Medical Career decisions among MBBS students in Bangladesh
Information regarding career choices of medical students is important to plan human resources for health, design need-based educational programs, and ensure equitable and quality health care services in a country.
The aim of the study is to identify career choices, nature of career, intended practice locations, and reasons for career choices of undergraduate MBBS students in Bangladesh.
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First, third, and Fifth-year students of Bangladesh Medical Colleges and Medical Univerity in Bangladesh completed a self-report questionnaire on career choices, nature of career, intended practice locations, and reasons for career choices. The students were requested to choose three long-term choices from the given specialties.
A total of 132 students responded (46 boys and 86 girls) and the response rate was 75 percent. The popular choices (first choice) among males and females were a medical specialty, surgical specialty, obstetrics and gynecology, and general practice. For first, second, and third choices altogether, male students chose surgical specialties and female students preferred medical specialties. The leading reasons for selecting a specialty were personal interest and wide job opportunities. More than 67 percent of respondents wanted to join private services and about 90 percent chose major cities as practice locations. About MBBS students in Bangladesh, 43 percent of respondents expressed willingness to practice medicine in Bangladesh, whereas 51 percent of the total respondents wanted to practice abroad.
Discussion – MBBS students in Bangladesh
The majority of students intended to specialize in established clinical specialties and subsequently practice in major cities, and more than half wanted to immigrate to other countries. Basic medical subjects and service-oriented (lifestyle-related) and preventive/social medical specialties were found to be less attractive. If this pattern continues, Bangladesh will suffer a chronic shortage of health personnel in certain specialties and in rural areas.
Reorientation of health care and medical education is needed along with policy settings to attract doctors to the scarcity and high-priority disciplines so that imbalances encountered would be minimal in the future.
In recent years, educational institutions around the world have been increasingly confronted with the challenge of making their curricula relevant to the needs of the time. Medical education in Bangladesh has also experienced many changes and challenges. The medical education system in Bangladesh inherited the typical features of colonial education, which is very much on the traditional pattern: lecture-based, teacher-centered, discipline-based, examination-driven, and hospital-oriented.
The curriculum structure is generally divided into basic sciences and clinical sciences. The bachelor of medicine and bachelor of surgery degree is a 5-year program followed by a 1 (one) year compulsory logbook-based internship. The medium of instruction in medical colleges is English.
One of the important developments in recent years in medical education in Bangladesh is the emergence of private medical colleges with the establishment of Bangladesh Medical College (BMC) in the center of Dhaka city (capital) in 1986 by Bangladesh Medical Studies and Research Institute (BMSRI). Currently, there are 61 medical colleges in Bangladesh, of which 43 are privately funded.BMC is now a well-established, leading medical institution in the country, and until now students graduated from BMC. In 2007, BMSRI added a new medical college ‘Uttara Adhunik Medical College (UAMC)’ on the outskirts of Dhaka city, and it has now two batches of students on year one and three.
Information concerning the career choices of medical students is important in planning the healthcare workforce and medical education programs and providing equitable and quality healthcare services to the community. The identification of career preferences and intended practice locations of the medical MBBS students in Bangladesh also provide a useful contribution to the projections, needs, and distribution of doctors across different specialties and regions in the country.
Choice of a career is a complex personal decision influenced by a multitude of extrinsic and intrinsic factors. Studies conducted in Asian countries demonstrated that medical students usually choose established hospital-based clinical specialties and want to practice in major cities. These create an acute shortage of medical teachers in medical colleges and doctors in rural areas. Moreover, a substantial number of medical students want to join private medical services.
The new trend of choosing surgical specialties by more female students and graduates also requires special attention by policymakers.
The study conducted in Malaysia on three batches of final-year students from 1992 to 1994 identified that 17% of the female students mentioned surgical specialties as their first, second, or third choice,6 and it was increased to 67% in 2003 cohort of medical graduates. Migration of doctors from Asian countries to the developed world has also posed another concern. It was estimated in 2006 that about 1% of the total number of practicing physicians of Bangladesh migrated to other countries (eg, the Middle East, USA, UK) which was almost 20% of the average annual graduates from medical colleges.
A recent study conducted among students, interns, and house officers in Nepal found that almost half of them planned to migrate to a developed country. The important reasons for migration among medical final-year students are poor salary structure, poor quality of training, and poor work environment in their home country. To the best of our knowledge, until now, no study examined the career choice among medical students in Bangladesh. The main aims of the study were to investigate the first, second, and third career choices of medical students in Bangladesh; their preferred permanent location for practicing medicine; nature of jobs; factors affecting the choice of specialty; and students’ willingness to practice medicine in Bangladesh and other countries.