Specialty Choice Attitudes Among Medical Interns: Evidence from Hormozgan University of Medical Sciences

Technical Summary: Specialty Choice Attitudes Among Medical Interns in Southern Iran

Problem Statement
The selection of a medical specialty is a critical determinant of both individual career trajectories and the future composition of the healthcare workforce. While specialty preferences are known to be influenced by a complex interplay of personal, educational, and socioeconomic factors, there is a paucity of evidence regarding the specific attitudes and decision-making processes of senior medical students in southern Iran. Existing literature often relies on data from residents or graduates rather than interns at the point of career decision-making. Furthermore, local data from the Hormozgan region and Bandar Abbas are limited, despite the potential influence of regional cultural, educational, and labor-market factors on specialty choice. This study addresses the gap in understanding the willingness of medical interns to pursue specialty training, their specific specialty preferences, and the factors driving these decisions within the context of Hormozgan University of Medical Sciences (HUMS).

Methodology
This was a descriptive-analytical cross-sectional study conducted in 2023 among medical interns at HUMS in Bandar Abbas, Iran.

• Study Population and Sampling: The target population included all medical students in the internship stage (N=129). Using a convenience census approach, all eligible interns were invited to participate. The final sample consisted of 83 participants who completed an online questionnaire, meeting the minimum sample size requirement calculated via the Morgan table (adjusted for a 10% non-response rate).
• Instrumentation: Data were collected using a validated online questionnaire adapted from Hashemipour et al. [21]. The instrument included sections on demographic and academic characteristics (age, gender, marital status, admission quota, national entrance exam rank, GPA, internship duration), employment status, and specific motivations for or against pursuing specialty training. Motivational items were rated on a three-point scale (Important, Moderately Important, Unimportant).
• Validity and Reliability: Content and face validity were established through review by faculty members and a pilot group of 10 students. Internal consistency reliability was confirmed in the current study with a Cronbach's alpha of 0.82.
• Statistical Analysis: Data were analyzed using SPSS version 27. Descriptive statistics summarized demographic and preference data. To identify factors associated with the willingness to pursue specialty training (the primary binary outcome), univariable, age- and sex-adjusted, and multiple logistic regression models were constructed. Statistical significance was set at P < 0.05.

Key Results

• Willingness to Train: Of the 83 participants, 60.2% (n=50) expressed willingness to pursue specialty training, while 39.8% (n=33) were unwilling.
• Motivations for Willingness: Among those willing to continue, the primary drivers were achieving a better economic position (49.4%), access to broader job opportunities (42.2%), and attaining higher social status (41.0%).
• Reasons for Unwillingness: Among those unwilling, the most cited reasons were fatigue from prolonged studying (26.5%), financial problems (25.3%), and a desire to start working immediately after graduation (21.7%).
• Specialty Preferences: Preferences were highly concentrated. Radiology was the most preferred first-choice specialty (28.9%), followed by Otorhinolaryngology/ENT (21.7%), Dermatology (10.8%), and Cardiology (8.4%). Several specialties, including Emergency Medicine, Neurology, and Internal Medicine, received no first-priority selections.
• Predictive Factors: In the final multivariable logistic regression model, no demographic (age, gender, marital status) or academic variables (GPA, entrance exam rank, admission quota) remained independently associated with the willingness to pursue specialty training. While GPA categories (16–17 and 17–18) showed significance in age- and sex-adjusted models, these associations did not persist in the final multivariable analysis.

Key Contributions

• Regional Evidence: The study provides the first specific data on specialty choice attitudes among medical interns in southern Iran, a region previously underrepresented in the literature.
• Shift in Preferences: It documents a distinct shift away from traditional high-demand clinical fields (e.g., Internal Medicine, Surgery) toward specialties perceived as offering better lifestyle control, financial prospects, and social prestige (e.g., Radiology, Dermatology, ENT).
• Determinants of Choice: The research highlights that economic considerations and educational fatigue are the dominant factors influencing the decision to pursue or forego residency, outweighing demographic or academic predictors in this cohort.
• Regression Findings: The study contributes the finding that standard demographic and academic metrics do not independently predict specialty choice willingness in this population, suggesting that unmeasured factors (e.g., personality, role models, clinical exposure quality) play a more significant role.

Significance and Claims
The authors claim that these findings underscore the complexity of specialty choice, which cannot be explained solely by measurable background variables. The concentration of interest in a limited number of specialties poses a risk of future workforce imbalances, potentially leading to oversupply in "lifestyle" specialties and shortages in essential but less preferred fields.

The paper argues that the dominance of economic factors and educational fatigue suggests a need for:

1. Structured Career Counseling: To provide balanced exposure to all specialties and counteract reliance on informal student culture or anecdotal impressions.
2. Policy Interventions: To address financial barriers and structural issues in residency training, particularly to make less preferred specialties more attractive.
3. Educational Reform: To improve the clinical learning environment, as the quality of exposure during rotations significantly shapes student perceptions.

The authors modestly note that the study's cross-sectional design precludes causal inference and that the single-center, relatively small sample size limits generalizability to other regions of Iran. They conclude that while a majority of interns are interested in specialization, the specific choices are driven by a desire for financial stability and manageable lifestyles, necessitating targeted interventions to align student preferences with national health system needs.