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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 5
| Issue : 3 | Page : 105-113 |
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Are the pre-internship expectations of interns in medical field met during internship?: Experience from Tanzania
Karpal S Sohal1, Sira S Owibingire2, Philipo F Garinga3, Evarist M Wilson4, Shaban D Shaban4
1 Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
2 Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
3 Department of Dental Services, Muhimbili National Hospital, Dar es Salaam, Tanzania
4 Muhimbili National Hospital, Dar es Salaam, Tanzania
| Date of Submission | 08-Nov-2021 |
| Date of Acceptance | 12-May-2022 |
| Date of Web Publication | 26-Sep-2022 |
Correspondence Address:
Dr. Karpal S Sohal
Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences, P. O. Box 65014, Dar es Salaam
Tanzania
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/EHP.EHP_32_21
Background: The transition period from an undergraduate student to an independent practitioner across healthcare professionals is challenging as new graduates experience a social, professional, and economic life that may be different from their prior expectations. Objective: The aim of this article is to determine the pre-internship expectations of the interns and to what level these expectations were met during internship. Materials and Methods: The study participants were interns posted at the Muhimbili National Hospital who had completed at least 6 months of internship training. A structured questionnaire was used to collect data regarding their social, economic, and career expectations before and during the internship. Data were analyzed using Statistical Package for Social Sciences version 23. The χ2 test was used to assess the association between variables, and the significance level was set at P < 0.05. Results: The median age of participants was 26 years, and the male-to-female ratio was 1.7:1. The overall mean pre-internship expectation score was 9.6 ± 3.6, whereas the mean scores were 3.6 ± 2.0, 3.7 ± 1.5, and 2.2 ± 1.4 for social, career, and economic expectations, respectively. The overall average expectation score during the internship was 6.1 ± 4.2. The mean scores were 1.9 ± 2.2, 3.0 ± 1.5, and 1.2 ± 1.5 for social, career, and economic expectations, respectively. There was a significant average difference between the expectation scores before and during the internship period. Conclusion: The pre-internship expectations of students in the field of health sciences are not met during the internship. The career expectations are relatively better met; however, social and economic expectations are largely not achieved during the internship period. Keywords: Expectations, healthcare field, interns, Tanzania
How to cite this article:
Sohal KS, Owibingire SS, Garinga PF, Wilson EM, Shaban SD. Are the pre-internship expectations of interns in medical field met during internship?: Experience from Tanzania. Educ Health Prof 2022;5:105-13 |
How to cite this URL:
Sohal KS, Owibingire SS, Garinga PF, Wilson EM, Shaban SD. Are the pre-internship expectations of interns in medical field met during internship?: Experience from Tanzania. Educ Health Prof [serial online] 2022 [cited 2023 Mar 30];5:105-13. Available from: https://www.ehpjournal.com/text.asp?2022/5/3/105/357123 |
| Introduction | |  |
The health workforce is an essential aspect of the delivery of health care.[1],[2] The medical field is an ever-evolving field in which the pace of change and the impact of globalization are significant.[1] Therefore, it is vital to identify the career expectations of expensively trained graduating students to understand their post-qualification plans and their proposed contribution to health care in general. Upon graduating from a medical school, the internship program is the very beginning of the process of transition from being a student to a junior health practitioner.
The medical internship is a transient period in the healthcare system and has undergone many innovations since its inception in the middle of the last century; yet still, it offers an important opportunity for personal development and career planning.[3] This is the period when theoretical knowledge and skills learned in the classroom are transferred to practice in the clinical environment.[4] However, it is during this transition period from studentship to intern practitioner problematic experiences can occur, and new graduates experience the reality of life[5] for which in most cases they are not well prepared during their training.[3] The particular journey of transition from an undergraduate student to an independent practitioner across healthcare professionals is challenging and has even been termed “transition shock.”[6],[7]
In the preparation for the internship, prior expectations are important. No matter what the level of stress is, when the actual work experience is equivalent to or less stressful than what was expected, commitment is enhanced. Conversely, when the experience is more stressful than expected, new interns may feel demoralized.[6] Apart from the professional aspects of the internship, these junior healthcare professions are social beings, as such, they have social expectations as well. Healthcare professionals are said to experience higher levels of stress, divorce, alcoholism, and burnout, compared with other professional groups.[8] These can be partly due to failure to meet the high expectations they had about the career.
In Tanzania, the internship program is mandatory for all healthcare fields, with an internship duration of 1 year. The internship is usually carried out in recognized public referral hospitals that have different specialties. Despite having several groups of healthcare interns going through this phase of their profession for more than five decades, there is no documentation about what are the pre-internship expectations of students and to what extent these expectations are met during the internship. Therefore, this study aimed to determine the expectations of the graduating health profession students about internships and to what level these expectations were met. This study was necessary as there was a need to know whether the medical field training model used does prepare the future medical professionals in all aspects of life. Currently, the training model used in Tanzania is that the pre-clinical years are mostly lecture-based, whereas in the clinical years it becomes practice-based teaching. Clinical teaching is usually bedside teaching in small-to-large groups and depending on the clinical course, the range of procedures a student is allowed to carry does vary.
| Materials and Methods | | |
This was a descriptive cross-sectional study that took place at the Muhimbili National Hospital (MNH) between July 2019 and October 2020. The study participants were interns who were posted at the MNH. All interns in the fields of Medicine (MD), Nursing (BScN), Dentistry (DDS), Pharmacy (BPharm), and Medical Laboratory Sciences (BMLS) who had completed at least 6 months of internship training were eligible to participate. Ethical clearance and approval for this study were sought from the Institutional Review Board of the MNH.
A stratified random sampling method was used to obtain the participants. The degree programs of interns at the MNH were used as strata, and the simple random sampling method was used for each program to attain the sample size required (150 participants). The sample size was estimated using the population adjustment formula for single proportion estimation based on 95% confidence level, a precision of 5%, and 58.6% expected proportion based on a study by Yadav et al.,[9] yielding a total sample of 150 participants.
Due to the variation in the number of interns according to different programs/cadres at the MNH, during sampling, medical interns contributed 40% of the estimated sample size. The interns from nursing comprised 25%, the pharmacy interns composed 20%, the intern dentists comprised 10%, and those in medical laboratory sciences made up 5% of the sample, respectively.
All study participants who consented to participate in the study were given a structured questionnaire (Appendix) that was specially designed for the study. The questionnaire had questions regarding sociodemographic data (age, sex, residence, program, etc.): 19 questions on social (8 questions), career (7 questions), and economic (4 questions) expectations before and during the internship. Each of the expectation questions had three possible responses (1—agree, 2—neither agree nor disagree, 3—disagree).
The data obtained from this study were entered into a computer and analyzed using Statistical Package for Social Sciences (SPSS) software version 22. The age of the participants was dichotomized as 21–26 years and ≥ 27 years. The overall expectation was obtained by counting all “agree” responses to make a total score of 19 for the questions. The total score was dichotomized as low expectation (score 0–9) and high expectation (score 10–19). A similar process was followed for each subsection of expectations, and the total section score was also dichotomized as high and low as follows: social expectation (low = 0–4 and high = 5–8), career expectation (low = 0–4 and high = 5–7), and economic expectation (low = 0–2 and high = 3–4). A descriptive analysis was performed by comparing the means of continuous variables and cross-tabulation for categorical variables. Statistical significance testing was done using the χ2 test, and P < 0.05 was considered statistically significant.
| Results | | |
Of the 150 questionnaires which were distributed to the interns, only 91 (60.6%) were returned. The age of participants ranged from 21 to 35 years with a median age of 26 years. Most (57, 62.6%) were males, and the male-to-female ratio was 1.7:1. Majority (76, 83.5%) were single. Most (54, 59.5%) of the participants were raised and grew up in urban areas. Only 34 (37.4%) participants had an immediate family member in the health-related field [Table 1]. | Table 1: Distribution of study participants according to the sociodemographic characteristics
Click here to view |
Regarding social life, before the internship, more than half (54, 59.3%) of the participants thought that they would have enough time for the family, whereas in reality only a few (23, 25.3%) agreed to have time for families. Before the internship, 64 (70.3%) participants thought that they would have ample time to worship during the internship period when compared with 29 (31.9%) participants who agreed to get ample time to worship during the internship period [Table 2]. | Table 2: Distribution of study participants according to their expectations before and during internship
Click here to view |
With regard to career and education, the majority of the interns agreed that during the internship they were able to perform procedures that they could not do while they were students (63, 69.2%), confidently interpret results of different investigations (65, 71.4%), and work independently (62, 68.1%). During the pre-internship period, 71 (78%) participants thought that they would be able to decide the field of future specialization, whereas during the internship only 54 (59%) had chosen a field of specialization. Most of the participants’ pre-internship career expectations were met during the internship period. Concerning economic expectations, most of the expectations were not fulfilled [Table 2].
The majority of the participants preferred to work in Tanzania both before internship (65, 71.4%) and during internship (61, 67%). Working in both private and public health facilities was the choice in 53 (58.2%) and 52 (57.2%) participants before and during internship, respectively. Before internship, 25 (27.4%) participants thought that they will prefer working exclusively in public health facilities, whereas after the internship 21 (23.1%) had a similar preference. Regarding working exclusively in a privately owned health facility, before internship, only 13 (14.3%) participants preferred the option, compared with 18 (19.8%) participants during the internship period [Figure 1]. | Figure 1: Number of participants according to the preferred type of practice before and during internship
Click here to view |
The overall mean pre-internship expectation score was 9.6 ± 3.6, whereas the mean scores for social expectation were 3.6 ± 2.0, for career expectation was 3.7 ± 1.5, and for economic expectation, it was 2.2 ± 1.4. In contrast, the overall average expectation score during the internship was 6.1 ± 4.2. The mean scores for social, career, and economic expectations were 1.9 ± 2.2, 3.0 ± 1.5, and 1.2 ± 1.5, respectively. There was a significant average difference between the expectation scores before and during the internship period (P < 0.001).
During the pre-internship period, there was no statistically significant relation (P ≥ 0.05) between expectation and different variables. During the internship period, a statistically significant association was noted between the overall expectation and sex of the participants (P = 0.031) and marital status (P = 0.002). The relation between marital status and social expectations during the internship was significant statistically (P = 0.004). The association between the sex of the participants and economic expectation during the internship was statistically significant (P = 0.005) [Table 3]. | Table 3: Pre- and during internship expectations of participants according to selected sociodemographic characteristics
Click here to view |
| Discussion | | |
This study is the first of its kind in Tanzania that assessed the pre-internship expectations of interns in the field of health and the extent to which the expectations were met during the internship period. The training in the field of medicine/health in this country has tried to keep up with the transformations in the healthcare system. Since independence, many doctors, pharmacists, nurses, and laboratory scientists have been trained to meet the needs of the ever-evolving healthcare system in the country. This education system, as in many other countries in the world, may have been able to impart clinical skills to the trainees, but may have not fully prepared them for other aspects of life, largely because the curriculum does not pay much attention to the career guidance. This was evident in this study, whereby in several domains of expectations, the pre-internship expectations were higher than the reality that was faced by the participants during internships.
In the current study, the majority of interns did not achieve the social life expectations they had during the pre-internship period. Interns reported that they did not have ample time for family and friends, nor did they have enough time for different social activities. It is well known that informal socialization and connecting with other employees affect the performance of an individual.[10] The opportunities for social experiences can enhance interns’ sense of the desirability of such a career, strengthen their aspirations, and make their commitment to the field of healthcare stronger.[10] Individuals constantly have expectations regarding social life, career, and relationship, and failure to achieve these expectations results in negative effects associated with continued distress and development of mood and anxiety disorders.[11]
Among several objectives of the internship program in the healthcare field is expectations that after completion of the internship period, interns acquire enough knowledge, skills, and attitudes to embark on a career as a healthcare provider.[3] In this study, the majority of the participants agreed that during internship they were able to perform procedures that they could not while they were students. Furthermore, they were confident in interpreting the results of different investigations and work independently. These findings indicate that the internship program set in MNH is effective and successful.
Similar to findings from elsewhere,[12],[13] data from the current study show that about 60% of the participants were sure of their future area of specialization, although it was less than 80% who reported to be sure of a specialty of their choice during the pre-internship period. Such a change in decision-making may have been affected by several factors including quality and effectiveness of supervision, the opportunity for experiential learning, personal attributes, and workload.[3] An internship provides participants with the opportunity of learning a realistic sense of job responsibilities, which may be completely different from what they learn in the classroom.[10] This together with the aforementioned factors influence the interns’ career choice either positively or negatively.
In this study, there was no statistically significant relation between pre-internship expectation and different variables such as sex, age, and marital status. This may indicate that, as students, most of the participants had similar visions/expectations regarding the internship. However, during the internship period, compared with their male counterparts, females had reported a higher level of achieving economic expectations. This may be explained by the cultural and traditional beliefs in gender roles in development within the family context. Most of the males have been brought up with the notion that they are the breadwinners of the family, as such, they have a role to act as providers; consequently, what they earn ends up in providing for the family and little is left for any economic development. It was also found that married participants achieved their social expectations more than single ones. This may not be surprising as married individuals may have more children than singles; aspect of parenthood may be a life-course transition that accounts for what initially appears to be the effects of marital status. Children, needing time and affection, may cause parents to cut back on other relationships and social activities[14]; as such, they have lower expectations of social life. On the contrary, singles tend to have more friends and many social activities; therefore, considering the busy schedule of work during the internship, singles fail to have enough time to meet their social expectations.
The results of the current study show that the majority of the participants preferred living and working within the country. Similar findings were reported by other studies.[12],[15] It is beyond doubt that the interns in health fields represent the future generation of healthcare providers within the country, and their willingness to work within the country is taken as a positive attitude, and it justifies the decision of the government to invest in the local training of health professions in the country.
The findings of this study depicted that most of the participants prefer to work in the public sector in conjunction with the private sector, similar to reports from elsewhere[16] but contrary to the findings from Cuba[13] where the majority preferred to work in the public sector. The findings of the current study may be contributed by the fact that despite the salary scale in public health facilities being lower than that in private facilities, one has job security. Then by working extra time in the private sector, one has a supplementary income. This explanation is further supported by the findings from this study, in which during the internship, the majority of the participants could not achieve their economic expectations.
The limitation of this study was its small sample size; however, despite this, the data from this study provide reliable information because at the MNH there is a vast mixture of interns who were trained in different universities and with different backgrounds. Therefore, this study has provided an important insight into the expectations of students in the field of health care regarding internships and to what extent these expectations are met. The findings from this study can be used to improve the training of undergraduate students in the country that not only focusses on issues about their careers but also other aspects of life.
| Conclusion | | |
This study shows that generally the pre-internship expectations of students in the field of health sciences are not met during the internship. Though the career expectations are mostly met, the social and economic expectations were largely not achieved during the internship period.
Acknowledgments
We gratefully acknowledge all the participants of the study for availing necessary information that was required in this study without hesitation.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Authors’ contribution
KSS: conceived the idea, guided the whole process of data collection, data analysis and writing and editing of the first draft, and approved the final draft.
SSO: broadened the conceived idea, was involved in data analysis, writing the first draft and its improvement, and approved the final draft.
PFG: guided the whole process of data collection and writing and editing of the first draft and approved the final draft.
EMW: guided the whole process of data collection and writing and editing of the first draft and approved the final draft.
SDS: broadened the conceived idea, was involved in writing the first draft and its improvement, and approved the final draft.
Appendix II: Questionnaire: This questionnaire consists of PART A and PART B, with questions regarding you’re a) pre-internship expectations and b) level of expectations 6 months into internship
Questionaire No:
PART A: Pre-internship Expectation
PART B: Internship and level of achieving the expectations
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| 13. | Ferrinho P, Valdes AC, Cabral J The experience of medical training and expectations regarding future medical practice of medical students in the Cuban-supported medical school in Timor-Leste. Hum Resour Health 2015;13:13. |
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[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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