Determinants of Choice of Specialty by Resident Doctors: A Multi-Center Based Study in South-West Nigeria.

BACKGROUND AND OBJECTIVES: An appropriately balanced specialty distribution in residency training will ensure adequate coverage and delivery of essential health needs to the people. An understanding of the factors which influence doctors' career choices is important for all those involved in the training of Resident doctors. The aim of this study is to examine the factors influencing the Resident Doctors' choice of specialty. METHODS: This was a cross-sectional study. A well-structured questionnaire was used as the instrument for data collection. RESULTS: A total of 110 Resident Doctors participated in the study with 74.5% falling within the age group 31-40 years, and 87 (79.1%) were males. A natural love for a specialty (66.4%), personal experience during medical school (47.3%) and the influence of mentors (30%), love for a particular class of patients (26.4%) and presumed higher income (17.3%) were reasons for initial choices of specialties. The most stated reasons for the change of specialty were because of the acquisition of more information (39.0%), the influence of mentors (26.8%), a change in perspective (24.4%), availability of vacancies (24.4%) and the influence of senior colleagues (17.1%). About 80% had no career guidance prior to the initial choice of specialty; likewise, 92% had no guidance prior to current program. However, 89% were happy with their final choices while only 21% would still consider a change of specialty. CONCLUSION: In our study, we found that personal interest in a specialty, previous experiences and mentorship were key to most individuals' choice or change in choice of specialties.

CONTEXTE ET OBJECTIFS: Une répartition équilibrée des spécialités dans le cadre de la formation des médecins résidents garantira une couverture adéquate et la satisfaction des besoins essentiels en matière de santé de la population. La compréhension des facteurs qui influencent les choix de carrière des médecins est importante pour tous ceux qui sont impliqués dans la formation des médecins résidents. L'objectif de cette étude est d'examiner les facteurs qui influencent le choix de la spécialité par les médecins résidents. MÉTHODES: Il s'agit d'une étude transversale. Un questionnaire bien structuré a été utilisé comme instrument de collecte des données. RÉSULTATS: Au total, 110 médecins résidents ont participé à l'étude, 74,5 % d'entre eux se situant dans la tranche d'âge 31­ 40 ans, et 87 (79,1 %) étaient des hommes. L'amour naturel pour une spécialité (66,4 %), l'expérience personnelle pendant les études de médecine (47,3 %) et l'influence des mentors (30 %), l'amour pour une catégorie particulière de patients (26,4 %) et un revenu présumé plus élevé (17,3 %) ont été les raisons des choix initiaux de spécialités. Les raisons les plus citées pour le changement de spécialité étaient l'acquisition de plus d'informations (39 %), l'influence des mentors (26,8 %), un changement de perspective (24,4 %), la disponibilité de postes vacants (24,4 %) et l'influence de collègues plus expérimentés (17,1 %). Environ 80 % n'ont bénéficié d'aucune orientation professionnelle avant le choix initial de la spécialité ; de même, 92 % n'ont bénéficié d'aucune orientation avant le programme actuel. Cependant, 89% sont satisfaits de leur choix final, tandis que seulement 21% envisageraient encore un changement de spécialité. CONCLUSION: Notre étude a révélé que l'intérêt personnel pour une spécialité, les expériences antérieures et le mentorat étaient des éléments clés dans le choix ou le changement de spécialité de la plupart des individus. Mots-clés: Faculté de médecine, Patients, Orientation professionnelle, Spécialité.

Paraneoplastic syndromes and oncological outcomes in renal cancer.

BACKGROUND: Paraneoplastic syndromes (PNS) have been defined as a constellation of symptoms and signs seen in patients with malignancy, which cannot be ascribed to the local or distant spread of the tumor. Renal cell carcinoma (RCC) is most commonly associated with PNS among urological malignancies. We describe the incidence of PNS and the association between the syndromes and oncological outcomes in our patients with RCC. SUBJECTS AND METHODS: A retrospective cohort study done at Lagos State University Teaching Hospital, Ikeja, Lagos. This was a retrospective review of our patients who had RCC over 11-year period (2006 to 2016). The incidence of PNS syndromes were hypercalcemia, Stauffer's syndrome, hypertension, anemia, elevated erythrocyte sedimentation rate (ESR), persistent leukocytosis, and its correlation to outcome of disease were analyzed. In addition, the age, gender, clinical features, and stage of disease were analyzed. Chi square, Fischer exact test, and Kaplan-Meier survival, curve and logistic regression. RESULTS: : In total, 101 patients were operated within the period. Age of the patients ranged from 11 to 81 years (mean of 45.17 ± 16.3). There were 46 males and 55 females with M:F ratio of 1:1.2. Majority of the patients, 74 (73%), had clear cell variant of RCC. Twenty-seven patients (26.7%) had triad of flank pain, flank mass, and hematuria. The incidence of PNS were hypercalcaemia 7 (6.9%), Stauffer's syndrome 12 (11.9%), hypertension 16 (15.8%), anemia 61 (60.4%), elevated ESR 56 (55.4%), and persistent leukocytosis 3 (3.0%). At a median follow-up of 6 months, 72 patients (71.3%) were alive, whereas 29 patients (28.7%) were dead. CONCLUSION: Among the PNS, only Stauffer's syndrome was significantly associated with poor outcome.