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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 30  |  Issue : 5  |  Page : 561-566

Postgraduate career and emigration intentions: A cross-sectional study of house officers in a North Central, Nigerian Tertiary Hospital


Department of Obstetrics and Gynaecology, National Hospital, Abuja, Nigeria

Date of Submission23-May-2021
Date of Decision23-Jun-2021
Date of Acceptance12-Jul-2021
Date of Web Publication11-Oct-2021

Correspondence Address:
Dr. Azuka Chinweokwu Ezeike
Department of Obstetrics and Gynaecology, National Hospital, Abuja
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/NJM.NJM_95_21

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  Abstract 


Background: Postgraduate career decisions and emigration intentions of medical graduates determine the quality of a nation's health system. Evaluating these choices help in developing evidence-based health plans and reforms. Objective: The aim of this study was to evaluate the postgraduate career and emigration intentions of House Officers in National Hospital Abuja. Methodology: This was a cross-sectional study of postgraduate career and emigration intentions of medical interns done in National Hospital Abuja from June to July 2020. Using a structured questionnaire, information was obtained on the sociodemographic data, undergraduate and internship experience, postgraduate career intention, specialty preference, and emigration intentions of the interns. Data were analyzed with SPSS version 23. Results: A total of 90 questionnaires were distributed with a 76% response rate. The mean age of the respondents was 26.23 ± 1.77 years with mean internship duration of 10.51 ± 1.58 months. Most were single 63 (91.3%) and 44 (63.8%) were females. While 52 (75.4%) opted to specialize, 50 (78.1%) had intention to emigrate. Surgery (32.7%) and obstetrics and gynecology (28.9%) were the most commonly desired specialties. Personal interest was the greatest determining factor for specialty choice (90.4%), while better working conditions were the most commonly reported driving force for emigration (51.6%), and the United Kingdom (52%) was the most commonly desired emigration destination. Conclusion: A high number of respondents had interest in specialization with a greater interest in the surgical specialties. Most also had the intention to immigrate to Western countries with the United Kingdom as the most preferred destination.

Keywords: Career, emigration, house officers, intention, postgraduate


How to cite this article:
Ezeike AC, Ebong AO. Postgraduate career and emigration intentions: A cross-sectional study of house officers in a North Central, Nigerian Tertiary Hospital. Niger J Med 2021;30:561-6

How to cite this URL:
Ezeike AC, Ebong AO. Postgraduate career and emigration intentions: A cross-sectional study of house officers in a North Central, Nigerian Tertiary Hospital. Niger J Med [serial online] 2021 [cited 2021 Dec 5];30:561-6. Available from: http://www.njmonline.org/text.asp?2021/30/5/561/327968




  Introduction Top


The internship period provides an opportunity for fresh graduates to be taught the basics of the medical profession under supervision. The usual duration is 1 year and it is the time for laying the foundation for future medical practice. In the medical profession, the decision on the career path to take is usually made after exposure to the clinical specialties during the internship period.[1],[2] This decision can be taken at the undergraduate level and in some cases after graduation.[3],[4],[5]

Career development beyond the basic medical degree is essential to develop the expertise needed to render specialized care to patients; as such the choice of postgraduate career path is a burning issue for medical graduates in the quest for career advancement.

There are enormous alternatives available to the fresh graduate and making a choice can be difficult for a young intern. Over the years, the career aspirations of medical graduates have continued to evolve as a result of changing dynamics of postgraduate medical education, the state of the health sector, and the prevailing economic conditions in the country.[1],[6]

There is an expectation that every country should have sufficient number of specialists at any point in time to meet its existing health-care demands. At the same time, doctors are also needed to practice at the secondary and primary health-care levels to meet the health-care needs across board. However, there has been a preponderance of doctors with intention to specialize when compared to those interested in primary health care.[7] The distribution of doctors among the different specialties has also not been even due to a number of factors.[5],[8]

Personal choice was reported by Eze et al. and Adeleye and Eze in their study on pre-residency doctors and final year medical students, respectively, as the predominant reason for the choice of career path.[5],[9] Odusanya and Nwawolo in their work in Lagos found that in addition to personal choice, most house officers were interested in specializing for other reasons such as job satisfaction and bright prospects.[6] Lifestyle friendliness, influence of a mentor, and personality trait were also reported by other authors.[8],[10],[11] The core clinical specialties, especially surgery and obstetrics and gynecology, were the most reported desired clinical specialties.[5],[6],[7],[9],[10]

A study done in Lagos in the early 2000s showed that up to 82.9% of the respondents were interested in pursuing specialist training while a multicentre study done 15 years later in four centres in the North-central and South-south regions of the country reported only 60.5%.[1],[6] This may be due to evolution in aspiration over time or geographical differences.

Reports from studies in Nigeria and Pakistan show that a substantial proportion of fresh graduates also intends to emigrate to other climes in search of better opportunities.[1],[6],[12] The poor condition of service, especially in developing countries and the need for financial independence, has also affected the choice of career path of medical graduates[1],[6],[12] The resultant shortfall in trained manpower due to brain drain is a major challenge in sub-Saharan Africa as the available manpower does not equate to the output from the medical colleges.[5] This brain drain can be quelled by government intervention in the health sector with improvement of working conditions.[13]

This study was aimed at evaluating the choice of interns with respect to postgraduate career path and chosen or intended country of practice. The knowledge of this will help provide evidence-based advice to policymakers on ways to improve postgraduate medical education.


  Methodology Top


Study design

This was a descriptive cross-sectional study of medical interns at National Hospital Abuja.

Study centre

National Hospital is one of the tertiary hospitals in the Federal Capital Territory of Nigeria. The study centre is located within the Abuja municipal area council. It is a tertiary health-care centre in the country and serves as a referral center for primary and secondary, including tertiary centres in the federal capital territory and surrounding states. It delivers specialized care in obstetrics and gynecology, surgery, pediatrics, internal medicine and also radiology, laboratory medicine, anaesthesiology, radiotherapy, oncology, and radiation physics and has accreditation for residency training in these specialties. It is accredited by the Medical and Dental Council of Nigeria for the training of house officers. As at the time of this study, the number of house officers doing their rotations in the hospital was 105 though only 90 could be accessed as the rest were either on admission or self-isolation on account of COVID-19.

House officers rotate through the four (4) clinical specialties of obstetrics and gynaecology, paediatrics, surgery, and internal medicine and may also do a few postings in the other specialties.

Data collection

Data were collected from June to July 2020, and purposive sampling method was utilized. Structured questionnaires were self-administered. The questionnaire had an introduction that highlighted the importance of the study to postgraduate medical education, that anonymity of the respondents will be maintained and the need for their consent. There were three other sections in which information on sociodemographic data, undergraduate and internship experience, and postgraduate career intentions were obtained. Undergraduate and internship learning experience were assessed on a five-point Likert scale.

Ethical consideration

Informed consent was obtained from the respondents, also confidentiality and anonymity were maintained and the principle of beneficence and non-maleficence were upheld in this study.

Statistical analysis

Data were analyzed with Statistical Package for the Social Sciences, version 23.0 (SPSS, Inc, Chicago, IL). Continuous variables were described as means and standard deviation while categorical variables were described as percentages. Comparison was made with Chi-square or Fisher's exact test for categorical variables. P < 0.05 was considered as statistically significant.


  Results Top


Of the 90 questionnaires distributed, 69 were completely filled and returned giving a response rate of 76%. The mean age of the respondents was 26.23 ± 1.77 years and mean internship duration was 10.51 ± 1.58 months. Most were single 63 (91.3%) and 44 (68.3%) were females. A greater proportion of the respondents were from the south-west geopolitical zone (21.7%) with the north-west contributing the least (5.8%). A higher number had their undergraduate training in Nigeria 37 (53.6%) while 32 (46.4%) trained outside the country. Five of the respondents (7.2%) reported regrets about their choice of medicine as a career. Most rated their undergraduate training experience as very good – 42 (60.9%), with the rest rating it as excellent – 15 (21.7%), average – 10 (14.5%), and poor – 2 (2.9%). Internship experience was rated as excellent by 3 (4.3%) with 27 (39.1%), 34 (49.3%), 4 (5.8%), and 1 (1.4%) rating it as very good, average, poor, and very poor, respectively.

Whereas 52 (75.4%) planned to specialize, 12 (17.4%) did not indicate interest in specialization, 5 (7.2%) were unsure of their intention. Surgery was the most common desired specialty (32.7%), closely followed by obstetrics and gynaecology (28.8%), community medicine (13.5%), and internal medicine (11.5%) [Figure 1]. Personal choice was the most common reason for specialty preference (87%) with parents' choice and influence of role model contributing 6 (8.7%) and 3 (4.3%), respectively. Fourteen (21.9%) opted to practice in Nigeria while 50 (78.1%) chose to emigrate [Table 1], with the United Kingdom as the most preferred destination [Figure 2].
Figure 1: Specialty preferences of the respondents

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Table 1: Postgraduate career intentions of the respondents

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Figure 2: Country of choice for emigration

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Other results are presented in tables and figures

[Table 1] shows the postgraduate career intentions of the respondents. Most 40 (58%) opted to pursue specialty training outside Nigeria.

[Table 2] shows the comparison of the decision for specialization, choice of specialty, and emigration intentions among the male and female respondents. There were no significant differences between the two groups (P > 0.05).
Table 2: Comparison of the decision for specialization, choice of specialty, and emigration intentions among the male and female respondents

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[Table 3] shows the reasons for specialty preference and emigration. Personal interest was the predominant reason for specialty preference while better working conditions were the predominant reason for emigration.
Table 3: Reasons for specialty preference and emigration

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[Table 4] shows multiple logistic regression of the factors influencing decision to either pursue specialty training or not. None of the factors contributed significantly to the model (P > 0.05).
Table 4: Multiple logistic regression of the factors influencing decision to either pursue specialty training or not

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[Figure 1] shows the specialty preferences of the respondents. Surgery was the most desired specialty (32.9%).

[Figure 2] shows the choice of country for emigration. The United Kingdom was the most desired destination (52%).


  Discussion Top


Postgraduate career development is crucial in the maintenance of the critical manpower in any country's health sector. The intention of fresh doctors has been found to evolve over the years and this evolution is influenced by a number of factors.[3] This study was designed to evaluate these choices and their determinants.

The response rate of 76% in this study is lower than 82% reported by Odusanya and Nwawolo and 81.8% by Azu et al. in South Africa.[4],[6] This can be explained by the fact that this study was done at the peak of COVID-19 pandemic in Nigeria with attendant disruption of clinical activities leading to limited availability of some of the interns.

The average age of the respondents of 26.23 ± 1.77 years is similar to reports by Odusanya and Nwawolo and Lawal and Afolabi but lower than the mean age of 33.5 years reported by Eze et al. from their study on pre-residency doctors.[6],[9],[14] The difference may be attributed to the lag time before decision is taken on postgraduate career path. The mean internship duration of 10.51 ± 1.58 months is higher than 8.72 ± 4.24 reported by Odusanya and Nwawolo because many of the house officers in our study were about concluding their internship at the time of data collection.[6] Most respondents were single as was the case in similar studies.[6],[15]

There were more females than males in this study, similar to reports by Azu et al. in a study on medical students in South Africa.[4] Conversely, Madu et al., Lawal and Afolabi, and Adeleye and Eze in their studies in Enugu, Ibadan, and Benin, respectively, recorded more males than females.[5],[14],[15] The similarity between findings in this study and reports from South Africa is because the high socioeconomic environment in these two locations will likely offer women more access to high educational attainment. This shows the influence of socioeconomic status on the gender dynamics in medical training.

Most of the respondents rated their undergraduate training and internship experience as very good. This is in tandem with findings from a study in Lagos where 86.6% and 80.6% of respondents gave favorable ratings to their undergraduate and internship experience, respectively.[6] Only 5.2% of the respondents expressed regrets in their choice of medicine as a profession when compared to another study where 47.6% felt that they will choose medicine as a profession if given the opportunity.[6]

A high proportion of respondents (75.4%) opted to pursue specialty training, this is similar to reports from South Africa, Lagos Nigeria, and India where reports show that 85.8%, 82.9%, and 78.2% of the respondents considered postgraduation specialization as important.[4],[6],[10] Similarly, in a multicenter study in Nigeria by Okonta et al., 60.5% of the participants opted to specialize.

The major clinical specialties of obstetrics and gynaecology and surgery were the most preferred when compared to other specialties, this concurs with reports by other authors.[5],[9],[10],[16] Aslam et al. in Pakistan reported internal medicine as the most preferred specialty though the study was done in both students and house officers and the limited exposure of the students must have affected their choices.[17] The greater exposure to these four specialties during the undergraduate and internship period could be responsible for the findings in this study. This has negative implication for the nation's health system as there is a need to have equitable distribution of specialists in all fields, including lifestyle-related specialties to provide holistic care to the citizenry.[3] The development of National medical education policy has been suggested as ways to ameliorate this.[4],[7]

More females (82.9%) than males (78.3%) were willing to specialize in this study, like in reports by Odusanya and Nwawolo[6] Conversely, in a study on female medical students in Kano, 51.5% were willing to be general practitioners while only 22.7% were willing to specialize, with the rest indecisive.[16] A greater percentage of males chose to specialize in surgery, while more females chose obstetrics and gynaecology and internal medicine. Pediatrics was chosen exclusively by females. This concurs with a study in Bangladesh were males were more likely to opt for the surgical specialties.[7] Furthermore, Eze et al. in their study reported that men were significantly more likely to choose surgery and obstetrics and gynecology while women were more likely to choose pediatrics.[9] Adeleye and Eze reported gender and having a role model as significantly associated with decision to specialize in surgery.[5]

Interest in specialty was the most common reason for the choice of specialty in this study and this concurs with reports by Odusanya and Nwawolo, Ahmed et al., and Azu et al.[4],[6],[7] Conversely, Okonta et al. reported job satisfaction as the most important factor.[1] Rewards from working in the specialty were the most common factor in a study on female medical students in Kano Nigeria.[16] Personality trait and lifestyle were the predominant influential factors in a study on the 1st- and 2nd-year residents in Brazil.[11] The limited role of the influence of role models as shown in this study also reported by Idowu et al. calls for concern as medicine is a mentor-driven profession.[18]

Majority (78.12%) of the respondents in this study opted to pursue their postgraduate career outside Nigeria. This figure is higher than 24.8% reported by Okonta et al. in a multicenter study in Nigeria.[1] Studies done in Pakistan and Bangladesh showed that 60.4% and 51% of the respondents considered emigrating to foreign countries.[7],[17] In a study in India, 14.4% of the medical graduates were planning to write foreign placement examinations.[10] Better working conditions and desire for professional excellence have been cited as reasons.[12] The higher figures in this study may be because an appreciable proportion of respondents had undergraduate training outside the country and may possibly want to have similar experience at the postgraduate level. In addition, the dwindling economic prospects in the country make emigration to countries with presumed better economic climate attractive. Awire et al. found out that the declining standard of medical training also significantly influences the desire to migrate. This has far-reaching consequences on the country's health sector because it results to drain in the existing health-care workforce.[19],[20]

Clarke et al. in their study on doctors in Ireland reported that dissatisfaction with work-life balance and poor quality of training was significantly associated with intention to leave.[21] Reports by Duvivier et al. showed a 304.6% increase in physician migration from Africa to America between 2005 and 2015 with Egypt, Nigeria, South Africa, and Ghana contributing the bulk.[22] The UK is the most preferred emigration destination in this study. This is converse to reports by Odusanya and Nwawolo and Imran et al. that reported North America and the USA, respectively.[6],[12]

Improvement in working experiences and conditions as demonstrated in Malawi and Ireland has been shown to reduce the likelihood of migration.[13],[21] The poor state of our health institutions, however, remains a challenge in sub-Saharan Africa.

The limitation of this study is that it is a self-administered questionnaire-based study and so is prone to responder bias.


  Conclusion Top


A high number of respondents had interest in specialization with a greater interest in the surgical specialties. Most also had the intention to immigrate to Western countries.

Early career guidance and balanced exposure to all the specialties during internship are needed to enable equitable distribution of specialists. Improvement in working conditions will also help to retain doctors within the country.

Acknowledgment

The authors appreciate the house officers who consented to be part of this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Okonta KE, Akpayak IC, Amusan EO, Ekpe EE, Adamu YB, Ocheli EO. Multi-center survey of house officers' choice of medical specialties in Nigeria: Preferences and determining factors. Pan Afr Med J 2015;20:338.  Back to cited text no. 1
    
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Eze BI, Okoye OI, Maduka-Okafor FC, Aguwa EN. Factors influencing choice of medical specialty of preresidency medical graduates in southeastern Nigeria. J Grad Med Educ 2011;3:367-71.  Back to cited text no. 9
    
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Imran N, Azeem Z, Haider II, Amjad N, Bhatti MR. Brain drain: Post graduation migration intentions and the influencing factors among medical graduates from Lahore, Pakistan. BMC Res Notes 2011;4:417.  Back to cited text no. 12
    
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Bailey N, Mandeville KL, Rhodes T, Mipando M, Muula AS. Postgraduate career intentions of medical students and recent graduates in Malawi: A qualitative interview study. BMC Med Educ 2012;12:87.  Back to cited text no. 13
    
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Lawal T, Afolabi A. Factors influencing the choice of surgery as a career by preregistration interns. Afr Health Sci 2013;13:814-9.  Back to cited text no. 14
    
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Madu A, Ubesie A, Madu K, Nonyelu C, Ibegbulam O. Medical specialist preferences and reasons among fresh Nigerian interns. Ann Med Health Sci Res 2014;4:S223-7.  Back to cited text no. 15
    
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Aslam M, Ali A, Taj T, Badar N, Mirza W, Ammar A, et al. Specialty choices of medical students and house officers in Karachi, Pakistan. East Mediterr Health J 2011;17:74-9.  Back to cited text no. 17
    
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Idowu AO, Oyebisi OO, Ehioghae O, Ijiomah E, Adesegun OA, Ogunkoya JO, et al. Career preferences among final year medical students and house officers: A multicentre survey in Southwest Nigeria. Res J Health Sci 2020;8:36-44.  Back to cited text no. 18
    
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Awire EI. Social and Structural Factors Affecting the Culture of Medical Migration in Nigeria: Insights from Four Public Medical Schools. [Doctoral Thesis]. Edinburgh:Queen Margaret University; 2017. Available from https://eresearch.qmu.ac.uk/handle/20.500.12289/8979. [Last accessed on 2021 May 12].  Back to cited text no. 19
    
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Awire E, Okumagba M. Medical education in Nigeria and migration: a mixed-methods study of how the perception of quality influences migration decision making. MedEdPublish. 2020; 9(1). Available from https://doi.org/10.15694/mep.2020.000001.1. [Last accessed 2021 May 12].  Back to cited text no. 20
    
21.
Clarke N, Crowe S, Humphries N, Conroy R, O'Hare S, Kavanagh P, et al. Factors influencing trainee doctor emigration in a high income country: A mixed methods study. Hum Resour Health 2017;15:66.  Back to cited text no. 21
    
22.
Duvivier RJ, Burch VC, Boulet JR. A comparison of physician emigration from Africa to the United States of America between 2005 and 2015. Hum Resour Health 2017;15:41.  Back to cited text no. 22
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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