Attitude toward career development in Japanese medical students: a questionnaire survey

STRENGTHS AND LIMITATIONS OF THIS STUDY

  • We performed a web-based questionnaire survey to all medical students (from first year to sixth year) in our medical school.

  • We asked all medical students in our medical school about goals of their future discipline, awareness of career development after graduation and intentions to obtain a medical specialty or a doctorate degree.

  • A 5-point Likert scale was used for responses (awareness toward career development: 5=strongly aware–1=not aware; intentions to acquire a medical specialty or doctorate degree: 5=strongly agree–1=strongly disagree).

  • We only performed quantitative analysis and did not include qualitative methods.

  • The data were collected from a single medical school; thus, caution should be exercised in generalising our findings to other medical schools.

Introduction

In Japan, students can enter medical school immediately after graduating from high school at ages 18–20 years.1 After completing medical school and obtaining a medical doctor degree (MD) by passing the national examination, the majority undergo an obligatory 2-year clinical training period (initial training) at ages 24–26 years.2 3 Subsequently, they pursue a medical specialty such as surgery, paediatrics or anaesthesiology, typically requiring an additional 4 years. After medical specialty board certification (about 8–10 years after graduating from medical school), they begin the lifelong process of learning to brush up on their skills and performance.4 Japanese doctors are also recommended to obtain a doctorate degree once they have some research experience.5 Consequently, young medical doctors are confronted with various complex steps and decisions at the onset of their careers. The declining number of medical doctors obtaining a doctorate degree poses a serious problem in Japan,6 because this tendency is tightly associated with research ability deterioration in the medical field. Thus, attitude toward a doctorate degree against a clinical board of medical specialties is also warranted.

Several studies on career development in specific medical professions have been conducted in other countries,7 8 which show various tendencies associated with a specific medical curriculum in the country. However, no study has investigated the general awareness of career development and how it evolves throughout medical schools in Japan. Hence, in this study, we conducted a questionnaire survey among all medical students in our university to assess their future medical professions, as well as their awareness of career development after graduation and their intentions to obtain a medical specialty and a doctorate degree.

Methods

Setting

The participants were recruited in the Faculty of Medicine of Kagawa University, which is the only medical school in Kagawa Prefecture. Kagawa Prefecture is located in the northeast of Shikoku region and has a population of 950 000.

Study population

We included all medical students (699 people) from first year to sixth year as participants. After obtaining verbal informed consent from medical students during break time in the classroom, we sent the access site link via an online communication system, WebClass (Japan Data Pacific, Tokyo, Japan), which they can access easily.

Study measures

We conducted a web-based questionnaire survey to evaluate goals of medical students regarding their future discipline, as well as their awareness of career development after graduation and intentions to acquire a medical specialty and obtain a doctorate degree. The content of the questionnaire is shown in Box 1. The three themes were generated by referring to several review articles and previous questionnaire studies, and responses were rated on a 5-point Likert scale (theme 2: 5=strongly aware–1=not aware; theme 3: 5=strongly agree–1=strongly disagree).9–11

Box 1

Web-based questionnaire

  • Theme 1. Discipline you want to major in.

  • Theme 2. Degree of awareness of career development after graduation (5-point Likert scale: 5=strongly aware, 4=aware, 3=somewhat aware, 2=weakly aware, 1=not aware).

    1. 1–2 years after graduation from medical school

    2. 3–7 years after graduation from medical school

    3. ≥8 years after graduation from medical school

  • Theme 3. Intentions to acquire a medical specialty or obtain a doctorate degree (5-point Likert scale: 5=strongly agree, 4=agree, 3=somewhat agree, 2=disagree, 1=strongly disagree).

    1. Medical specialty

    2. Doctorate degree

The content of the questionnaire was evaluated by three medical education professionals. A pilot test was then performed by four medical clerks in our centre. The online survey was conducted in Japanese using Google Form (Google, California, USA) over a 5-week period (from 27 April to 31 May 2023).

Overview of the Japanese medical education system

Online supplemental figure provides a general career overview of Japanese medical students and doctors.

Supplemental material

Japanese medical schools typically have a 6-year study period. Students are permitted to enter a medical school upon graduating from high school after passing the entrance examination. As with other medical schools in Japan, medical students at the Faculty of Medicine of Kagawa University complete all basic and clinical medicine lectures and skill training before beginning a clinical clerkship, typically in the fifth and sixth years of medical school. At the end of the sixth year, students take a graduation examination and the national examination for medical doctors. The curriculum at our university is typical and representative of Japan, following a standard structure.12 13 Although our curriculum incorporates a systematic programme covering basic, social and clinical medicine, there is currently no structured career development programme in place.

After receiving an MD certificate, almost all undergo the obligatory initial clinical training for 2 years. Doctors then typically apply for specialist training 3–7 years after graduation to acquire a medical specialty. A doctorate degree is recommended by medical universities, which requires entering a graduate medicine programme or writing original papers. Some doctors who pursue this path choose not to major in clinical medicine, but rather basic research or social medicine. Thus, medical doctors in Japan often obtain a doctorate degree simultaneously or after acquiring a medical specialty.

Patient and public involvement

None.

Statistical analysis

Statistical analyses were performed using JMP Pro V.13.2.1 (SAS Institute, Cary, North Carolina, USA).14 Results were compared using the Χ2 test. P<0.05 was considered statistically significant. Data are presented as mean±SD.

Results

The overall response rate to the questionnaire was 66.5% (465 of 699) (table 1). Future medical professions desired by medical students are shown in figure 1. Over 90% (420 of 465) of medical students in the overall study population desired the clinical discipline. Only 10 of 465 respondents (2.2%) chose basic research.

Table 1

Attitudes toward career development for various stages after graduating from medical school

Figure 1
Figure 1

Future medical professions desired by medical students.

Medical students’ awareness of career development is summarised in table 2. There were no significant differences in awareness of career development between the three assessed periods (1–2 years after graduation, 3–7 years after graduation or ≥8 years after graduation).

Table 2

Intentions to acquire a medical specialty or doctorate degree

In contrast, awareness of career development for ≥8 years after graduation was significantly lower compared with that for 1–2 years after graduation among fourth–sixth year students (fourth p=0.0023, fifth p<0.001, sixth p<0.001). Awareness of career development for 3–7 years after graduation was significantly lower compared with that for 1–2 years after graduation among third–sixth year students (third p<0.001, fourth p=0.003, fifth p<0.001, sixth p<0.001). In the sixth year medical students, only 10.3% of them showed strong awareness of career development for ≥8 years after graduation, while 39.7% of them did for 1–2 years after graduation.

Intentions to acquire a medical specialty or a doctorate degree are shown in table 3. In the total study population, significantly fewer medical students considered obtaining a doctorate degree compared with medical specialty (p<0.001 in all grades). In the sixth year medical students, only 13.0% showed strong intention to acquire a doctorate degree, while 43.5% of them did for medical specialty.

Table 3

Questionnaire response rate

Discussion

The amount of knowledge and skills which medical students are expected to acquire is escalating due to emerging advances in medicine.15 While training during medical school is insufficient to meet this demand, continuous career development and a lifelong commitment to refining knowledge and skills are essential for medical doctors.16 17

While many medical doctors are engaged in clinical work, various strategies to enhance patient outcomes have originated from professionals working in non-clinical fields such as basic or social medicine research.18 While most medical students in Japan pursue a clinical specialty, some may later explore non-clinical fields such as basic research and social medicine. A medical background and clinical experience are useful for these alternative paths. Actually, many medical doctors also later switch their specialty from clinical to basic research or social medicine based on their particular circumstances. Thus, back-up planning in designing a medical career is important, especially when faced with the possibility of not being able to accomplish the primary career goal.

In our study, most medical students in the latter part of their medical school studies showed higher awareness of career development for 1–2 year after graduation (obligatory initial training period) vs 8–10 years in the future (lifelong learning). This suggests that most medical students were focused on the 2-year initial training period after graduation and only vaguely considered the lifelong learning (≥8 years after graduation). Intentions to obtain a doctorate degree were also significantly lower compared with that for a medical specialty in all grades. Surprisingly, over 90% of fourth–sixth year medical students were in agreement regarding their intentions to acquire a medical specialty, while 40–50% showed an interest in obtaining a doctorate degree. Such decline in research orientation or doctorate degree acquisition is significantly lower compared with previous reports in other countries.19–21

This tendency might be at least partially explained by the medical education system in Japan. Japan’s modern medical education system was first introduced in the last quarter of the 19th century from Germany and was designed such that medical doctors would work toward obtaining a doctorate degree to demonstrate an ability to conduct research.22 However, after World War II, the systematic medical education system of the USA was introduced and substantially increased the number of professional qualifications available. Young Japanese doctors now strive to obtain both a doctorate degree and professional qualifications in their desired specialty. While doctorate training in academic laboratories provides a foundation to train knowledgeable medical personnel, it can be a burden on young medical doctors.23 This burden might be anticipated by medical students from an early stage and diminish their desire to obtain a doctorate degree later in their careers.

Although over 90% of sixth year medical students show intention to acquire a medical specialty, their attitude toward awareness of career development was relatively low for the training period (1–2 years or 3–7 years after graduation). The discrepancy suggests that medical students may struggle to envision and plan their future careers within the current medical education curriculum. Furthermore, there is no significant difference between the first and second half of the medical students in our study. This result implies that the existing medical education curriculum does not have a significant impact on the attitudes toward career development among medical students.

To address this issue, effective educational interventions are essential. Initiating career development after obtaining an MD degree may be too late. Early exposure to clinical settings and mentorship in research experiences could positively impact the ability of medical students to shape their careers and engage in lifelong education.

A comprehensive and longitudinal career development programme should be implemented before students graduate from medical school. The career design curriculum should not only underscore the importance of acquiring a medical specialty or a doctorate degree but should also instil in students the lifelong need for learning, work–life balance and the significance of contributing to society.24–26 Additionally, incorporating simulation exercises for designing their own future may prove effective.27 These curricula could also benefit from incorporating aspects such as stress management or mindfulness. Career counselling in medical school is another potential source of support.28 Career advice can be delivered to medical students or young doctors through various programmes, workshops and specialty student interest groups. For instance, one study proposed that a supervising team structure, along with the frequency of supervision, influenced PhD graduates’ career decisions, performance and satisfaction with training programmes, contingent on certain contextual factors.29 A systematic career development programme that includes emphasising the significance of research and increasing awareness of the importance of a doctorate degree, alongside its coexistence with clinical work, may prove effective for medical students. To evaluate the educational impact of these career development programmes, it is essential to consider not only medical students’ awareness or intentions but also the actual increase in the rate of acquiring medical specialties or doctorate degrees several years later.

This study has several limitations worth noting. First, as the data were collected from a single institute, caution should be exercised in generalising our findings to other medical schools. Nevertheless, it is probable that our results are applicable to medical schools in Japan due to the widespread application of the Model Core Curriculum for Medical Education across all institutions. This is because the Model Core Curriculum for Medical Education serves as a systematically organised model, derived by extracting core components that should be universally addressed by all Japanese universities when developing their respective medical education curricula.30 In the future, a nationwide survey on attitude toward career development in Japanese medical students is warranted. Second, we only performed quantitative analysis on career development using a Likert scale. Future studies that incorporate a mixed-methods approach, combining qualitative research through interviews or text-mining analysis, could provide valuable insights into gender differences in attitudes toward career development.31–33

In the future, an international comparison study on career development may be significant. In many countries including Japan, students enter medical school at ages 18–20 years after high school graduation.34 In contrast, students in some countries such as the USA need to obtain an undergraduate degree before entering medical school,35 which means that these medical students have more life experiences. As the basic difference on life experience due to entrance age may affect their career development attitude, such an international comparison analysis on educational system may contribute to the difference in career development attitude.7 8

Conclusion

We performed a questionnaire survey to Japanese medical students regarding attitudes toward career development after graduation. Our findings indicate that while medical students demonstrated acute awareness of the initial training period after graduation, their consideration of events further in the future, such as medical specialty training and lifelong learning, was only vague. Additionally, the desire to obtain a doctorate degree was considerably weaker compared with that for a medical specialty. A systematic and longitudinal career development programme for medical students would be necessary.

Supplemental material

Data availability statement

Data are available upon reasonable request. Summarised data relevant to the study are included in the article or uploaded as supplemental information (online supplemental data). Raw data can also be shared by the authors upon reasonable request.

Ethics statements

Patient consent for publication

Ethics approval

This study was approved by the Research Ethics Committee of the Faculty of Medicine of Kagawa University (no. 2023-013). As this Research Ethics Committee judged written informed consent is unnecessary, verbal informed consent was obtained from students by medical teachers and clerks who also witnessed the process before the survey. All students were informed about the nature and purpose of the study and anonymity was guaranteed. Students were also informed that they had the opportunity to withdraw from the study if they notified the investigator within a week after they responded to the survey. We also emphasised that withdrawing from the study would not influence their academic outcomes in any way. The study population included no minors, as all medical students in Japan are older than 18 years.34 35

This post was originally published on https://bmjopen.bmj.com