Factors impacting on the decision of graduate  entry medical school students to pursue  a career in obstetrics and gynecology  in Ireland

Background Challenges in recruiting appropriately trained obstetricians and gynaecologists have been identified  across the world. Given well documented staff shortages within obstetrics and gynaecology in Ireland, it is  increasingly important to understand the factors which influence medical students to choose or reject a career in  the speciality. The aim of this study was to ascertain the perceptions of final year graduate entry medical students of  obstetrics and gynaecology, including the factors which may influence a student’s decision to pursue in a career in  the speciality. Methods Paper-based surveys of graduate entry medical students (n=146) were conducted at the beginning  and end of a six week rotation in obstetrics and gynaecology in Ireland. Responses to the surveys pre- and post-rotation were matched and changes in career choices, merits and demerits over time were analysed. All analysis was  conducted using SPSS for Windows version 25. Results The responses of 72 students to both questionnaires could be matched (response rate of 49.3%). No male  students expressed an interest in obstetrics, gynaecology or both as a first choice of career in the pre rotation survey.  Obstetrics as a first choice of career increased from 6.9% pre rotation to 19.4% post rotation (p=0.04) and this increase  was seen in male and female students. Gynaecology as a first choice increased slightly from 1.4 to 4.2% (p=0.50)  and the dual speciality increased from 6.9 to 13.9% (p=0.23). Students identified many merits of obstetrics pre-rotation with more than 60% identifying it as exciting, interesting fulfilling and challenging. However, incompatibility  with family life was cited as a demerit by 72% of respondents and 68.1% identified fear of litigation as a demerit.  Participants were less positive overall about the merits of a career in gynaecology with less than 40% viewing it as  exciting, fulfilling, and varied. Conclusions While respondents were positive about the merits of a career in obstetrics and gynecology, concerns  remain about work-life balance, career opportunities, and the high-risk nature of the specialty. These concerns should be addressed by the profession and policy makers if they wish to attract sufficient numbers to address anticipated  need in the coming years. Gender differences in speciality choice were also evident. If males are to be recruited into  obstetrics and gynaecology, consideration should be given to the positive impact of internship.