Abstract
OBJECTIVE: The selection of medical specialties by medical students (MS) and factors shaping their decisions represent critical determinants of the medical workforce landscape, warranting in-depth exploration. In many countries, infectious diseases (ID) fail to be acknowledged as a satisfying specialty. Furthermore, the shortage of ID specialists has become a critical challenge in China's healthcare system. Therefore, we undertook a survey to investigate MS' specialty preference, especially their interests in ID, and the determinants influencing their decision-making processes. METHODS: We recruited the fifth, sixth, and seventh year MS to carry out this investigation. Initially, 10 semi-structured interviews were conducted to gather qualitative insights. Subsequently, 117 participants completed a questionnaire. RESULTS: In the qualitative study of 10 MS, motivations for medical school included personal interest (6/10) and a desire to help others (5/10). All planned to practice medicine post-graduation, with intended specialties mainly surgery (5/10) and internal medicine (4/10); key career choice factors were specialty interest (9/10) and job availability (4/10). All were unfamiliar with ID, with limited exposure to ID. None intended to pursue ID careers, primarily due to greater interest in other specialties (10/10), plus concerns like occupational exposure (2/10). In the quantitative study of 117 participants, the majority of MS applied for medical school based on personal interests (76.9%), and most (88.9%) intended to practice medicine after graduation. Internal Medicine (31.6%) and Surgery (24.8%) were the most popular first-choice specialties, with work-life balance (82.1%), interest in the specialty (81.2%), and expected income (70.9%) being the top factors influencing specialty choice. Notably, only 6.8% of MS expressed interest in pursuing a career in ID, while 48.7% reported no interest. The primary reasons for disinterest included concerns about occupational exposure, lack of inherent interest in ID, and limited procedural opportunities. Multivariate logistic regression analysis identified the overall evaluation of the ID curriculum as the sole factor associated with MS' lack of interest in ID (OR 0.376, 95% CI 0.188-0.754, P=0.006). CONCLUSION: In our study, MS showed limited interest in becoming ID specialists. To enhance the appeal of the ID specialty, efforts could focus on training students on occupational safety and protection, improving the quality of ID-related courses, and optimizing career incentives. These strategies might help increase MS' interest in ID and contribute to a more balanced medical workforce.