Theses (MSc. Public Health)

Background: Shortage and disproportionate distribution of specialists is a major concern for healthcare and public health in Malaysia. The nature of medical specialization pathway in Malaysia is also continuously evolving over the years. The house officers' career specialty preference has implications for the healthcare system particularly in future distribution and availability of specialist manpower in this country. Understanding the junior doctor’s specialty preference and the factors contributing to their choice will be beneficial for specialist workforce provision to cater to the growing population's health need for specialist care. Aims: The objectives of this study were to identify the preferred choice of specialist training among house officers and to determine the factors associated with their choice. This study also aimed to qualitatively identify the young doctor's perception on specialist training opportunities and to explore in depth the motivational factors for their career specialty preference. Methodology: This was a mixed methods study with exploratory sequential design conducted for 6 months from July 2020 to December 2020. Qualitative method involved audio recorded in-depth interviews among seven house officers of a tertiary care hospital to explore their perception on specialist training opportunities in Malaysia and the motivational factors for their career specialty preference. The interview recordings were transcribed with the aid of Microsoft Word 365 dictation tool and thematically analysed with the aid of NVIVO version 1.0 (2020) software. Questionnaire with 33 scale items of motivational factors for career specialty preference was developed based on the qualitative findings, validated, and distributed to randomly selected 262 house officers from the same hospital in the quantitative phase. Exploratory factor analysis was done based on 185 responses from the main quantitative study before proceeding with the hypothesis testing. Quantitative data on socio demographic characteristics, choice of specialist training and motivational factors were analysed using descriptive statistics (proportion, mean and standard deviation). For inferential statistics; bivariate comparison, univariate analysis and multivariate analysis (multinomial logistic regression) were done to determine the factors associated with the choice of specialist training. For quantitative data analysis Statistical Package for the Social Sciences (SPSS) version 26 was utilized. Results: Two major themes identified from qualitative were 1) Perception of specialist training opportunities (with two subthemes; i. Advantages of specialist training and ii. Perceived challenges of specialist training in Malaysia) and 2) Motivational factors for their career specialty choice (with seven subthemes; i. Work schedule, ii. Patient care characteristics, iii. Specialty characteristics iv. Personal factors, v. Past work experience, vi. Training factors, vii. Career prospects). There were 185 respondents for the cross-sectional questionnaire survey. Overall Cronbach's alpha for pre-test, main study and post exploratory factor analysis were 0.82, 0.85 and 0.83. Exploratory factor analysis done on 185 responses from main study retained 26 items out of 33 items in 7 constructs with 64.9% variance. House officers' first choice of specialty were medical based specialties (40.5%), followed by surgical based specialties (31.5%) and primary care or community health related specialties (14.6%) and acute care-related specialties (13.5%). By multivariate analysis, "age", "health professional in family", "work schedule and personal factors", "career prospects" and “specialty characteristics” were the significant factors associated with specialty choice. Conclusions: The factors influencing the specialty choice vary according to the specialties. The information on house officers' specialty preference and the factors associated with their choice that were identified in this study will provide evidence based information to develop policies to encourage more doctors to specialize in specialties with shortage of doctors and to formulate career specialty guidance. Keywords: house officers, choice of specialist training, specialty, junior doctors