Factors Impacting On The Decision Of Graduate Entry Medical School Students To Pursue A Career In Obstetrics And Gynecology in Ireland

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Given well documented staff shortages within obstetrics and gynaecology in Ireland, it is increasingly important to understand the factors which influence medical students to choose or reject a career in the speciality. The aim of this study was to ascertain the perceptions of final year graduate entry medical students of obstetrics and gynaecology, including the factors which may influence a student’s decision to pursue in a career in the speciality. Methods: Paper-based surveys of graduate entry medical students (n = 146) were conducted at the beginning and end of a six week rotation in obstetrics and gynaecology in Ireland. Responses to the surveys pre- and post-rotation were matched and changes in career choices, merits and demerits over time were analysed. All analysis was conducted using SPSS for Windows version 25. Results: The responses of 72 students to both questionnaires could be matched (response rate of 49.3%). No male students expressed an interest in obstetrics, gynaecology or both as a first choice of career in the pre rotation survey. Obstetrics as a first choice of career increased from 6.9% pre rotation to 19.4% post rotation (p=0.04) and this increase was seen in male and female students. Gynaecology as a first choice increased slightly from 1.4% to 4.2% (p=0.50) and the dual speciality increased from 6.9% to 13.9% (p=0.23). Students identified many merits of obstetrics pre-rotation with more than 60% identifying it as exciting, interesting fulfilling and challenging. However, incompatibility with family life was cited as a demerit by 72% of respondents and 68.1% identified fear of litigation as a demerit. Participants were less positive overall about the merits of a career in gynaecology with less than 40% viewing it as exciting, fulfilling, and varied. Conclusions: While respondents were positive about the merits of a career in obstetrics and gynecology, concerns remain about work-life balance, career opportunities, and the high-risk nature of the specialty. These concerns should be addressed by the profession and policy makers if they wish to attract sufficient numbers to address anticipated need in the coming years. Gender differences in speciality choice were also evident. If males are to be recruited into obstetrics and gynaecology, consideration should be given to the positive impact of internship. career obstetrics gynaecology rotation recruitment high-risk work-life balance Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Difficulties in identifying appropriately trained obstetricians and gynecologists have been documented around the world, in countries including the US, Oman, and Saudi Arabia.[ 1 , 2 , 3 , 4 ] Staff shortages can cause existing staff to be overworked and put women and their babies at risk. Mahha et al have recognised this as being a contributory factor in poorer patient outcomes, including the loss of pregnant women and their babies.[ 4 , 5 , 6 ] In Ireland, the shortage of appropriately trained consultant obstetricians and gynaecologists has been acknowledged for many years.[ 7 , 8 , 9 ] Ireland has the lowest number of consultant obstetricians and gynaecologists per 100,000 females amongst wealthy OECD countries [ 7 , 8 ] with 3.6 per 100,000 in Ireland compared to 4.6 in England, 4.7 in Scotland, 6.6 in Australia and 6.2 in New Zealand.[ 7 ] This is compounded by the challenges faced due to retirement in the short to medium term with 40% of consultants in the speciality in Ireland aged 55 years or over. [ 9 ] In a review of consultant needs to 2028 and the training pipeline needed to meet this demand, it was estimated that an increase of 50% in the number of current obstetricians and gynaecologists is required to meet anticipated demand in Ireland. [ 9 ] Retention may also prove to be an issue with a survey of doctors in training working in obstetrics and gynaecology reporting that 71.5% indicated that they had considered leaving the speciality. [ 10 ] There have been mixed messages about workforce demand in the United Kingdom. In 2015 the Centre for Workforce Intelligence reported a 53% increase in the consultant workforce between 2003–2013 and noted that if this continued there would be an oversupply of obstetricians and gynaecologists by 2028, requiring an ‘immediate, substantial and sustained’ reduction in trainee intake.[ 11 ] However in 2017 it was reported that “88% of obstetric units reported difficulties in filling middle-grade rotas”, [ 12 , 13 ] thus suggesting that fears of an oversupply have not been realised and problems with recruitment in this specialty remain. More recently, Ismail and Kevelighan described the speciality as facing a “recruitment crisis with < 1 in 30 of medical school graduates seeking the speciality as their first career choice”.[ 14 ] Recruitment is therefore an issue worthy of consideration by the profession in many jurisdictions, not least because of patient safety concerns. In this context, the attractiveness of the speciality to graduates and the availability of training becomes very significant. Research indicates that the numbers who seek to pursue obstetrics and gynecology as a career are low nationally and internationally.[ 4, 12, 15, 16, 17] A 2012 UK study identified 3.8% of respondents having chosen obstetrics and gynaecology as a career, with 8.7% found to have seriously considered but subsequently rejected the speciality.[ 16 ] The weak interest in the specialty has more recently been evidenced by a study of first year graduate entry medical students in Wales published in 2020, which found that just 4% would consider it as a first option while 61.3% would consider it as a second option, demonstrating the importance of addressing student concerns about the speciality and harnessing their enthusiasm as they complete medical school.[ 12 , 14 ] Difficulties extend beyond recruiting doctors to the speciality, with a recent study by the Royal College of Obstetricians and Gynaecologists raising concerns about high attrition rates from training programmes, specialists retiring early or leaving practice.[ 18 ] Against this backdrop, this study explores the views of graduate entry medical students in Ireland on obstetrics and gynaecology as a career choice for the first time, and the factors which influence their decision on whether to pursue a career in the speciality. Methods University of Limerick Graduate Level Entry Medical School is unique in Ireland as it is the only one of Ireland’s six medical schools to accept only graduate entry students into its four year programme. Medical students are required to complete a six week intensive teaching rotation in obstetrics and gynaecology in their final year in University Maternity Hospital Limerick. University Maternity Hospital Limerick is the sole provider of obstetric, midwifery and neonatology services in the Midwest region. In 2020, there were 4,149 live births. Participants All fourth year graduate entry medical students in the University of Limerick (n = 146, 61% female) were invited to participate at two time points; day one of their rotation and six weeks later, upon completion of their rotation in obstetrics and gynecology in the University Maternity Hospital, Limerick. Measures Two paper-based surveys (a 15 item pre- and 19 item post- rotation questionnaire) were developed by researchers based in the University of Limerick, Ireland. No existing surveys addressed our domains of interest at the time of this study. Design of the survey questionnaire was therefore informed by the literature and some previously validated questions. [ 19 , 20 ] The survey included questions on demographics, views on a career in obstetrics and/or gynaecology, perceived merits and demerits of the specialties, and the impact of the regulatory and medico-legal culture on career choices. Both surveys were broadly similar to allow an exploration of the impact of the rotation on participants. Four additional questions were added to the questionnaire administered after the rotation to capture the full experience on placement. Ethical approval was obtained from the Faculty of Education and Health Sciences Research Ethics Committee at the University of Limerick. A gatekeeper was used to distribute, collect and remove any identifying data before the researchers involved in supervision and grading gained access to it. Statistical Analysis Categorical variables are summarised using counts and percentages. Numeric data was tested for normality and median (range) used for non-normal distributions. McNemar’s test was used to test for differences in paired nominal data pre and post rotation. A 5% level of significance was employed for all statistical tests with no adjustment for multiple testing. All analysis was undertaken using SPSS for Windows Version 25. Results Responses from 72 students (response rate 49%) could be matched pre and post rotation and therefore, only the responses of 72 students were included in the data analysis. The characteristics of these participants are summarised in Table 1 . Table 1 Characteristics of participants (n = 72) 1 Characteristic Frequency (%) Gender Male 24 (33.3%) Female 47 (65.3%) Prefer not to say 1 (1.4%) Age Median (min, max) 26 (24–34) Type of Primary Degree Health Related 51 (71.8%) Non-Health Related 20 (28.2%) Time since obtaining primary degree ≤ 3 years 15 (21.1%) 4–5 years 40 (56.3%) > 5 years 16 (22.5%) 1 Missing data for up to 3 participants for some variables; percentages of valid responses given The majority of participants (65%) identified as female, which is similar to the full cohort (61%). The median age was 26 years (range 24–34 years) and the majority (71.8%) had a primary degree in a health-related discipline. Interest in Obstetrics and/or Gynaecology as a Career generally When asked if they were interested in a career in obstetrics, gynaecology or both, five (6.9%) participants identified obstetrics as their first choice pre rotation, with 12 (16.7%) identifying it as a second choice. Gynaecology was less attractive with just one (1.4%) and six (8.3%) participants interested in it as a first or second choice respectively. Five (6.9%) were interested in the dual specialism as a first choice, and eight (11.1%) were interested in it as a second choice. No male students expressed an interest in obstetrics, gynaecology or both as a first choice of career in the pre rotation survey. Interest amongst this cohort in a career in obstetrics, gynaecology or both as a first choice increased following the rotation. The biggest increase was for obstetrics as a first choice (6.9–19.4%, p = 0.04) and this increase was seen in male and female students (Table 2 ). Gynaecology as a first choice increased slightly from 1.4–4.2% (p = 0.50) and the dual speciality increased from 6.9–13.9% (p = 0.23). Table 2 Interest in obstetrics, gynaecology or both as a first choice of career by gender and pre and post rotation Obstetrics Gynaecology Both Pre Post Pre Post Pre Post 1st choice (% Total) 5 (6.9%) 14 (19.4%) 1 (1.4%) 3 (4.2%) 5 (6.9%) 10 (13.9%) Female (% Female) 5 (10.6%) 11 (23.4%) 1 (2.1%) 3 (6.4%) 5 (10.6%) 9 (19.1%) Male (% Male) 0 (0%) 3 (12.5%) 0 (0%) 0 (0%) 0 (0%) 1 (4.2%) Merits of a career in obstetrics Participants identified many merits of a career in obstetrics pre rotation, with the majority viewing it as exciting (65.3%), interesting (77.8%), fulfilling (77.8%), and challenging (66.7%). Additionally, a minority viewed obstetrics as varied (41.7%) and/or having good training and career opportunities (25%). Figure 1 shows the perception of each merit pre and post rotation. The percentage who perceived the career as exciting, challenging, rewarding, varied and having good training and career opportunities increased post rotation but there were decreases in the percentage who perceived it as interesting or fulfilling. The biggest change was in the percentage of participants who viewed it as a challenging career, increasing from 66.7% pre rotation to 79.2% post rotation. Merits of a career in gynaecology Participants were less positive overall about the merits of a career in gynaecology pre rotation with just 15.3% viewing it as exciting, 36.1% as fulfilling, 36.1% as varied, 41.7% viewed it as challenging and 19.4% identifying training/career as a merit of the specialty before their rotation. Figure 2 shows the perception of each merit pre and post rotation. The percentage who perceived the career as exciting, challenging, interesting and having good training and career opportunities increased post rotation but there were decreases in the percentage who perceived it as rewarding or fulfilling. The biggest change was in the percentage of participants who viewed it as a challenging career, increasing from 41.7% pre rotation to 55.6% post rotation. Demerits of a career in obstetrics Data was also collected on the perception of participants of the demerits of a career in obstetrics or gynaecology. Pre rotation participants viewed obstetrics as demanding (56.9%), stressful (55.6%), having long hours/being incompatible with family life (72.2%) and high risk (50%) while 68.1% identified a fear of litigation as a demerit. Interestingly, only 5.6% viewed the speciality as boring, 11.1% as narrow and 4.2% as broad. Figure 3 shows the perception of each demerit pre and post rotation. Percentages for all demerits increased post rotation with the biggest increase for the perception of a demanding career, increasing from 56.9% pre rotation to 69.4% post rotation. Demerits of a career in gynaecology The demerits of gynaecology were less obvious with a minority viewing it as demanding (27.8%), boring (33.3%), stressful (27.8%), having long hours/being incompatible with family life (22.2%), high risk (19.4%), narrow (34.7%), broad (4.2%) while 36.1% identified a fear of litigation as a demerit. Figure 4 shows the perception of each demerit pre and post rotation. Changes pre and post were small (< 10%) with the biggest change for fear of litigation decreasing from 36.1% pre rotation to 26.4% post rotation. Factors impacting on the decision to pursue a career in OBGYN The factors that may impact a participant’s decision to pursue a career in obstetrics and/or gynaecology more specifically were also explored. It is clear that the intensity of the workload is a factor in the decision to pursue a career in obstetrics with 64.3% of participants indicating that they were somewhat or to a great extent influenced by this factor compared to 46.4% for gynaecology. A minority of participants (45%) indicated that having to pursue both obstetrics and gynaecology impacted on their decision to pursue obstetrics somewhat or to a great extent, compared with 40% in relation to gynaecology. The results show similar patterns pre and post rotation. Discussion Despite very positive perceptions about the merits of a career in obstetrics, just five (6.9%) participants identified obstetrics as their first choice pre rotation. Gynaecology was less attractive with just one (1.4%) interested in it as a first choice. However, both obstetrics and/or gynaecology became more attractive as a first choice post rotation, with obstetrics more than doubling in popularity to 19.4% and 13.9% interested in the dual specialism of obstetrics and gynaecology as a first choice. Interest in gynaecology only as a first choice, while increasing from a very low base, remained low at 4.2%, demonstrating a clear preference amongst students for obstetrics. [ 14 ] These figures are significantly higher than international comparators. A survey conducted in Switzerland showed that 5.9% of fourth year residents were interested in a career in Obstetrics and Gynaecology. [ 21 ] Large scale studies conducted in the UK from 1975–2005 demonstrated a decline in obstetrics and gynaecology as a first choice in the 1990s “from 4.2% of 1996 qualifiers to 2.2% of 1999 qualifiers”. [ 17 ] Subsequent studies identified the speciality as “the first choice of career for 5.7% of post-2002 graduates in year 1, 4.3% in year 3 and 3.8% in year 5.” [ 12 ] In two studies of graduate entry medical students in Wales published in 2014 and 2020, Ismail and Kevelighan found that 4% and 3.9% would consider the speciality as first career choice respectively. [ 14 , 20 ] The low interest levels in obstetrics and gynaecology internationally are a concern given the need to increase recruitment into the specialism(s) and leads to considerations of why the speciality is not more attractive. In an Irish context, the increased interest post-rotation is encouraging, placing us in a better position than colleagues internationally to meet future demand and leading to considerations of the availability of training opportunities to meet demand amongst this cohort. The results of this research echo previous national and international findings which indicate that individuals identifying as female are more likely to be interested in the speciality.[ 4 ] Interestingly, individuals identifying as male were more likely to pursue this specialism post-rotation. This is reflective of the positive impact of the rotation on perceptions of obstetrics and gynaecology more generally, highlighting that students “can be persuaded to reconsider obstetrics and gynecology as a future career”. [ 4 , 20 ] Continued exposure to the specialism will therefore be vital to recruitment efforts in the future. [ 20 ] The factors impacting upon the popularity of obstetrics are varied, with work life balance an oft-cited concern, including almost 80% of the respondents to this survey who viewed obstetrics as having long hours and/or being incompatible with family life post rotation. 62.5% of respondents to our survey indicated that the intensity of the workload is a factor in the decision of whether to pursue a career in obstetrics and 44.4% when contemplating gynaecology. O’Sullivan notes that, the speciality is “traditionally perceived as a “lifestyle unfriendly”. [ 22 ] Stokes et al suggest that it is highly likely that “controllable lifestyle is at the forefront for many trainees” in obstetrics and gynaecology. [ 23 ] A 2010 study of over 600 medical students in Australia found obstetrics and gynaecology ranked second from the bottom of 19 specialities in terms of lifestyle friendliness.[ 24 ] In a study of specialities which were seriously considered by doctors but subsequently rejected published in 2012, work life balance was the most oft cited reason for rejecting obstetrics and gynaecology.[ 16 ] So while the merits of obstetrics and gynaecology are appreciated by medical students, concerns around work life balance must be addressed if the speciality is to meet future staffing demands. Just one third of respondents considered career opportunities and training to be a merit of obstetrics or gynaecology post rotation. This is an issue which should be addressed given previous research which indicated that poor career prospects was a significant factor in the rejection of obstetrics and gynaecology as a career. [ 16 , 25 ] As Turner et al note, “[t]he unwillingness of young doctors to enter obstetrics and gynaecology may be attributable to concerns about workforce planning and career progression problems, rather than any lack of enthusiasm for the specialty.” [ 17 ] This is something which should be considered, including why men felt less positive about career prospects and training opportunities and what steps can and should be taken to correct this. Conclusions With an aging workforce and already understaffed service, Ireland faces serious challenges to recruit and retain young doctors in obstetrics and gynaecology. As has been previously discussed, this challenge is not unique to Ireland. It is therefore critical to understand how the speciality is viewed amongst medical students and the challenges it faces in recruiting the next generation of obstetricians and gynaecologists. This research provides new insights into the factors which influence the decision of graduate entry medical students to pursue or reject a career in the speciality. In doing so, it provides insights into the decision-making process of graduate doctors for the first time in an Irish context, whilst contributing to the international debates on this topic. Information of this nature will help encourage an understanding of barriers to increased recruitment and retention in obstetrics and gynaecology. Declarations i. Ethical Approval and consent to participate Ethical approval was obtained from the Faculty of Education and Health Sciences Research Ethics Committee at the University of Limerick (Number 2018_09_14_EHS). All methods were carried out in accordance with relevant guidelines and regulations. Informed consent was obtained from all subjects ii. Consent to Publication Not applicable iii. Data Availability statement The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. iv. Conflict of interest Not applicable. v. Funding Funding was received from the School of Medicine at the University of Limerick to support this research. vi. Acknowledgment The authors would like to acknowledge the support received from the University of Limerick School of Medicine and final year students in the School of Medicine to conduct this research. vii. Author contribution Dr. Eimear Spain conceived the idea, wrote the main manuscript text, conducted the analysis, critically reviewed and edited the manuscript, and approved the final version. Dr. Mary Tumelty wrote the main manuscript text, conducted the analysis, critically reviewed and edited the manuscript, and approved the final version. Prof. Hannigan interpreted data, conducted the analysis, critically reviewed and edited the manuscript, and approved the final version. Dr. Cinnamond coded, interpreted and analysed data and approved the final version. Dr. Cheema facilitated the collection of data, coded data and approved the final version. Prof. Amanda Cotter conceived the idea, facilitated collection of data, critically reviewed and edited the manuscript, and approved the final version. References Gibbons JM Jr. Springtime for obstetrics and gynecology: will the specialty continue to blossom? Obstet Gynecol. 2003;102(3):443–5. Al Salehi A, Al Dughaishi T, Rizvi G, Gowri V. Obstetrics and gynaecology as a future career for medical graduates in Oman: Factors that attract and discourage graduates. Sultan Qaboos Univ Med J. 2019;19:e58–62. Abu-Rafea BF, Al-Hassan BF, Al Nakshabandi KA, Rahbini NO, Al-Shaikh GK. Factors influencing students’ decision in choosing obstetrics and gynecology as a career in a university hospital in Central Saudi Arabia. Saudi Med J. 2011;32:730–4. Mahha AJ, Abutaleb AA, Madkhali AM, Hakami MM, Jelan NS, Hakami RH. Saudi medical students' views on obstetrics and gynecology as a future career specialty. J Family Med Prim Care. 2020 Feb 28;9(2):859–863. doi: 10.4103/jfmpc.jfmpc_974_19 . Eine Donnellan I, Times 14. th 2010 available at https://www.irishtimes.com/news/doctor-warns-about-staff-shortages-1.650439 HSE REPORT into the circumstances pertaining to the death of Mrs Tania McCabe and her infant son Zach at Our Lady of Lourdes Hospital, Drogheda on Friday 9. March, 2007, Final Report 27-03-2008. Available at https://static.rasset.ie/documents/news/report-into-maternal-and-child-death-at-our-lady-of-lourdes-hospital.pdf . Turner. Consultant workforce planning for obstetrics and gynaecology in the Republic of Ireland 2012–2022. Available at https://www.hse.ie/eng/about/who/acute-hospitals-division/woman-infants/national-reports-on-womens-health/consultant-workforce-planning-for-obgyn-in-ireland-2012-2022.pdf National Clinical Programme, Obstetrics and Gynaecology, Consultant Workforce Planning. 2015 Supplementary Report https://rcpi- live-cdn.s3.amazonaws.com/wp-content/uploads/2018/04/Consultant-Workforce-Planning-Supplement-June-2015.pdf HSE, National Doctors Training &, Planning, Demand For Medical Consultants And Specialists To. 2028 And The Training Pipeline To Meet Demand: A High Level Stakeholder Informed Analysis, 2020 https://www.hse.ie/eng/staff/leadership-education-development/met/plan/demand-for-medical-consultants-and-specialists-to-2028-november-updates-v2.pdf] McCarthy CM, et al. Medicine, media and the law: The effect on training in Obstetrics and Gynaecology. Eur J Obstet Gynecol Reprod Biol. 2021;257:35–41. Centre for Workforce Intelligence. Securing the future workforce supply. Obstetrics and gynaecology stocktake. London: Centre for Workforce Intelligence; 2015. Lambert TW, Smith F, Goldacre MJ. Career choices for obstetrics and gynaecology: recent updates from 40 years of national surveys of UK medical graduates. JRSM Open October. 2019. 10.1177/2054270419861611;./ . NMPA Project Team. National Maternity and Perinatal Audit: organisational report 2017. London: The Royal College of Obstetricians and Gynaecologists; 2017. Ismail S, Kevelighan EH. A questionnaire survey of first-year graduate-entry medical students’ perception of obstetrics and gynaecology as a future career speciality. J Obstet Gynaecol. 2020;40(3):354–9. https://doi.org/10.1080/01443615.2019.1634021 . Stokes JE, Shanahan IM. R.K. Sarkar Factors Influencing Career Choices of Medical Students in Obstetrics and Gynaecology Ir Med J;Vol 114 ; No. 10 ; P493 Goldacre MJ, Goldacre R, Lambert TW. Doctors who considered but did not pursue specific clinical specialties as careers: questionnaire surveys. J R Soc Med. 2012;105(4):166–76. 10.1258/jrsm.2012.110173 . Turner G, Lambert TW, Goldacre MJ, Barlow D. Career choices for obstetrics and gynaecology: national surveys of graduates of 1974–2002 from UK medical schools. BJOG. 2006;113:350–6. The Royal College of Obstetricians and Gynaecologists. Obstetrics and Gynaecology workforce report 2018. London: The Royal College of Obstetricians and Gynaecologists; 2018. Morgan H. How can recruitment be improved in obstetrics and gynaecology? The Obstetrician & Gynaecologist. 2011;13. 10.1576/toag.13.3.175.27670 . Ismail SIMF, Kevelighan EH. Graduate medical students' perception of obstetrics and gynaecology as a future career specialty. J Obstet Gynaecol. 2014;34:341–5. Buddeberg-Fischer B, Klaghofer R, Abel T, Buddeberg C. Swiss residents' speciality choices-impact of gender, personality traits, career motivation and life goals. BMC Health Serv Res. 2006;6:137. O'Sullivan S. 2020. The challenges facing recruitment and retention of doctors in obstetrics and gynaecology in Ireland. MD Thesis, University College Cork Stokes JE, Shnahan IM, Sarkar RK. Factors influencing Career Choices of Medical Students in Obstetrics and GynaecologyIr Med J114 (10)493 Creed PA, Searle J, Rogers ME. Medical specialty prestige and lifestyle preferences for medical students. Soc Sci Med. 2010;71:1084–8. [PubMed] [Google Scholar]. Lambert TW, Davidson JM, Evans J, Goldacre MJ. Doctors' reasons for rejecting initial choices of specialties as long-term careers. Med Educ. 2003;37:312–8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 19 Jun, 2023 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Major revision 02 Mar, 2023 Reviews received at journal 28 Feb, 2023 Reviewers agreed at journal 28 Feb, 2023 Reviewers invited by journal 28 Feb, 2023 Editor assigned by journal 28 Feb, 2023 Editor invited by journal 06 Feb, 2023 Submission checks completed at journal 06 Feb, 2023 First submitted to journal 13 Jan, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Cork","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mary","middleName":"","lastName":"Tumelty","suffix":""},{"id":173847849,"identity":"3b46133d-555f-4fd7-b20d-e06fb945d41c","order_by":2,"name":"Ailish Hannigan","email":"","orcid":"","institution":"University of Limerick","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ailish","middleName":"","lastName":"Hannigan","suffix":""},{"id":173847850,"identity":"371b4530-8baa-4dd0-b2cf-98e8217787a5","order_by":3,"name":"Kaitlyn Cinnamond","email":"","orcid":"","institution":"University Hospital Limerick","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kaitlyn","middleName":"","lastName":"Cinnamond","suffix":""},{"id":173847851,"identity":"5eddef8e-361f-4054-8d95-5bada47717fc","order_by":4,"name":"Ayesha Cheema","email":"","orcid":"","institution":"Nottingham University Hospitals NHS Trust","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ayesha","middleName":"","lastName":"Cheema","suffix":""},{"id":173847852,"identity":"e2d93668-6df9-419b-969e-8ab1f8ba3473","order_by":5,"name":"Amanda Cotter","email":"","orcid":"","institution":"University Maternity Hospital Limerick","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Amanda","middleName":"","lastName":"Cotter","suffix":""}],"badges":[],"createdAt":"2023-01-13 17:14:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2475999/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2475999/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-023-04425-8","type":"published","date":"2023-06-19T21:17:37+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":32662827,"identity":"8b984ae4-225f-4fc8-b426-1213c894c423","added_by":"auto","created_at":"2023-02-08 18:50:31","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":5978,"visible":true,"origin":"","legend":"\u003cp\u003ePerceptions of merits of a career in obstetrics pre and post rotation (n=72)\u003c/p\u003e","description":"","filename":"Onlinedrawingimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-2475999/v1/d67967452d33e59ba819bfc3.png"},{"id":32663093,"identity":"1cc24c8d-a476-4c44-b563-06c0231cc800","added_by":"auto","created_at":"2023-02-08 18:58:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":5693,"visible":true,"origin":"","legend":"\u003cp\u003ePerceptions of merits of a career in gynaecology pre and post rotation (n=72)\u003c/p\u003e","description":"","filename":"Onlinedrawingimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-2475999/v1/74523dd5e7a8dcf51adc0f1e.png"},{"id":32662826,"identity":"4cc84985-9579-46ec-aec9-6201eb1805d1","added_by":"auto","created_at":"2023-02-08 18:50:31","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":6840,"visible":true,"origin":"","legend":"\u003cp\u003ePerceptions of demerits of a career in obstetrics pre and post rotation (n=72)\u003c/p\u003e","description":"","filename":"Onlinedrawingimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-2475999/v1/047ce08afd29b79ebade976d.png"},{"id":32662828,"identity":"682bfaf3-6c0c-4389-915f-95ec74c05037","added_by":"auto","created_at":"2023-02-08 18:50:31","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":6853,"visible":true,"origin":"","legend":"\u003cp\u003ePerceptions of demerits of a career in obstetrics pre and post rotation (n=72)\u003c/p\u003e","description":"","filename":"Onlinedrawingimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-2475999/v1/defec1e5958f77e49554df37.png"},{"id":44731433,"identity":"1bbe4a3b-76d0-4b0f-9ba8-bc4a70fdb79f","added_by":"auto","created_at":"2023-10-16 21:43:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":343151,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2475999/v1/c9674595-8ef8-460d-b509-1a42a122c2f7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors Impacting On The Decision Of Graduate Entry Medical School Students To Pursue A Career In Obstetrics And Gynecology in Ireland","fulltext":[{"header":"Background","content":"\u003cp\u003eDifficulties in identifying appropriately trained obstetricians and gynecologists have been documented around the world, in countries including the US, Oman, and Saudi Arabia.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Staff shortages can cause existing staff to be overworked and put women and their babies at risk. Mahha et al have recognised this as being a contributory factor in poorer patient outcomes, including the loss of pregnant women and their babies.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] In Ireland, the shortage of appropriately trained consultant obstetricians and gynaecologists has been acknowledged for many years.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Ireland has the lowest number of consultant obstetricians and gynaecologists per 100,000 females amongst wealthy OECD countries [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] with 3.6 per 100,000 in Ireland compared to 4.6 in England, 4.7 in Scotland, 6.6 in Australia and 6.2 in New Zealand.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] This is compounded by the challenges faced due to retirement in the short to medium term with 40% of consultants in the speciality in Ireland aged 55 years or over. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] In a review of consultant needs to 2028 and the training pipeline needed to meet this demand, it was estimated that an increase of 50% in the number of current obstetricians and gynaecologists is required to meet anticipated demand in Ireland. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Retention may also prove to be an issue with a survey of doctors in training working in obstetrics and gynaecology reporting that 71.5% indicated that they had considered leaving the speciality. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThere have been mixed messages about workforce demand in the United Kingdom. In 2015 the Centre for Workforce Intelligence reported a 53% increase in the consultant workforce between 2003\u0026ndash;2013 and noted that if this continued there would be an oversupply of obstetricians and gynaecologists by 2028, requiring an \u0026lsquo;immediate, substantial and sustained\u0026rsquo; reduction in trainee intake.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] However in 2017 it was reported that \u0026ldquo;88% of obstetric units reported difficulties in filling middle-grade rotas\u0026rdquo;, [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] thus suggesting that fears of an oversupply have not been realised and problems with recruitment in this specialty remain. More recently, Ismail and Kevelighan described the speciality as facing a \u0026ldquo;recruitment crisis with \u0026lt;\u0026thinsp;1 in 30 of medical school graduates seeking the speciality as their first career choice\u0026rdquo;.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Recruitment is therefore an issue worthy of consideration by the profession in many jurisdictions, not least because of patient safety concerns.\u003c/p\u003e \u003cp\u003eIn this context, the attractiveness of the speciality to graduates and the availability of training becomes very significant. Research indicates that the numbers who seek to pursue obstetrics and gynecology as a career are low nationally and internationally.[ 4, 12, 15, 16, 17] A 2012 UK study identified 3.8% of respondents having chosen obstetrics and gynaecology as a career, with 8.7% found to have seriously considered but subsequently rejected the speciality.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] The weak interest in the specialty has more recently been evidenced by a study of first year graduate entry medical students in Wales published in 2020, which found that just 4% would consider it as a first option while 61.3% would consider it as a second option, demonstrating the importance of addressing student concerns about the speciality and harnessing their enthusiasm as they complete medical school.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Difficulties extend beyond recruiting doctors to the speciality, with a recent study by the Royal College of Obstetricians and Gynaecologists raising concerns about high attrition rates from training programmes, specialists retiring early or leaving practice.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAgainst this backdrop, this study explores the views of graduate entry medical students in Ireland on obstetrics and gynaecology as a career choice for the first time, and the factors which influence their decision on whether to pursue a career in the speciality.\u003c/p\u003e "},{"header":"Methods","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003cp\u003eUniversity of Limerick Graduate Level Entry Medical School is unique in Ireland as it is the only one of Ireland\u0026rsquo;s six medical schools to accept only graduate entry students into its four year programme. Medical students are required to complete a six week intensive teaching rotation in obstetrics and gynaecology in their final year in University Maternity Hospital Limerick. University Maternity Hospital Limerick is the sole provider of obstetric, midwifery and neonatology services in the Midwest region. In 2020, there were 4,149 live births.\u003c/p\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003cp\u003eAll fourth year graduate entry medical students in the University of Limerick (n\u0026thinsp;=\u0026thinsp;146, 61% female) were invited to participate at two time points; day one of their rotation and six weeks later, upon completion of their rotation in obstetrics and gynecology in the University Maternity Hospital, Limerick.\u003c/p\u003e \u003cp\u003eMeasures\u003c/p\u003e \u003cp\u003eTwo paper-based surveys (a 15 item pre- and 19 item post- rotation questionnaire) were developed by researchers based in the University of Limerick, Ireland. No existing surveys addressed our domains of interest at the time of this study. Design of the survey questionnaire was therefore informed by the literature and some previously validated questions. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] The survey included questions on demographics, views on a career in obstetrics and/or gynaecology, perceived merits and demerits of the specialties, and the impact of the regulatory and medico-legal culture on career choices. Both surveys were broadly similar to allow an exploration of the impact of the rotation on participants. Four additional questions were added to the questionnaire administered after the rotation to capture the full experience on placement.\u003c/p\u003e \u003cp\u003e Ethical approval was obtained from the Faculty of Education and Health Sciences Research Ethics Committee at the University of Limerick. A gatekeeper was used to distribute, collect and remove any identifying data before the researchers involved in supervision and grading gained access to it.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eCategorical variables are summarised using counts and percentages. Numeric data was tested for normality and median (range) used for non-normal distributions. McNemar\u0026rsquo;s test was used to test for differences in paired nominal data pre and post rotation. A 5% level of significance was employed for all statistical tests with no adjustment for multiple testing. All analysis was undertaken using SPSS for Windows Version 25.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eResponses from 72 students (response rate 49%) could be matched pre and post rotation and therefore, only the responses of 72 students were included in the data analysis. The characteristics of these participants are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of participants (n\u0026thinsp;=\u0026thinsp;72)\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (65.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrefer not to say\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (min, max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (24\u0026ndash;34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of Primary Degree\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth Related\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (71.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Health Related\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (28.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime since obtaining primary degree\u003c/b\u003e\u003ca class=\"FNLink\" href=\"#Fn1\" id=\"#FNLinkFn1\"\u003e\u003c/a\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (56.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (22.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003csup\u003e1\u003c/sup\u003eMissing data for up to 3 participants for some variables; percentages of valid responses given\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe majority of participants (65%) identified as female, which is similar to the full cohort (61%). The median age was 26 years (range 24\u0026ndash;34 years) and the majority (71.8%) had a primary degree in a health-related discipline.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eInterest in Obstetrics and/or Gynaecology as a Career generally\u003c/h2\u003e \u003cp\u003eWhen asked if they were interested in a career in obstetrics, gynaecology or both, five (6.9%) participants identified obstetrics as their first choice pre rotation, with 12 (16.7%) identifying it as a second choice. Gynaecology was less attractive with just one (1.4%) and six (8.3%) participants interested in it as a first or second choice respectively. Five (6.9%) were interested in the dual specialism as a first choice, and eight (11.1%) were interested in it as a second choice. No male students expressed an interest in obstetrics, gynaecology or both as a first choice of career in the pre rotation survey.\u003c/p\u003e \u003cp\u003eInterest amongst this cohort in a career in obstetrics, gynaecology or both as a first choice increased following the rotation. The biggest increase was for obstetrics as a first choice (6.9\u0026ndash;19.4%, p\u0026thinsp;=\u0026thinsp;0.04) and this increase was seen in male and female students (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Gynaecology as a first choice increased slightly from 1.4\u0026ndash;4.2% (p\u0026thinsp;=\u0026thinsp;0.50) and the dual speciality increased from 6.9\u0026ndash;13.9% (p\u0026thinsp;=\u0026thinsp;0.23).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInterest in obstetrics, gynaecology or both as a first choice of career by gender and pre and post rotation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eObstetrics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eGynaecology\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePre\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePost\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st choice\u003c/p\u003e \u003cp\u003e(% Total)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (19.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10 (13.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003e(% Female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (23.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (19.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003e(% Male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eMerits of a career in obstetrics\u003c/h2\u003e \u003cp\u003eParticipants identified many merits of a career in obstetrics pre rotation, with the majority viewing it as exciting (65.3%), interesting (77.8%), fulfilling (77.8%), and challenging (66.7%). Additionally, a minority viewed obstetrics as varied (41.7%) and/or having good training and career opportunities (25%).\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the perception of each merit pre and post rotation. The percentage who perceived the career as exciting, challenging, rewarding, varied and having good training and career opportunities increased post rotation but there were decreases in the percentage who perceived it as interesting or fulfilling. The biggest change was in the percentage of participants who viewed it as a challenging career, increasing from 66.7% pre rotation to 79.2% post rotation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eMerits of a career in gynaecology\u003c/h2\u003e \u003cp\u003eParticipants were less positive overall about the merits of a career in gynaecology pre rotation with just 15.3% viewing it as exciting, 36.1% as fulfilling, 36.1% as varied, 41.7% viewed it as challenging and 19.4% identifying training/career as a merit of the specialty before their rotation. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the perception of each merit pre and post rotation. The percentage who perceived the career as exciting, challenging, interesting and having good training and career opportunities increased post rotation but there were decreases in the percentage who perceived it as rewarding or fulfilling. The biggest change was in the percentage of participants who viewed it as a challenging career, increasing from 41.7% pre rotation to 55.6% post rotation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eDemerits of a career in obstetrics\u003c/h2\u003e \u003cp\u003eData was also collected on the perception of participants of the demerits of a career in obstetrics or gynaecology. Pre rotation participants viewed obstetrics as demanding (56.9%), stressful (55.6%), having long hours/being incompatible with family life (72.2%) and high risk (50%) while 68.1% identified a fear of litigation as a demerit. Interestingly, only 5.6% viewed the speciality as boring, 11.1% as narrow and 4.2% as broad. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the perception of each demerit pre and post rotation. Percentages for all demerits increased post rotation with the biggest increase for the perception of a demanding career, increasing from 56.9% pre rotation to 69.4% post rotation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eDemerits of a career in gynaecology\u003c/h2\u003e \u003cp\u003eThe demerits of gynaecology were less obvious with a minority viewing it as demanding (27.8%), boring (33.3%), stressful (27.8%), having long hours/being incompatible with family life (22.2%), high risk (19.4%), narrow (34.7%), broad (4.2%) while 36.1% identified a fear of litigation as a demerit. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the perception of each demerit pre and post rotation. Changes pre and post were small (\u0026lt;\u0026thinsp;10%) with the biggest change for fear of litigation decreasing from 36.1% pre rotation to 26.4% post rotation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eFactors impacting on the decision to pursue a career in OBGYN\u003c/h2\u003e \u003cp\u003eThe factors that may impact a participant\u0026rsquo;s decision to pursue a career in obstetrics and/or gynaecology more specifically were also explored. It is clear that the intensity of the workload is a factor in the decision to pursue a career in obstetrics with 64.3% of participants indicating that they were somewhat or to a great extent influenced by this factor compared to 46.4% for gynaecology. A minority of participants (45%) indicated that having to pursue both obstetrics and gynaecology impacted on their decision to pursue obstetrics somewhat or to a great extent, compared with 40% in relation to gynaecology. The results show similar patterns pre and post rotation.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eDespite very positive perceptions about the merits of a career in obstetrics, just five (6.9%) participants identified obstetrics as their first choice pre rotation. Gynaecology was less attractive with just one (1.4%) interested in it as a first choice. However, both obstetrics and/or gynaecology became more attractive as a first choice post rotation, with obstetrics more than doubling in popularity to 19.4% and 13.9% interested in the dual specialism of obstetrics and gynaecology as a first choice. Interest in gynaecology only as a first choice, while increasing from a very low base, remained low at 4.2%, demonstrating a clear preference amongst students for obstetrics. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThese figures are significantly higher than international comparators. A survey conducted in Switzerland showed that 5.9% of fourth year residents were interested in a career in Obstetrics and Gynaecology. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] Large scale studies conducted in the UK from 1975\u0026ndash;2005 demonstrated a decline in obstetrics and gynaecology as a first choice in the 1990s \u0026ldquo;from 4.2% of 1996 qualifiers to 2.2% of 1999 qualifiers\u0026rdquo;. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] Subsequent studies identified the speciality as \u0026ldquo;the first choice of career for 5.7% of post-2002 graduates in year 1, 4.3% in year 3 and 3.8% in year 5.\u0026rdquo; [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] In two studies of graduate entry medical students in Wales published in 2014 and 2020, Ismail and Kevelighan found that 4% and 3.9% would consider the speciality as first career choice respectively. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] The low interest levels in obstetrics and gynaecology internationally are a concern given the need to increase recruitment into the specialism(s) and leads to considerations of why the speciality is not more attractive. In an Irish context, the increased interest post-rotation is encouraging, placing us in a better position than colleagues internationally to meet future demand and leading to considerations of the availability of training opportunities to meet demand amongst this cohort.\u003c/p\u003e \u003cp\u003eThe results of this research echo previous national and international findings which indicate that individuals identifying as female are more likely to be interested in the speciality.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Interestingly, individuals identifying as male were more likely to pursue this specialism post-rotation. This is reflective of the positive impact of the rotation on perceptions of obstetrics and gynaecology more generally, highlighting that students \u0026ldquo;can be persuaded to reconsider obstetrics and gynecology as a future career\u0026rdquo;. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] Continued exposure to the specialism will therefore be vital to recruitment efforts in the future. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe factors impacting upon the popularity of obstetrics are varied, with work life balance an oft-cited concern, including almost 80% of the respondents to this survey who viewed obstetrics as having long hours and/or being incompatible with family life post rotation. 62.5% of respondents to our survey indicated that the intensity of the workload is a factor in the decision of whether to pursue a career in obstetrics and 44.4% when contemplating gynaecology. O\u0026rsquo;Sullivan notes that, the speciality is \u0026ldquo;traditionally perceived as a \u0026ldquo;lifestyle unfriendly\u0026rdquo;. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] Stokes et al suggest that it is highly likely that \u0026ldquo;controllable lifestyle is at the forefront for many trainees\u0026rdquo; in obstetrics and gynaecology. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] A 2010 study of over 600 medical students in Australia found obstetrics and gynaecology ranked second from the bottom of 19 specialities in terms of lifestyle friendliness.[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] In a study of specialities which were seriously considered by doctors but subsequently rejected published in 2012, work life balance was the most oft cited reason for rejecting obstetrics and gynaecology.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] So while the merits of obstetrics and gynaecology are appreciated by medical students, concerns around work life balance must be addressed if the speciality is to meet future staffing demands.\u003c/p\u003e \u003cp\u003eJust one third of respondents considered career opportunities and training to be a merit of obstetrics or gynaecology post rotation. This is an issue which should be addressed given previous research which indicated that poor career prospects was a significant factor in the rejection of obstetrics and gynaecology as a career. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] As Turner et al note, \u0026ldquo;[t]he unwillingness of young doctors to enter obstetrics and gynaecology may be attributable to concerns about workforce planning and career progression problems, rather than any lack of enthusiasm for the specialty.\u0026rdquo; [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] This is something which should be considered, including why men felt less positive about career prospects and training opportunities and what steps can and should be taken to correct this.\u003c/p\u003e "},{"header":"Conclusions","content":"\u003cdiv id=\"Sec12\" type=\"Conclusion\" class=\"Section2\"\u003e \u003cp\u003eWith an aging workforce and already understaffed service, Ireland faces serious challenges to recruit and retain young doctors in obstetrics and gynaecology. As has been previously discussed, this challenge is not unique to Ireland. It is therefore critical to understand how the speciality is viewed amongst medical students and the challenges it faces in recruiting the next generation of obstetricians and gynaecologists. This research provides new insights into the factors which influence the decision of graduate entry medical students to pursue or reject a career in the speciality. In doing so, it provides insights into the decision-making process of graduate doctors for the first time in an Irish context, whilst contributing to the international debates on this topic. Information of this nature will help encourage an understanding of barriers to increased recruitment and retention in obstetrics and gynaecology.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003ei. Ethical Approval and consent to participate\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Faculty of Education and Health Sciences Research Ethics Committee at the University of Limerick (Number 2018_09_14_EHS). All methods were carried out in accordance with relevant guidelines and regulations. Informed consent was obtained from all subjects\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eii. Consent to Publication\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eiii. Data Availability statement\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eiv. Conflict of interest\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ev. Funding\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFunding was received from the School of Medicine at the University of Limerick to support this research.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003evi. Acknowledgment\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge the support received from the University of Limerick School of Medicine and final year students in the School of Medicine to conduct this research.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003evii. Author contribution\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDr. Eimear Spain conceived the idea, wrote the main manuscript text, conducted the analysis, critically reviewed and edited the manuscript, and approved the final version. Dr. Mary Tumelty wrote the main manuscript text, conducted the analysis, critically reviewed and edited the manuscript, and approved the final version. Prof. Hannigan interpreted data, conducted the analysis, critically reviewed and edited the manuscript, and approved the final version. Dr. Cinnamond coded, interpreted and analysed data and approved the final version. Dr. Cheema facilitated the collection of data, coded data and approved the final version. Prof. Amanda Cotter conceived the idea, facilitated collection of data, critically reviewed and edited the manuscript, and approved the final version.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGibbons JM Jr. Springtime for obstetrics and gynecology: will the specialty continue to blossom? Obstet Gynecol. 2003;102(3):443\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl Salehi A, Al Dughaishi T, Rizvi G, Gowri V. Obstetrics and gynaecology as a future career for medical graduates in Oman: Factors that attract and discourage graduates. Sultan Qaboos Univ Med J. 2019;19:e58\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbu-Rafea BF, Al-Hassan BF, Al Nakshabandi KA, Rahbini NO, Al-Shaikh GK. Factors influencing students\u0026rsquo; decision in choosing obstetrics and gynecology as a career in a university hospital in Central Saudi Arabia. Saudi Med J. 2011;32:730\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahha AJ, Abutaleb AA, Madkhali AM, Hakami MM, Jelan NS, Hakami RH. Saudi medical students' views on obstetrics and gynecology as a future career specialty. J Family Med Prim Care. 2020 Feb 28;9(2):859\u0026ndash;863. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/jfmpc.jfmpc_974_19\u003c/span\u003e\u003cspan address=\"10.4103/jfmpc.jfmpc_974_19\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEine Donnellan I, Times 14. th 2010 available at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.irishtimes.com/news/doctor-warns-about-staff-shortages-1.650439\u003c/span\u003e\u003cspan address=\"https://www.irishtimes.com/news/doctor-warns-about-staff-shortages-1.650439\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHSE REPORT into the circumstances pertaining to the death of Mrs Tania McCabe and her infant son Zach at Our Lady of Lourdes Hospital, Drogheda on Friday 9. March, 2007, Final Report 27-03-2008. Available at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://static.rasset.ie/documents/news/report-into-maternal-and-child-death-at-our-lady-of-lourdes-hospital.pdf\u003c/span\u003e\u003cspan address=\"https://static.rasset.ie/documents/news/report-into-maternal-and-child-death-at-our-lady-of-lourdes-hospital.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurner. Consultant workforce planning for obstetrics and gynaecology in the Republic of Ireland 2012\u0026ndash;2022. Available at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.hse.ie/eng/about/who/acute-hospitals-division/woman-infants/national-reports-on-womens-health/consultant-workforce-planning-for-obgyn-in-ireland-2012-2022.pdf\u003c/span\u003e\u003cspan address=\"https://www.hse.ie/eng/about/who/acute-hospitals-division/woman-infants/national-reports-on-womens-health/consultant-workforce-planning-for-obgyn-in-ireland-2012-2022.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Clinical Programme, Obstetrics and Gynaecology, Consultant Workforce Planning. 2015 Supplementary Report https://rcpi-\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003elive-cdn.s3.amazonaws.com/wp-content/uploads/2018/04/Consultant-Workforce-Planning-Supplement-June-2015.pdf\u003c/span\u003e\u003cspan address=\"http://live-cdn.s3.amazonaws.com/wp-content/uploads/2018/04/Consultant-Workforce-Planning-Supplement-June-2015.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHSE, National Doctors Training \u0026amp;, Planning, Demand For Medical Consultants And Specialists To. 2028 And The Training Pipeline To Meet Demand: A High Level Stakeholder Informed Analysis, 2020 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.hse.ie/eng/staff/leadership-education-development/met/plan/demand-for-medical-consultants-and-specialists-to-2028-november-updates-v2.pdf]\u003c/span\u003e\u003cspan address=\"https://www.hse.ie/eng/staff/leadership-education-development/met/plan/demand-for-medical-consultants-and-specialists-to-2028-november-updates-v2.pdf]\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcCarthy CM, et al. Medicine, media and the law: The effect on training in Obstetrics and Gynaecology. Eur J Obstet Gynecol Reprod Biol. 2021;257:35\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCentre for Workforce Intelligence. Securing the future workforce supply. Obstetrics and gynaecology stocktake. London: Centre for Workforce Intelligence; 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLambert TW, Smith F, Goldacre MJ. Career choices for obstetrics and gynaecology: recent updates from 40 years of national surveys of UK medical graduates. JRSM Open October. 2019. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/2054270419861611;./\u003c/span\u003e\u003cspan address=\"10.1177/2054270419861611;./\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNMPA Project Team. National Maternity and Perinatal Audit: organisational report 2017. London: The Royal College of Obstetricians and Gynaecologists; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsmail S, Kevelighan EH. A questionnaire survey of first-year graduate-entry medical students\u0026rsquo; perception of obstetrics and gynaecology as a future career speciality. J Obstet Gynaecol. 2020;40(3):354\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/01443615.2019.1634021\u003c/span\u003e\u003cspan address=\"10.1080/01443615.2019.1634021\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStokes JE, Shanahan IM. R.K. Sarkar Factors Influencing Career Choices of Medical Students in Obstetrics and Gynaecology\u003cem\u003eIr Med J;Vol 114\u003c/em\u003e; \u003cem\u003eNo. 10\u003c/em\u003e;\u003cem\u003eP493\u003c/em\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoldacre MJ, Goldacre R, Lambert TW. Doctors who considered but did not pursue specific clinical specialties as careers: questionnaire surveys. J R Soc Med. 2012;105(4):166\u0026ndash;76. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1258/jrsm.2012.110173\u003c/span\u003e\u003cspan address=\"10.1258/jrsm.2012.110173\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurner G, Lambert TW, Goldacre MJ, Barlow D. Career choices for obstetrics and gynaecology: national surveys of graduates of 1974\u0026ndash;2002 from UK medical schools. BJOG. 2006;113:350\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Royal College of Obstetricians and Gynaecologists. Obstetrics and Gynaecology workforce report 2018. London: The Royal College of Obstetricians and Gynaecologists; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorgan H. How can recruitment be improved in obstetrics and gynaecology? The Obstetrician \u0026amp; Gynaecologist. 2011;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1576/toag.13.3.175.27670\u003c/span\u003e\u003cspan address=\"10.1576/toag.13.3.175.27670\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsmail SIMF, Kevelighan EH. Graduate medical students' perception of obstetrics and gynaecology as a future career specialty. J Obstet Gynaecol. 2014;34:341\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuddeberg-Fischer B, Klaghofer R, Abel T, Buddeberg C. Swiss residents' speciality choices-impact of gender, personality traits, career motivation and life goals. BMC Health Serv Res. 2006;6:137.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO'Sullivan S. 2020. The challenges facing recruitment and retention of doctors in obstetrics and gynaecology in Ireland. MD Thesis, University College Cork\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStokes JE, Shnahan IM, Sarkar RK. Factors influencing Career Choices of Medical Students in Obstetrics and GynaecologyIr Med J114 (10)493\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCreed PA, Searle J, Rogers ME. Medical specialty prestige and lifestyle preferences for medical students. Soc Sci Med. 2010;71:1084\u0026ndash;8. [PubMed] [Google Scholar].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLambert TW, Davidson JM, Evans J, Goldacre MJ. Doctors' reasons for rejecting initial choices of specialties as long-term careers. Med Educ. 2003;37:312\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"career, obstetrics, gynaecology, rotation, recruitment, high-risk, work-life balance","lastPublishedDoi":"10.21203/rs.3.rs-2475999/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2475999/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eBackground:\u003c/em\u003e Challenges in recruiting appropriately trained obstetricians and gynaecologists have been identified across the world. Given well documented staff shortages within obstetrics and gynaecology in Ireland, it is increasingly important to understand the factors which influence medical students to choose or reject a career in the speciality. The aim of this study was to ascertain the perceptions of final year graduate entry medical students of obstetrics and gynaecology, including the factors which may influence a student’s decision to pursue in a career in the speciality.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMethods:\u003c/em\u003e Paper-based surveys of graduate entry medical students (n = 146) were conducted at the beginning and end of a six week rotation in obstetrics and gynaecology in Ireland. Responses to the surveys pre- and post-rotation were matched and changes in career choices, merits and demerits over time were analysed. All analysis was conducted using SPSS for Windows version 25.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eResults:\u003c/em\u003e The responses of 72 students to both questionnaires could be matched (response rate of 49.3%). No male students expressed an interest in obstetrics, gynaecology or both as a first choice of career in the pre rotation survey. Obstetrics as a first choice of career increased from 6.9% pre rotation to 19.4% post rotation (p=0.04) and this increase was seen in male and female students. Gynaecology as a first choice increased slightly from 1.4% to 4.2% (p=0.50) and the dual speciality increased from 6.9% to 13.9% (p=0.23).\u003c/p\u003e\n\u003cp\u003eStudents identified many merits of obstetrics pre-rotation with more than 60% identifying it as exciting, interesting fulfilling and challenging. However, incompatibility with family life was cited as a demerit by 72% of respondents and 68.1% identified fear of litigation as a demerit. Participants were less positive overall about the merits of a career in gynaecology with less than 40% viewing it as exciting, fulfilling, and varied.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConclusions:\u003c/em\u003eWhile respondents were positive about the merits of a career in obstetrics and gynecology, concerns remain about work-life balance, career opportunities, and the high-risk nature of the specialty. These concerns should be addressed by the profession and policy makers if they wish to attract sufficient numbers to address anticipated need in the coming years. Gender differences in speciality choice were also evident. If males are to be recruited into obstetrics and gynaecology, consideration should be given to the positive impact of internship.\u003c/p\u003e","manuscriptTitle":"Factors Impacting On The Decision Of Graduate Entry Medical School Students To Pursue A Career In Obstetrics And Gynecology in Ireland","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-02-08 18:50:26","doi":"10.21203/rs.3.rs-2475999/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-03-02T10:27:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-02-28T21:19:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"da4e0266-17be-4a88-baa9-5b8c22428d1d","date":"2023-02-28T19:35:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-02-28T11:44:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-02-28T11:32:49+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-02-06T17:12:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-02-06T17:10:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2023-01-13T17:10:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"439b71d0-b2c8-460a-9fe2-b22aeafd0d6e","owner":[],"postedDate":"February 8th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T21:28:06+00:00","versionOfRecord":{"articleIdentity":"rs-2475999","link":"https://doi.org/10.1186/s12909-023-04425-8","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2023-06-19 21:17:37","publishedOnDateReadable":"June 19th, 2023"},"versionCreatedAt":"2023-02-08 18:50:26","video":"","vorDoi":"10.1186/s12909-023-04425-8","vorDoiUrl":"https://doi.org/10.1186/s12909-023-04425-8","workflowStages":[]},"version":"v1","identity":"rs-2475999","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2475999","identity":"rs-2475999","version":["v1"]},"buildId":"GqpaHPwrfC8PjnIFayRh5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}