BackgroundIn resource-poor settings with low doctor-population ratio, there is need for equitable distribution of healthcare workforce. The specialty preferences of medical students determine the future composition of physician workforce hence its relevance in career guidance, healthcare planning and policy formulation. This study was aimed at determining the specialty preferences of final year medical students in medical schools of southeast Nigeria, the gender differences in choice of specialty and the availability of career guidance to the students during the period of training.MethodsA descriptive cross-sectional study was conducted among final year medical students in the six accredited medical schools in southeast Nigeria using self-administered semi-structured questionnaire. Information on reason for studying Medicine, specialty preference and career guidance were obtained. Chi-square test of statistical significance was used in the analysis.ResultsA total of 457 students participated in the study with a response rate of 86.7 %. The mean age was 25.5 ± 2.9 years and 57.1 % were male. Majority (51 %) opted to study Medicine in-order to save lives while 89.5 % intended to pursue postgraduate medical training. A higher proportion (51.8 %) made the decision during the period of clinical rotation. The five most preferred specialties among the students were Surgery (24.0 %); Paediatrics (18.8 %); Obstetrics and Gynaecology (15.6 %); Internal Medicine (11.0 %) and Community Medicine (6.8 %) while Pathology (2.0 %); Anaesthesia (0.7 %) and Ear, Nose and Throat (0.2 %), were the least preferred. Compared to females, a higher proportion of male students intended to specialise in Surgery (32.3 % vs 13.0 %, p < 0.001) in contrast to Paediatrics (11.2 % vs 28.8 %, p < 0.001). Majority of the students, 74.6 % had no form of career guidance during their stay in medical school and 11.2 % were undecided on choice of specialty.ConclusionIn spite of the high proportion of students willing to pursue specialist medical training after graduation, most opted for the four core clinical specialities of Surgery, Paediatrics, Obstetrics and Gynaecology and Internal Medicine. Majority of the students made these decisions during clinical rotations. Also, majority had no form of career guidance throughout their stay in medical school. To ensure an equitable distribution of a limited physician workforce in a resource-poor setting, there is need for proper career guidance for the students and this should be in line with the national health needs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0781-3) contains supplementary material, which is available to authorized users.

No abstract

Background Retaining patients on antiretroviral treatment in care is critical to sustaining the 90:90:90 vision. Nigeria has made some progress in placing HIV-positive patients on treatment. In an effort to increase access to treatment, ART decentralization has been implemented in the country. This is aimed at strengthening lower level health facilities to provide comprehensive antiretroviral treatment. We determined the level of retention and adherence to treatment as well as the associated factors among private and public secondary level hospitals in Anambra State. Method We conducted a cross-sectional study among patients who had taken antiretroviral treatment for at least one complete year. A structured questionnaire and patient record review were used to extract information on patient adherence to treatment, and retention in care. Adherence to treatment was ascertained by patient self-report of missed pills in the 30 days prior to date of interview. Retention in care was ascertained using the 3-month visit constancy method reviewing the period spanning 12 months prior to the study. Result We found a comparable level of retention in care (private 81.1%; public 80.3%; p = 0.722). However, treatment adherence was significantly higher amongst participants in the private hospitals compared to those in the public hospitals (private: 95.3%; public: 90.7%; p = 0.001). Determinants of good retention in the private hospitals included disclosure of one’s HIV status (AOR: 1.94, 95% CI: 1.09–3.46), being on first-line regimen (AOR: 3.07, 95% CI: 1.27–7.41), whereas being on once-daily regimen (AOR: 0.58, 95% CI: 0.36–0.92), and being currently married (AOR: 0.54 95% CI: 0.32–0.91) determined poor retention. In the public hospitals, only disclosure (AOR: 3.12 95% CI: 1.81–5.56) determined good retention, whereas, spending less than N1000 on transport (AOR: 0.230 95% CI: 0.07–0.78) and residing in a rural area (AOR: 0.64 95% CI: 0.41–0.99) determined poor retention. None of the factors determined adherence. Conclusion Retention in care was high and comparable among the different hospital types and HIV disclosure status was an important factor relating to retention in care. The other factors that determined retention were however different at public and private hospitals. The HIV program manager should consider these variations in designing programs to improve patient retention in care and adherence to treatment.

Background Healthcare workers are a burnout-prone occupational group and the prevalence is particularly high among physicians. With the prevailing low physician-patient ratio in Nigeria which has worsened with the recent wave of physician emigration, among other socio-economic constraints; a setting for high physician burnout may have been nurtured. Our survey set out to determine the prevalence of burnout among physicians practicing in Nigeria, ascertain the factors that were associated with the development of burnout and evaluate the respondents’ perceived impact of physician burnout on patient safety. Methods We used the Oldenburg burnout inventory as the measurement tool for burnout in the cross-sectional study conducted between November and December, 2019 among physicians in five tertiary health institutions in Nigeria. A 5- point Likert-type scale was used to evaluate the participants rating of their perceived impact of physician burnout on patient safety. Data entry and analysis were done using IBM Statistical package for social sciences software version 25 and the level of statistical significance was determined by a p value < 0.05. Results The response rate was 61% (535/871), and burnout prevalence was 75.5% (404/535). Majority of the physicians (74.6%) perceive that physician burnout could impact patient safety. Physicians’ professional grade, age and years in practice, but not specialty, gender or marital status were associated with the exhaustion domain, whereas only the physicians’ age was associated with the disengagement domain of burnout. No socio-demographic or work-related characteristics determined overall burnout in our respondents. Conclusion Physician burnout in Nigeria is high and pervasive, and this should alert physicians to be wary of their general and mental health status. Public health policy should address this development which has implications for patient safety, physician safety and healthcare system performance.