1. + The attitude of medical students toward otolaryngology, head and neck surgery Ahmad Alroqi,MBBS,Ahmad Alkurdi,MD,Khalid Almazrou,MD,FAAP Presented By Dr. Ahmad Alroqi The 4th Annual Postgraduate Medical Education Research Day

2. + Background and Objectives The exposure to otolaryngology in medical school curriculum is relatively less compared to other specialties. The aim of this study was to review this attitude toward otolaryngology, head and neck surgery.

3. + Methods This study surveyed medical students from different medical schools within Saudi Arabia during their attendance of medical career day (2010). Participation within this study was completely voluntary, and confidentiality was maintained at all times as no identifying information were recorded in the survey’s results

4. + Students were contacted between teaching sessions and invited to participate in the survey by the study representatives. The questionnaire consisted of 13 closed-ended questions addressed to report the experience and attitudes of Saudi medical students toward post-graduate specialty

5. + The first 5 questions of the survey assessed demographic information and specialty preferences. The next 6 questions were in (agree, disagree and don’t know ) format, and addressed The importance of otolaryngology knowledge in medical practice, Contact between the physician and otolaryngology diseases during practice, and The importance of knowledge and skills in different subspecialties of otolaryngology in general medical practice.

6. + The remaining 4 questions explored The opinion of the medical students regarding best area to study otolaryngology, Best way to improve teaching in otolaryngology in undergraduate, Duration of otolaryngology clerkship in medical school, and Their postgraduate preference if they choose otolaryngology.

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8. + Questionnaire development was self-constructed. The analysis was made using SPSS.

9. + Results The overall response rate of the medical students was 76.22% (343/450). The mean age of the respondents was 22.52 years ranging between 18 and 29 year. Male response was 57.4%, compared to females 42.6%.

10. + The medical students were from different medical schools. The interns represent 7.9%, senior medical student (4 th, 5th and 6 th year) represent 39.8%, junior medical students (1 st, 2 nd, and 3 rd year) were 10.2 %. 6.6% of the medical students reported a primary interest in otolaryngology as a postgraduate career The overall percentage of females interested in otolaryngology is 7.2% compared to 5.7% in males

11. + Out of the medical students who were interested in otolaryngology, 18.2% were interns, whereas 50% were senior medical students There are certain specialties that were preferred by females more than males and vice versa

12. + The percentages of female medical students who choose Obstetrics/gynecology 88.2% (P-value= 0.002) and Dermatology 58.3 % (P-value = 0.774), While, the percentages of males who were interested in Surgery, 69.8%( P-value < 0.0001 ) Ophthalmology, 65.4%( P-value = 0.169 ) Pediatric and, 65%(P-value = 0.081 ) Family medicine were, 55.6%( P-value > 0.9 )

13. + Different specialties preferred by medical students Specialties preferred by medical student Male %Female % (n=343) Surgery42.225.235 Internal medicine17.224.520.2 Pediatric13.510.112.1 Ophthalmology8.96.57.9 Otolaryngology5.77.26.3 Obstetrics and gynecology110.85.1 Emergency medicine4.254.5 Dermatology2.653.6 Family medicine2.62.92.7 Radiology2.12.22.1 Basic science00.70.3

14. + Otolaryngology and medical practice Agree %Disagree %Don’t know % Knowledge in otolaryngology diseases is not necessary in medical practice in general 7.383.69.1 Otolaryngology diseases faces all physician during practice 74.39.316.3 Knowledge and skills of treatment in ear diseases is necessary in medical practice in general 74.31411.7 Knowledge and skills of treatment in nose diseases is necessary in medical practice in general 77.412.610 Knowledge and skills of treatment in head and neck diseases is necessary in medical practice in general 51.93414.1 Knowledge and skills of treatment in larynx diseases is necessary in medical practice in general 46.334.319.4

15. + According to the questionnaire, the best area to study otolaryngology diseases is at Clinics (76.9%) Daily rounds (12%), Lectures in the medical school (7.6%), and Operative rooms (3.5%) The medical students considered that the best way to improve teaching of otolaryngology diseases is by Increasing the training period (60.3%) Adding a mandatory training period during the internship (26.2%), Equalizing the training period with other specialties (13.4%)

16. + Duration of otolaryngology study in medical school The average exposure time to otolaryngology in medical schools was 3.25 weeks (95% CI 3.05-3.45) with those exposed to four weeks or more representing 16.3 % only What is the duration of otolaryngology clerkship in your college % One week 1.7 Two weeks 25.7 Three weeks 30.6 More than three weeks 16.3 No answer 25.7

17. + Preferred residency program if choosing otolaryngology North America was the preferred area for postgraduate residency training program according to 50.2% of the students, followed by local Saudi program 33.4% Preferred otolaryngology residency program % North America 50.2 Local programs 33.4 Europe 10.5 Australia 5.6 Asia 0.3

18. + No clear link was observed between the exposure time to otolaryngology during undergraduate rotations and choosing it as post-graduate career ( P-value = 0.155 ).

19. + Introduction The attitude of medical students toward certain specialty has been studied. Psychiatry was one of the most specialties studied due to the lack of interest as a career in certain countries 1,2, followed by geriatric medicine for the same reason 3,4. Many factors in those studies have been identified to know why medical students choose a certain career and ignore another. Not only the interest of medical students, their feedback about the teaching process has been also included in those studies

20. + Attitude of medical students toward otolaryngology, head and neck surgery had received limited attention in the literature 7. The aim of our study is to explore the attitude of medical students towards the field of otolaryngology, head and neck surgery and to look at the factors that might affect their choice.

21. + Discussion Seventy-eight percent of medical students believed that the main factor influencing their decision to pursue otolaryngology was their exposure to the residents, showing the importance of residents-students relation in directing the students to otolaryngology specialty 7,9. According to Avgerinos 5 et al, the vast majority of students wish to specialize (97.6%), while general practice gathered a very low percentage (1.7%).

22. + Students were asked to rank factors according to their importance in their career choice. The single most important factor was career progression. Other factors include on-call commitment, teachers as role models, and the interest for a particular subject 6.

23. + Fewer females than males were found to consider or choose a surgical career, possibly due to differences in qualities of importance in specialties, availability of role models, and exposure through electives. Our study showed that 25.2% of female medical students were interested in surgical specialties 10.

24. + By looking at the factors affecting medical students in formulating their specialty preferences, the most preferred specialty expressed by male students was general surgery, internal medicine and orthopedics, While the specialty most preferred by female students was obstetrics and gynecology, pediatrics and surgery.

25. + In our study, the three main specialties preferred by male medical students in descending order are Surgery 42.2%, Internal medicine 17.2% and Pediatric 13.5% While in females are Surgery 25.2%, Internal medicine 24.5% and Obstetrics/gynecology 10.8%.

26. + Third year medical students perceive that the most important urological learning environment is outpatient evaluation of patients 12

27. + Although otolaryngologic problems are common in primary care, it has received limited time for teaching in undergraduate medical education 17, 18. In our survey, 78.1% of the medical students spent three weeks or less in the study compared to 21.9% only who had more than three weeks time

28. + A survey of undergraduate otolaryngology experience at Newcastle University Medical School had revealed that 54 % had a formal otolaryngology attachment; 17 % had not attended otolaryngology clinic 42 % had not attended otolaryngology theatre; less than 50 % had seen common otolaryngology operations; 8 % had never heard of a septoplasty 19

29. + The three most common student expectations were to see and learn common ENT operations, to see the anatomy involved and to learn about the disease being operated upon. 60 % of students reported that their expectations had been met. On a Likert scale from 1 (strongly disagree) to 7 (strongly agree), The importance of theatre attendance as part of the curriculum was rated to be 4.7 (95 per cent confidence interval (CI) = 3.7 to 4.2) and The satisfaction of educational needs in operating theatre teaching was rated to be 3.9 (95 per cent CI = 3.7 to 4.2). Students perceived attending otolaryngology theatre sessions to be beneficial 20

30. + In our study 25.7% of the medical students didn’t answer the question about duration of studying otolaryngology during the medical school, this probably because they didn’t have otolaryngology rotation at the time the study was conducted

31. + Conclusions The attitude of medical students toward otolaryngology had received limited attention. This paper explored this issue through a different student levels. Our study showed the limited undergraduate medical education in otolaryngology, head and neck surgery that could get reflected on the career preference. Low percentage of medical students interested in this field, especially at the junior level. We recommend increasing the undergraduate exposure to otolaryngology, head and neck surgery, with more concentration on the operative rooms teaching.

32. + Thank You