Background
The imbalance of the supply of physicians has been reported among different specialties and regions in China.1,2 As the composition of the medical workforce is fundamentally shaped by specialty choices among medical students (MS), exploring these decisions and their influencing factors emerges as a critical research priority. Medical trainees often developed career preference prior to the residency phase.3 Specialty selection constitutes a dynamic, multi-factorial process. Previous studies have identified multiple factors, including demographic characteristics, financial issues including potential income and indebtedness, profession-related beliefs, work-life balance, and personality profiles.4–8 However, these findings exhibit substantial variability across different countries and student populations. For example, indebtedness was reported to affect career preference in many countries,9–11 but MS in China have little to no educational debt. In contrast, doctor-patient conflicts—specifically referring to workplace violence, including verbal abuse, threats, or physical harm toward healthcare providers—may exert a more pronounced influence on career choices among Chinese MS. Furthermore, the importance of what students consider may change with time, location, culture, healthcare structure, government policy, age, workforce, etc. The way MS choose their specialties directly shapes the makeup of the medical workforce—and this pattern has a particularly significant impact on specialties that are crucial yet understaffed. Among these, infectious diseases (ID) stands out as a prime example.
In 2019, the World Health Organization identified ten critical threats to global health, six of which were directly associated with ID. Routine ID consultations have been demonstrated to significantly reduce mortality rates in Staphylococcus aureus,12 Candida13 and gram-negative bloodstream infection.14 ID consultations are also effective in boosting vaccine coverage,15 reducing healthcare costs16 and promoting antimicrobial stewardship.17,18 The coronavirus disease of 2019 (COVID-19) pandemic has further underscored the critical importance of ID expertise and drew public attention to the ID physician workforce again. Despite their indispensable role, ID faces a global workforce crisis, shortage and unequal distribution of ID specialists were reported in many countries including the United States,19 Canada,20 Japan,21 and Korea.22 Notably, China has witnessed a successive decline in the percentage of ID specialists in hospitals, from 2.2% in 2005 to 1.1% in 2010, and further to 0.7% by 2012.23 In 2023, China has approximately 68,000 licensed (assistant) physicians specializing in ID, accounting for 1.4% of the total clinical physician workforce, the density of ID physicians in China stands at 0.48 per 10,000 population, far below that of respiratory medicine doctors (1.2 per 10,000) and cardiovascular specialists (1.1 per 10,000).1
Career or specialty choice is a pivotal milestone in the professional development of MS, as this decision is hard to change following entry into the residency training. Most previous studies focused on quantitative surveys, in-depth qualitative analysis of decision-making processes are lacking.4,7,8,24–26 The research on career choices of MS in China is still very limited, such as the career choices of the Chinese 8-year stomatology MS and the influence of COVID-19 on the career choices of MS, etc.27,28 In many countries, ID fail to be acknowledged as a satisfying specialty.21–25,28 Less is known about the interest in ID and the potential factors associated with the decision among Chinese MS.
In China, ID medicine is categorized as a primary specialty in medical education, not a sub-specialty of internal medicine. However, in practice, ID medicine is integrated into general internal medicine training. MS who receive training in general internal medicine can work directly as ID specialists upon graduation based on their voluntary choice. As a result, MS may lack in-depth exposure to ID as an independent field, reducing their motivation to pursue it. Additionally, major epidemics like COVID-19 have a significant impact on ID specialty choices compared to other fields. Specifically, concerns about occupational hazards may reduce MS’ willingness to engage in the field of ID. A survey indicated that 9.5% of participants showed decreased willingness to major in ID after the COVID-19 outbreak.28
We aimed to comprehensively understand the specialty preferences (especially interests in ID) of Chinese MS and conduct an in-depth analysis of the factors influencing their specialty choices. By doing so, we hope to develop targeted strategies to offer more effective and personalized career counseling services.
Methods
Participants
At Peking Union Medical College, the standard undergraduate medical education program spans eight years. From the fifth to the eighth year, they engage in clinical medicine studies and clinical practice. We recruited the fifth-, sixth-, and seventh-year MS to conduct this cross-sectional survey.
Interviews
We conducted this survey according to the AMEE Guide.29 In the initial phase, 10 semi-structured standard script interviews were conducted to explore the major factors assumed to influence MS’ career choices and uncover unanticipated factors. Participants were recruited via convenient sampling and the sample size was determined according to the empirical saturation principle. All interviews were audio-recorded with participants’ informed consent, each lasting approximately 10–15 minutes. The interview grid included questions on reasons to apply for medical school, future career plans, factors influencing specialty choices, perceptions of the ID specialty, clinical exposure to ID, the likelihood of choosing the ID specialty and the reasons. The interview guide is provided in Supplementary Data S1.
Questionnaire
In the second phase, we designed and developed a questionnaire (Supplementary Data S2). The questionnaire was developed by referencing existing questionnaires on the topic and adapted to align with China’s medical education system.3,8,24,25,30–32 Additionally, it was evaluated by three ID specialists. Prior to distribution, it underwent review and pretesting by four MS to assess its clarity and comprehensiveness, with modifications made based on their feedback. Each questionnaire required approximately 5 minutes to complete, indicating good feasibility.
The questionnaire included three sections. The first section collected demographic information. The second section (Q1-Q8) focused on the career plan and factors influencing career preference. The third section (Q9-Q17) obtained data about the interest in ID, exposure to ID field, impact of COVID-19 pandemic on ID interest, and potential strategies to enhance the appeal of the ID specialty.
We employed a convenience sampling approach for participant recruitment. The questionnaire, administered in Chinese, was distributed anonymously online in April 2025. It was shared via WeChat across multiple MS groups. To participate, individuals were required to click a “Consent and Continue” button to confirm their voluntary involvement, with submission only permitted after all items had been completed.
Usually, the sample size of valid questionnaires should be 5–10 times the number of questions.33 There are 17 questions in this questionnaire. Thus, it was determined that a minimum of 85 valid questionnaires were required for this study.
Statistical Analysis
The qualitative interview data were analyzed using thematic analysis, following the six-phase framework outlined by Braun & Clarke.34 Specifically, we implemented each stage as follows: (1) Familiarization with data: Transcripts were repeatedly read by the research team to gain a holistic understanding, with preliminary notes taken to document initial observations and potential patterns. (2) Generating initial codes: Two researchers independently coded the transcripts inductively, focusing on meaningful units of data, and discrepancies were resolved through discussion to develop a consistent codebook. (3) Searching for themes: Codes were then clustered into potential themes, with the team collectively reviewing how codes aligned to form overarching concepts. (4) Reviewing themes: Themes were refined against the full dataset to ensure they accurately represented the data and did not overlap excessively. (5) Defining themes: Each theme was clearly named and described, with boundaries established to distinguish it from other themes. (6) Writing up: The analysis was synthesized, with illustrative quotes integrated to support interpretations.
Descriptive statistical analyses were performed on questionnaire responses. For single-choice questions, the proportion of each response option was calculated, while selection rates for multiple-choice items were counted. Normally distributed continuous variables were presented as means with standard deviations (SD), while categorical variables were presented as percentages (%). The Chi-square test was applied to categorical variables for group comparisons. Multivariate logistic regression analysis was conducted to identify independent factors associated with MS’ lack of interest in ID, variables were chosen based on their relevance to the research topic (supported by prior literature) and results of chi-square analyses (P<0.10). Statistical significance was set at P <0.05. All analyses were performed using IBM SPSS Statistics 26.0.
Results
Qualitative Study
In this qualitative study, we recruited a sample consisting of five female and five male participants aged between 22 and 26 years old. There were two fifth-year MS, six sixth-year MS, and two seventh-year MS. Themes and a selection of exemplar statements are presented in Table 1.
|
Table 1 Themes and a Selection of Exemplar Statements
|
Reasons for Applying to Medical School
Personal interest (specifically interest in the medical subject itself, 6/10) was the primary driver, followed by a desire to help others (5/10), family expectations (3/10), aspirations for a stable livelihood (1/10), and a childhood wish (1/10).
Post-Graduation Plans
All participants expressed a desire to become a physician.
Intended Specialties
The majority chose surgery (5/10) or internal medicine (4/10), with one participant indicating ophthalmology (1/10).
Factors Influencing Career Choice
Interest in the specialty (9/10) was the most commonly mentioned, followed by job availability (4/10), workload (2/10), income (2/10), suggestions from others (2/10), and personal experience (1/10).
Familiarity with and Exposure to ID
All interviewees reported being unfamiliar with the ID field. Their clinical exposure to ID was limited to taking ID-related courses or encountering infected patients during rotations in other departments.
Willingness to Pursue a Career in ID
None of the participants indicated such a desire. The most common reason was greater interest in other specialties (10/10), with additional concerns including occupational exposure (2/10), low income (1/10), and job availability (1/10).
Quantitative Study
General Characteristics of Participants
In total, 117 responses were collected: 52 from the fifth-year MS, 38 from the sixth-year MS, 27 from the seventh-year MS. The mean age of participants was 24±1 years (range: 23 to 29 years). The sample was composed by 76 (65.0%) females and 41 (35.0%) males, with no significant gender distribution differences observed among the three MS groups. One third of the participants (33.3%, 39/117) reported having doctors or nurses among their family members.
Career Plan and Factors Influencing Career Preference
We have included all items’ raw counts and proportions in Supplementary Data S3.
The most frequent reason to apply for medical school was personal interest (76.9%), while only 35.0% of students’ choice was affected by family expectation. The majority of MS (88.9%) want to practice medicine after graduation. Internal Medicine and Surgery were the most popular specialty, with 31.6% and 24.8% of MS choosing them as their first specialty choice respectively. Among these factors influencing career plan, work-life balance (82.1%), interest in the specialty (81.2%), and expected income (70.9%) were the three most common ones. Significant difference was found among the three groups of MS from different grades regarding the proportion of those who cited family expectations as the reason for studying medicine, with the proportions ranging from 11.1% to 46.2% (Cramer’s V=0.287, P=0.008). Compared with female MS, a higher proportion of male MS chose to study medicine due to family expectations (P=0.007), selected surgery as their first-choice specialty (P=0.030), and were willing to pursue research during their career (P=0.028). Details of each question and and the corresponding answer about career plan and factors influencing career preference are shown in Table 2.
 |
Table 2 Career Choice and Factors Influencing Career Preference
|
Interest in ID and Factors Influencing Specialty Choice
Only 18% of MS stated that they were very familiar or familiar with ID specialty. Regarding the overall evaluation of ID courses, 64.1% of MS declared that were “very good” or “good”. Nearly 30.0% of MS had experience with ID as a medical profession, and senior students had more opportunities to be exposed to the ID field. Only 6.8% of MS were interested in pursuing a career in ID, the most common reason was “interest in ID”. However, about half of the MS (48.7%) declared that they had no interest in ID specialty, particularly among the sixth-year MS. “Concerned about occupational exposure”, “lack of interest in ID”, and “ lack of procedures” were the three most common reasons why MS had no interest in ID. Among them, the proportion of the fifth-year MS who had concerns about occupational exposure was the highest (Cramer’s V=0.535, P<0.001). No significant differences in these opinions were observed between male and female MS groups. The specifics of the questions and responses are presented in Table 3.
 |
Table 3 Interests in the Infectious Diseases Specialty and Factors Influencing Specialty Choice
|
Multivariate logistic regression analysis revealed that only the overall evaluation of ID curriculum (OR 0.376, 95% CI 0.188–0.754, P=0.006) was the independent related factor influencing MS’ lack of interest in ID (Table 4).
 |
Table 4 Results of Multivariate Logistic Regression Analysis
|
Strategies to Enhance the Appeal of ID Specialty
In terms of “ potential measures to enhance the attractiveness of ID”, “improved salary” was the most common suggestion, followed by “improved job availability”, “early exposure to the broad field of ID”, and “decreased workload”, with the proportion was 76.9%, 47.0%, 40.2% and 35.0%, respectively. Regarding the “Others” option, two responses mentioned “increasing understanding of the specialty”, and these have been categorized under “Early exposure to the broad field of infectious diseases”.
Discussion
Studying medicine and pursuing a career as a doctor constitutes a highly challenging journey. There are various motivations behind this decision. In our study, most of the students (76.9%) had made their choice according to their own interests, and nearly half of them made their choice because they think that doctors can help others, these findings were similar to other studies.35,36 However, a significant proportion of participants (35%) reported that their decision was influenced by family expectations, a common motivator in some countries.35,37 Notably, in our current study, the proportion of students citing family influence has increased over the past three years (from 11.1% to 46.2%). This trend may reflect the growing prestige of the medical profession in China. However, the reluctance of MS to practice medicine after graduation remains a concern. A recent study found that only 66.99% of medical undergraduates in China were willing to practice medicine after graduation.38 In contrast, 88.9% of students in our study expressed a strong desire to become doctors. This high level of commitment could be attributed to the fact that our participants were graduates of one of China’s top medical colleges, where career prospects are typically better.
Choosing a medical specialty is a complex process influenced by multiple factors. A recent thematic network study has identified five key themes that shape specialty selection among MS in low- and middle-income countries: personal determinants, life fulfillment aspects, influential career aspects, educational determinants, and interpersonal effects. Additionally, the most frequently observed sub-themes included specific personal factors, controllable lifestyle, quality of working life, and future working conditions.39 We found that Internal Medicine and Surgery were the most preferred medical specialties, and the determinants for specialty choice included work-life balance, personal interest, income, and job availability, etc. These findings are similar with previous studies in many countries. A large number of studies reported that controllable lifestyle is an important determinant of specialty selection by MS, which is related to working hours, having enough personal or leisure time, and life stability.4,30,39 Additionally, some studies also revealed that one of the most important factor for choosing a specialty is that the individual student thinks it interesting and challenging.7,39,40 It is worthy noting that up to 30.8% of MS considered patient-provider conflict as a factor influencing career choice in our study. Previous research has also shown that workplace violence is a significant predictor of dropout intentions among Chinese medical undergraduates.41 Another study also noted that both safety needs and risk aversion motivation hold significant importance in Chinese MS’ career choice in the face of severe workplace violence.42 These challenges highlight the need for policymakers to address these issues by alleviating the doctor-patient relationship.
The imbalance in the supply of doctors across different specialties is critical to the healthcare workforce. Our research shows only 6.8% of MS expressed their interest in ID, while nearly half of the participants declared that they had no interest in ID specialty. Concerns about occupational exposure emerged as a key factor, with a strong, practically meaningful association across training years (Cramer’s V=0.535, P<0.001). This large effect size underscores the significance of the observed pattern: fifth-year MS reported the highest proportion of such concerns, in contrast to 41.7% of sixth-year and 57.1% of seventh-year MS. This pattern likely relates to clinical exposure timing—fifth-year students, newly entering clinical settings, may lack familiarity with occupational exposure risks, leading to widespread concern. Moreover, 24.8% of students indicated that their willingness to pursue an ID career had decreased following the COVID-19 pandemic. Similarly, a survey in Japan also revealed that only 1.5% (5/328) of MS expressed a desire to become ID specialists, while 11% of the students developed a negative preference toward ID specialty after experiencing the COVID-19 pandemic.25 Therefore, strengthening the training of occupational safety and protection to prevent the occurrence of occupational exposure, alongside optimizing workplace safety protocols, may reduce MS’ concerns about occupational exposure and increase their interest in ID.
We found that the quality of ID-related courses was the only independent factor negatively associated with disinterest in ID specialties. This observation suggests that improving the quality of such courses may enhance MS’ interest in ID. Notably, a study involving pharmacy students similarly showed that enhancing the quality of didactic ID curriculum has the potential to boost interest in ID career.32 Consistent results were reported in two separate studies examining the link between ID education and fellowship choices among internal medicine residents.3,43 Although this research found no direct association between interest in ID and exposure to ID, some interviewees mentioned that if they had a deeper understanding of ID specialty at that time, they might have considered it as a career choice. Previous literature showed that early exposure to ID including clerkship experiences, mentored by an ID physician and participation in medical student interest groups can impact future career choice of ID.24,44,45
To enhance the attractiveness of ID, most participants believed that raising salaries is an effective measure. Although educational debt is not an important issue among MS in China, there are still difficulties in promoting specialization in low-income fields like ID without debt-driven financial pressures. A national survey has indicated that ID physicians in China experienced higher mental stress, lower salaries, and greater job dissatisfaction compared to other physicians. Of the 1071 physicians surveyed, 942 (88.0%) earned an annual income below $15,000.23 Therefore, it is crucial for healthcare authorities to address this issue by increasing compensation for ID physicians to ensure fair remuneration for their essential work.
This study has several limitations. First, this study may be subject to selection bias. Given that it was conducted at a single institution, institutional-specific factors—such as curriculum design and clinical exposure models—could have influenced the results, potentially limiting their generalizability to other medical schools. Additionally, participation was voluntary, which might introduce bias if students with stronger (or weaker) career preferences were more likely to respond. That said, to our knowledge, this is the first study conducted in Chinese MS to explore their interest in ID and influencing factors. As such, the results may offer valuable preliminary insights into this area. Second, the process of specialty selection is intricately complex. Although we designed the questionnaire through an extensive literature review and integration of in-depth interview findings, there is still a possibility that some influencing factors might have been overlooked. Additionally, for certain identified factors—such as rare or context-specific barriers—small cell counts in our data limited our ability to conduct robust statistical testing. Our analysis provided only preliminary data on Chinese MS’ choice regarding ID specialty, the findings may serve as a foundation to inform future research—such as larger cohort studies or intervention studies on curriculum improvements. Third, this study is a cross – sectional investigation. MS’ specialty preferences may change during their medical education. A longitudinal study with multiple time-point assessments would provide more comprehensive insights into the dynamic nature of their decision-making processes.
In conclusion, our study found that MS showed limited enthusiasm for pursuing careers as ID specialists. Thus, sustained efforts are needed to boost interest in the ID specialty. Specifically, we propose targeted measures as follows: alleviating concerns over occupational exposure via specialized occupational safety training and refined workplace safety protocols; enhancing the quality of ID-related courses by revising curricula to incorporate case-based discussions and clinician-led sessions; and optimizing career incentives—including ensuring competitive salary structures and emphasizing the unique professional value of ID specialists. These measures might contribute to fostering greater enthusiasm for pursuing a career in ID.
Ethical Approval and Informed Consent
This study was approved by the Ethics Committee of Peking Union Medical College Hospital (No. I-25PJ1129). Before the survey commenced, all participants were presented with an online informed consent form that detailed the study purpose and procedures. Participants were required to click the “Consent and Continue” button to confirm their voluntary participation; non-clicking prevented access to the survey questions.
Disclosure
Ling Qin, Tianxi Wang, Ruiyi Yan and XiaoQin are co-first authors for this study. The authors declare that there are no financial or commercial interests that may constitute a conflict of interest.
References
1. National Health Commission of People’s republic of China. China health statistical yearbook. 2023. Available from: http://www.nhc.gov.cn/mohwsbwstjxxzx/tjtjnj/202501/b8d57baa95834269b5b3562bfec801a7.shtml.
2. Dong E, Sun X, Xu T, et al. Measuring the inequalities in healthcare resource in facility and workforce: a longitudinal study in China. Front Public Health. 2023;11:1074417. doi:10.3389/fpubh.2023.1074417
3. Bonura EM, Lee ES, Ramsey K, Armstrong WS. Factors influencing internal medicine resident choice of infectious diseases or other specialties: a national cross-sectional study. Clinl Infect Dis. 2016;63(2):155–163. doi:10.1093/cid/ciw263
4. Nisar S, Rehman A, AbouTouk M, Alsanosi SM, Ikram N, Rehman A. Factors affecting the specialty choice among medical students of Saudi Arabia; an exploratory study. BMC Med Educ. 2024;24(1):1414. doi:10.1186/s12909-024-06408-9
5. Khan S. The impact of gendered experiences on female medical students’ specialty choice: a systematic review. Am J Surg. 2023;225(1):33–39. doi:10.1016/j.amjsurg.2022.10.023
6. Lefebvre C, Hartman N, Tooze J, Manthey D. Determinants of medical specialty competitiveness. Postgraduate Med J. 2020;96(1139):511–514. doi:10.1136/postgradmedj-2019-137160
7. Avidan A, Weissman C, Elchalal U, Tandeter H, Zisk-Rony RY. Medical specialty selection criteria of Israeli medical students early in their clinical experience: subgroups. Israel J Health Policy Res. 2018;7(1):20. doi:10.1186/s13584-018-0215-2
8. Kim -Y-Y, Kim U-N, Kim YS, Lee J-S. Factors associated with the specialty choice of Korean medical students: a cross-sectional survey. Human Resources Health. 2016;14(1):45. doi:10.1186/s12960-016-0141-8
9. Mohareb AM, Brown TS. Medical student debt and the US infectious diseases workforce. Clinl Infect Dis. 2023;76(7):1322–1327. doi:10.1093/cid/ciac862
10. Fritz EM, van den Hoogenhof S, Braman JP. Association between medical student debt and choice of specialty: a 6-year retrospective study. BMC Med Educ. 2019;19(1):395. doi:10.1186/s12909-019-1797-2
11. Grayson MS, Newton DA, Thompson LF. Payback time: the associations of debt and income with medical student career choice. Medical Education. 2012;46(10):983–991. doi:10.1111/j.1365-2923.2012.04340.x
12. Vogel M, Schmitz RPH, Hagel S, et al. Infectious disease consultation for Staphylococcus aureus bacteremia – a systematic review and meta-analysis. J Infect. 2016;72(1):19–28. doi:10.1016/j.jinf.2015.09.037
13. Kobayashi T, Marra AR, Schweizer ML. Impact of infectious disease consultation in patients with candidemia: a retrospective study, systematic literature review, and Meta-analysis. Open Forum Infect Diseases. 2020;7(9):ofaa270. doi:10.1093/ofid/ofaa270
14. Ong SWX, Luo J, Fridman DJ, et al. Association between infectious diseases consultation and mortality in hospitalized patients with gram-negative bloodstream infection: a retrospective population-wide cohort study. Clinl Infect Dis. 2024;79(4):855–863. doi:10.1093/cid/ciae282
15. Runyo F, Matignon M, Audureau E, et al. Infectious disease consultation is effective in boosting vaccine coverage in patients awaiting kidney transplantation: a French prospective study. Transplant Infect Dis. 2021;23(4):e13607. doi:10.1111/tid.13607
16. Pliakos EE, Ziakas PD, Mylonakis E. Economic analysis of infectious disease consultation forstaphylococcus aureusbacteremia among hospitalized patients. JAMA Network Open. 2022;5(9):e2234186. doi:10.1001/jamanetworkopen.2022.34186
17. Tagashira Y, Horiuchi M, Tokuda Y, Heist BS, Higuchi M, Honda H. Antimicrobial stewardship for carbapenem use at a Japanese tertiary care center: an interrupted time series analysis on the impact of infectious disease consultation, prospective audit, and feedback. Am J Infect Control. 2016;44(6):708–710. doi:10.1016/j.ajic.2015.12.016
18. Nishiura H, Itoh N, Akazawa N, et al. Effects of infectious disease consultation and antimicrobial stewardship program at a Japanese cancer center: an interrupted time-series analysis. PLoS One. 2022;17(1):e0263095. doi:10.1371/journal.pone.0263095
19. Lanjewar S, Filipiak R, Osman F, Tischendorf JS. Factors associated with infectious disease fellowship fill rate: an analysis of 2019, 2020, and 2021 match cycles. J Infect Dis. 2023;227(4):483–487. doi:10.1093/infdis/jiab549
20. Horn L, Tzanetos K, Thorpe K, Straus SE. Factors associated with the subspecialty choices of internal medicine residents in Canada. BMC Med Educ. 2008;8(1):37. doi:10.1186/1472-6920-8-37
21. Watari T, Hagiya H. Shortage and unequal distribution of infectious disease specialists in Japan: how can we refine the current situation? PLoS One. 2023;18(10):e0291677. doi:10.1371/journal.pone.0291677
22. Jang Y, Park SY, Kim B, et al. Infectious diseases physician workforce in Korea. J Korean Med Sci. 2020;35(49):e428. doi:10.3346/jkms.2020.35.e428
23. Zhang C, Li S, Ji J, et al. The professional status of infectious disease physicians in China: a nationwide cross-sectional survey. Clin Microbiol Infect. 2018;24(1):82.e85–82.e10. doi:10.1016/j.cmi.2017.05.008
24. Telchik C, Peterson CJ, Yakubik T, Park S, Baffoe-Bonnie A, Sisco L. Gauging medical students’ interests in infectious diseases. Clinl Infect Dis. 2024;80(5):1045–1052. doi:10.1093/cid/ciae552
25. Bongomin F, Hagiya H, Otsuka Y, et al. Interest in infectious diseases specialty among Japanese medical students amidst the COVID-19 pandemic: a web-based, cross-sectional study. PLoS One. 2022;17(4):e0267587. doi:10.1371/journal.pone.0267587
26. Lambert EM, Holmboe ES. The relationship between specialty choice and gender of U.S. medical students, 1990-2003. Acad Med. 2005;80(9):797–802. doi:10.1097/00001888-200509000-00003
27. Yan X, Zhang X, Shen Y, Yi Z, Wu L, Ai H. Career choice and future plan of Chinese 8-year stomatology medical doctor program students. J Chin Med Assoc. 2015;78(9):555–561. doi:10.1016/j.jcma.2015.06.006
28. Deng J, Que J, Wu S, et al. Effects of COVID-19 on career and specialty choices among Chinese medical students. Med Educ Online. 2021;26(1):1913785. doi:10.1080/10872981.2021.1913785
29. Artino AR, La Rochelle JS, Dezee KJ, Gehlbach H. Developing questionnaires for educational research: AMEE guide No. 87. Med Teach. 2014;36(6):463–474. doi:10.3109/0142159X.2014.889814
30. Takeda Y, Morio K, Snell L, Otaki J, Takahashi M, K I. Characteristic profiles among students and junior doctors with specific career preferences. BMC Med Educ. 2013;13(1):125. doi:10.1186/1472-6920-13-125
31. Peiffer-Smadja N, Ardellier F-D, Thill P, et al. How and why do French medical students choose the specialty of infectious and tropical diseases? A national cross-sectional study. BMC Med Educ. 2020;20(1):397. doi:10.1186/s12909-020-02317-9
32. Jeffres MN, Biehle LR, MacDougall C. Comprehensive assessment of didactic curriculum and career interest in infectious diseases among graduating united states pharmacy students. Open Forum Infect Diseases. 2018;5(11):ofy284. doi:10.1093/ofid/ofy284
33. Hair JF, Tatham RL, Black WC. Multivariate Data Analysis.
34. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. doi:10.1191/1478088706qp063oa
35. Al-Hemiary N, Al-Nuaimi AS, Al-Saffar H, Randall I. Why people apply to medical school in Iraq? J Med Educ Curricul Develop. 2017;4:2382120517726997. doi:10.1177/2382120517726997
36. Gąsiorowski J, Rudowicz E, Safranow K. Motivation towards medical career choice and future career plans of Polish medical students. Adv Health Sci Educ. 2014;20(3):709–725. doi:10.1007/s10459-014-9560-2
37. Saad SMFS, Faruqi AA, Faruqi AA. Students’ views regarding selecting medicine as a profession. J Pak Med Assoc. 2011;61(8):832–836.
38. Yu S, Zou F, Wang Q, et al. Willingness to practice medicine and related influential factors among medical undergraduates during COVID-19: a cross-sectional study. BMC Med Educ. 2023;23(1):427. doi:10.1186/s12909-023-04418-7
39. Sarikhani Y, Ghahramani S, Bayati M, Lotfi F, Bastani P. A thematic network for factors affecting the choice of specialty education by medical students: a scoping study in low-and middle-income countries. BMC Med Educ. 2021;21(1):99. doi:10.1186/s12909-021-02539-5
40. Ibrahim M, Fanshawe A, Patel V, et al. What factors influence British medical students’ career intentions? Med Teach. 2014;36(12):1064–1072. doi:10.3109/0142159X.2014.923560
41. Peng P, Liu L, Wu Q, et al. Establishment and validation of a nomogram for dropout intention in Chinese early year medical undergraduates. BMC Med Educ. 2024;24(1):868. doi:10.1186/s12909-024-05835-y
42. Wang S, Zhao H, Sun Z. Working intentions of medical students in response to healthcare workplace violence and descending resources reform in China. BMC Med Educ. 2022;22(1):351. doi:10.1186/s12909-022-03428-1
43. Barsoumian AE, Hartzell JD, Bonura EM, Ressner RA, Whitman TJ, Yun HC. Factors influencing selection of infectious diseases training for military internal medicine residents. Clinl Infect Dis. 2018;67(10):1582–1587. doi:10.1093/cid/ciy322
44. Blyth DM, Barsoumian AE, Yun HC. Timing of infectious disease clinical rotation is associated with infectious disease fellowship application. Open Forum Infect Diseases. 2018;5(8):ofy155. doi:10.1093/ofid/ofy155
45. Marcus JE, Yun HC, Barsoumian AE. The impact of infectious diseases scholarly mentorship on subsequent infectious disease fellowship application. Clinl Infect Dis. 2024;79(6):1408–1413. doi:10.1093/cid/ciae438