2014, 36: 978–982
Informed choice of entering medical school and academic success in Iranian medical students YASIN FARROKHI-KHAJEH-PASHA, SAHARNAZ NEDJAT, AEEN MOHAMMADI, ELAHEH MALAKAN RAD & REZA MAJDZADEH Tehran University of Medical Sciences, Iran
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Abstract Background: One of the challenges medical education policy-makers confront is matriculants’ informed choice of entering medicine. However, students’ reasons for choosing medicine do not seem rational. Aim: We compared students who made an informed choice about entering medicine with those who did not, in terms of academic success. Methods: The study was carried out with a self-administered questionnaire on 220 final-year medical students randomly selected from six Iranian medical schools. Depending on their informed choice of entering medicine or not at the time of application, they were divided into two groups. We compared these two groups’ academic achievement as well as their satisfaction with medicine. Results: The students who had not made an informed choice had a higher tendency not to choose medicine if they were to start over (p value 0.001). The pre-admission scores of students who had made an informed choice of medicine were worse than the other group (p ¼ 0.03). However, their final year scores as well as their satisfaction with medicine were higher than the other group. Conclusions: Idealistic views of medicine should be replaced by rational and logical ones to help students select the careers best suited to their abilities and talents.
Introduction
Practice points
Medicine is a highly competitive field of study all over the world. It is still prestigious and popular in Iran. However, there seems to be a significant gap between reality and the delusion of a medical career in the society. The relatively dark future of employment, the difficulties associated with the lifestyle and the lengthy years of education are overlooked by the society. Instead, it is perceived as a highly appreciated and financially promising career (Nedjat et al. 2008). In Iran, many students lack adequate awareness toward the medical career at the time of choosing their field of study (Nejat et al. 2006). Mostly, they are influenced by factors such as family pressure and physicians’ social prestige in choosing medicine, without having sufficient knowledge of its implications and professional outlook. They choose medicine at an age and level of maturity that lacks experience in medical practice, and cannot judge their own personal aptitudes. However, researches in other countries also show that medical students have an over-dramatized and romanticized view of medicine at the beginning of academic studies. In a Finish article, the authors investigated the association between the reasons that influenced doctors to enter medicine and their career satisfaction. The majority of respondents said that their major reasons for choosing medicine were: their interest in helping people, a wide range of job opportunities, medicine as
The pre-admission scores of students who had made an informed choice of medicine were worse than those who had not. The medical students who had not made an informed choice about entering medicine had a lower tendency to choose medicine if they were to start over. The final year scores as well as the satisfaction of the students who had made an informed choice of medicine were higher than those who had not made an informed choice.
a highly appreciated profession, and their own previous scholastic achievement (Hyppo¨la¨ et al. 1998). In an Irish article, the factors influencing school students’ decision to study medicine at academic level were determined. The opportunity to help others, the intellectual challenge offered by medicine, the financial reward, perceived personality fit with a medical career, advice from friends and family, past experience of medical professionals and television were, respectively, the major reasons for choosing medicine (McHugh et al. 2011). In Australian medical universities, only 52% of the students seemed to have a clear ambition to enter medicine; while parental pressure and social esteem were
Correspondence: Saharnaz Nedjat, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran. E-mail: [email protected]
978
ISSN 0142-159X print/ISSN 1466-187X online/14/110978–5 ß 2014 Informa UK Ltd. DOI: 10.3109/0142159X.2014.918256
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Who is more satisfied with medical courses?
mentioned as other factors. Moreover, only 11% of the students claimed having any reasonable knowledge about the field before choosing it (Marley & Carman 1999). In Iran, most of the medical students are selected from high-school graduates solely on the basis of academic performance through one academic entrance exam. Only 2% enter medicine after their bachelor graduation. In our previous article, we tried to evaluate the predictive validity of the university entrance exam for success in the field of medicine (Farrokhi-Khajeh-Pasha et al. 2012). We showed that although the exam is not a poor predictor of medical school performance by itself, it is not supplemented by any other scale. Moreover, we discussed the necessity of evaluating matriculants’ non-cognitive characteristics in a field such as medicine. However, the importance of the rationales used by students in selecting their academic field of study and its aftermath has not been studied in Iran yet. In the present study, we compared students who made an informed choice of selecting medicine with those who did not in terms of academic success in medical school and their satisfaction with studying medicine. The findings of the present study can be applied by medical education policy-makers to modify the medical applicant selection current method.
Methods Study population and sampling The reference population of this study consisted of all medical students who were registered in public medical schools of Iran in 2003 (N ¼ 2208). The questionnaires were sent to a random sample of 220 students out of 2003-matriculants in six universities. These universities were chosen from all three levels of universities based on the classification made by the Ministry of Health and Medical Education (MOHME). The classification is based on the level of education and research provided in Iran’s medical universities (level 1 universities are the highest-ranking and level 3 are the lowest-ranking) (Mohammadi et al. 2006). Strictly speaking, the selected sample of students should have been at the stage of internship in 2009; the time when the study was performed. However, the 22 unavailable students were substituted with those who had the most similar Konkoor scores to them. The unavailability of these students can be the result of delay in beginning the medical course or changing the original university chosen by the matriculant, or to a less-extent attrition which is not the usual case for medicine in Iran (Mohagheghi 2010). All of the respondents were at their internship stage.
Data collection tool To address the questions of this study we designed a questionnaire composed of multiple choice questions (MCQs) with Likert-type scale items. To define the main questions of the questionnaire, we studied similar studies conducted elsewhere (Ewan & Bennett 1981; Hyppo¨la¨ et al. 1998; McHugh et al. 2011). Finally, the questionnaire was assessed by ‘‘educational’’ experts, and their comments and suggestions were incorporated into the questionnaire.
The reliability of the questionnaire was assessed by a test–retest. The questionnaire was administered twice to 20 final-year medical students at TUMS at two weeks’ time interval. The reliability of the questionnaire was acceptable (ICC range ¼ 0.62–0.91, Cronbach’s alpha ¼ 0.93). The questionnaire contained some general questions about background variables, such as age and gender. We used two questions to assess whether the matriculants had made an informed choice of studying medicine. The first one asked about the most important reason for choosing medicine at the time of entering medical school. The proposed choices for this question included personal interest, family pressure, physicians’ social prestige and others. The other question asked the students to score their determination in choosing medicine as their academic field of study on a 0–4 point Likert scale. The answers to both questions were used to divide the students into two groups. The students who had selected ‘‘personal interest’’ in the first question and scored 3 or 4 in the second question were regarded by the research team to have made an informed choice. In another question, the students were asked to score their current satisfaction with their field of study. The students were also asked if they would reconsider medical school entry again if they were to start over. The academic performances of these two groups of students were compared. Pre-admission information included in the study was retrieved from the database of the ‘‘National Organization of Educational Testing’’ and consisted of ‘‘high-school grade point average’’ (HSGPA) which indicated the average grades of the final three years of high school and the score obtained in the university entrance exam (Konkoor). Data on the academic performance of medical students were gathered from the MOHME and consisted of the ‘‘Comprehensive Basic Science Exam’’ (CBSE) scores, ‘‘Comprehensive Pre-Internship Exam’’ (CPIE) scores and ‘‘medical school grade point average’’ (MSGPA), which were computed from all courses completed prior to internship and were weighted according to the number of course hours. The details of these variables have been discussed in an earlier study (Farrokhi-Khajeh-Pasha et al. 2012).
Analysis The respondents were divided into two groups: those who had made an informed choice of entering medicine on the basis of their interest, and those who had selected medicine because of other reasons such as social, economic and cultural factors. Mean age, HSGPA, Konkoor, CBSE, CPIE and MSGPAs in students who had selected medicine on the basis of personal interest rather than other reasons were compared to others using independent-sample t test. 2 was used to compare the two groups of this study in terms of gender differences and answers to ‘‘reconsidering medical school entry’’, and to compare the proportion of students who had made an informed choice of medicine at different university levels.
Results Two hundred and six questionnaires (response rate ¼ 93.64%) were completed and returned by the interns, i.e. the final year
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Table 1. Reconsidering medical school entry among students who had made an informed choice of medicine and those who had not.
Students who had made an informed choicethe first group Students who had not made an informed choicethe second p Value
Reconsidering medical school entry in the same university (%)
Reconsidering medical school entry in another university
Not choosing medicine at all
39 (58.2%) 56 (40.9%) 0.019
25 (37.3%) 42 (30.7%) 0.342
3 (4.5%) 39 (28.5%) 0.0001
group
Table 2. Academic achievement and satisfaction toward medicine among students who had made an informed choice of medicine and those who had not.
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Students who Students who had made an had not made informed an informed choice choice p Value HSGPA (0–20)* Konkoor score (0–15 000)* CBSE (0–210)* CPIE (0–202)* MSGPA (0–20) Satisfaction with selection of medicine (0–4)*
18.54 10 325.24 148.15 134.61 15.67 3.40
19.01 10 307.59 144.32 129.32 15.51 2.55
0.03 0.90 0.19 0.04 0.34 50.001
HSGPA, high-school grade point average; CBSE, comprehensive basic science exam; CPIE, comprehensive pre-internship exam; MSGPA, medical school grade point average. *Attainable scores.
medical students who were being trained at educational hospitals. The mean age of the respondents was 25.17% and 63.1% were girls. There were no differences between the two groups regarding age and sex (p value ¼ 0.40 and 0.31 for age and sex, respectively). Sixty-seven (32.5%) respondents had made an informed choice of medicine. Table 1 shows the responses to the question of reconsidering medical school entry. As it is depicted in this table, the students who had not made an informed choice had a higher tendency not to choose medicine if they were to start over (p value 0.001). The mean score for the ‘‘level of satisfaction with selection of medicine’’ as the academic field in the range of 0 (no satisfaction) to 4 (complete satisfaction) was 2.83 (SD ¼ 1.00) for all the students in the study. Table 2 represents the results of independent T tests comparing the two groups of students; those who had made an informed choice of medicine and those who had not. The differences were significant in HSGPAs, CPIE and satisfaction. The HSGPAs (related to pre-admission performance) of students who had made an informed choice of medicine were lower than their classmates in medical school. On the contrary, the CPIE scores (related to the final year of medical school) and the level of satisfaction of students who had made an informed choice were higher than the others.
Discussion In this study we have tried to address the concern that medical students may choose medicine solely because of becoming a 980
doctor and the prestige and economic factors associated with it. We tried to ask final year medical students about their reasons for choosing this academic field of study at the time of medical school entry, and to evaluate its effect on their future academic success. The results of the present study showed that only 32.5% of respondents had made an informed choice of medicine and on the basis of personal interest. Not only in Iran, but also in other countries the major reasons of students for choosing medicine seem not to be so pragmatic (Hyppo¨la¨ et al. 1998; McHugh et al. 2011). Also, most students seem not to have reasonable knowledge about medicine before choosing it (Marley & Carman 1999). The students face an unexpected world in the medical school and this has a negative effect on their educational success. After having studied medicine and getting involved with the medical career in educational hospitals, 4.5% of students who had made an informed choice of medicine and 28.5% of those who had not said that they would consider another profession if they were to start over. The first group of students had gained lower high-school GPAs compared to the second group of students. However, the Konkoor score between these two groups were not significantly different, which is not surprising; all these individuals had passed the same exam with the highest grades among the pool of applicants, and only those who score the highest in this exam can get admission into medical school. However, the CPIE scores of medical students who had made an informed choice were higher than the others. As CPIE is conducted at the end of the medical education program, this can imply that personal interest and an informed choice have positive effects on medical students’ academic performance. The level of satisfaction was also higher among students with personal interest in medicine. The final year medical students who were at their internship stage of medical education were selected for this study to ensure that the respondents had already gained some experience in the medical career. At the time, this study was conducted, only those 2003 matriculants could participate in this research who had reached each milestone of their medical education on time and with no or at the most two semesters delay. This may have led to selection bias; excluding students with attrition or more than two semesters delay in their medical education. However, we did not have any other choice to study interns of the same matriculation year at the same time. Moreover, respondents had begun their medical studies – on an average – seven years before the survey was carried out and they were asked to recall the time when they had entered medical school, which may have resulted in recall bias.
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Who is more satisfied with medical courses?
However, emotionally important life events such as career choice are usually not forgotten easily (Hyppo¨la¨ et al. 1998). Certain steps have been taken to help both medical education policy-makers and applicants to choose the best fitted students for medicine. Graduate entry to medicine, which is the usual way of admitting medical students in some countries, allows applicants to acquire the required mental maturity to choose this field with more awareness (Nedjat et al. 2008). This is acquired as a result of their previous academic experience and higher age at the time of application. In many medical schools, in other countries, programs require candidates to complete a personal interview during which an attempt is made to assess each candidate’s interpersonal skills, motivation and problem exploration (Eva et al. 2004). Although there is debate on the shortcomings of these interviews, they can help both sides of application to choose the best option. Incorporating work experience in medicine among the requirements of medical school application in some countries is another way that can increase students’ awareness of the life to which they are about to commit themselves to. Such experience helps the student make an informed career choice, and exploring it during the interview can reflect student motivation to study medicine. In the previous article, we discussed the need for developing admission requirements with improved validity to supplement the academic performance for admission to medical schools (Farrokhi-Khajeh-Pasha et al. 2012). The results of the present study approve the necessity of this change in the admission process and show that students’ reasons for choosing medicine are not so rational at the beginning of academic studies, which ultimately reveals its negative effect on educational achievement. The admission process should concentrate on other factors besides the academic performance which play an important role in becoming a ‘‘good doctor’’. Enough maturity at the time of choosing medicine to evaluate one’s talent for success in medicine and incorporating good measurements to evaluate non-cognitive factors were some proposed remedies in this study. Comparing the views of students at the time of choosing medicine with those after graduation from medical school can be a good proposal for future studies. The findings of this study show that the policy-makers in medical field should pay more attention to the selection methods of medical applicants, since the informed choice of medicine can play a major role in the academic success and job satisfaction of medical students.
be left alone in their decision to choose a career, as this greatly affects their paths as professionals in the future. They should be provided with abundant advice and information to help them make better and informed choices. We should not leave these students alone with a great decision at the beginning of their youth; with a decision that has a great impact on their future and, of course, the future of society. We should help them make a choice with eyes wide open.
Notes on contributors YASIN FARROKHI-KHAJEH-PASHA, MD, MPH, is a resident of radiology, Imam Khomeini Hospital, Faculty of Medicine, Tehran University of Medical Science. SAHARNAZ NEDJAT, MD, PhD, is an Associate Professor in Epidemiology, faculty of School of public health and knowledge utilization research center, Tehran University of Medical Sciences. AEEN MOHAMMADI, MD, MPH, PhD, is a faculty member of E-Learning in Medical Education department in Virtual School, Tehran University of Medical Sciences. ELAHEH MALAKAN RAD, MD, FACC, is an Associate Professor in pediatric interventional cardiology, Pediatric’s Center of Excellence, Tehran University of Medical Sciences. REZA MAJDZADEH, DVM, PhD, is a Professor in Epidemiology, faculty of School of public health and knowledge utilization research center, Tehran University of Medical Sciences.
Acknowledgements This study is based on the MD-MPH dissertation of the first author. The authors are very grateful to the National Organization of Educational Testing for providing the database of all applicants applying for the 2003 Konkoor for ‘‘experimental sciences’’. Thanks also to Organization of Educational Testing of the Ministry of Health and Medical Education for providing the data on medical school GPAs of 2003 matriculants at public medical schools, the scores of participants and the reliabilities of the CBSE and CPIE from 2005 to 2010. Declaration of interest: This study was financially supported by Tehran University of Medical Sciences’ Vice Chancellor of Research (project no. 10041, 88-03-76). The authors declare that they have no competing interests.
References Conclusions Creating a true image of personal required capacities for a career is crucial for the achievement of success in the future. Before entering medical school, the students see the tip of the iceberg of a medical lifestyle which portrays a highly appreciated individual in the society without any financial concerns. However, they change their mind about medicine when they face its reality in hospitals, which negatively affects their academic achievements. Matriculate students should not
Eva KW, Rosenfeld J, Reiter HI, Norman GR. 2004. An admissions OSCE: The multiple mini-interview. Med Educ 38:314–326. Ewan CE, Bennett MJ. 1981. Medicine in prospect – The first-year student’s view. Med Educ 15:287–293. Farrokhi-Khajeh-Pasha Y, Nedjat S, Mohammadi A, Malekan Rad E, Majdzadeh R, Monajemi F, Jamali E, Yazdani S. 2012. The validity of Iran’s national university entrance examination (Konkoor) for predicting medical students’ academic performance. BMC Med Educ 12:60. Hyppo¨la¨ H, Kumpusalo E, Neittaanma¨ki L, Mattila K, Virjo I, Kujala S, Luhtala R, Halila H, Isokoski M. 1998. Becoming a doctor – Was it the wrong career choice? Soc Sci Med 47:1383–1387.
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Marley J, Carman I. 1999. Selecting medical students: A case report of the need for change. Med Educ 33:455–459. McHugh SM, Corrigan MA, Sheikh A, Lehane E, Broe P, Hill AD. 2011. A study of the factors influencing school-going students considering medical careers. Surgeon 9:191–194. Mohagheghi M. 2010. ‘Reasons of medical students’ attrition’ Jahan News [online]. [Accessed 13 November 2013] Available from http:// jahannews.com/vdcc01qss2bqi08.ala2.html.
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Mohammadi A, Mojtahedzadeh R, Karimj A. 2006. National educational stratification of medical schools in Iran. J Med Educ 9:55–61. Nedjat S, Majdzadeh R, Rashidian A. 2008. Graduate entry to medicine in Iran. BMC Med Educ 8:47. Nejat S, Emami Razavi S, Rashidian A, Yazdani Sh, Majdzadeh R. 2006. The motives of medical students in Tehran university for choosing medicine field and their outlooks for their profession: Qualitative versus quantitative approach. Strides Dev Med Educ 3:1–10.
Informed choice of entering medical school and academic success in Iranian medical students YASIN FARROKHI-KHAJEH-PASHA, SAHARNAZ NEDJAT, AEEN MOHAMMADI, ELAHEH MALAKAN RAD & REZA MAJDZADEH Tehran University of Medical Sciences, Iran
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Abstract Background: One of the challenges medical education policy-makers confront is matriculants’ informed choice of entering medicine. However, students’ reasons for choosing medicine do not seem rational. Aim: We compared students who made an informed choice about entering medicine with those who did not, in terms of academic success. Methods: The study was carried out with a self-administered questionnaire on 220 final-year medical students randomly selected from six Iranian medical schools. Depending on their informed choice of entering medicine or not at the time of application, they were divided into two groups. We compared these two groups’ academic achievement as well as their satisfaction with medicine. Results: The students who had not made an informed choice had a higher tendency not to choose medicine if they were to start over (p value 0.001). The pre-admission scores of students who had made an informed choice of medicine were worse than the other group (p ¼ 0.03). However, their final year scores as well as their satisfaction with medicine were higher than the other group. Conclusions: Idealistic views of medicine should be replaced by rational and logical ones to help students select the careers best suited to their abilities and talents.
Introduction
Practice points
Medicine is a highly competitive field of study all over the world. It is still prestigious and popular in Iran. However, there seems to be a significant gap between reality and the delusion of a medical career in the society. The relatively dark future of employment, the difficulties associated with the lifestyle and the lengthy years of education are overlooked by the society. Instead, it is perceived as a highly appreciated and financially promising career (Nedjat et al. 2008). In Iran, many students lack adequate awareness toward the medical career at the time of choosing their field of study (Nejat et al. 2006). Mostly, they are influenced by factors such as family pressure and physicians’ social prestige in choosing medicine, without having sufficient knowledge of its implications and professional outlook. They choose medicine at an age and level of maturity that lacks experience in medical practice, and cannot judge their own personal aptitudes. However, researches in other countries also show that medical students have an over-dramatized and romanticized view of medicine at the beginning of academic studies. In a Finish article, the authors investigated the association between the reasons that influenced doctors to enter medicine and their career satisfaction. The majority of respondents said that their major reasons for choosing medicine were: their interest in helping people, a wide range of job opportunities, medicine as
The pre-admission scores of students who had made an informed choice of medicine were worse than those who had not. The medical students who had not made an informed choice about entering medicine had a lower tendency to choose medicine if they were to start over. The final year scores as well as the satisfaction of the students who had made an informed choice of medicine were higher than those who had not made an informed choice.
a highly appreciated profession, and their own previous scholastic achievement (Hyppo¨la¨ et al. 1998). In an Irish article, the factors influencing school students’ decision to study medicine at academic level were determined. The opportunity to help others, the intellectual challenge offered by medicine, the financial reward, perceived personality fit with a medical career, advice from friends and family, past experience of medical professionals and television were, respectively, the major reasons for choosing medicine (McHugh et al. 2011). In Australian medical universities, only 52% of the students seemed to have a clear ambition to enter medicine; while parental pressure and social esteem were
Correspondence: Saharnaz Nedjat, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran. E-mail: [email protected]
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ISSN 0142-159X print/ISSN 1466-187X online/14/110978–5 ß 2014 Informa UK Ltd. DOI: 10.3109/0142159X.2014.918256
Med Teach Downloaded from informahealthcare.com by Nyu Medical Center on 06/08/15 For personal use only.
Who is more satisfied with medical courses?
mentioned as other factors. Moreover, only 11% of the students claimed having any reasonable knowledge about the field before choosing it (Marley & Carman 1999). In Iran, most of the medical students are selected from high-school graduates solely on the basis of academic performance through one academic entrance exam. Only 2% enter medicine after their bachelor graduation. In our previous article, we tried to evaluate the predictive validity of the university entrance exam for success in the field of medicine (Farrokhi-Khajeh-Pasha et al. 2012). We showed that although the exam is not a poor predictor of medical school performance by itself, it is not supplemented by any other scale. Moreover, we discussed the necessity of evaluating matriculants’ non-cognitive characteristics in a field such as medicine. However, the importance of the rationales used by students in selecting their academic field of study and its aftermath has not been studied in Iran yet. In the present study, we compared students who made an informed choice of selecting medicine with those who did not in terms of academic success in medical school and their satisfaction with studying medicine. The findings of the present study can be applied by medical education policy-makers to modify the medical applicant selection current method.
Methods Study population and sampling The reference population of this study consisted of all medical students who were registered in public medical schools of Iran in 2003 (N ¼ 2208). The questionnaires were sent to a random sample of 220 students out of 2003-matriculants in six universities. These universities were chosen from all three levels of universities based on the classification made by the Ministry of Health and Medical Education (MOHME). The classification is based on the level of education and research provided in Iran’s medical universities (level 1 universities are the highest-ranking and level 3 are the lowest-ranking) (Mohammadi et al. 2006). Strictly speaking, the selected sample of students should have been at the stage of internship in 2009; the time when the study was performed. However, the 22 unavailable students were substituted with those who had the most similar Konkoor scores to them. The unavailability of these students can be the result of delay in beginning the medical course or changing the original university chosen by the matriculant, or to a less-extent attrition which is not the usual case for medicine in Iran (Mohagheghi 2010). All of the respondents were at their internship stage.
Data collection tool To address the questions of this study we designed a questionnaire composed of multiple choice questions (MCQs) with Likert-type scale items. To define the main questions of the questionnaire, we studied similar studies conducted elsewhere (Ewan & Bennett 1981; Hyppo¨la¨ et al. 1998; McHugh et al. 2011). Finally, the questionnaire was assessed by ‘‘educational’’ experts, and their comments and suggestions were incorporated into the questionnaire.
The reliability of the questionnaire was assessed by a test–retest. The questionnaire was administered twice to 20 final-year medical students at TUMS at two weeks’ time interval. The reliability of the questionnaire was acceptable (ICC range ¼ 0.62–0.91, Cronbach’s alpha ¼ 0.93). The questionnaire contained some general questions about background variables, such as age and gender. We used two questions to assess whether the matriculants had made an informed choice of studying medicine. The first one asked about the most important reason for choosing medicine at the time of entering medical school. The proposed choices for this question included personal interest, family pressure, physicians’ social prestige and others. The other question asked the students to score their determination in choosing medicine as their academic field of study on a 0–4 point Likert scale. The answers to both questions were used to divide the students into two groups. The students who had selected ‘‘personal interest’’ in the first question and scored 3 or 4 in the second question were regarded by the research team to have made an informed choice. In another question, the students were asked to score their current satisfaction with their field of study. The students were also asked if they would reconsider medical school entry again if they were to start over. The academic performances of these two groups of students were compared. Pre-admission information included in the study was retrieved from the database of the ‘‘National Organization of Educational Testing’’ and consisted of ‘‘high-school grade point average’’ (HSGPA) which indicated the average grades of the final three years of high school and the score obtained in the university entrance exam (Konkoor). Data on the academic performance of medical students were gathered from the MOHME and consisted of the ‘‘Comprehensive Basic Science Exam’’ (CBSE) scores, ‘‘Comprehensive Pre-Internship Exam’’ (CPIE) scores and ‘‘medical school grade point average’’ (MSGPA), which were computed from all courses completed prior to internship and were weighted according to the number of course hours. The details of these variables have been discussed in an earlier study (Farrokhi-Khajeh-Pasha et al. 2012).
Analysis The respondents were divided into two groups: those who had made an informed choice of entering medicine on the basis of their interest, and those who had selected medicine because of other reasons such as social, economic and cultural factors. Mean age, HSGPA, Konkoor, CBSE, CPIE and MSGPAs in students who had selected medicine on the basis of personal interest rather than other reasons were compared to others using independent-sample t test. 2 was used to compare the two groups of this study in terms of gender differences and answers to ‘‘reconsidering medical school entry’’, and to compare the proportion of students who had made an informed choice of medicine at different university levels.
Results Two hundred and six questionnaires (response rate ¼ 93.64%) were completed and returned by the interns, i.e. the final year
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Table 1. Reconsidering medical school entry among students who had made an informed choice of medicine and those who had not.
Students who had made an informed choicethe first group Students who had not made an informed choicethe second p Value
Reconsidering medical school entry in the same university (%)
Reconsidering medical school entry in another university
Not choosing medicine at all
39 (58.2%) 56 (40.9%) 0.019
25 (37.3%) 42 (30.7%) 0.342
3 (4.5%) 39 (28.5%) 0.0001
group
Table 2. Academic achievement and satisfaction toward medicine among students who had made an informed choice of medicine and those who had not.
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Students who Students who had made an had not made informed an informed choice choice p Value HSGPA (0–20)* Konkoor score (0–15 000)* CBSE (0–210)* CPIE (0–202)* MSGPA (0–20) Satisfaction with selection of medicine (0–4)*
18.54 10 325.24 148.15 134.61 15.67 3.40
19.01 10 307.59 144.32 129.32 15.51 2.55
0.03 0.90 0.19 0.04 0.34 50.001
HSGPA, high-school grade point average; CBSE, comprehensive basic science exam; CPIE, comprehensive pre-internship exam; MSGPA, medical school grade point average. *Attainable scores.
medical students who were being trained at educational hospitals. The mean age of the respondents was 25.17% and 63.1% were girls. There were no differences between the two groups regarding age and sex (p value ¼ 0.40 and 0.31 for age and sex, respectively). Sixty-seven (32.5%) respondents had made an informed choice of medicine. Table 1 shows the responses to the question of reconsidering medical school entry. As it is depicted in this table, the students who had not made an informed choice had a higher tendency not to choose medicine if they were to start over (p value 0.001). The mean score for the ‘‘level of satisfaction with selection of medicine’’ as the academic field in the range of 0 (no satisfaction) to 4 (complete satisfaction) was 2.83 (SD ¼ 1.00) for all the students in the study. Table 2 represents the results of independent T tests comparing the two groups of students; those who had made an informed choice of medicine and those who had not. The differences were significant in HSGPAs, CPIE and satisfaction. The HSGPAs (related to pre-admission performance) of students who had made an informed choice of medicine were lower than their classmates in medical school. On the contrary, the CPIE scores (related to the final year of medical school) and the level of satisfaction of students who had made an informed choice were higher than the others.
Discussion In this study we have tried to address the concern that medical students may choose medicine solely because of becoming a 980
doctor and the prestige and economic factors associated with it. We tried to ask final year medical students about their reasons for choosing this academic field of study at the time of medical school entry, and to evaluate its effect on their future academic success. The results of the present study showed that only 32.5% of respondents had made an informed choice of medicine and on the basis of personal interest. Not only in Iran, but also in other countries the major reasons of students for choosing medicine seem not to be so pragmatic (Hyppo¨la¨ et al. 1998; McHugh et al. 2011). Also, most students seem not to have reasonable knowledge about medicine before choosing it (Marley & Carman 1999). The students face an unexpected world in the medical school and this has a negative effect on their educational success. After having studied medicine and getting involved with the medical career in educational hospitals, 4.5% of students who had made an informed choice of medicine and 28.5% of those who had not said that they would consider another profession if they were to start over. The first group of students had gained lower high-school GPAs compared to the second group of students. However, the Konkoor score between these two groups were not significantly different, which is not surprising; all these individuals had passed the same exam with the highest grades among the pool of applicants, and only those who score the highest in this exam can get admission into medical school. However, the CPIE scores of medical students who had made an informed choice were higher than the others. As CPIE is conducted at the end of the medical education program, this can imply that personal interest and an informed choice have positive effects on medical students’ academic performance. The level of satisfaction was also higher among students with personal interest in medicine. The final year medical students who were at their internship stage of medical education were selected for this study to ensure that the respondents had already gained some experience in the medical career. At the time, this study was conducted, only those 2003 matriculants could participate in this research who had reached each milestone of their medical education on time and with no or at the most two semesters delay. This may have led to selection bias; excluding students with attrition or more than two semesters delay in their medical education. However, we did not have any other choice to study interns of the same matriculation year at the same time. Moreover, respondents had begun their medical studies – on an average – seven years before the survey was carried out and they were asked to recall the time when they had entered medical school, which may have resulted in recall bias.
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Who is more satisfied with medical courses?
However, emotionally important life events such as career choice are usually not forgotten easily (Hyppo¨la¨ et al. 1998). Certain steps have been taken to help both medical education policy-makers and applicants to choose the best fitted students for medicine. Graduate entry to medicine, which is the usual way of admitting medical students in some countries, allows applicants to acquire the required mental maturity to choose this field with more awareness (Nedjat et al. 2008). This is acquired as a result of their previous academic experience and higher age at the time of application. In many medical schools, in other countries, programs require candidates to complete a personal interview during which an attempt is made to assess each candidate’s interpersonal skills, motivation and problem exploration (Eva et al. 2004). Although there is debate on the shortcomings of these interviews, they can help both sides of application to choose the best option. Incorporating work experience in medicine among the requirements of medical school application in some countries is another way that can increase students’ awareness of the life to which they are about to commit themselves to. Such experience helps the student make an informed career choice, and exploring it during the interview can reflect student motivation to study medicine. In the previous article, we discussed the need for developing admission requirements with improved validity to supplement the academic performance for admission to medical schools (Farrokhi-Khajeh-Pasha et al. 2012). The results of the present study approve the necessity of this change in the admission process and show that students’ reasons for choosing medicine are not so rational at the beginning of academic studies, which ultimately reveals its negative effect on educational achievement. The admission process should concentrate on other factors besides the academic performance which play an important role in becoming a ‘‘good doctor’’. Enough maturity at the time of choosing medicine to evaluate one’s talent for success in medicine and incorporating good measurements to evaluate non-cognitive factors were some proposed remedies in this study. Comparing the views of students at the time of choosing medicine with those after graduation from medical school can be a good proposal for future studies. The findings of this study show that the policy-makers in medical field should pay more attention to the selection methods of medical applicants, since the informed choice of medicine can play a major role in the academic success and job satisfaction of medical students.
be left alone in their decision to choose a career, as this greatly affects their paths as professionals in the future. They should be provided with abundant advice and information to help them make better and informed choices. We should not leave these students alone with a great decision at the beginning of their youth; with a decision that has a great impact on their future and, of course, the future of society. We should help them make a choice with eyes wide open.
Notes on contributors YASIN FARROKHI-KHAJEH-PASHA, MD, MPH, is a resident of radiology, Imam Khomeini Hospital, Faculty of Medicine, Tehran University of Medical Science. SAHARNAZ NEDJAT, MD, PhD, is an Associate Professor in Epidemiology, faculty of School of public health and knowledge utilization research center, Tehran University of Medical Sciences. AEEN MOHAMMADI, MD, MPH, PhD, is a faculty member of E-Learning in Medical Education department in Virtual School, Tehran University of Medical Sciences. ELAHEH MALAKAN RAD, MD, FACC, is an Associate Professor in pediatric interventional cardiology, Pediatric’s Center of Excellence, Tehran University of Medical Sciences. REZA MAJDZADEH, DVM, PhD, is a Professor in Epidemiology, faculty of School of public health and knowledge utilization research center, Tehran University of Medical Sciences.
Acknowledgements This study is based on the MD-MPH dissertation of the first author. The authors are very grateful to the National Organization of Educational Testing for providing the database of all applicants applying for the 2003 Konkoor for ‘‘experimental sciences’’. Thanks also to Organization of Educational Testing of the Ministry of Health and Medical Education for providing the data on medical school GPAs of 2003 matriculants at public medical schools, the scores of participants and the reliabilities of the CBSE and CPIE from 2005 to 2010. Declaration of interest: This study was financially supported by Tehran University of Medical Sciences’ Vice Chancellor of Research (project no. 10041, 88-03-76). The authors declare that they have no competing interests.
References Conclusions Creating a true image of personal required capacities for a career is crucial for the achievement of success in the future. Before entering medical school, the students see the tip of the iceberg of a medical lifestyle which portrays a highly appreciated individual in the society without any financial concerns. However, they change their mind about medicine when they face its reality in hospitals, which negatively affects their academic achievements. Matriculate students should not
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