INTRODUCTION

Choosing a specialists career in medicine is vital for the adequate supply of health professionals in the specialty especially medical doctors.¹ There is a critical lack of manpower of skilled healthcare workers in developing countries within the sub-Saharan Africa region, with Nigeria inclusive.² Due to population growth, new health issues have been discovered which have to be attended to by specially skilled medical professionals and there is an increased burden on health facilities.³ Medical and dental schools are training centres for doctors and dentists who will care for the population, although some may decide to migrate to other countries⁴ and such decisions affect the specialists composition in the country.^4-6 Another issue is that some specialties tend not to be attractive and are chosen by few persons.⁴

Making a specialist career choice in medicine is influenced by many complex factors.^7-9 Some of these factors are affection for the specialty, having a feeling of satisfaction with the chosen specialty, understanding the scope of that particular specialty, parental influence; especially if either of the parents works in that specialty,³ economic factors, the number of years required for training, stress faced in the specialty, risks and occupational hazards associated with the specialty,⁸ expectations by the family, job opportunities, the opportunity of having a personal practice, role models and mentors in the specialty, prestige associated with the specialty, lifestyle and time available for oneself, economic security and number of patients that will be attended to.^6,10 Having mentors and role models at the undergraduate stage affects choosing a specialty for residency training, this also extends to subspecialisation during the residency training. Nigeria is a developing country, trainings in some medical specialties are not yet available in the country and anaesthesiology is a specialty that is both rewarding and challenging.¹¹ From various studies conducted in various parts of the world, anaesthesia has been viewed as not being attractive to both medical students and resident doctors. The choice of medical specialties by new graduate doctors thus add to the burden of poor manpower experienced in anaesthesia.^6,12

In 1967, the training in anaesthesia commenced in West Africa as a diploma and in 1970 as a postgraduate fellowship.¹³ Having subspecialisations in anaesthesia in Nigeria will increase awareness about the specialty to medical students.¹⁴ Hence this study is on the choice of subspecialisation in anaesthesia among anesthesiology resident doctors in two Nigerian hospitals.          

 MATERIALS AND METHODS

This was a cross-sectional study conducted in 2018 among resident doctors in two teaching hospitals in Port Harcourt, Nigeria. Participation in the study was voluntary.

A semi-structured questionnaire divided into four sections was used for the study. Section A on demographics comprised of four questions on age, sex, marital status and hospital ownership’s structure where the anesthesiology resident is working. Section B on professional practice comprised of five questions on the anesthesiology resident cadre/rank at the workplace, the number of years of practicing anaesthesia, if the anaesthesia was practiced before commencing residency training in anaesthesia, highest professional qualification/certification in anaesthesia and if anaesthesia was studied in medical school. Section C had questions related to the choice of anaesthesia as a medical specialty with three questions on the time in medical career when the choice to specialize in anaesthesia was made, an attempt at the primary examination in any of the medical faculties of a postgraduate medical college besides anaesthesia and reasons for choosing anaesthesia for residency. Section D is comprised of seven questions on the choice of anaesthesia subspecialty.

RESULTS

A total of 36 anesthesiology residents in Port Harcourt participated in the study.  Table 1 shows the social demographics of the respondents. Most of the respondents were between the ages of 30-39 years (69.4%, n = 25), 24 (66.7%) were males, 28 (77.8%) were married and 34 (94.4%) worked in a university teaching hospital.

Table 1: Social demographics of the respondents (n=36)

Table 2 shows the professional history of the respondents. This shows that 11 (30.6%) of the respondents were senior house officers, 21 (58.3%) had practiced anaesthesia for 1-5 years, 6(16.7%) practiced anaesthesia before commencing residency and 34 (94.4%) of the respondents studied anaesthesia as an undergraduate.

Table 2: Professional History of the respondents

Table 3 shows the time and reasons for choosing anaesthesia as a medical specialty. 14 (38.9%) of the respondents chose anaesthesia as a specialty after the National Youth Service Corps, 16(44.4%) had written a primary examination and 18 (50%) chose the specialty because of the satisfaction and excitement of working as an anesthesiologist.

Table 3: Time and reasons for choosing anaesthesia

Table 4 shows the results of choosing a subspecialty in anaesthesia. Thirty-five (97.2%) of the respondents will like to subspecialise in anaesthesia, 17 (47.2%) reported that they will be interested in a subspecialty training that is only available abroad even if it is self-sponsored, 21 (58.;3%) are interested in critical care and 17 (47.5%) are interested in anaesthesia because of the available opportunity in Nigeria.

Table 4: Choice of Anesthesia subspecialty

DISCUSSION

It is necessary to have subspecialist anaesthesiologists in Nigeria to administer anaesthesia for the various surgical specialties, but the training for most of these subspecialisations are not available in Nigeria. Some of these subspecialisations in anaesthesia are in cardiothoracic anaesthesia, paediatric anaesthesia, neuroanaesthesia, adult and paediatric intensive care medicine, obstetric anaesthesia, pain medicine and transplant anaesthesia. Though a postgraduate fellowship in some of these anaesthesia subspecialties is not available in Nigeria, 97.2% of residents in this study would like to subspecialise. This high interest in subspecialisation in anaesthesia is similar to a study conducted among anesthesiology residents in Turkey where 21.70% do not desire to subspecialise in anaesthesia.¹⁵ Availability of space for residency did not affect the choice of anaesthesia as a medical specialty by 50% of anesthesiology residents. Availability of sponsorship was key in this study as 52.8% said they were not interested in subspecialisation if the training is not available in Nigeria and training abroad will be self-sponsored. This means a lot of expenditure due to the exchange gap between the Nigerian Naira and foreign currencies. Most of the residents were interested in critical care and obstetric anaesthesia.

Most of the residents have not had any formal training in any anaesthesia subspecialty as only 22.2% had received formal training in an anaesthesia subspecialty. The availability of training opportunities in Nigeria was the reason why the majority will like to subspecialise in anaesthesia. Few residents in this study though have chosen anaesthesia as a medical specialty, did not study anaesthesia in medical school. This may be due to the absence of an anesthesiology department manned by physician anesthesiologists. This may also be the reason why anaesthesia is not attractive to resident doctors as some of them have not been exposed to anaesthesia as a medical specialty in medical school. Some of the respondents who participated in this study were supernumerary resident doctors from other hospitals that either do not have accreditation for residency in anaesthesia or there is no anaesthesia department in their primary place of work.  Various studies have shown that the duration of exposure of medical students during clinical clerkship affects their interest in the specialty.^3,5,11 Hence the short duration of exposure by medical students to anaesthesia rotation in medical school contributes to the lack of interest in the specialty.^9,14 Only 13.9% chose their medical residency specialty while in medical school as the majority of them chose during internship. This is similar to the study by Tyagi et al where 84% of the study population who were anaesthesia students chose their specialty in anaesthesia after internship.¹⁰ There is hope that there will be development in the different subspecialties in anaesthesia to cater and provide the required manpower in anaesthesia and also the different surgical specialties and subspecialties.

CONCLUSION

There is a lack of manpower in anaesthesia in developing countries. This is due to the short duration of anaesthesia rotation during clinical clerkship in medical school and sometimes no exposure at all. Most Nigerian anaesthesia trainees are willing to subspecialise in anaesthesia. However, this is greatly influenced by the availability of sponsorship in the form of bursaries and scholarships, as most of these anaesthesia subspecialty trainings have to be done abroad in developed countries, with a huge financial burden involved. Most of the study population will like to subspecialize in critical care medicine and obstetric anaesthesia.

Limitations

This study was conducted among a small population and the result may be different if a larger population is studied.