Reasons to pursue a career in medicine: a qualitative study in Sierra Leone

Abstract

BackgroundMany low-income and crises-affected countries like Sierra Leone struggle with the recruitment and retention of their health professionals, particularly nurses and doctors. There are multiple factors that influence the ‘recruitment to retention’ pipeline. The first stage of an exploration into the issues influencing the availability of qualified health care workers may focus on the aspects which influence their entry into relevant educational programmes. This paper explores the reasons given by junior doctors in Sierra Leone for wanting to become a doctor. It also describes entry procedures into undergraduate medical education.MethodsIn-depth interviews were conducted with purposively sampled junior doctors (n = 15) from the only medical school in Sierra Leone in October 2013. Digital diaries and two follow-up interviews were used to explore their evolving career experiences and aspirations until November 2016. In addition, semi-structured interviews with key informants (n = 20), including senior teaching staff at the medical school (n = 7), were conducted. Thematic analysis was used to explore linkages and themes across cases.ResultsSix themes were identified. The most commonly mentioned reasons for wanting to become a doctor were a desire to help (theme 4) and the influence of family and friends, via role modelling (theme 2) and verbal encouragement (theme 3). Other motives were an interest from a young age (theme 1), being attracted by the job prospects (theme 5), and having an intellectual and science capacity (theme 6). Junior doctors gave at least two and up to six reasons for applying to enter the medical profession. Doctors were allowed entry to the medical school largely based on their previous academic performance.ConclusionsThis study showed that multiple reasons underlie the decision to apply for entrance to medical school and the decision to enter medicine is complex. These findings may inform the review of future admission procedures by the medical school in Sierra Leone and similar settings, which is a crucial step in addressing the human resource needs for healthcare that currently exist.

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“…Next, the fact that the 3rd and 4th motivations were "attractiveness of the medical profession and its characteristics" and "vocation" is rather a good thing, since researchers have shown that these motivations are associated with significant subsequent satisfaction in practice (Heikkilä et al, 2015). The category "vocation" has been found in other studies (Heikkilä et al, 2015;Wouters et al, 2017), and also seems to fit Woodward's « child's dream » category (Woodward et al, 2017). The 5 th category « social influence of a family member practicing medicine or a related profession » includes reasons also found in the qualitative study of Woodward et al: « inspired by role models » and « influence of family members ».…”

“…Students' interactions with medical staff have been implicated in the decline of the idealism students present towards their future profession (Morley et al, 2013). Some authors argue that if this "idealistic" motivation does not meet the practical experience, some students may feel disillusioned and may withdraw from medical education (Girasek et al, 2011;Woodward et al, 2017). One study showed that one-third of medical students would never do these studies again (Pruthi et al, 2013).…”

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“…In this study, economic status and personal background are the reasons for students to choose medicine. Usually students choose medicine for various reasons such as global recognition, job opportunities abroad, status and respect in society, stability in employment, and job security (Newton et al, 1998;Woodward et al, 2017).…”

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“…However, there is still a lack of research evidence to back up or refute this belief. Although there have been past studies in other countries which question the motivation of students applying to study medicine, it was found that results vary across different countries or cultures (Woodward, Thomas, Jalloh, Rees, & Leather, 2017), thus further cementing the need to carry out this study.…”