Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
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Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2012 | Month : August | Volume : 6 | Issue : 6 | Page : 1034 - 1037 Full Version

Chasing a Postgraduate Degree in Ophthalmology: The Medical Intern’s Perspective


Published: August 1, 2012 | DOI: https://doi.org/10.7860/JCDR/2012/.2318
Sheetal Amarnath Savur

1. Associate Professor, Department of Ophthalmology, Yenepoya Medical College, Mangalore, India.

Correspondence Address :
A-20, KMC Staff Quarters, RNE Apartments,
Light House Hill Road, Mangalore - 575003 (India).
Phone: +919632352678
E-mail: sheetalsavur@gmail.com

Abstract

Background: There is a dearth of studies on career intensions of interns in India in general and Ophthalmology in particular. The exposure in ophthalmology as an undergraduate trainee as well as an intern is lesser in comparison with other major subjects like medicine and surgery. As a result their understanding of the specialty as a career option could be inadequate and biased. The results of this study could be used to assess the need of incorporating career guidance in ophthalmology during internship.

Aim: To study the medical interns’ perspective of Ophthalmology as a career and to analyze the factors that might influence their decision.

Methods and Material: All interns undergoing compulsory rotatory internship in a medical college in Dakshina Kannada were included in the prospective, questionnaire based study, conducted from September to December 2010. Summary statistics are generated using MS Excel, and most are presented as frequencies and percentages. Chi square /and Fisher’s exact test of significance was used wherever applicable and the significance is reported at 5% level.

Observation: Most respondents (33.9%) had ophthalmology as their third choice for pursuing post graduation. There was no significant gender preference (p=0.623) for the branch. 41.5% (37) said that they would not take up ophthalmology because they felt they lacked skill / fine motor co-ordination in activities. 57.3% (51) would opt for this specialty because there was scope for more family time.56.1% (50) would not want to take it up because there was a lot of dependence on equipment for diagnosis.

Conclusions: Ophthalmology is amongst the top five preferred branches for specialization. It is most preferred for its perceived controllable lifestyle. Perceived lack of inherent skill was an important deterring factor. Incorporation of career counseling and hand-eye coordination tests during internship will help dispel myths about the speciality and aid decision making .

Keywords

Career choices, Ophthalmology, Perceptions, Career counseling

Introduction
Pursuing a postgraduate degree in a particular branch in medicine is often influenced by factors other than aptitude and interest. The undergraduate and the internship experience is often inadequate, as the medical college set-up is not necessarily representative of the current advanced practice pattern and hence, a student may not be aware of all the various options that may be available. As a result, the ophthalmology final year student as well the intern is not aware of all the newer innovations and the possible diversifications within the speciality. This can result in a sub-optimal performance or even frustration during the training period and even after that. There has been a sea of change in ophthalmology as a specialty, due to the rapid technological advances and the expanding subspecialties. There have been no studies till date to the best of the author’s knowledge on the intern’s perceptions about ophthalmology as a career option in India. This study was undertaken to study the perceptions of the interns regarding pursuing ophthalmology as a career, the factors which affect their choice and to identify whether there was a need to implement career guidance in ophthalmology, routinely during the internship.

Aim
To study the medical intern’s perspectives about ophthalmology as a career and to analyze the factors that might influence their decision.

Material and Methods

A pilot study was conducted, which included the interns who underwent a compulsory rotatory internship in a medical collegein Dakshina Kannada. The study was prospective and questionnaire based in nature. It was conducted from September 2010 to December 2010. Ethical clearance was obtained from the institutional Ethics committee. A written informed consent which stated the willingness to participate in the study and the permission to use the data for publication was obtained from the participants. The questionnaire was semi-structured and pretested among 10 respondents. It was modified to enhance its comprehension and clarity. The interns anonymously completed the questionnaire in one sitting and immediately returned it. The questions which were included, brought to light their perceptions regarding the different aspects of the specialty like, its financial/ earning potential, lifestyle issues which included emergency calls, the importance of the inherent talent, fine motor skill activities and financial investment issues.

Summary statistics are generated by using MS Excel, and most were presented as frequencies and percentages. The Chi square/and the Fisher’s exact tests of significance were used wherever they were applicable and the significance was reported at a 5% level.

Results

Observation
Among the 98 interns who underwent compulsory rotatory internship, 3 were away at the time of the study. Among the 95 students who were administered the questionnaire, only 89 completed the questionnaire. The response rate was 93.6% (n=95). There were 38 (42.6%) males and 51(57.3%) females. The mean age of the respondents was 23 years. The preferential order for ophthalmology has been depicted in (Table/Fig 1).

Majority of the respondents 76.4% (68) felt that ophthalmology, as a specialty, had few emergencies. 46% (41) wanted to take it up because they felt that emergencies were few, while 47.1% (42) did not want to take it up because they felt that emergencies were few. The rest (6.7%) did not comment. There was a significant association (p=0.02) between those who felt that ophthalmology had only few emergencies and those who wanted to pursue ophthalmology as their specialty. Though the specialty involved only few emergency calls, there was no significant gender preference (p=0.623) for the branch.

The respondent’s perception on the requirement of fine motor skills and good hand-eye coordination in ophthalmology has been indicated below (Table/Fig 2). 41.5% (37) said that they would not take up ophthalmology because they felt that they lacked skill / fine motor co-ordination in activities like embroidery. 83.1% (74) felt that the specialty might allow them to spend more time with their families. 57.3% (51) said that they would opt for this specialty only because there was scope for more family time. There was no gender preference (females) for this branch on this basis unlike in other studies. 25.8 % (23) felt that ophthalmology was not amongst the most prestigious of specialties. However, 70.7% (63) disagreed. 3.3% (3) did not respond to this question.

60.6% (54) respondents felt that setting up an ophthalmic practice required heavy investment. 31.4% (28) disagreed and 7.8% (7) did not respond to this question. The intern’s view on the income potential of this specialty has been depicted below (Table/Fig 3). 35.9% (32) wanted to take up this specialty because of its earning potential. 71.9% (64) felt that the diagnosis in ophthalmology was becoming more machine dependent.56.1% (50) said that they would not want to take it up because of this reason.

Discussion

The Professionals with career orientation compatible with their job setting, report a higher degree of satisfaction and a stronger levelof commitment (1). A mismatch between a person’s attributes and those of the environment (2),(3) may cause people to experience anxiety, stress and job dissatisfaction. (1),(2) The reasons for choosing a particular specialty were analysed in a few studies; A Canadian study (4) cited intellectual stimulation as the most important factor on the basis of which a specialty was chosen. A study which was conducted by Trevor et al., in the UK (5) stated that the enthusiasm for and the commitment to the specialty was the single most important influence. Although profit maximization was the most rational economic theory for physician behaviour, some physicians may be satisfied with achieving a minimum “target income”, while balancing their own interests and preferences for their professional lives (6),(7).

An intern spends 10 weeks in ophthalmology as an undergraduate and two weeks as an intern. This duration is far less as compared to the time which was spent in major specialties like medicine, surgery, obstetrics and gynaecology and paediatrics. This brief exposure may not provide a sufficient opportunity to get acquainted with the various aspects of the specialty. Many are drawn to the field of ophthalmology because of its perceived, controllable lifestyle. Today’s doctors are less prepared to work extremely long and irregular hours (8). The concerns about the quality of life issues sometimes make the Doctors abandon their initial career choice, and this particularly applies to the hospital medical specialties (9).

A majority of the respondents in this study (83.1%) perceived that this specialty had scope to spare more time for the family. This may be due to the perceived flexibility of the scheduling; the fewer on-call responsibilities and the lesser number of totals work hours. 57.3% wanted to take up this specialty mainly because of this reason. Our findings were similar to a those of a US studywhich was done in 2003 (10), where the lifestyle considerations were important for those who chose general ophthalmology careers. Choosing ophthalmology as a specialty was influenced by the attractive working hours and good working environment, as was seen in another study (5). However, 47.1% respondents did not want to take up ophthalmology as it involved handling a lesser number of emergencies. The reasons which were quoted were “few emergencies means lesser money earned” and “no thrill without emergencies”.

Our study showed no gender preference (females) for this branch, unlike in other studies, where women were more likely than men to choose this specialty, mainly because of its controllable lifestyle. The enhanced earning potential due to the advancement in the technology and the increased awareness amongst the patients have tremendously increased the demand for this specialty amongst men. Also, with the changing roles and the sharing of the domestic responsibilities in modern nuclear families, the gender bias in choosing this specialty is decreasing.

As high as 47% felt that fine motor skills and good hand eye coordination were the requisites for taking up this specialty. Some even quoted “not good in embroidery and therefore may not be good in fine surgery”, “too delicate a structure and therefore may be very difficult to work” and “don’t have the inherent talent”. Hand eye coordination, no doubt, is required but being adept at skills like embroidery is not a requisite. Undue importance is given to the inherent talent at times, thus underestimating the potential of hard work and good training through which any skill can be acquired. During the undergraduate training and often during the internship, there is no hands-on experience. A short stint of wet lab training during the internship may be useful . An aptitude test which assesses the hand eye coordination may also be offered to them during their internship.

The specialties like orthopaedics, paediatrics and general surgery are generally considered to be more prestigious than others. Some of the reasons which have been quoted for this disparity by some respondents were, “these specialties required top ranks”, “the earnings are more” and “the surgeries are more challenging”. 70.7% of the respondents in this study felt that ophthalmology was as prestigious as the core specialties. Many expressed that expertise, skill and success earned prestige and that it came, irrespective of the specialty. Most of the participants (60.6%) agreed that a basic ophthalmic practice required heavy investment. Unlike many other branches like general medicine, paediatrics and orthopaedics where the diagnosis was mainly clinical and required inexpensive and minimal equipment. This may be an important deterring factor in choosing ophthalmology as a career, especially for those who intended to set up their own practice in rural or urban areas. The various practice options should be made known during the internship, which can help the interns in deciding and choosing the options of their choice.

A large number of respondents (67.4%) felt that the specialty was financially rewarding. 24.7% wanted to take up the specialty because of its better financial prospects. In the Canadian study (4), the earning potential was an important factor for the interns in forming their career choice, in addition to the intellectual stimulation and the flexibility of the employment. As per a study (11) whichwas by Scott JR et al., “women are more influenced than men by both personal and family values and less motivated by financial aspirations ”.

Most of the respondents (71.9%) felt that the diagnosis in ophthalmology is becoming increasingly in ophthalmology is becoming increasingly machine dependent. 56.1% felt that this discouraged them from taking up this specialty. As students and interns, their access to equipments like slit lamps and direct and indirect ophthalmoscopes is limited and it is likely that they may develop inhibitions to their use.

Weaknesses of this study
This study was conducted at only one centre. It is very likely that the medical student’s career decisions are subject to an ongoing dynamic process which is influenced by contingencies. Not all the students who are involved would have reflected upon the ideas about their future careers. The study needs to be strengthened by more comparative studies between different batches of interns and also between different universities.

Conclusion

Ophthalmology is amongst the top five preferred branches for specialization. It is preferred mostly for its perceived controllable lifestyle. It has also been perceived to be financially rewarding. However, the perceived lack of inherent skills was an important deterrent amongst many, which needs to be addressed. Heavy investment and a dependency on the equipments were the factors which discouraged them from taking up ophthalmology. The incorporation of career counselling and hand-eye coordination tests during internship will facilitate their decision making.

Key Messages
Incorrect perceptions may lead to wrong career choices and may become a source of constant dissatisfaction. It is important to provide interns a platform where they can be exposed to some of the skills that a particular specialty may require. It is also important to guide and help them choose a specialty commensurate with their aptitude, personality and expectation.

Acknowledgement

Ithank Dr. Uma Kulkarni and Dr. Rashmi Jain for refining the questionnaire and Miss Neevan for her help in the statistical analysis.

References

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Walsh WB, Craik K, Price RH. Person Environment Psychology. 2nd edn. Mahwah, New Jersey: Lawrence Erlbaum Associates 2000; 1-352.
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Noble J. The factors which influence a career choice in ophthalmology. Can J Ophthalmol 2006; 41(5):596-9.
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Lambert TW, Goldacre MJ ,Bron AJ. The career choices for ophthalmology which were made by newly qualified doctors in the United Kingdom, 1974–2005. BMC Ophthalmology 2008; 8:3.
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Mitchell JM, Hadley J, Gaskin DJ. The physician’s responses to the Medicare fee schedule reductions. Med Care. 2000; 38:1029-39.
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Evans J, Goldacre MJ, Lambert TW. Views of the UK medical graduates about the flexible and part-time working in medicine: a qualitative study. Med Educ 2000; 34:355-62.
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Lambert TW, Davidson JM, Evans J, Goldacre MJ. The doctor’s reasons for rejecting the initial choices of specialties as long termcareers. Med Educ 2003; 37:312-18.
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Gedde SJ, Budenz DL, Haft P, Tielsch JM, Lee Y, Quigley HA. The factors which influence the career choice among graduating ophthalmology residents. Ophthalmology 2005; 112(7):1247-54.
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Scott JR, Gunderson CA. A study on the prospective ophthalmology resident’s career perceptions. Med Educ Online [serial online] 2003; 8:9.

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