Factors influencing the decision to pursue emergency medicine as a career among medical students in Singapore

Abstract

INTRODUCTIONThe emergency medicine (EM) residency programme was introduced in Singapore in 2010 as part of a nationwide effort by the Ministry of Health Holdings (MOHH) to improve existing postgraduate training systems across all medical and surgical specialties.(1,2) It is modelled after the American residency system and replaces the old specialty training programme, which involved rotating apprenticeships of varying duration with different governing bodies for employment, accreditation and evaluation of training. The need to generate specialists at a faster rate to meet the rising demand for healthcare services in Singapore served as another driver for transition to the residency programme system. The EM residency programme achieves this by means of a seamless progression structure and earlier enrolment into specialist training, by allowing medical students to apply for a residency programme in their graduating year.For EM residency programme directors, it is challenging to select residents from a pool of medical students with whom they have limited interaction. It is difficult to gauge applicants' aptitude, attitude and work ethos without direct observation of their work experience. Medical school test results are not always reliable indicators of future success in EM.(3) By denying medical student applicants and restricting resident recruitment to older medical officers who have rotated to the EM department, they may risk losing top performing graduating students to other training specialties. For graduating medical students, choosing and applying for a residency can often result in considerable anxiety, as application for a residency programme is competitive and unpredictable, and requires a significant investment of time and commitment. (4,5) This demanding situation is compounded by the shorter exposure to EM in the residency programme as compared to the old system, in which applicants typically had six months to two years of work experience in EM. The introduction of the residency programme meant that the duration of training will be shortened, the pace of knowledge acquisition will be accelerated, and EM trainees consequently become consultants at a younger age and with less experience. As such, careful selection of EM applicants is important to the future development of EM in Singapore. (3,5) Our study team aimed to determine the interest levels and motivating factors for pursuing EM as a career among medical students in Singapore.

How can Medical Education Support the Current Healthcare Initiatives in Singapore?

“…19 While these studies are essential for programme directors of these specialties, it is not relevant to understanding what current medical students feel about the current medical education and healthcare trends. Factors found to affect the choice of specialty, and sponsoring institute in local studies 17,19 were largely similar to those found in overseas studies. 21 Some of these factors were seen to be important to students choosing a primary care career, and perhaps these factors could be highlighted specifically by faculties trying to encourage students towards a primary care career.…”

“…14 Deans of medical schools have even expressed concerns about the availability of residency training positions, 15 with some suggesting that these shortages would not have been present if the specialist residency programmes were not capped 30 years ago. 16 In Singapore, published studies are centered around what factors influence medical student choices for specific specialties like emergency medicine 17 and psychiatry, or focusing on the impact of a specific factor like debt on specialty choice, 18 or factors affecting the choice of a sponsoring institute. 19 While these studies are essential for programme directors of these specialties, it is not relevant to understanding what current medical students feel about the current medical education and healthcare trends.…”

Emergency physician personnel crisis: a survey on attitudes of new generations in Slovenia

“…The components in PCA have then been used to compute Spearman correlation coefficients, and we have found that the importance of prestige positively but weakly correlates with the choice of EM, while it negatively but weakly correlates with the importance of work conditions. This is contrary to the Singaporean medical students, who had prestige (measured directly, unlike our study where we measured it through PCA) positioned as a negative factor of influence [ 66 ]. Age correlated negatively, which also translates to actual applications for EM residency in Slovenia [ 11 ].…”

Assessing awareness and attitude of Egyptian medical students towards emergency medicine as a specialty and career choice: A single-institutional study

“…Chew et al reported that focus on urgent care, salary, and exposure to elective EM training influenced junior students to seek EM as a career choice. Senior students were more likely to pursue EM due to exposure to elective EM training [14] .…”