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Factors influencing subspecialty choice among medical students: a systematic review and meta-analysis
  1. Yahan Yang1,2,
  2. Jiawei Li3,
  3. Xiaohang Wu1,
  4. Jinghui Wang1,
  5. Wangting Li1,
  6. Yi Zhu4,5,
  7. Chuan Chen4,6,
  8. Haotian Lin7
  1. 1 State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
  2. 2 Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
  3. 3 Zhongshan School of Mathematics, Sun Yat-Sen University, Guangzhou, China
  4. 4 Department of Molecular and Cellular Pharmacology, University of Miami School of Medicine, Miami, Florida, USA
  5. 5 Cataract, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
  6. 6 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
  7. 7 Cataract, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
  1. Correspondence to Dr Haotian Lin; haot.lin{at}


Objective To characterise the contributing factors that affect medical students’ subspecialty choice and to estimate the extent of influence of individual factors on the students’ decision-making process.

Design Systematic review and meta-analysis.

Methods A systematic search of the Cochrane Library, ERIC, Web of Science, CNKI and PubMed databases was conducted for studies published between January 1977 and June 2018. Information concerning study characteristics, influential factors and the extent of their influence (EOI) was extracted independently by two trained investigators. EOI is the percentage level that describes how much each of the factors influenced students’ choice of subspecialty. The recruited medical students include students in medical school, internship, residency training and fellowship, who are about to or have just made a specialty choice. The estimates were pooled using a random-effects meta-analysis model due to the between-study heterogeneity.

Results Data were extracted from 75 studies (882 209 individuals). Overall, the factors influencing medical students’ choice of subspecialty training mainly included academic interests (75.29%), competencies (55.15%), controllable lifestyles or flexible work schedules (53.00%), patient service orientation (50.04%), medical teachers or mentors (46.93%), career opportunities (44.00%), workload or working hours (37.99%), income (34.70%), length of training (32.30%), prestige (31.17%), advice from others (28.24%) and student debt (15.33%), with significant between-study heterogeneity (p<0.0001). Subgroup analyses revealed that the EOI of academic interests was higher in developed countries than that in developing countries (79.66% [95% CI 70.73% to 86.39%] vs 60.41% [95% CI 43.44% to 75.19%]; Q=3.51, p=0.02). The EOI value of prestige was lower in developed countries than that in developing countries (23.96% [95% CI 19.20% to 29.47%] vs 47.65% [95% CI 34.41% to 61.24%]; Q=4.71, p=0.01).

Conclusions This systematic review and meta-analysis provided a quantitative evaluation of the top 12 influencing factors associated with medical students’ choice of subspecialty. Our findings provide the basis for the development of specific, effective strategies to optimise the distribution of physicians among different departments by modifying these influencing factors.

  • medical students
  • career choice
  • meta-analysis

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  • Contributors HL contributed to the conceptualising and design of the study and to research funding, coordinated the research and oversaw the project. YY, JL and XW contributed to data collection and interpretation, and to data analysis. JW, YZ, CC and WL contributed to the design of the study. All authors contributed to the drafting and revision of the paper and approved the final manuscript for publication.

  • Funding The principal investigator of this study (Haotian Lin) is currently supported by National key R & D project (2018YFC010302), the Key Research Plan for the National Natural Science Foundation of China Cultivation Project (91546101), the National Natural Science Foundation of China (81770967), the Fundamental Research Funds for the Central Universities (16ykjc28), the Guangdong Provincial Natural Science Foundation for Distinguished Young Scholars of China (2014A030306030), the Guangdong Province Universities and Colleges Youth Pearl River Scholar Funded Scheme (2016), the Clinical Research and Translational Medical Center of Pediatric Cataract in Guangzhou City (201505032017516) and Ministry of Science and Technology of China Grants (2015CB964600).

  • Disclaimer These sponsors and funding organisations had no role in the design or performance of this study.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Extracted data are available upon request to the corresponding author.

  • Patient consent for publication Not required.

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