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Perceptions of house officers working in hospitals of Lahore about joining the field of anaesthesiology as a career.

Byline: Sohail Anjum and Usman Mahboob

Abstract

Objective: To determine the perceptions of house officers working in hospitals about joining anaesthesiology as a career.

Methods: This quantitative, descriptive questionnaire-based study was carried out from September 2014 to February 2015 in 26 teaching hospitals of Lahore, Pakistan, and comprised house officers. Those with at least three months of working experience in anaesthesiology were included. They were approached in their respective departments and a validated self-reporting questionnaire was delivered to them and received back by hand. SPSS 16 was used for data analysis.

Results: Of the 73 house officers approached, 53(72.6%) responded; 35(66%) men and 18(33%) women. Overall, 25(47.16%) respondents refused to join anaesthesiology as a career and 27(50.94%) included it in their first three career choices. Moreover, 25(47.16%) cited minimal interaction with patient as a reason for not taking anaesthesia as a career choice; 29(56.6%) of the respondents believed an anaesthetist had no or little role in surgery. Change in attitude about anaesthesiology as a specialty after having an anaesthesia rotation was mentioned by 26(49.05%) respondents.

Conclusion: House officers had reservations about joining anaesthesiology as a career. The findings are suggestive of a positive effect of anaesthesiology house job on house officers attitude about the specialty.

Keywords: Anaesthesiology, Career, House officers, Perceptions, Hospital. (JPMA 66: 1205; 2016)

Introduction

Shortage of manpower is a major problem in the healthcare systems of developing countries. This problem is even more alarming as far as anaesthesia is concerned. Pakistan, with a population of 192 million, has only 1,163 qualified anaesthetists (anaesthetist-to-population ratio is 1:160,000).1 Choosing a career can be affected by different extrinsic and intrinsic factors.2 Attitude about anaesthesiology as a career choice may be different from student to student of various regions in the world.3 To study such factors, it may be important to develop future recruitment plans in a specialty which is already not a preferable choice of the medical students of developing countries.4 Understanding the house officers perceptions about various specialties can be a valuable input to the health systems leadership in order to promote such a specialty distribution which could match our populations growing needs.5 Additionally, institutional care also demands the involvement of allied disciplines such as anaesthesiology.

The current study was planned to determine the perceptions of house officers working in hospitals about joining anaesthesiology as a career option.

Subjects and Methods

This quantitative, descriptive questionnaire-based study was carried out from September 2014 to February 2015 in 26 teaching hospitals of Lahore, Pakistan, recognised by Pakistan Medical and Dental Council (PMDC), and comprised house officers. The study was approved from institutional review board (IRB) of the University of Lahore. Informed consent was obtained from all the participants. The participation was voluntary and no harm to the participants was anticipated. They were assured that confidentiality will be observed. Total anaesthesia house officer slots in Lahore (10 public-sector and16 private-sector teaching hospitals recognised by the PMDC) were 73 per rotation. All the slots were filled at the time of the study. House officers with at least three months of working experience in anaesthesiology were included.

All Anaesthesia house officers were approached in their respective departments and a validated self-reporting-questionnaire (Annexure)7 was delivered to them and answers were obtained. The questionnaire was taken with permission from the author.7 After informed consent and proper briefing, the questionnaire was distributed to the participants in their respective departments. Filled-in questionnaires were received back by hand. Responses from the participants were analysed using descriptive statistics. Independent variables included gender and experience in number of months spent in anaesthesiology. Dependent variables were the responses in the provided questionnaire. SPSS 16 was used for statistical analysis.

Results

Of the 73 house officers, responses were received from 53(72.6%).Of them, 35(66%) were men and 18(33%) women. Besides, 25(47.16%) respondents refused to join anaesthesiology as a career, while 27(50.94%) included anaesthesiology in their first three career choices. Giving reasons for not joining anaesthesiology as a career choice, 25(47.16%) cited 'minimal interaction with patient' while 14(26.41%) believed the 'specialty has less prestige' (Table-1)

Table-1: Responses (%) of house officers to different questions

Would you choose anaesthesiology as your###Number of###Yes###No###May be

career specialty? (%) Responses###responses (%)###Number (%)###Number (%)###Number (%)

Males###35(66%)###11(20.75%)###15(28.30%)###9(16.98%)

Females###18(33%)###'4(7.54%)###10(18.86%)###4(7.54%)

Total###53(100%)###15(28.30%)###25(47.16%)###13(24.52%)

Change of attitude after house job###Yes Number (%)###No Number (%)

Has your attitude been changed towards

specialty of anaesthesiology after house job in it?###26(49.05%)###24(45.28%)

House officers who included anaesthesiology in###Number of###First preference###Second preference###Third preference

first three career preferences(%)Responses###responses (%)###Number (%)###Number (%)###Number (%)

Males###20(3.77%)###8(15.09%)###4(7.54%)###8(15.09%)

Females###7(13.20%)###4(7.54%)###3(5.66%)###0(0%)

Total###27(50.94%)###12(22.64%)###7(13.20%)###8(15.09%)

Reasons for not considering anaesthesia as a career (%) Responses

Contact with patient is minimal###25(47.16%)

Previous specialty exposure is absent###2(3.77%)

Patients do not recognize anaesthetist###11(20.75%)

Specialty has less prestige###14(26.41%)

What should be the ideal duration of###Number of responses (%)

anaesthesia house job?###in favour of 3 months

###34(64.15%)

In addition, 29(56.6%) of the respondents were of the opinion that anaesthetist had no or little role in surgery, and 12(24.52%) believed patients undergoing surgery appreciate anaesthetists' services (Table-2)

Table-2: (%) of Responses for questions about knowledge/awareness of anaesthesia.

Questions###(%) of Number in favour

The specialty's clinical application is limited?###29 (56.60%)

In Pakistan, anaesthesiology is an established specialty?###20 (39.62%)

Before entering medical college, did you know that anaesthesiology was a medical specialty?###26 (50.94%)

Does anaesthetist play an intra-operative role equal to surgeon?###38 (73.58%)

Does anaesthetist play pre and post operative role equal to surgeon?###35 (67.92%)

Does anaesthetist play a role of assistant for surgeon?###20 (39.62%)

Do patients undergoing surgery appreciate anaesthetist services?###12 (24.52%)

Is anaesthesia field interesting?###28 (52.83%)

Furthermore, 36(67.9%) participants considered financial reward as a factor which helped them in deciding their career choice whereas the 'immediate results of a treated patient' was considered a factor by 9(16.9%) respondents (Table-3)

Table-3: Factors for career in the first three preferences.

Factors###Responses###Responses###Total

for choice###by males:###by females:###responses:

of career###Number (%)###Number (%)###Number

(%)

Reward of finances###24(45.28%)###12(22.64%)###36(67.92%)

Preference relevant to society###16(30.18%)###3(5.66%)###19(35.84%)

Permanent working time###14(26.41%)###10(18.86%)###24(45.28%)

Searching job overseas###8(15.09%)###3 (5.66%)###11(20.75%)

Chances of teaching###17(32.07%)###4(7.54%)###21(39.62%)

Immediate results of treated patient###4(7.54%)###5(9.43%)###9(16.98%)

Appreciation by society###7(13.20%)###4(7.54%)###11(20.75%)

Self-satisfaction requirement###7(13.20%)###10(18.86%)###17(32.07%)

Opportunities of research###7(13.20%)###3(5.66%)###10(18.86%)

Discussion

Six countries of South Asia are included in those 57 countries which are facing human resources crisis,8 which also stands true for anaesthesia services. The anaesthetist-to-population ratio in Pakistan is 1:160,0001 compared to about 1:1 million in Nigeria,9 both being at the lower end and facing a human resource problem. India also has shortage of anaesthesiologists. At present there are 14,900 qualified anaesthetists for an Indian population of 1.21 billion which means one specialist anaesthesiologist for every 81,208 people.10 In this scenario, a medical students career choice plays a pivotal role in healthcare delivery system of any country.11 There can be academic and non-academic factors which may be associated with retention of undergraduate medical students, hence preventing their future career opportunities.12

Selection of a residency programme has received scarce attention compared to the selection of specialisation choice itself.13 Specialty content, patients contact, quality of medical school's educational programme, personal factors and lifestyle are the factors associated in choosing a specialty.14 People chiefly focus on various objective and subjective origins to construct their personal occupational opinion.15 In order to cope specialist workforce requirements, understanding dynamics of career decisions about specialties will be critically significant.16 The consolidated opinions of house officers about anaesthesiology explain perception patterns about medical specialty which are prevalent in Pakistani house officers, e.g. anaesthesiology is generally unpopular (47.16% house officers refused to join anaesthesiology as a career) among both genders. However, awareness of anaesthesia is increasing (50.94% respondents in our study included anaesthesiology in their first three career choices).

Our study provides the administrators of healthcare system with relevant information if particular aspects of a specialtys conditions of work, clinical scenario and salaries need to be considered. For example, 67.92% respondents in our study considered financial rewards as the main factor for career selection. The percentage of house officers which remained uninfluenced even after specific rotation of house job and their career choice could not be altered was45%, but 49% claimed a change of attitude about specialty of anaesthesia after their rotation. They mentioned giving more regard to the anaesthetists because anaesthesiology has just recently been added in the undergraduate medical curriculum.17 Moreover,34 (64.15%) believed a period of three months should be the ideal duration of an anaesthesiology house job.

While a significant number (52.83%) of respondents considered specialty of anaesthesiology as an interesting one, an alarming proportion (39.62%) had a negative perception about anaesthetist that he was considered an assistant to a surgeon. Such a perception that anaesthetists are looked as dispensable technicians is seen in another study.4

Students rejecting anaesthesiology have concerns about least patient contact, less prestige and less recognition by patient. Therefore, in contrast to surgeons, the image of anaesthetists require improvement to endorse the levels at which surgeons and anaesthetists work in peers.15 Generally the environment of tertiary healthcare setting and the house officers personal educational experiences in various teaching hospitals might have influenced their preferences about their career selection. In order to boost the process of providing specialist-delivered service, training numbers need to be increased.18

One limitation of our study was that our sample remained limited to house officers with three months experience whose choices might alter after their house job training was finished. Before students ultimately decide a career, their choices usually undergo many transitions. A trend is also seen in new graduates to go abroad for better opportunities. The opportunities that are available abroad may also affect the career choice of young doctors.19 This trend could result from the impact of policies run by other governments. Hence, this factor may also influence career choice perceptions.

Conclusion

House officers had reservations about joining anaesthesiology as a career choice. The findings are suggestive of a positive effect of anaesthesiology house job on house officers' attitude about anaesthesiology. Several factors may contribute towards decisions regarding career perceptions. For a developing country like Pakistan, with shortage of anaesthesia personnel, such information is useful in strengthening individual programmes and planning for the future.

Acknowledgement

We are grateful to all the study participants for sharing their views.

Disclaimer: None.

Conflict of Interest: None.

Funding Support: None.

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Publication:Journal of Pakistan Medical Association
Geographic Code:9PAKI
Date:Oct 31, 2016
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