|Year : 2012 | Volume
| Issue : 2 | Page : 76-80
The attitude of medical students toward otolaryngology, head and neck surgery
Ahmad Alroqi, Ahmad Alkurdi, Khalid Almazrou
Department of otolaryngology, King Abdul Aziz Medical City, Riyadh, Saudi Arabia
|Date of Web Publication||3-Jan-2020|
MBBS Ahmad Alroqi
ORL Division. King Abdul Aziz Medical City, PO Box 22490 Riyadh
Source of Support: None, Conflict of Interest: None
Background and Objectives: The exposure to otolaryngology in medical school curriculum is relatively less compared to other specialties. The aim of this study was to review this attitude toward otolaryngology, head and neck surgery.
Methods: A cross-sectional, self-constructed questionnaire was administered to medical students within Saudi Arabia from different universities during their attendance of medical career day (2010). Questions were primarily closed ended. The analysis was made using SPSS.
Results: The overall response rate was 76.22%. Male response was 57.4%, compared to females 42.6% (P-value = 0.008). 6.6% of the medical students reported a primary interest in otolaryngology as a postgraduate career. The overall percentage of females interested in otolaryngology was 7.2% compared to 5.7% in males. Out of the medical students who were interested in otolaryngology, 7.9% were interns, whereas 39.8% were senior medical students. According to the questionnaire, the best area to study otolaryngology diseases is at the hospital clinics 76.9% followed by the daily rounds 12%, lectures in the medical school 7.6%, and operative rooms 3.5%. The medical students considered that the best way to improve teaching of otolaryngology diseases is by increasing the training period 60.3%. The average exposure time to otolaryngology in medical schools was 3.25 weeks (95% CI 3.05-3.45). North America was the preferred area for postgraduate residency training program according to 50.2% of the students, followed by local Saudi program 33.4%.
Conclusions: Undergraduate exposure to otolaryngology is probably limited, may need to be increased and to include operating room teaching to widen the concept of our
Keywords: medical students, otolaryngology, North America, Saudi Arabia, medical schools
|How to cite this article:|
Alroqi A, Alkurdi A, Almazrou K. The attitude of medical students toward otolaryngology, head and neck surgery. Saudi J Otorhinolaryngol Head Neck Surg 2012;14:76-80
|How to cite this URL:|
Alroqi A, Alkurdi A, Almazrou K. The attitude of medical students toward otolaryngology, head and neck surgery. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2012 [cited 2023 Jan 30];14:76-80. Available from: https://www.sjohns.org/text.asp?2012/14/2/76/274779
| Introduction|| |
Otolaryngology, head and neck surgery is a competitive field for medical students. It needs a dedicated time during the college study to have a conclusive view in which medical students judgment and attitude is representative. The attitude of medical students toward certain specialty has been studied. Psychiatry was one of the most specialties studied due to the lack of interest as a career in certain countries ,2 , followed by geriatric medicine for the same reason ,. Many factors in those studies have been identified to know why medical students choose a certain career and ignore another. Not only the interest of medical students, their feedback about the teaching process has been also included in those studies ,.
Attitude of medical students toward otolaryngology, head and neck surgery had received limited attention in the literature .
The aim of our study was to explore the attitude of medical students towards the field of otolaryngology, head and neck surgery and to look at the factors that might affect their choice.
| Methods.|| |
This study surveyed medical students from different medical schools within Saudi Arabia during their attendance of medical career day (2010). Participation within this study was completely voluntary, and confidentiality was maintained at all times as no identifying information were recorded in the survey’s results. Students were contacted between teaching sessions and invited to participate in the survey by the study representatives. The questionnaire consisted of 13 closed-ended questions addressed to report the experience and attitudes of Saudi medical students toward post-graduate specialty. The first 5 questions of the survey assessed demographic information and specialty preferences. The next 6 questions were in (agree, disagree and don’t know ) format, and addressed the importance of otolaryngology knowledge in medical practice, contact between the physician and otolaryngology diseases during practice, and the importance of knowledge and skills in different subspecialties of otolaryngology in general medical practice. The remaining 4 questions explored the opinion of the medical students regarding best area to study otolaryngology, best way to improve teaching in otolaryngology in undergraduate, duration of otolaryngology clerkship in medical school, and their postgraduate preference if they choose otolaryngology. Questionnaire development was self-constructed. The analysis was made using SPSS.
| Results.|| |
The overall response rate of the medical students was 76.22% (343/450). The mean age of the respondents was 22.52 years ranging between 18 and 29 year. Male response was 57.4%, compared to females 42.6% (P-value = 0.008 Binomial Test). The medical students were from 21 different medical schools. The interns represent 7.9%, senior medical student (4th, 5th and 6th year) represent 39.8%, junior medical students (1st, 2nd , and 3rd year) were 10.2 %. 6.6% of the medical students reported a primary interest in otolaryngology as a postgraduate career. The overall percentage of females interested in otolaryngology was 7.2% compared to 5.7% in males [Table 1]. Among medical students who chose otolaryngology, the percentage of females was 48% compared to 52% in males. Out of the medical students who were interested in otolaryngology, 18.2% were interns, whereas 50% were senior medical students. There were certain specialties that were preferred by females more than males and vice versa. The percentages of female medical students who choose obstetrics/gynecology and dermatology were 88.2% (P-value= 0.002 ‘Binomial test’), and 58.3 % (P-value = 0.774 ‘Binomial test’) respectively, while, the percentages of males who were interested in general surgery, ophthalmology, pediatric and family medicine were 69.8%( P-value < 0.0001 ), 65.4%( P-value = 0.169 ), 65%(P-value = 0.081 ), and 55.6%( P-value > 0.9 ) ‘Binomial test’ respectively.
When asked; Is knowledge in otolaryngology diseases not necessary in medical practice in general? 83.6 (P-value <0.0001’Binomial test’)% disagreed. 74.4 % of medical students thought that otolaryngology diseases face all physicians during general practice(P-value <0.0001 ‘Binomial test’). The majority of medical students agreed that knowledge and skills of treatment in ear and nose diseases are necessary in medical practice generally (P-value <0.0001 ‘Binomial test’). However, knowledge and skills of head and neck diseases and knowledge and skills of laryngeal diseases were necessary according to 60.4%(P-value<0.0001 ‘Binomial test’) and 46.49%(P-value = 0.016 ‘Binomial test’) of medical students respectively [Table 2].
According to the questionnaire, the best area to study otolaryngology diseases was at the hospital clinics (76.9%) followed by daily rounds (12%), lectures in the medical school (7.6%), and operative rooms (3.5%) (P-value < 0.0001 ‘Non-parametric chi square test’). The medical students considered that the best way to improve teaching of otolaryngology diseases was by increasing the training period (60.3%) then by adding a mandatory training period during the internship (26.2%), then equalizing the training period with other specialties ( surgery, medicine and obstetrics/gynecology) (13.4%) (P-value = 0.0001 ‘Non-parametric chi square test’) . The average exposure time to otolaryngology in medical schools was 3.25 weeks (95% CI 3.05-3.45) with those exposed to four weeks or more representing 16.3 % only [Table 3].
North America was the preferred area for postgraduate residency training program according to 50.2% of the students, followed by local Saudi program 33.4% (P-value <0.0001 ‘Non-parametric chi square test’) [Table 4].
No clear link was observed between the exposure time to otolaryngology during undergraduate rotations and choosing it as post-graduate career ( P-value = 0.155 ' One way ANOVA’).
| Discussion|| |
The attitude of medical students toward various medical specialties has been studied. And according to those studies many factors related to their attitude were identified. Certain studies looked at the timing of clerkship and its effect on student performance, attitudes, and career plans. They support earlier clerkship during undergraduate rotations .
Seventy-eight percent of medical students believed that the main factor influencing their decision to pursue otolaryngology was their exposure to the residents, showing the importance of residents-students relation in directing the students to otolaryngology specialty .
According to Avgerinos et al, , the vast majority of students wish to specialize (97.6%), while general practice gathered a very low percentage (1.7%). The scientific challenge (61.4%) and interaction with patients (60.6%) seem to be the major influencing factors for most of the students’ specialty preferences, whilst less common variables influencing career choice are the high demand/supply ratio for certain health services (40.4%), the income potential (31.4%), the active tempo (26.2%) and prestige (15%). 70.3% of those asked consider the possibility of specializing abroad.
Students were asked to rank factors according to their importance in their career choice. The single most important factor was career progression. Other factors include on-call commitment, teachers as role models, and the interest for a particular subject .
Fewer females than males were found to consider or choose a surgical career, possibly due to differences in qualities of importance in specialties, availability of role models, and exposure through electives. However, our study showed that 25.2% of female medical students were interested in surgical specialties .
By looking at the factors affecting medical students in formulating their specialty preferences, the most preferred specialty expressed by male students was general surgery, followed by internal medicine and orthopedics, while the specialty most preferred by female students was obstetrics and gynecology, followed by pediatrics and surgery. Students showed little interest in orthopedics, ophthalmology, and dermatology. While 3.1% of females expressed interest in anesthesiology, no male students did. Other specialties were less attractive to most students. Intellectual content of the specialty and the individual’s competencies were the most influential on their preference of specialty. Other influential factors were the “reputation of the specialty”, “anticipated income”, and “focus on urgent care” . In our study, the three main specialties preferred by male medical students in descending order were general surgery 42.2%, internal medicine 17.2% and pediatrics 13.5% while in females were general surgery 25.2%, internal medicine 24.5% and obstetrics/gynecology 10.8%.
Third year medical students perceive that the most important urological learning environment is outpatient evaluation of patients . This finding is in accordance with our results. Teaching in the OR is more focused on technical aspects of the operation than the goals of a core surgery clerkship . This was consistent with our study in which clinics were thought to be the best area of teaching by the majority of medical students (76.9%) while operative rooms is not a preferred area of teaching (3.5%).
A study was performed to determine students’ perceptions of surgeons across 4 years suggested that the junior surgery clerkship had a favorable but transient impact on the negative perceptions of medical students. Perceptions returned to negative values within 1 year of the clerkship .. In our study 35% of the medical students were interested in surgery as a career. The attitude toward general surgery showed that fewer than half of the final year medical students surveyed were willing to consider general surgery as a future career choice. The two most popular attractions to general surgery were challenging postgraduate training and highly regarded career esteem. The two most common disincentives were family considerations and the sacrifice of personal time . In a prospective study about choosing general surgery, data suggested that medical students seem to be more concerned with issues of “controllable lifestyle” such as adequacy of family and/or leisure time, high level of stress, and amount of work and commitment .
Although otolaryngological problems are common in primary care, it has received limited time for teaching in undergraduate medical education ,. In our survey, 78.1% of the medical students spent three weeks or less in the study compared to 21.9% only who had more than three weeks time.
A survey of undergraduate otolaryngology experience at Newcastle University Medical School had revealed that 54 percent had a formal otolaryngology attachment; (17 percent) and (42 percent) respectively had not attended otolaryngology clinic or theatre; less than 50 percent had seen common otolaryngology operations; (8 per cent) had never heard of a septoplasty .
The three most common student expectations were to see and learn common ENT operations, to see the anatomy involved and to learn about the disease being operated upon. Sixty per cent of students reported that their expectations had been met. On a Likert scale from 1 (strongly disagree) to 7 (strongly agree), the importance of theatre attendance as part of the curriculum was rated to be 4.7 (95 per cent confidence interval (CI) = 3.7 to 4.2) and the satisfaction of educational needs in operating theatre teaching was rated to be 3.9 (95 per cent CI = 3.7 to 4.2). Students perceived attending otolaryngology theatre sessions to be beneficial .
In our study 25.7% of the medical students didn’t answer the question about duration of studying otolaryngology during the medical school, this probably because they didn’t have otolaryngology rotation at the time the study was conducted.
| Conclusions|| |
The attitude of medical students toward otolaryngology had received limited attention. This paper explored this issue through a different student levels.
Our study showed the limited undergraduate medical education in otolaryngology, head and neck surgery that could get reflected on the career preference. Low percentage of medical students interested in this field, especially at the junior level .
We recommend increasing the undergraduate exposure to otolaryngology, head and neck surgery, with more concentration on the operative rooms teaching.
| References|| |
Maric NP, Stojiljkovic DJ, Milekic B, Milanov M, Stevanovic D, Jasovic-Gasic M. How medical students in their pre-clinical year perceive psychiatry as a career: the study from Belgrade. Psychiatr Danub.
Ndetei DM, Khasakhala L, Ongecha-Owuor F, Kuria M, Mutiso V, Syanda J, Kokonya D. Attitudes toward psychiatry: a survey of medical students at the University of Nairobi, Kenya. Acad Psychiatry.
2008 Mar-Apr; 32(2):154-9.
Golden AG, van Zuilen MH, Mintzer MJ, Issenberg SB, Silverman MA, Roos BA. A fourth-year medical school clerkship that addressed negative attitudes toward geriatric medicine. J Am Geriatr Soc.
2010 Apr; 58(4):746-50.
Chua MP, Tan CH, Merchant R, Soiza RL. Attitudes of first-year medical students in Singapore towards older people and willingness to consider a career in geriatric medicine. Ann Acad Med Singapore.
Avgerinos ED, Msaouel P, Koussidis GA, Keramaris NC, Bessas Z, Gourgoulianis K. Greek medical students’ career choices indicate strong tendency towards specialization and training abroad. Health Policy.
2006;79(1):101-6. Epub 2006 Jan 18.
Ranta M, Hussain SS, Gardiner Q. Factors that inform the career choice of medical students: implications for otolaryngology. J Laryngol Otol.
McCaffrey JC. Medical student selection of otolaryngology-head and neck surgery as a specialty: influences and attitudes. Otolaryngol Head Neck Surg.
Dewey RB Jr, Agostini M. Attitudes and performance of third- vs fourth-year neurology clerkship students. Arch Neurol.
Ashikawa H, Xu G, Veloski JJ. Students’ ratings of otolaryngology clerkship activities: the role of residents. Med Teach.
Baxter N, Cohen R, McLeod R. The impact of gender on the choice of surgery as a career. Am J Surg.
Khader Y, Al-Zoubi D, Amarin Z, Alkafagei A, Khasawneh M, Burgan S, El Salem K, Omari M. Factors affecting medical students in formulating their specialty preferences in Jordan. BMC Med Educ.
Teichman JM, Monga M, Littlefield JH. Third year medical student attitudes toward learning urology. J Urol.
Irani JL, Greenberg JA, Blanco MA, Greenberg CC, Ashley S, Lipsitz SR, Hafler JP, Breen E. Educational value of the operating room experience during a core surgical clerkship. Am J Surg.
Naylor RA, Reisch JS, Valentine RJ. Do student perceptions of surgeons change during medical school? A longitudinal analysis during a 4-year curriculum. J Am Coll Surg. 2010;210(4):527-32.
Tambyraja AL, McCrea CA, Parks RW, Garden OJ. Attitudes of medical students toward careers in general surgery. World J Surg.
Gelfand DV, Podnos YD, Wilson SE, Cooke J, Williams RA. Choosing general surgery: insights into career choices of current medical students. Arch Surg.
2002 ;137(8):941-5; discussion 945-7.
Wong A, Fung K. Otolaryngology in undergraduate medical education. J Otolaryngol Head Neck Surg.
Glicksman JT, Brandt MG, Parr J, Fung K. Needs assessment of undergraduate education in otolaryngology among family medicine residents. J Otolaryngol Head Neck Surg.
Doshi J, Carrie S. A survey of undergraduate otolaryngology experience at Newcastle University Medical School. J Laryngol Otol.
2006;120(9):770-3. Epub 2006 Jul 19.
Lee MS, Montague ML, Hussain SS. Student-perceived benefit from otolaryngology theatre attendance. J Laryngol Otol.
[Table 1], [Table 2], [Table 3], [Table 4]