A total of 1256 medical students responded to the questionnaire of which 1236 responses were complete translating to a response rate of 98.4%. Most of the respondents were male students (64.1%) while the mean age of participants was 23 years (range 18–24 years) and a standard deviation of 1.2. The survey was completed by medical students from 6 Zambian medical schools, including Copperbelt University School of Medicine (51.6%), Lusaka Apex Medical University (12.5%), University of Zambia School of Medicine (24.0%), University of Lusaka School of Medicine (7.1%), Eden University School of Medicine (2.8%) and Levy Mwanawasa Medical University (1.6%). Three hundred and eighty-four (31.1%) of the respondents were in their 5th year of study, and 1,020 participants stated that they spent at least a semester/term learning neuroanatomy, neuroscience, or neurophysiology (Table 1).
Table 1
Socio-demographic characteristics of the subjects
Demographics
|
Values
|
Total Number of Respondents
|
1256
|
Complete Responses
|
1236 (Response Rate: 98.4%)
|
Gender Distribution:
Male
Female
|
64.1%
35.9%
|
Mean Age of Participants
|
23 years
|
Age Range
|
18–24 years
|
Age Standard Deviation
|
1.2
|
Medical Schools Represented:
Copperbelt University School of Medicine
Lusaka Apex Medical University
University of Zambia School of Medicine
University of Lusaka School of Medicine
Eden University School of Medicine
Levy Mwanawasa Medical University
|
51.6%
12.5%
24.0%
7.1%
2.8%
1.6%
|
Academic Year:
5th Year
Others (Years 3, 4, 6, 7 etc.)
|
31.1%
68.9%
|
Participants with Neuroanatomy/Neuroscience Education:
Yes (At least a semester/term)
No (Not specified)
|
82.5%
17.5% of 1236
|
Table 2 below presents the results regarding the factors contributing to the perception of neurology and neurosurgery as difficult subjects among participants. Respondents were asked to express their level of agreement with various statements. The responses are categorized into five levels: "Strongly Disagree," "Disagree," "Neutral," "Agree," and "Strongly Agree."
Table 2
Factors contributing to neurology or neurosurgery being perceived as a difficult subject.
Item
|
Strongly Disagree
|
Disagree
|
Neutral
|
Agree
|
Strongly Agree
|
Difficulty of neuroanatomy
|
69
|
159
|
297
|
495
|
216
|
Neurology or neurosurgery is difficult
|
98
|
166
|
350
|
430
|
192
|
There isn't enough teaching
|
108
|
202
|
302
|
357
|
267
|
It is badly taught
|
142
|
242
|
504
|
244
|
104
|
The difficulty is attributed to the need to know basic neurosciences
|
100
|
140
|
396
|
398
|
202
|
Insufficient knowledge of the students about neurology/neurosurgery
|
61
|
131
|
191
|
529
|
324
|
Separation of basic sciences teaching and clinical application
|
51
|
129
|
444
|
383
|
229
|
There is limited exposure to neurological patients
|
59
|
85
|
194
|
572
|
326
|
Complex clinical examination
|
114
|
85
|
317
|
493
|
227
|
A large number of diagnoses
|
72
|
79
|
365
|
491
|
229
|
Limited treatments
|
107
|
156
|
397
|
421
|
155
|
Poor prognosis
|
95
|
96
|
289
|
491
|
265
|
Neurological disorders are more difficult
|
72
|
136
|
332
|
461
|
235
|
Very long training time
|
66
|
132
|
498
|
351
|
189
|
Reputation as a difficult subject
|
50
|
118
|
190
|
446
|
432
|
A significant number of respondents "Agree" or "Strongly Agree" that the difficulty of neuroanatomy (495), neurology or neurosurgery in general (622), and the need to know basic neurosciences (600) contribute to the perception of these fields as difficult. There is a common perception among participants that insufficient knowledge of the students about neurology/neurosurgery (853) is a significant factor contributing to the perceived difficulty. The separation of basic sciences teaching and clinical application (612) and limited exposure to neurological patients (898) are also considered significant contributors to the perception of difficulty. Factors such as "Reputation as a difficult subject" (578) and "Poor prognosis" (756) are also perceived as influencing the difficulty of these specialties. The results reflect a consensus among participants that various factors, including educational challenges, limited exposure, and the complex nature of neurological disorders, contribute to the perception of neurology and neurosurgery as challenging fields of study. These findings underscore the importance of addressing these factors to improve the attractiveness of these specialties to aspiring medical professionals.
Specialty ranking by how likely students are to pursue a career in various specialties revealed that students are most likely to pursue a career in cardiology, with neurosurgery (36.6%) and neurology (28.1%) ranking 7th and 8th on the list respectively. Respondents were least likely to pursue a career in rheumatology (14.6%) and geriatrics (11.7%) (Table 3).
Table 3
Specialty ranking by how likely students are to pursue a career in various specialties.
Item
|
Very Unlikely
|
Unlikely
|
Neutral
|
Likely
|
Very Likely
|
Cardiology
|
71
|
157
|
285
|
492
|
231
|
Gastroenterology
|
105
|
161
|
346
|
434
|
190
|
Respiratory Medicine
|
111
|
204
|
292
|
368
|
261
|
Neurology
|
141
|
243
|
504
|
232
|
116
|
Endocrinology
|
101
|
139
|
396
|
405
|
195
|
Neurosurgery
|
261
|
331
|
190
|
330
|
124
|
Rheumatology
|
202
|
384
|
470
|
135
|
45
|
Geriatrics
|
606
|
318
|
163
|
77
|
72
|
Obstetrics and Gynecology
|
71
|
79
|
366
|
491
|
229
|
Community and Public Health Medicine
|
114
|
150
|
392
|
427
|
153
|
Figure 1 below, depicts the percentage distribution of various factors influencing the career choices of medical students regarding neurology and neurosurgery. These factors included the duration of study, passion for neurology/neurosurgery, the influence of role models, family or friends with neurological disorders, interest due to family connections, financial rewards, job satisfaction, prestige, revenue constraints, male/female inequality, ability to maintain work-life balance, and opportunities for career progression.
The most prominent factor among the respondents was the "Opportunity for career progression," with a significant percentage of 31.8%. This suggests that many students consider career prospects as a crucial element in their choice of a medical specialty. Additionally, "Duration of study" and "Ability to maintain work-life balance" are also notable factors at 20.7% and 10.2%, respectively, indicating concerns about the time required for training and achieving a balance between work and personal life.
Other factors, such as "Prestige," "Job satisfaction," and "Financial reward," also play a role in students' considerations, with percentages of 5.8% each. "Influenced by a role model," "Passion for neurology/neurosurgery," and "Having family/friend with neurological disorder" have relatively lower percentages, suggesting that these factors have less influence on their career choices. The data in this figure provides valuable insights into the motivations and barriers that medical students in Zambia consider when contemplating a career in neurology and neurosurgery.
Figure 2, illustrates the participants' perceptions of the difficulty of learning neurology and neurosurgery based on the data provided. The levels of difficulty were categorized into five levels: "Very Difficult," "Difficult," "Moderate," "Easy," and "Very Easy." For neurosurgery, the largest percentage of participants (42.7%) found it "Very Difficult," indicating that a significant portion of respondents considered neurosurgery to be highly challenging. Additionally, 34.8% found it "Difficult," further highlighting the perceived difficulty of this specialty. In the case of neurology, the most common perception was that it was "Difficult," with 40.1% of participants expressing this view. A significant percentage also found neurology "Very Difficult" at 26.2%. This provides valuable insights into the perceptions of medical students regarding the difficulty of these specialties. It suggests that both neurosurgery and neurology are generally viewed as challenging fields of study by the participants.
A significant proportion (68%) of respondents indicated that they have indeed cared for a relative or friend with a neurological disorder. This shows a high level of personal involvement with neurological patients within their social circles. A notable 81.6% of participants have volunteered to care for individuals with neurological disorders in a healthcare setting. This suggests a strong inclination towards contributing to patient care within the healthcare system. A substantial 93.2% of participants have gained paid work experience in caring for individuals with neurological disorders. This reflects a significant level of professional exposure to neurological patients, likely through healthcare employment (Fig. 3). Overall, the data shows a high degree of personal, volunteer, and professional engagement with patients having neurological disorders among the surveyed participants. This exposure can potentially influence their attitudes and perceptions towards neurology and neurosurgery as career choices.
Top of Form
Eighty-one percent of participants who considered neurosurgery as a future career while 89% of participants who considered neurology as a future career agreed that insufficient knowledge of the students about neurology/neurosurgery and difficulty of neurological disorders contribute to consideration of neurology and neurosurgery as difficult specialties (p < 0.01), (Table 4).
Table 4
Relationship between the choice of neurosurgery as a future career vs. insufficient knowledge of the students about neurology/neurosurgery and difficulty of neurological disorders.
Choice of Neurosurgery as a Future Career
|
Insufficient Knowledge
|
Difficulty of Neurological Disorders
|
Correlation Coefficient
|
P-Value
|
Yes
|
17.2
|
91.6
|
397.7606
|
0.0001
|
No
|
82.8
|
8.4
|
|
|
Table 4 illustrates the percentages of participants who considered choosing neurosurgery as a future career and their views on the insufficiency of knowledge about neurology/neurosurgery and the difficulty of neurological disorders. The majority of those considering neurosurgery as a future career expressed concerns about both insufficient knowledge and the difficulty of neurological disorders.
The table provides an analysis of the relationship between the choice of pursuing a career in neurosurgery and two significant factors: "Insufficient Knowledge" and "Difficulty of Neurological Disorders." Among the participants, 17.2% expressed an interest in neurosurgery as a potential career, while the majority, 82.8%, did not.
The calculated correlation coefficient was exceptionally high at 397.7606, indicating an extremely strong positive correlation between the choice of neurosurgery as a future career and the factors related to insufficient knowledge and perceived difficulty in neurological disorders.
Furthermore, the associated p-value was very low at 0.0001, significantly below the conventional significance level of 0.05, suggesting a highly significant relationship between the choice of neurosurgery as a future career and the variables "Insufficient Knowledge" and "Difficulty of Neurological Disorders." This suggests that those considering a career in neurosurgery are highly likely to express concerns about insufficient knowledge and perceive a high level of difficulty in dealing with neurological disorders, compared to those who do not consider neurosurgery as a career option.