Hrev_master [page 30] [Healthcare in Low-resource Settings 2021; 9:9710] Attitude of the first year medical students towards medicine as career: Motivations and apprehensions of being a doctor Saurabh Sharma,1 Pawan Parashar,2 Chandra Mohan,3 Alka Singh,2 Sartaj Ahmad4 1Medical Education Unit; 2Department of Community Medicine, Subharti Medical College, Meerut; 3Department of Cardiology, Himalayan Institute of Cardiology, Dehradun; 4Medical Sociology, Department of Community Medicine, Subharti Medical College, Meerut, India Abstract The choice of a career as a doctor is a complex personal decision influenced by a multitude of factors. These include family background, role models, media, and per- sonal experiences. The present study was done with the objectives to know the rea- sons for first-year medical students for join- ing MBBS and their apprehensions. A cross-sectional study carried out among first-year students of batch 2018, 2019, and 2020 of a Medical College of North India. The data was collected within 10 days of admission in MBBS. A total of 278 students were given pre-designed and pre-validated questionnaire after informed consent. Out of multiple reasons for being doctor respect in society was the largest, i.e. 83%, while 72% joined because of high earning by the doctor. More than 80% had a professional image of the doctor as a calm, helping and well-groomed person, while 60% thought doctors don’t listen properly, and 57% had a perception that doctors are not much con- cerned about the problems of patient. Sixty- eight percent (68%) thought media doesn’t portray a good image of doctors. According to students outrage in the community and lack of trust for doctors were the major rea- sons for violence against doctors. Munnabhai MBBS, Anand and Patch Adams, Sanjeevani and House MD were the movies and series motivated most students to be a doctor. Respect in society was the prime motivator to be a doctor among stu- dents still they feel media doesn’t justify the image of doctors. Movies and television series can be used to keep the students high in morale and excitement. Introduction There are more than 76928 MBBS (Bachelor of Medicine and Bachelor of Surgery) seats in 532 Medical Colleges in India for pursuing the MBBS course. This is not enough as India is yet to achieve the World Health Organization (WHO) recom- mended the doctor-patient ratio. Medicine is still not the first choice for students of this era. The perspective of the students and the rationale for choosing a particular career are of great importance for councilors around the world.1-2 The students have many career options and thus they may feel confused what to choose. The decision process may involve many aspects like personal interest, peer pressure, self-motivation, financial reasons etc.3 A career in medicine is unique as it is believed to be very virtuous providing a chance to serve humanity more than any other career.4 Many factors affect the choice of medicine as career and career choices are influenced both by the graduate’s inclina- tion before starting medical school as well as any exposure during training in medical school.5-6 These include gender and residen- cy conditions e.g. part-time work and parental leave availability, family back- ground, parent’s socioeconomic status, prestige, income and role models, control- lable lifestyle versus non controllable lifestyle, local market forces committed relationship and the of employment avail- ability.7-12 The final choice results from an inte- grated interplay between external and inter- nal factors of the prime motivation of med- ical students by asking students about the personal reasons for being a doctor.13 A reflective analysis of doctor s’ rea- sons for entering medicine found five main factors being good in science stream, ambi- tion of being a doctor, wanting a good inter- esting career, influenced by friends and relations, and desire to serve community.14 Sometimes possible motivations fall into conflict. Serving people and doing sci- entific research are both admirable motiva- tions, but very often both activities cannot be carried out at the same time requiring a decision as to which is the more important for a particular doctor.15 Considering all these aspects the pres- ent study has been undertaken with the objectives to assess the reasons for joining MBBS. Students were also questioned about the image of a doctor in mind devel- oped because of their personal experience and media before joining medical school because by this we will come to know by what mindset they entered medical school and can work to correct the same. Materials and Methods The present study was a cross-sectional study and it has been carried out among first-year students of a Medical College of Swami Vivekanand Subharti University, sit- uated in Northern part of India. A total of 278 students were given a pre-designed and Healthcare in Low-resource Settings 2021; volume9:9710 Correspondence: Alka Singh, Department of Community Medicine, Subharti Medical College, Subhartipuram, NH-58, Delhi- Haridwar, Meerut Bypass Rd, Meerut, Uttar Pradesh 250005, Meerut, India. E-mail: alkasingh24593@gmail.com Key words: Medical students; attitude; career; motivation; media and movies. Acknowledgements: The Authors acknowl- edge the respondents who had truly given their views and participated openly regarding ques- tions asked by them on different aspects of choosing the career. Contributions: SS, PP, AS: research idea, design, data collection, data analysis, manu- script writing; CM: research idea, design, data collection, manuscript writing; SA: research idea, design, data analysis, manuscript writ- ing. Conflict of interest: The authors declare no conflict of interest. Availability of data and materials: All data generated or analyzed during this study are included in this published article. Ethics approval and consent to participate: The Ethics Committee of INSTITUTION approved this study (SMC/IEC/2018/189). The study is conformed with the Helsinki Declaration of 1964, as revised in 2013, con- cerning human and animal rights. All partici- pants in this study signed a written informed consent form for participating in this study. Informed consent: Written informed consent was obtained from a legally authorized repre- sentative(s) for anonymized patient informa- tion to be published in this article. Received for publication: 27 February 2021. Revision received: 19 November 2021. Accepted for publication: 19 November 2021. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2021 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2021; 9:9710 doi:10.4081/hls.2021.9710 pre-validated questionnaire. The question- naire was designed after reviewing previ- ously published content about the similar topic5-12 and after a thorough discussion among the research team members. The face validity of questionnaire was done by distributing the questionnaire to senior medical faculty after explaining them the intent of the study. They were then asked to evaluate whether the questions effectively capture the topic under investigation and whether the questionnaire was free of con- fusing or leading questions. Later a pilot study was done on 30 medical students other than those who would have been par- ticipating in the study, and retrospective approach with verbal probes were used to test and validate it. The questionnaire included gender, age, presence of doctors in the family and the questions regarding rea- sons for choosing a medical school, profes- sional image of doctors they have in mind influenced by their personal experience and media. The questionnaire had multiple- choice (multiple options allowed) and open- ended questions. The study was done from April 2018 to Feb 2021.All the 278 students (88 students in 2018, 83 students in 2019, and 107 in 2020) present on the day of data collection were given questionnaire and everyone responded. Informed consent was taken from the students. Data entry and analysis were done by using Microsoft excel and the chi-square test of association was used. Results The present study was conducted among 278 students in the first year of col- lege. Among them, 65% and 35% were males and females respectively. In the study, only 28.9% of students have at least one member of the family who is a doctor and lives in the same household. Table 1 shows the reasons for the choice of medi- cine as a career among students. Table 2 shows the professional image of doctors among students by their personal experi- ences in interactions with doctors. Figure 1 shows the view of students regarding the media putting the correct image of doctors in public. Figure 2 shows the causes of vio- lence against doctors as perceived by stu- dents. Table 3 shows the list of movies/series, which most inspired the stu- dents to be a doctor. There was no statistical Article Table 1. Reasons behind the choice of medicine as career among students (N=278). Reasons (multiple options chosen) Percentage (%) Frequency Passion for this profession 47 130 Respect in society 83 230 Parents’ choice 41 114 Monetary benefits 72 200 Others 7 19 Table 2. Professional image of doctors among students (n=278). Professional Image Positive Number (%) Negative Number (%) Behavior Calm 85 Arrogant 15 Nature Helping 80 Non helping 20 Dressing Well dressed 68 Clumsily dressed 32 Grooming Well Groomed 90 Badly Groomed 10 Communicator Soft spoken 66 Harsh 34 Listener Patient Listener 40 Non Listener 60 Empathy Pacifier 43 Not Concerned 57 Table 3. Movies/series which inspired stu- dents most to be a doctor. Sr no Name of the Movies/ TV Serials 1 Munabhai MBBS 2 Anand 3 Patch Adams 4 Awakenings 5 Contagion 6 Sanjeevani (series) 7 Kabirsingh 8 Bhoolbhulaiya 9 House MD 10 Sherlock Holmes 11 The Good Doctor 12 Kahaan hum kahaan tum (series) 13 Savitridevi college and hospital 14 Kyonki its fate Figure 1. Students views media portraying good image of doctors. Figure 2. According to students reasons of violence against doctors. [Healthcare in Low-resource Settings 2021; 9:9710] [page 31] [page 32] [Healthcare in Low-resource Settings 2021; 9:9710] difference observed among students of 2018, 2019, and 2020 batch regarding their attitude and motivation towards being a doctor (χ2-2.5, p-0.27). When both the gen- ders were compared regarding their attitude and motivation towards being a doctor the difference was not found to be statistically significant (χ2-7.9, p-0.094). Discussion Medical education in India is regulated by National Medical Commission (NMC). As per NMC guidelines, undergraduate medical education includes 4.5 years of col- lege and 1 year of compulsory rotatory internship. The first year is of premedical subjects while from the second year onwards there are clinical rotations in the wards along with theory lectures. Undergraduate students are assessed by term exams and final university exams for 4 phases, which includes both theory and practical exam. Practical exams happen after every clinical rotation. In 2019 NMC launched AETCOM (Attitude, Ethics and Communication Module) and Foundation course to enhance the prospect of human dignity and welfare in medical education. Post-graduation (MD/MS) lasts three years. The study was done on first-year undergrad- uate medical students in the first month of joining the course as by this time these stu- dents are not influenced by the environment in Medical College and express the percep- tions and views close to those of a layman non-medical person. Twenty-eight percent (28.9%) of stu- dents had medical background and they have seen the life of doctors in their family, so their views may not match with that of the students who were first doctors in their family. Eighty-three percent (83%) of the stu- dents have chosen medicine because they have seen very high respect for doctors in society. This finding matches with a sys- temic review by Sonu Goel et al.16 where it was observed that the main reason in upper- middle-income countries was respect for themselves and social and professional sta- tus. Forty-seven percent (47%) of the stu- dents joined because they love the profes- sion the result is close to 61% which was observed in the study done by Seetharaman and Logaraj17 in South India. Self-interest was found to be the main reason for 82.6% of the students in a study done by Jothula.18 In a systemic review by Sonu Goel et al.16 interest in science and medicine was the reason for joining medical studies in most of the high-income countries. Forty- one percent (41%) of the students in our study chose this profession because of the pressure by parents and they were not inter- ested in the stream, while in their studies Seetharaman and Logaraj17 and Jothula18 found parental wish or pressure to be 53% and 26.6% respectively; 72% in our study sought monetary benefits for choosing a profession in comparison of 44% and 54% of Jothula18 and Seetharaman and Logaraj17 respectively. Usually in childhood or young age, a person gets inspired to be in a profession by observing someone successful in that pro- fession or a role model. In our study, we asked for the professional image of the doc- tor to get an idea of the mindset with which they are joining the medical school. In our study behavior, nature, dressing, grooming, communication, and empathy were consid- ered and results show most of the students had a positive professional image of doctors except for two aspects (being a good listen- er and empathy). Only 40% of students have seen a doctor being good listener and 43% felt they have empathy. Empathy to students was described as an intellectual quality that permits an understanding of the experience, concerns, and perspectives of a patient, as well as the skill to communicate that understanding. The students should be taught about the importance of empathy to be a successful doctor.19 Discussion about empathy among stu- dents regularly becomes more important after it was found in multiple researches that clinical empathy level declines while getting more experienced and older.20-24 Media these days play a big role in shaping the thought process of a person so the image of doctors shown in media may affect the decision of a student to pick med- icine as a career. Sixty-eight percent (68%) of students were of the opinion that media portray a bad image of doctors and most of the things in media create a bad image of doctors. In their opinion, this has an impact on a lack of trust among patients and doc- tors and thus could be one of the reasons for violence against doctors. In an article, Gupta25 expressed that in India an important factor responsible for assault against doc- tors is the unpleasant image of medical pro- fessionals projected by the media, leading to the general belief that doctors exploit patient’s distress to mint money. Violence against doctors has been reported from all over the world, with negative media reports about hospitals and doctors, out-of-pocket medical expenditures by the patients, and lack of trust in doctors and hospitals have been reported to be some of the causative factors.26-27 Fictional diseases and treatments are rare to occur, but when extraordinary themes are repeated many times they become routine in the general person’s view. So people come to expect either won- der or tragedy, whereas, in reality, both are unusual.28 The disparity between fictional and actual medical accounts can influence patients’ perceptions of physicians’ ability to find a solution. News about violence for the people of profession students aspires to be in for whole life creates fear among stu- dents and 63% of students had the percep- tion that every doctor has to go through these types of incidences at least once in their professional life. According to the view of students while media generally play a bad plot for doctors there are some movies and television series, which creates a very good image of doctors and inspired the students to be a doctor. Some of these are Munnabhai MBBS, Anand, Sanjeevani (series), Kabirsingh, Bhoolbhulaiya, House MD, Sherlock Holmes, The good doctor, Kahaan hum kahaan tum (series), Savitri Devi college and hospital, Kyonki its fate, Patch ADAMS, Awakenings, Contagion, etc. This aspect can be used further to educate med- ical students on various aspects of humanity and profession. Movies are increasingly being used to educate students about many of the essential values of the medical pro- fession.29 Movies may address various con- sequences of disease such as suffering, emotions, social conflicts, and ethical dilemmas.30 Movies have been used as teaching-learning aids in diverse subjects/areas such as microbiology, phar- macology, medical ethics, doctor-patient relationship, clinical research, mental ill- ness, and professionalism among others.31 Conclusions Students enter medical school with high enthusiasm and expect to have a good repu- tation in society as doctors. 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