Motives for Choosing Medicine as a University Major: A Cross-Sectional Study

Document Type: Original Article

Authors

1 PhD candidate of Medical ethics, Tehran University of Medical Sciences, Tehran, Iran

2 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: Awareness of the motives of the students for choosing to study medicine demonstrates their understanding of the nature of this major and their expectations from their future profession. The evaluation of the volume of students who choose this major with wrong motives is necessary for educational planning of professional commitment. This study was conducted to evaluate the motives of choosing to study medicine in the first-year medical students of Tehran University of Medical Sciences.
Methods:This descriptive analytical study was conducted on first-semester medical students of Tehran University of Medical Sciences in the 2014-15 academic year who were selected through census sampling. The data collection tool was a self-administered questionnaire, which included questions on 17 different motives in a Likert scale in addition to demographic characteristics.
Results: Of 131 distributed questionnaires, 124 (93%) were completed and returned. Eighty-six participants (65.61%) mentioned helping others as their main motive for choosing medicine followed by interest in the human body, interaction with people, professional prestige, and starting a good profession after graduation. On the other hand, unfamiliarity with other majors, competition with others, and teamwork were the least important motives.
Conclusions: The students’ motives are mostly altruistic and in accordance with medical professionalism. These motives should be reinforced to enhance professional performance. Moreover, the faculty of medicine should recognize and offer counseling services to students with undesirable motives.

Keywords

Main Subjects


Introduction

Motivation is the main reason for most activities, including learning. In other words, there is a motive behind every action. Motivation and interest are the main pillars of progress that could serve as determinants for continuing a certain major and showing professional commitment. Academic motivation is one of the requirements of learning and helps the learner with maintaining its continuity1 .

Because of limited job opportunities and intense competition in university entrance examination, students choose their major based on inappropriate motives, even without any desire or awareness about the major 2, resulting in a waste of time and energy.

Because of inadequate knowledge about the major, many students decide to change their major despite the time, energy, and money they have put into achieving the major. This issue is seen in other countries like the US, as well 3,4. Some students start a major without knowledge about its professional requirements and commitments, which would result in inefficient study and unethical and unprofessional performance. 

Many studies have evaluated the motives and factors affecting the choice of medicine 5-8 and have identified different elements 9-12. Researchers have categorized these factors as internal and external. Internal factors are usually controlled by the person 13,14 while external factors are out of the person’s control and affect the choice indirectly. Personality is one of the most important internal factors in choosing an academic major 15-17. Family, educational environment, peers, media, and socioeconomic background are some external factors 18. Achieving a high social status, decent income, authority, interest in science, communication with people, obtaining a doctorate degree right after high school diploma, competition with others, high rank in the university entrance exam, family’s insistence 19-21, influence of the physician in the health care team, and lack of knowledge about other majors are some factors that play a role in choosing medicine as an academic degree by students 22,23.

Since the students’ motives for choosing medicine reflect their understanding of the nature of this major and their belief in the medical professional commitments, evaluation of the reasons for choosing to study medicine can help to determine the appropriate educational approach and to correct their attitude to strengthen the commitments. Medicine in Tehran University of Medical Sciences (TUMS) is the top rank choice of those who take the university entrance exam. The unique opportunity to choose any other major or university may put candidate under pressure to choose the first top rank major against their wishes.  Since no similar study has been done in TUMS, we decided to evaluate the motives of choosing medicine in those who could choose and accepted in any other major in the University.

Materials and Methods

This descriptive cross-sectional study was conducted on all first-term medical students of Tehran University of Medical Sciences in 2014. The only inclusion criterion was being a first-year medical student at Tehran University of Medical Sciences, and those who failed to answer at least 80% of items on the questionnaire were excluded. The students were given a researcher-made self-administered questionnaire and were asked to complete and return it in the same session.

This study was done respecting all ethical considerations mentioned in Helsinki Declaration. The questionnaire was included a section to inform participants of their anonymity and voluntary participation. The nature and objectives of the study were explained clearly and in detail in groups or, if not possible, individually and participation was voluntary. So their answer to questions considered as their implied consent.

The questionnaire had two parts. The first part contained questions on demographic information including the type of high school, sex, admission quota, and medical field code. The second part included 17 items as reasons for choosing medicine and the participants were asked to select one of the 4 choices (was not the reason, was a weak reason, was a plausible reason, was a major reason) for each item as the reason for choosing medicine. The items of this part were determined using the literature review and comments of three experts in the fields of medical education and professionalism. The participants were asked to rate each item using a 4 point likert scale from “was not a reason” to “was a major reason”. The face and content validity of the questionnaire was established using expert opinion.

In addition to descriptive statistics, chi square was used to compare the motives between different groups. An alpha error of 0.05 was acceptable in analytical analyses.

Results

Of 131 distributed questionnaires, 124 were completed and returned (RR=93%). Sixty-three participants were men (48.1%), 86 (65.5%) were non-payer, and 71 (54.2%) went to public schools (Table 1).

 Table 1- prevalence of demographic attributes of participants

percentage

frequency

 

Variable

48.1

63

men

Sex

46.6

61

women

54.2

71

state school

Type of high school

8.4

11

popular model schools

26.7

35

private school

28.2

37

tuition payer

Admission quota

65.6

86

non-payer

21.4

28

Zone 1

Admission quota

37.4

49

Zone 2

12.2

16

Zone 3

20.6

27

Other quota

As for the motives of choosing medicine, the most common motive was helping others (Table 2), followed by interest in the human body, interaction with people, professional prestige, and starting a decent job after graduation. On the other hand, unfamiliarity with other majors, competition with others, and teamwork had the lowest frequency among major and plausible motives.

Although high income was not a main motive, 77 participants (62%) mentioned it as a major or moderate reason. 

Table 2- frequency of different reasons for choice of medicine

was a major reason

was a moderate reason

was a minor reason

was not the reason

 

n

%

n

%

n

%

n

%

Motives

28

21.4

62

47.3

24

18.3

17

13.0

Finding a decent job

35

26.7

56

42.7

31

23.7

9

6.9

Professional prestige

21

16.0

56

42.7

41

31.3

13

9.9

High income

84

65.6

30

22.9

9

6.9

6

4.6

Helping others

24

18.3

35

26.7

26

19.8

46

35.1

Enthusiasm about science and learning

43

32.8

47

35.9

25

19.1

15

11.5

Interaction with people

58

44.3

40

30.5

23

17.6

10

7.6

Interest in the human body

28

21.4

34

26.0

33

25.2

36

27.2

Enthusiasm about research

11

8.4

24

18.3

35

26.7

61

46.6

Dislikes other disciplines

9

6.9

37

28.2

25

19.1

54

41.2

Family’s insistence

26

19.8

40

30.5

29

22.1

29

22.1

authority of the physician in health care team

17

13.0

20

15.3

31

23.7

55

42.0

I ranked high in entrance exam so I worried about getting regretful

24

18.3

37

28.2

31

23.7

32

24.4

Interest in phenomena of life and death

3

2.3

8

6.1

13

9.9

100

76.3

Competing with others

6

4.6

23

17.6

40

30.5

55

42.0

Teamwork

1

0.8

8

6.1

10

7.6

104

79.4

Not knowing other majors

Finding a decent job, high income, and having high rank in the entrance exam were significantly correlated with their admission quota (Table 3); these reasons were more appreciated by students in the zones with more facilities. No significant relationship was found between other reasons of choosing medicine and admission quota or other demographic variables. 

Table 3- correlation between reasons for choice of medicine and admission quota

P – value

Zone 3

Zone 2

Zone 1

 

 

n

%

n

%

n

%

 

0.023

3

18.8

12

5.24

9

1.32

Finding a decent job

0.029

1

6.3

9

4.18

8

6.28

High income

0.002

1

6.3

8

3.16

8

6.28

I ranked high in entrance exam so I worried about getting regretful

 Discussion

The patient’s trust in the physician is necessary for effective physician- patient relationship and the physician’s success in diagnosis, treatment, and prevention of the diseases 24. The patients should believe that the main objective of health professionals is to provide health for people rather than their own benefits 25. Medical students are expected to choose this major with humanitarian motives and prefer altruistic to profit-seeking motives. 

People who choose a profession are expected to know the characteristics of the profession and to be motivated by those characteristics. Interaction with people and helping others are two characteristics of medicine that were found to be the major motives of the students for choosing to study medicine. 

Our study showed that these characteristics of medicine have been fully recognized and the students start this major with altruistic motives. In a study by Zarghami et al. in Babol, interest in helping others was the most important reason for choosing to study a medicine with a mean importance score of 3.07 out of 4 26.

Choosing a career is a complex and multidimensional process that affects all aspects of a person’s life and is one of the most important decisions in the lifetime. People wish to find a job that satisfies their psychosocial as well as financial needs 27. In this study, professional prestige and social respect were the next important reasons while in a similar study in England, professional prestige had a far lower priority with a frequency of 19% 28. The reason for the difference may be the difference in the social status of this profession between the two societies.

Income is a natural motive for choosing a career. In our study, although high income was not the main motive of many students, about half of them considered it a moderate reason for choosing to study medicine. Although, high income has been found to be the main reason for studying dentistry 29-31, it is not the case for studying medicine 32 confirmed by our findings. In addition, our results showed that high income was even less important motive for students from underserved areas.

Attention to undesirable motives is necessary to provide proper counseling to students to prevent educational decline. Although the family’s insistence was not a common reason for choosing medicine, 28% of the participants mentioned it as a moderate reason. Moreover, 11 students mentioned competition with another person as the reason for choosing medicine. Our results showed that students from underserved areas chose their major based on better reasons and far less than others chose medicine because of their high rank in the entrance exam.

The teamwork nature of medicine was not a motive for most students. There are two possible explanations for this finding: the students were not aware of this characteristic or they were aware but it did not interest them.  It seems that more detailed assessment of the students’ knowledge about the necessities and characteristics of this profession is necessary and the required information should be given to the students in the beginning of their studies.

Another important finding of the study was that helping others was not a motive or was a minor motive for choosing medicine in 15 students. We believe the students were aware of this characteristic of medicine. Choosing a major that involves helping others while the learner has no altruistic motives requires serious attention and these students should receive proper counseling to change either their attitude or their major because this motive is the most fundamental basis for professional commitment in medicine.   

This study had some limitations. Exclusive evaluation of the students of one university decreases the generalizability of the results. Statistics indicate that the students with the highest ranks in the university entrance exam choose medicine as the major and Tehran University of Medical Sciences as the first university choice for academic education. Therefore, assessment of only one medical university may not show the motivation problems of all medical students. However, this issue improve its internal validity of the results for TUMS as the most popular university for this major. The result of this study might be under influence of social desirability of some items such as helping others. This bias may ends to overestimate the altruistic motives.

The results of this study do not represent the students’ concept of medicine, indicating the importance of doing qualitative research in this regard. It is necessary to evaluate the changes of these motives over time and investigate the effect of the educational environment, age, and professional duties and responsibilities on the students’ attitude and motives.

Conclusion

Our study showed that although the majority of the students had altruistic motives, a marked proportion of them had undesirable motives in terms of their attitude towards this major. Mentorship training may help to empower students’ good motives and correct their wrong attitudes. We suggest that medical schools should evaluate the students’ motives upon admission and during their course of study and use the results for educational planning and correction of the hidden curriculum.

Acknowledgment

We would like to thank Dr Mahboobeh Mafinejad for her help in data gathering

Conflict of interest

Authors have no conflict of interest

 

1.Seif AA. learning Psychology. 2010; 10th Edition. Tehran, Doran Publication:120-125.( in Persian)

2.Sorori-Zanjani R, Tajkey J, Mazloomzade S, Jafari MR. University Entrance Motivations of Pharmacy Students of Zanjan Pharmacy School. Journal of Medical Education Development. 2009 Feb 1;1(1):29-35.

3.Rice CD, Hayden WJ, Glaros AG, Thein DJ. Career changers: dentists who choose to leave private practice. The Journal of the American College of Dentists. 1996 Dec;64(1):20-6.

4.Rice CD, Glaros AG, Shouman R, Hlavacek M. Career choice and occupational perception in accelerated option and traditional dental students. Journal of dental education. 1999;63(4):354-58.

5.Perrot LJ, Deloney LA, Hastings JK, Savell S, Savidge M. Measuring student motivation in health professions' colleges. Advances in health sciences education. 2001 Nov 1;6(3):193-203.

6.Story M, Mercer A. Selection of medical students: an Australian perspective. Internal medicine journal. 2005 Nov 1;35(11):647-9.

7.Lloyd-Jones G. Beyond 'tomorrow's doctors': a review of basic medical education in the UK. Ann Trop Paediatr. 2005; 25(2):71-8.

8.Powell A, Boakes J, Slater P. What motivates medical students: How they see themselves and their profession. Medical Education. 1987 May 1;21(3):176-82.

9.Sulong S, McGrath D, Finucane P, Horgan M, O’Flynn S, O’Tuathaigh C. Studying medicine–a cross-sectional questionnaire-based analysis of the motivational factors which influence graduate and undergraduate entrants in Ireland. JRSM open. 2014 Apr 1;5(4):2042533313510157.

10.Wierenga AR, Branday JM, Simeon DT, Pottinger A, Brathwaite B. Motivation for and concerns about entering a medical programme. The West Indian medical journal. 2003 Dec;52(4):304-10.

11.Hastings JK, West DS, Perrot L, Deloney LA. Pharmacy student motivation: Phase 1 of a longitudinal study. American Journal of Pharmaceutical Education. 2005;5(1):13-23.

12.Kusurkar R, Kruitwagen C, ten Cate O, Croiset G. Effects of age, gender and educational background on strength of motivation for medical school. Advances in health sciences education. 2010 Aug 1;15(3):303-13.

13.Lumsden MA, Bore M, Millar K, Jack R, Powis D. Assessment of personal qualities in relation to admission to medical school. Medical education. 2005 Mar 1;39(3):258-65.

14.Röding K. Perceptions of admission committee members: some aspects on individual admission to dental education at Karolinska Institutet. European Journal of Dental Education. 2005 Aug 1;9(3):115-22.

 15.Bore M, Munro D, Kerridge I, Powis D. Selection of medical students according to their moral orientation. Medical Education. 2005 Mar 1;39(3):266-75.

 16.Ernst RL, Yett DE. Review Article: Physicians' Background Characteristics and their Career Choices: a Review of the Literature. Medical Care Research and Review. 1984 Mar 1;41(1):1-36.

 17.McManus IC, Smithers E, Partridge P, Keeling A, Fleming PR. A levels and intelligence as predictors of medical careers in UK doctors: 20 year prospective study. BMJ. 2003 Jul 17;327(7407):139-42.

  18.McManus IC, Livingston G, Katona C. The attractions of medicine: the generic motivations of medical school applicants in relation to demography, personality and achievement. BMC Medical Education. 2006 Feb 21;6(1):1.

19.Lentz BF, Laband DN. Why so many children of doctors become doctors: Nepotism vs. human capital transfers. Journal of Human Resources. 1989 Jul 1:396-413.

20.Horton RC. Admission to medical school: from audit to action. Journal of the Royal Society of Medicine. 1986 Sep;79(9):504.

21. McManus IC, Esmail A, Demetriou M. Factors affecting likelihood of applicants being offered a place in medical schools in the United Kingdom in 1996 and 1997: retrospective study. BMJ. 1998 Oct 24;317(7166):1111-7.

22. AmirAliAkbari S, Arfaeei K, Fardanesh H, AlaviMajd H. Student motivation in choosing midwifery in Tehran university of medical sciences from 1384 to-1385. Iran J Med Educ. 2008;7(2):451-3. [in Persian]

23. Hashemipour M. Dental students' motivation for entering dentistry in Kerman school of dentistry. Iran J Med Educ. 2006 Jun 15;6(1):109-15. [in Persian]

24. Lynch DJ, McGrady AV, Nagel RW, Wahl EF. The patient-physician relationship and medical utilization. Primary care companion to the Journal of clinical psychiatry. 2007;9(4):266.

25. Brennan MD, Monson V. Professionalism: good for patients and health care organizations. Mayo Clin Proc. 2014 May;89(5):644-52.

26. Zarghami M, Ghaffari Saravi V, Khalilian A, Sefidchian A. Factors influencing the specialty field choices of medical school graduates. JBUMS. 2003; 5 (5) :18-23.

27. Shafiabadi A. Career advice and professional tips and job-selection theories. 21st ed. Tehran: Nashre Rosd. 2012. P. 15, 46-8, 54-5, 209-24. [in Persian]

28. Crossley ML, Mubarik A. A comparative investigation of dental and medical student's motivation towards career choice. British Dental Journal. 2002 Oct 26;193(8):471-3.

29.Neamatollahi H, Mehrabkhani M, Ghafarpour S, Ghasemi A. Evaluation of mashhad dental school students’ motives and viewpoints on their career choices in 2010. Journal of Mashhad Dental School. 2014 Jan 1;38:71-84. [in Persian]

30. Zadik D, Gilad R, Peretz B. Choice of dentistry as a career and perception of the profession. Journal of Dental Education. 1997 Oct;61(10):813-6.

31. Gilavand A, barekat GH, Hosseinpour M. The Incentives of Choosing the Field of Study by Dental Students at Autonomous Campus in Ahvaz Jundishapur University of Medical Science in 2015.Faslnameh Toseh Amozesh Jundishapur.2016;7(16):64. [in Percian]

32. Kazemizadeh Z, Rezaeian M, Farnoodi M. Evaluation of motivations for choosing field of study among medical and dental students of Rafsanjan University of Medical sciences. Journal of Rafsanjan University of Medical Sciences. 2011 Dec 15;10(4):279-88. [in Percian]