Sociodemographic Factors Influencing Indonesian Medical Students in

Career Preference: A Multimodal Career Scale Approach

Rizma Adlia Syakurah1,

1
Department of Public Health, Faculty of Medicine, Sriwijaya University,
Palembang, 30128
2
Departement of Public Health, Faculty of Medicine, Gadjah Mada University
Abstract
Background: The aim of the study was to investigate sociodemographic factors of Indonesian medical
students career preference that was reflected on five career scale.
Method: The study involved 1030 medical students from various universities in Indonesia. The data had
been collected online during the period from October 1 to October 15, 2015. Mann-Whitney test and
Kruskall-Wallis test were used to identify the significance of each sociodemographic factor for each
career scale that led to their career preference.
Results: Univariate analysis showed that most of the participants were female, had not been married,
enrolled in state university, were 3 rd year students, had been accepted through SNMPTN / SBMPTN
written test, had parents who work on non-medical field, had family monthly earnings Rp5.000.000-
10.000.000, and had a plan to choose career in specialty choice. The study indicated the significant
relationship (p<0.05) between some of the sociodemographic variables and all of the career scale.
Conclusion: Sociodemographic factors have a significant association with medical students career
preference. By knowing these factors, facilitators can help students to choose their career according to
their characteristics.
Keywords: sociodemographic, career, medical, factors, career scale, medical students
1. Background
The reasons why medical students choose their careers are complex. Career is defined
as a development and advancement of someones life, occupation, or position. Therefore,
career preference is defined as any efforts by someone to choose one in many kinds of
occupational choices which gives him a hope to be advanced 1. In medicine, there are two
group of career choices, which are clinical specialty field and non-specialty field.2
Career preference for medical students is a starting point of career development.
Some literatures find that many factors influenced career preference and career
development, which were financial appreciation, vacancy rate, durations of specialty-
training program, social status, academic performance, experience and perception about any
specialty, and the demographic factors, like gender and age 3, 4, 5.
The existed variables, or known as sociodemographic factors, which influenced
medical students in their career preference need to be considered in an effort to help a
medical student in choosing his/her career independently and opened choices. 6 The aim of the
study was to investigate sociodemographic factors of Indonesian medical students career
preference that was reflected on five career scale.

2. Method
The study design was cross-sectional, using a total sampling method. The participants
were medical students of any universities in Indonesia. The participants asked to voluntarily
fill the survey which was collected online using Google Form Application during the period
from October 1 to October 15, 2015. There are 1030 participants included in the survey.
The survey consisted of eight questions that defined the sociodemographic factors in
this study. The participants were grouped by gender and marital status. The participants were
also asked and were grouped by university of origin, which is state or private university. The
other determinants are enrollment scheme which was special invitation (SNMPTN/PMDK),
national written selection (SBMPTN), provincial government partnership (BPKD), special
government scholarship scheme for lower economic status students (Bidikmisi), or local
university written selection (USM). The participants were also grouped paternal or marital
occupation which were grouped by medical field, health bureaucrate, and non-medical field
and family monthly earnings which was grouped into <Rp5.000.000, Rp5.000.000-
Rp10.000.000, or >Rp10.000.000. The participants were also asked and were grouped by
existing career planning which was specialty choice, non-specialty choice, or undecided plan.
The participants then asked to fill five career scale which each consisted of a set of questions
that formulated on Likert Scale. Five career scale which were conducted based on the
previous literature were Career Self Efficacy Source Scale (CSESS), Career Decision Self-
Effication Form (CDSESF), Career Exploration Survey Revised (CESR), Career Decision
Making Outcome Expectation (CDMOE), and Career Exploration Plan Intention (CEPI).
Career Self Efficacy Source Scale (CSESS) then subgroup to be five source scales, which are
vicarious experience, verbal persuasion, positive emotion, negative emotion, and personal
accomplishment. Any of sociodemographic data normality was tested. All data generated a
probability value (p) of 0.000. Because the p-value less than 0.05 then it could be concluded
that the data distribution was not normal. Because the data distribution was not normal, the
data obtained from the study was processed by Mann-Whitney and Kruskal-Wallis.

3. Result
In this study, 1030 participants were included. The participants were grouped by the
sociodemographic factors, which are gender, age, marital status, home university, the
university entrance test type, father's occupation, mother's occupation, family income per
month, and the election of a career. The data could be seen in Table 1.

Table 1. Characteristics of Participants

Variable Frequency Percentage (%)
Gender
Male 345 33,5
Female 685 66,5
Marital Status
Married 1003 97,4
Unmarried 27 2,6
University of Origin
State 697 67,7
Private 333 32,3
Enrollment Scheme
Special Invitation (SNMPTN) 372 24,7
National Written Selection (SBMPTN), 221 38,4
Provincial Partnership (BPKD) 28 2,1
Bidik Misi 9 0,9
Local university written selection (USM) 303 22,2
Others 97 11,7
Fathers occupation
Medical field 119 11,6
Health bureaucrat 29 2,8
Non-medical field 882 85,6
Mothers occupation
Medical field 151 14,7
Health bureaucrat 35 3,4
Non-medical field 844 81,9
Family income
< Rp 5.000.000,- 223 21,7
Rp 5000.000 s/d Rp 10.000.000 461 44,8
> Rp 10.000.000,- 346 33,5
Career selection plan
Specialist 657 63,8
Non-specialist 97 9,4
Not yet determined 276 26,8
Total 1030 100.0

A total of 66.5% of the participants were women, compared with 33% of whom were
male. The majority of participants were not married (97.4%). Participants were dominated by
students of state universities, which amounted to 67.7%. Most participants were accepted
through national written test (SBMPTN) pathway, in the amount of 38.4%. Occupation of
father and mother was respectively dominated by non-medical background, as many as
85.6% and 81.9%. Majority of the family came from middle class (family income
>Rp5.000.000,-) with a total of 78.3%. Specialist was the main choice of participants, namely
63.8% of the total sample.
 Table 2. Statistical Hypothesis Testing for Career Scales and Career Selection Plan
Famil
Variable Marita Universit Fathers Mothers Career
Gende Enrollmen y
l y of occupatio occupatio selectio
r t Scheme Incom
Scale Status Origin n n n plan
e
CSESS 0,563 0.019* 0,253 0,103 0,030* 0,315 0,652 0,033*
Vicarious
0,261 0,093 0,782 0,938 0,648 0,099 0,031* 0,034*
Experience
Verbal
0,291 0,531 0,122 0,564 0,588 0,92 0,981 <0,001*
Persuasion
Positive
0,032* 0,803 0,719 0,039* 0,686 0,367 0,49 <0,001*
Emotion
Negative
0,451 0,133 0,052 0,213 0,629 0,032* 0,020* <0,001*
Emotion
Personal
Accomplishme 0,259 0,249 0,804 0,478 0,202 0,069 0,843 <0,001*
nt
CDESF 0,311 0,463 0,004* 0,380 0,199 0,969 0,477 <0,001*
CESR 0,002* 0,911 0,180 0,070 0,153 0,560 0,153 0,560
CDMOE 0,009* 0,067 0,680 0,921 0,289 0,769 0,488 0,351
CEPI 0,095 0,220 0,280 0,597 0,895 0,903 0,322 <0,001*
Career Selection
0,451 0,001 0,446 0,507 0,319 0,459 0,649 -
Plan

Self Efficacy (CSESS) source had a significant assosciation with marital status (p
<0.05), father's occupation (P <0.05) and carreer selection plan (p <0.05). For each CSESS
source, found that vicarious experience which had a significant association with family
income and career selection plan, verbal persuasion which had a significant association with
career selection plan, positive emotion which had a significant association with gender and
career selection plan, negative emotion which had a significant association with family
income and career selection plan, and personal accomplishment which had a significant
association with career selection plan. Self Efficacy Careers (CDESF) had a significant
association with university of origin (P <0.05) and carreer selection plan (p <0.05). Career
exploration (CESR) had a significant association with the two sociodemographic variables,
namely gender and career selection plan (p <0.05). Outcome Expectation (CDMOE) had a
significant association with gender (p <0.05) and exploratory intention (CEPI) had a
significant association with carreer selection plan (p <0.05).

4. Discussion
In the process of determining their career choice, medical students will be affected by
various factors, both derived from their internal and external environment. Sociodemographic
factors such as age, gender, parental factors, and family income were considered as a strong
influence towards the long term career choice. 3 These factors need to be identified to give the
students more preferences and to maintain their independence in choosing their own career.7
This research was conducted on 1030 samples of medical students from across
Indonesia with various backgrounds. As much as 66.5% of medical students are women and
the remaining are male (33.5%). These results indicate the existence of a trend, which there is
an increasing trend of number of female students compared with male students. It is also
found in studies conducted at the University of King Abdul Aziz bin Saub stating that from a
sample of research on similar topics obtained 2/3 of the sample was female student women.8
Bivariate analysis found that gender had a significant association with career
exploration and outcome expectation. Gender was already known as one of the determining
factors for someone to make decisions about their medical career choice. Despite the growing
understanding of gender equality, there were still many jobs that would be fragmented to a
certain gender.9 The emerging paradigm found in the daily life. Men tend to choose to
continue to study specialties, especially major specialties such as surgery and internal
medicine. On the other hand, more women are choosing to pursue a career as a structural
doctor or working in the management of health institutions, and even if specialties is chosen,
women tend to choose a minor specializaties or pediatrics.10,11
The second variable studied is the status of marriage. The majority of research
subjects is not married (97.4%). It is probably because most of the subject is still in the
process of studies in pre-clinical and clinical phase, so it is decided to postpone the marriage.
There is a significant association between marital status with a source of self-efficacy.
Sources of self-efficacy as social persuasion and emotional state could be affected by a
person's marital status, which in turn also affect career choice. 12 Someone who was married
will eventually enter into a new and greater social environment, such as the partner and
his/her families.13 State of emotions, especially negative emotions such as fear and anxiety
about his ability to serve two roles at once, wife and student, might influence the final
decision.13 This is consistent with a study conducted beforehand where there was a
association between marital status and career choice, especially a career in primary care (with
OR 2.2). In the study also noted that marital status was the only significant predictor of the
specialization selection.14 Marital status is also able to influence the selection of a career in
relation to the duration of the period of education a career, because it was difficult to split
time between his duties as a housewife and as a student.11
The enrollment scheme is dominated by national written test (SBMPTN), amounted to
38.4%. From the results of the bivariate analysis we found no association at all between the
entrance pathway with their career choices, except the positive emotion source. It is also
found in family income variable, which is also not found a significant association with each
of the career scale. Although, we found that there was a significant association with vicarious
experience and negative emotion source. In this study found the majority of subjects came
from upper-middle family (78,3%), in line with studies that say that the typical medical
students come from families with high social status.8 Level of parental income will affect
career choice, especially if it comes from the lower middle group. Students who come from
families who is tangled by poverty issue will have a limited career options, thus affecting
their decisions.15
Family income is also related to the university of origin. A total of 67.7% of the
students come from public universities. Univeresity of origin has a significant association
with career Self-efficacy. Career Self-efficacy can be defined as a person's judgment about
their ability to perform a behavior career in relation to the development, selection, and
adjustment to career.16 Career self-efficacy will also influence how someone will weigh up
whether he could carry out the career choice and cause the final result of the motivation or
avoidance. Students from private universities usually come from families with middle income
and above, compared to students of state universities, so it has aa wider alternative career
path, related to the issues discussed above, namely the level of low family income would
indirectly restrict someone career choice.15 However, on the other hand, students from public
universities are usually more easily accepted in public universities of origin, especially in
case of specialization education. Surely this situation a barrier for students from private
colleges.
Parents occupation is also considered as a factor that determine the selection of
medical students carrer selection.7,8 Perception of parents will affect their children career
choice in the future. The work of parents also affects the child's willingness to consult about
his future. Medical students with medical background of parents would prefer to consult
about his career choice, something not found in students with parents whose background is
non-medical.7
In this study, most of the subjects have parents who comes from a non-medical
background (85.6% and 81.9%). However, a significant association was found only in
fathers occupation with the source of self-efficacy (CSESS). Sources of self-efficacy can be
vicarious experience (eg, father backgrounds specialist will usually be followed by children
who take the same career path), social persuasion from parents, and also positive emotion. 17
Other studies show conflicting results , where it was found theres significant role of mother
in the selection of their children career.8, 15Parents background is important because non-
medical parents tend to know very little alternative career options after graduation from
medical school.7 Most of them only know specialistic education as the only choice of study,
so that their children will only have limited choice of career selection.8
The last variable is the plan of career. In this variable was obtained a result that show
majority of subject has chosen specialization as their future career plans, with the
presentation of 63.8%. The results were consistent, even more extreme, with a previous study
that found as much as 100% of all the subjects choosing specialistic education as their plan of
career.6 Plan of career have a significant association with career Self Efficacy ,Career
Exploration, and Exploratory Intention. This is due to the career preferences at the time of
entering the medical faculty will affect career choice when faced with the choice of future
entrants. However, this may change, as the exposure of students to new things during their
studies.14

5. Conclusion
Self Efficacy source had a significant assosciation with marital status, father's
occupation and carreer selection plan. Self Efficacy Careers had a significant association with
university of origin and carreer selection plan. Career exploration had a significant
association with the two sociodemographic variables, namely gender and career selection
plan. Outcome Expectation had a significant association with gender and exploratory
intention had a significant association with carreer selection plan. The research shows that
sociodemographic factors have a significant association with medical students career
preference. By knowing these factors, facilitators can help students to choose their career
according to their characteristics.
6. References

1. Departemen Pendidikan Nasional. Kamus Besar Bahasa Indonesia. Ed. 3. Balai

Pustaka. 2012.
2. Scott, A., Joyce, C., Cheng, T., & Wang, W., 2013, Medical career path decision
making: an evidence check rapid review for the NSW Ministry of Health, Report by
Sax Institute Australia
3. Korkmaz, H. The Characteristics of Medical Students and Motivation Towards Career
Choice: Implications For Curriculum. 2013
4. Soethout MBM, Heymans MW, Cate OTJ. Career Preference and Medical Students
Biographical Characteristics and Academic Achievement. Mecial Teacher, 30:1, e15-
e22. 2009
5. Sanfey HA et al. Influences on Medical Students Career Choice: Gender of
Generation? Archives of Surgery 141:1086-1094. 2006.
6. Ausman, J et al. Social Factors Influencing Career Choice in a Medical School in the
United Arab Emirates. Education in Medicine Journal Vol 5 Issue 1:14-20. 2013
7. Newton, DA. Grayson MS. Whitley TW. What Predicts Medical Student Career
Choice? Journal of General Internal Medicine Vol 13:200-203. 1998.
8. Subait AA et.al. Factors Influencing the Career Choices among Medical Unviersity
students of King Saub bin Abdulaziz University Riyadh Saudi Arabia; A Cross-
sectional Study Design. The Saudi Journal for Dental Research, 2016.
9. Al-Nuaimi Y, Bayat A. Modernising Medical Careers and Factors Influencing Career
choices of Medical Students. British Journal of Hospital medicine Vol 69 No 3: 163-
166. 2008
10. Stagg P, Greenhill J, Worley PS. A new model to understand the career choice and
practice location decisions of medical graduates. Rural and Remote Health 9:1245.
2009.
11. Otis GD, Weiss JR. Patterns of Medical Career Preference. Journals of Medical
Education Vol 48 Issue 12: 1116-1123. 1973
12. Bandura A. Self-efficacy: the exercise of control. New York: W. H. Freeman. 1997.
13. Glynn, R.W. & Kerin, M.J., 2010, Factors influencing medical students and junior
doctors in choosing a career in surgery, The Surgeon, Journal of the Royal Colleges
of Surgeons of Edinburgh and Ireland, vol. 8, hh:187-191.
14. Taylor KM, & Betz NE. Applications of self-efficacy theory to the understanding and
treatment of career indecision. Journal of Vocational Behavior, 22, 63-81. 1983.
15. Osipow, S.H., 1983, Theories Of Carier Developmen, Pretice Hall-inc, New Jersey.
Puertas, E.B., Arosquipa, C., Gutierrez, D., 2013, Factors that influence career
choice in primary care among medical students from high-, middle-, and low-
income countries: a systematic review, Rev Panam Salud Publica vol. 34
(5), Washington.