Year : 2020 | Volume
| Issue : 1 | Page : 1-6
Factors impacting anesthesiology residents in Saudi Arabia when they are planning their future
Abdulaleem Alatassi1, Hesham Albabtain2, Aljazi Alrashid2, Maryam Almaidan1, Ahmed Haroun Mahmoud1
1 Department of Pediatric Anesthesia, King Abdullah Specialized Children Hospital, Ministry of the National Guard - Health Affairs; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
2 Department of Anesthesia, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Dr. Ahmed Haroun Mahmoud
Department of Pediatric Anesthesia, King Abdullah Specialized Children Hospital, Ministry of the National Guard - Health Affairs, P.O. Box 22490, Riyadh 11426 MC 1938
Source of Support: None, Conflict of Interest: None
|Date of Submission||15-Feb-2019|
|Date of Decision||08-Mar-2019|
|Date of Acceptance||20-Mar-2019|
|Date of Web Publication||6-Jan-2020|
Purpose: This study is undertaken to examine the factors that influence Saudi Board anesthesia residents' preferences in terms of future practice location, fellowship training, and research.
Methods: A cross-sectional study was conducted. Data on fellowship training, research, and future practice location preferences, as well as demographics, were collected using surveys distributed to all anesthesia residents enrolled at Saudi anesthesiology residency program (N = 302).
Results: A total of 117 residents (38.7%) responded to the survey. Of those 88.5% of residents planned on further subspecializing. The most highly sought fellowships were acute and chronic pain, regional anesthesia, simulation, and pediatric anesthesia. Residents pursuing fellowship training were mostly affected by personal interest, improving employment prospects, and future income. Only 11.5% of residents intended to incorporate research into their next practice—personal interest, employability, and lifestyle were the most influential in their decision.
Conclusion: Most anesthesia residents training in Saudi Arabia choose to pursue fellowship training. However, less than one-fifth have an interest in incorporating research into their future careers.
Keywords: Anesthesia residents; future career; Saudi Arabia
|How to cite this article:|
Alatassi A, Albabtain H, Alrashid A, Almaidan M, Mahmoud AH. Factors impacting anesthesiology residents in Saudi Arabia when they are planning their future. Saudi J Anaesth 2020;14:1-6
|How to cite this URL:|
Alatassi A, Albabtain H, Alrashid A, Almaidan M, Mahmoud AH. Factors impacting anesthesiology residents in Saudi Arabia when they are planning their future. Saudi J Anaesth [serial online] 2020 [cited 2020 Jan 18];14:1-6. Available from: http://www.saudija.org/text.asp?2020/14/1/1/275090
| Introduction|| |
During the years of residency training, residents are faced with a plethora of critical decisions to ponder, namely whether it be further subspecializing by enrolling in a fellowship program; or to pursue a career in academia; and the whereabouts of their future practice among other pivotal future decisions. The determinant factors spring from a range of individual personal and professional goals and needs.
Understanding how the factors are involved in a resident's mind is vital to the planning of the residency program and the development of the curriculum. Harris et al. found out that role models, lifestyle issues, and opportunities for teaching were the most critical factors in making decisions for pediatric residents. In considering the pursuit of subspecialty training, income potential, a scope of practice, and personal factors, such as family time, are the most critical factors that affect internal medicine residents. Lifestyle factors and personal debt influence general surgery residents, whereas desire to acquire specialized skills and prestige affect ophthalmology residents more. Factors that influence career decision-making are multiple, and each specialty has its unique set of considerations in career planning. In the anesthesia resident population of Saudi Arabia, such career altering factors are yet to be adequately examined. Further, data suggest that only a few anesthesia residents go for an academic career., Taking a closer look at how anesthesia residents of Saudi Arabia plan their career will aid in determining the status and shed light on possible factors that may affect their decision to go into research.
This study aims to identify the preferences of anesthesia residents training in Saudi Arabia in subspecialty fellowship training, research, and future practice location and to delineate the factors that influence those preferences.
| Methods|| |
A 10-item questionnaire (available through an online link) was adapted, with some modifications, from a published article after obtaining the approval from its author. It was designed to assess: (1) the demographic data; (2) desire to go for fellowship, subspecialty type, and factors affecting; (3) desire to go for research in future and factors affecting; and (4) choices of practice location in future and influential factors. The target population of the survey was residents training in Saudi anesthesiology residency program. We generated survey item based on factors influential in resident career decision-making identified in the literature.,,,,, We obtained research ethics approval from King Abdullah International Medical Research Center (KAIMRC). We contacted all anesthesia residents (postgraduates from 1st to 5th year) and those currently enrolled in Saudi anesthesiology residency program through emails. We sent them details including the study nature, purpose, study and goals, details about consent, study confidentiality, and a link to the online electronic survey hosted by SurveyMonkey.com. Consent was implied when residents voluntarily accessed the online survey link. All data were secured online and password protected, and only the first author downloaded the data from the online survey tool.
Data responses were summarized using mean (SD) for continuous variables and frequency (percentage) for nominal variables. The survey response rate was calculated using the number of responses divided by the total number of anesthesia residents in Saudi Arabia. On the basis of numbers reported by the Saudi Commission for Health Specialties and with confirmation from contacting the program director, there were 302 anesthesiology residents registered at Saudi anesthesiology residency program. Association with the dichotomous outcomes of wanting to pursue fellowship training or future research was assessed using a multivariable logistic regression model. Independent variables in the model included demographic information (age, gender, medical school, and postgraduate status). Statistical analyses were conducted using SPSS. All tests used an α = 0.05 level of significance.
| Results|| |
A total of 117 residents participated; of which 81 (69.23%) were males, and 36 (30.77%) were females. Of the participants, 80 residents (68.38%) were <30 years of age, and 37 (31.62%) were more than 30 years old. A total of 101 residents (86.32%) have had their medical school in Saudi Arabia, and 16 (13.68%) had their medical school outside Saudi Arabia; 94 participants (80.34%) have obtained their boards, while 23 of them (19.66%) are still in training [Table 1].
A total of 100 participants (88.5%) intended to pursue fellowship, whereas 11.5% intended to pursue future research. Only 20 residents intended to practice inside Saudi Arabia in the future. Most of the residents, 79 (67.52%), have intentions to practice in North America in the future, while 15.38% have intentions to practice in other locations. The summary of location preferences and future is given in [Table 2].
|Table 2: Number of Residents Pursuing fellowship or research and location of future practice|
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Moreover, 68% of residents pursuing fellowships are young less than 30 years old and 72% are males. Also 53.85% of those pursuing future research are males. However, correlation of age and gender to pursuing fellowship or research showed no significant difference. Similarly, 85% of those pursuing fellowships and 92.31% of those pursuing future research had their medical school in Kingdom of Saudi Arabia (KSA) and most of them have already obtained their board. Moreover, still correlation of medical school and level of education to pursuing fellowship or research showed no significant difference [Table 3].
|Table 3: Correlation of independent variables age, gender, medical school, postgraduate status to those pursuing fellowship or future research|
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The findings show that 90% of those planning to work in KSA in the future, and 67.09% of those choosing North America as a future location are males; however, it was not statistically significant (with P value 0.05); 65% of those planning to work in KSA in the future and 70.89% of those choosing North America as a future location is <30 years old; 90% of those planning to work in KSA in future and 84.81% of those choosing North America as a future location have studied medicine in KSA; 85% of those planning to work in KSA in the future and 78.48% of those choosing North America as a future location have already obtained their board, while 15 and 21.52% are still in training [Table 4] and [Figure 1].
|Table 4: Correlation of independent variables age, gender, medical school, postgraduate status to the choice of future location|
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|Figure 1: Correlation of independent variables: age, gender, medical school, postgraduate status to the choice of future location|
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Regional anesthesia (20.5%), acute or chronic pain (20.5%), simulation (11.97%), and pediatric anesthesia (11.97%) were the most common anesthesia fellowships that residents planned to pursue or to which they had submitted applications [Table 5] and [Figure 2].
|Table 5: Anesthesia fellowship training programs that anesthesia residents plan to pursue|
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|Figure 2: Anesthesia fellowship training programs that anesthesia residents plan to pursue|
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Among those deciding to pursue fellowship training, personal interest (94%), enhancing employability (91%), and income potential (87%) were the most common factors influencing this decision [Table 6] and [Figure 3].
|Table 6: Influential factors for residents who decided to pursue fellowship training|
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|Figure 3: Influential factors for residents who decided to pursue fellowship training|
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Moreover, among those deciding to pursue research after residency, personal interest (100%), enhancing employability (84.62%), and lifestyle (84.62%) were the most common factors influencing this decision [Table 7] and [Figure 4].
|Table 7: Influential factors for residents who decided to pursue research after residency|
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|Figure 4: Influential factors for residents who decided to pursue research after residency|
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Although the city or town of practice was the most influential factor (93.16%) in resident's preference for future location overall and those pursuing fellowship (92%) and future research (100%), peers had the least significant effect (65.8%) over all of them. Income potential was the second most influential factor in all respondents (89.7%) and for those pursuing fellowship (91%). Lifestyle was the third influential factor in all respondents (89.7%) and for those pursuing fellowship (89%), but it was the second most influential factor for those pursuing research (92.3%) [Table 8] and [Figure 5].
In the logistic regression model, only male sex (adjusted odds ratio [aOR] 5.07; 95% confidence interval [CI]: 1.06–24.14; P = 0.04) was associated with wanting to practice inside KSA in the future. The odds of choosing KSA for future practice location for males is five times the odds ratios for females [Table 9].
|Table 9: Adjusted odds ratios for factors included in multivariable logistic regression model|
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| Discussion|| |
The present study determined the preferences of Saudi anesthesia residents training inside and outside the KSA for fellowship, research, and future practice location and identified the factors that influence those preferences. A total of 117 residents (38.7%) out of 302 anesthesia residents enrolled at Saudi anesthesiology residency program responded to the survey.
The data gathered demonstrated that the majority (88.5%) of the anesthesia residents are interested in pursuing fellowship training. This has also been reported among general surgery residents, radiology residents, and anesthesia residents elsewhere. However, only 11.5% tended to pursue research in their plans. It was also found that males desire to continue fellowship training (72%) and exceeded females (28%). Many factors were seen in the literature that hinders female students from pursuing their fellowship training. Among those were work stresses, poor control over work environment, and family-related concerns. In contrast, Warner et al. show that females were more likely to pursue advanced fellowship training than males who were more likely to enter private practice positions.
An interesting finding was that both fellowship and research pursuers share the top two influential factors that shape their future career plans. At the forefront was personal interest, which was also seen among Saudi medical students and interns., However, it is believed that attention is not perpetual and could change later in life while the person is exposed to different factors, such as experiences and environmental factors. Enhancing employability was the second most common factor for those desiring to pursue fellowship training and research after residency. Several studies show that acquiring more experience will increase the chance of employability. A study by Dale et al. shows that general practice specialists experienced enhanced employability when completing a one-year fellowship program. Furthermore, fellowship-trained physicians are attracted to an institution, as their subspecialty knowledge can be shared with other faculty members and residents, and they can further expand an already existing subspecialty program. It was noted that academic productivity of anesthesiologist is much less when compared to other disciplines. This situation may provide a competitive advantage for anesthesia residents interested in research.
The four most popular anesthesia subspecialties were acute or chronic pain, regional, simulation, and pediatric. Dedicated acute pain and regional anesthesia services are invaluable in improving acute pain management, which in turn has the potential to improve medical outcomes, enhance patient satisfaction, and reduce costs. Thus, healthcare providers will be encouraged to recruit anesthesiologists trained in such subspecialty. Furthermore, a study by O'Leary and Crawford indicated that subspecialty areas most frequently perceived to require improved training included pediatric cardiac anesthesia, chronic pain medicine, and regional anesthesia. Despite that many studies point out the preference of patients and surgeon for regional anesthetic option, this is not the case seen in Saudi patients (personal communication). An Australian study shows that more patients, especially females, may accept regional anesthesia if reassured appropriately about not hearing or seeing the surgery. Once patients have experienced regional anesthesia, they are more likely to choose it in future.
Most respondents indicated that they prefer to practice outside of Saudi Arabia, specifically in Canada. Interestingly, the logistic regression analysis revealed that only male sex is associated with choosing Saudi Arabia for future practice location. Several factors influence the resident's preference for the next place; among that, the city of practice and lifestyle were prioritized for both fellowship and research pursuers while peers had the least effect. Teaching and research opportunities were the main influential factors for residents pursuing future research, whereas income potential scores second influential factor for residents seeking fellowship. These findings point out that personal interests have an essential role in the career plans of Saudi anesthesia residents.
There are several limitations to the current study. First, the data collected for this investigation may not be representative of all Saudi anesthesia residents since the response rate was only 38.7%, and more than half of the residents were not captured. Second, the number of residents pursuing research was minimal which does not allow any definite conclusions. Third, the subspecialties provided for anesthesia residents inside the Kingdom are limited to pediatric, pain, and cardiac. Thus, the higher number of residents who chose to practice outside may be due to the lack of other subspecialties programs rather than their actual preferences. Fourth, we did not include any contribution of social factors to the result of your study especially for female resident. Fifth, those who got their board, they are not good candidates for our questionnaire; in particular, they had already made their decision about their future career. Finally, the results of our study cannot be generalized as the number of females is limited. In conclusion, the overall findings can be utilized to improve the residency program curriculum and planning the methods of selection which can be of help in addressing the job market needs of the kingdom.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Khan J, Gilbert J, Sharma A, LeManach Y, Yee D. Perspectives of anesthesia residents training in Canada on fellowship training, research, and future practice location. Can J Anesth 2015;62:956-63.
Harris MC, Marx J, Gallagher PR, Ludwig S. General vs subspecialty pediatrics: Factors leading to residents' career decisions over a 12-year period. Arch Pediatr Adolesc Med 2005;159:212-6.
Garibaldi RA, Popkave C, Bylsma W. Career plans for trainees in internal medicine residency programs. Acad Med 2005;80:507-12.
Gedde SJ, Budenz DL, Haft P, Tielsch JM, Lee Y, Quigley HA. Factors influencing career choices among graduating ophthalmology residents. Ophthalmology 2005;112:1247-54.
Schwinn DA, Balser JR. Anesthesiology physician scientists in academic medicine: A wake-up call. Anesthesiology 2006;104:170-8.
Borges NJ, Navarro AM, Grover A, Hoban JD. How, when, and why do physicians choose careers in academic medicine? A literature review. Acad Med 2010;85:680-6.
Arnold RW, Goske MJ, Bulas DI, Benya EC, Ying J, Sunshine JH. Factors influencing subspecialty choice among radiology residents: A case study of pediatric radiology. J Am Coll Radiol 2009;6:635-42.
Borman KR, Vick LR, Biester TW, Mitchell ME. Changing demographics of residents choosing fellowships: Long term data from the American Board of Surgery. J Am Coll Surg 2008;206:782-9.
Kolasinski SL, Bass AR, Kane-Wanger GF, Libman BS, Sandorfi N, Utset T. Subspecialty choice: Why did you become a rheumatologist? Arthritis Rheum 2007;57:1546-51.
Rosenberg TL, Kelley K, Dowdall JR, Replogle WH, Liu JC, Raol NP, et al
. Section for residents and fellows-in-training survey results. Otolaryngol Head Neck Surg 2013;148:582-8.
Mok PS, Probyn L, Finlay K. Factors influencing radiology residents' fellowship training and practice preferences in Canada. Can Assoc Radiol J 2016;67:99-104.
Khan J, Gilbert J, Sharma A, LeManach Y, Yee D. Perspectives of anesthesia residents training in Canada on fellowship training, research, and future practice location. Can J Anaesth 2015;62:956-63.
Gautam M. Women in medicine: Stresses and solutions. West J Med 2001;174:37-41.
Frank E, McMurray JE, Linzer M, Elon L. Career satisfaction of US women physicians: Results from the women physicians' health study. Society of General Internal Medicine Career Satisfaction Study Group. Arch Intern Med 1999;159:1417-26.
Arlow FL, Raymond PL, Karlstadt RG, Croitoru R, Rybicki BA, Sastri SV. Gastroenterology training and career choices: A prospective longitudinal study of the impact of gender and of managed care. Am J Gastroenterol 2002;97:459-69.
Warner NS, Warner MA, Eldrige JS, Datta R, Moeschler SM, Long TR. Factors influencing immediate post-residency career decisions for graduating anesthesiology residents. J Educ Perioper Med 2018;20:E616.
Abdulghani HM, Al-Shaikh G, Alhujayri AK, Alohaideb NS, Alsaeed HA, Alshohayeb IS, et al
. What determines the selection of undergraduate medical students to the specialty of their future careers? Med Teach 2013;35(Suppl 1):S25-30.
Ai-Faris EA, Kalantan K, Al-Nour MB, Ai-Umran K, Ai-Rowais N, Jarallah JS, et al
. Future specialty and practice intentions among Saudi medical students. J Fam Community Med 1996;3:41-9.
] [Full text]
Dale J, Russell R, Harkness F, Wilkie V, Aiello M. Extended training to prepare GPs for future workforce needs: A qualitative investigation of a 1-year fellowship in urgent care. Br J Gen Pract 2017;67:e659-67.
Culley DJ, Fahy BG, Xie Z, Lekowski R, Buetler S, Liu X, et al
. Academic productivity of directors of ACGME-accredited residency programs in surgery and anesthesiology. Anesth Analg 2014;118:200-5.
Tedore T, Weinberg R, Witkin L, Giambrone GP, Faggiani SL, Fleischut PM. Acute pain management/regional anesthesia. Anesthesiol Clin 2015;33:739-51.
O'Leary JD, Crawford MW. Perspectives on Canadian core fellowship training in pediatric anesthesia: A survey of graduate fellows. Can J Anaesth 2015;62:1071-81.
Oldman M, McCartney CJ, Leung A, Rawson R, Perlas A, Gadsden J, et al
. A survey of orthopedic surgeons' attitudes and knowledge regarding regional anesthesia. Anesth Analg 2004;98:1486-90.
Dove P, Gilmour F, Weightman WM, Hocking G. Patient perceptions of regional anesthesia: Influence of gender, recent anesthesia experience, and perioperative concerns. Reg Anesth Pain Med 2011;36:332-5.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]