2(3):161-7. doi:10.47482/acmr.2021.31.
• Williams MK, Estores IM, Merlo LJ. Promoting Resilience in Medicine: The Effects of a Mind–Body Medicine Elective to Improve Medical Student Well-being. Global Advances in Health and Medicine. 2020;9:2164956120927367. doi:10.1177/2164956120927367.
• Mao Y, Zhang N, Liu J, Zhu B, He R, Wang X. A systematic review of depression and anxiety in medical students in China. BMC Medical Education. 2019;19(1):1-13. doi:10.1186/s12909-019-1744-2.
• Coentre R, Góis C. Suicidal ideation in medical students: recent insights. Advances in Medical Education and Practice. 2018;9:873. doi:10.2147/AMEP.S162626.
• Ekmekci P, Kurtoglu B, Güner MD. Change in choices regarding the residency of Turkish medical students during the course of medical education. Tıp Eğitimi Dünyası. 2021;20(60):35-48. doi:10.25282/ted.757823.
• Mayda A, Yılmaz M, Filiz B, Deler M, Demir H, Doğru M, et al. A research on the anxiety about future in medical classes 4, 5, 6 of a university (in Turkish). Journal of Health Sciences Institute of Duzce University. 2014;4(3):7-13.
• Ergin A, Uzun SU, Topaloğlu S. Future occupational anxiety and trait anxiety levels of 5th and 6th year medical students at Pamukkale University and their contributing factors (in Turkish). Medical Journal of Mugla Sitki Kocman University. 2016;3(3):16-21.
• Şahin B, Musaoğlu E, Doğan B, Yıldırım A, Arslan T, Şahin H. Profile differences of medical doctors from three different hospitals in Turkey concerning burnout, job satisfaction, and depression. Turkish J Clinical Psychiatry. 2019;22(2):148-56. doi:10.5505/kpd.2019.73792.
• Griffin B, Hu W. Parental career expectations: effect on medical students’ career attitudes over time. Medical Education. 2019;53(6):584-92. doi:10.1111/medu.13812.
• Pisaniello MS, Asahina AT, Bacchi S, Wagner M, Perry SW, Wong M-L, et al. Effect of medical student debt on mental health, academic performance and specialty choice: a systematic review. BMJ Open. 2019;9(7):e029980. doi:10.1136/bmjopen-2019-029980.
• Turan S, Üner S. Preparation for a postgraduate specialty examination by medical students in Turkey: processes and sources of anxiety. Teaching and Learning in Medicine. 2015;27(1):27-36. doi:10.1080/10401334.2014.979186.
• Querido SJ, Vergouw D, Wigersma L, Batenburg RS, De Rond ME, Ten Cate OT. Dynamics of career choice among students in undergraduate medical courses. A BEME systematic review: BEME Guide No. 33. Medical Teacher. 2016;38(1):18-29. doi:10.3109/0142159X.2015.1074990.
• Torres-Roman JS, Cruz-Avila Y, Suarez-Osorio K, Arce-Huamaní MÁ, Menez-Sanchez A, Aveiro-Róbalo TR, et al. Motivation towards medical career choice and academic performance in Latin American medical students: A cross-sectional study. PloS One. 2018;13(10):e0205674. doi:10.1371/journal.pone.0205674.
• Mohammed TA-H, Abdulrahman AA, Saud KA, Alaa NT. Specialty preferences and factors affecting future career choice among medical graduates in Saudi. Journal of Family Medicine and Primary Care. 2020;9(3):1459. doi:10.4103/jfmpc.jfmpc_1199_19.
• Mennin S. Ten global challenges in medical education: wicked issues and options for action. Medical Science Educator. 2021;31(1):17-20. doi:10.1007/s40670-021-01404-w.
• Parlier AB, Galvin SL, Thach S, Kruidenier D, Fagan EB. The road to rural primary care: a narrative review of factors that help develop, recruit, and retain rural primary care physicians. Academic Medicine. 2018;93(1):130-40. doi:10.1097/ACM.0000000000001839.
• Dahal S, Khanal S, Rijal S, Bhandari P, Pandey R. Experiences of Young Doctors Working in Rural Nepal. Journal of the Nepal Medical Association. 2022;60(249). doi:10.31729/jnma.7504.
• Hansen N, Jensen K, MacNiven I, Pollock N, D’Hont T, Chatwood S. Exploring the impact of rural health system factors on physician burnout: a mixed-methods study in Northern Canada. BMC Health Services Research. 2021;21(1):1-10. doi:10.1186/s12913-021-06899-y.
• Saijo Y, Yoshioka E, Hanley SJ, Kitaoka K, Yoshida T. Job stress factors affect workplace resignation and burnout among Japanese rural physicians. The Tohoku Journal of Experimental Medicine. 2018;245(3):167-77. doi:10.1620/tjem.245.167.
• Dursun S, Aytaç SS. The Prevalence of Violence against Healthcare Workers in Turkey and Employee Job Satisfaction. Pakistan Journal of Medical and Health Sciences. 2021;15(6):1607-10. doi:10.53350/pjmhs211561607.
• Ünal GÖ, İşcan G, Ünal O. The occurrence and consequences of violence against healthcare workers in Turkey: before and during the COVID-19 pandemic. Family practice. 2022:1-8. doi:10.1093/fampra/cmac024.
• Sevimli S. How are medical ethics practices impacted by terror attacks on the healthcare system in Turkey? (2019). PhilPapers, Eubios Ethics Instute, Christchurch, New Zealand. 2019 [cited 2023 Feb 2]: Available from: https://philarchive.org/rec/SEVHAM
• Li Y, Cao L, Mo C, Tan D, Mai T, Zhang Z. Prevalence of burnout in medical students in China: A meta-analysis of observational studies. Medicine. 2021;100(26). doi:10.1097/MD.0000000000026329.
• Gil-Calderón J, Alonso-Molero J, Dierssen-Sotos T, Gómez-Acebo I, Llorca J. Burnout syndrome in Spanish medical students. BMC medical education. 2021;21(1):1-7. doi:10.1186/s12909-021-02661-4.
• Seo C, Corrado M, Fournier K, Bailey T, Haykal K-A. Addressing the physician burnout epidemic with resilience curricula in medical education: a systematic review. BMC Medical Education. 2021;21(1):1-25. doi:10.1186/s12909-021-02495-0.
• Demenech LM, Oliveira AT, Neiva-Silva L, Dumith SC. Prevalence of anxiety, depression and suicidal behaviors among Brazilian undergraduate students: A systematic review and meta-analysis. Journal of Affective Disorders. 2021;282:147-59. doi:10.1016/j.jad.2020.12.108.
• Neufeld A, Malin G. How medical students cope with stress: a cross-sectional look at strategies and their sociodemographic antecedents. BMC Medical Education. 2021;21(1):1-12. doi:10.1186/s12909-021-02734-4.
• Gupta P, BK A, Ramakrishna K. Prevalence of depression and anxiety among medical students and house staff during the COVID-19 health-care crisis. Academic Psychiatry. 2021;45(5):575-80. doi:10.1007/s40596-021-01454-7.