Understanding Outlook and Conduct of Medical Students Concerning Applications for Postgraduate Training: A Questionnaire Survey

Introduction:

Medical education has an elaborate curriculum in which the choice of specialization plays a pivotal role1. This postgraduate curriculum is meticulously designed to focus not only on the cognitive domain, psychomotor skills development, and subject knowledge acquisition, but also on attitudinal changes and communication skills among budding healthcare professionals2. It further primes medical students to hone their teaching skills and become future medical educators2,3. During postgraduate studies, students are encouraged to engage in innovative practices and conduct both medical and educational research under the guidance of mentors4.

By the end of postgraduate training programs, students are expected to be proficient in managing healthcare services at all levels and to demonstrate leadership qualities5,6. Furthermore, specialists are expected to provide a standard of care comparable to that of other international healthcare systems6. Thus, moving into postgraduate training requires an accurate understanding of the varied specialties and a strategic vision for the future7.

However, the transition from undergraduate medical school to postgraduate training presents several challenges. Many medical graduates, having completed demanding undergraduate programs, feel relieved—yet unprepared for the unfamiliar and professional responsibilities that follow6,8. One of the vital transitions for any medical graduate is this immediate post-graduation period, where they begin assuming the full responsibilities of a physician7. The choice between pursuing postgraduate training or entering practice directly becomes a significant dilemma, often prompting students to seek counseling9.

Globally, the selection of specialty education is influenced by a combination of factors including personal interest, country of residence, working environment, quality of life, role models, and access to technological advancements10-12. A study conducted in Jordan to identify the preferred specialties and attitudes of medical students toward postgraduate education showed that approximately 59.3% were interested in medical or non-surgical specialties, and 74.3% preferred to pursue their training abroad6. Similarly, a study of medical students at Kuwait University found that 37.2% had decided on their future specialty prior to graduation13.

In Saudi Arabia, medical education has undergone rapid changes. Over the past two decades, the number of medical colleges has expanded from five to more than twenty-one, introducing a variety of curricula—ranging from traditional and innovative to problem-based and community-oriented models14. Consequently, there are many specialties for medical graduates to consider when planning their postgraduate careers. Ideally, medical curricula should provide structured guidance to support students in this critical decision-making process.

The present study aimed to assess the status of medical university students in Saudi Arabia to gain a more comprehensive understanding of their knowledge, preferences, and perceptions regarding postgraduate medical education, and to identify similarities and distinctions that may enhance the generalizability of the findings.

Methods

Study design and participants A cross-sectional survey was conducted using an online questionnaire created in Google Forms. The medical school under consideration in the present survey offered a six-year program, which included an additional year dedicated to an internship. In the current survey, all students who were enrolled in the fourth, fifth, and sixth years of the program, as well as those currently undergoing their internship, were included. The questionnaire was disseminated via WhatsApp for one month in May 2021. No exclusion criteria were applied for participation in the study. The questionnaire used in this study was originally developed and validated in previous research at a different university in Saudi Arabia 15. It contains 17 multiple-choice questions divided into four sections (Additional File 1). The first section includes three questions on basic demographics; the second includes four questions assessing knowledge about postgraduate training; the third contains four questions about attitude; and the fourth includes six questions assessing behavior regarding postgraduate training.

Data collection and analysis

The data collected from every participant were collated and analyzed descriptively. The responses

entered by the participants in the Google Form were automatically processed by Google Sheets,

generating numbers and graphs.

Sample size calculation

Calculating the Sample Size

The sample size was calculated using the formula for cross-sectional studies, assuming a 95% confidence level, a 5% margin of error, and an estimated proportion (p) of 50% to maximize variability. The initial required sample size was 384. As the total population of medical students in the clinical years was approximately 120, the finite population correction was applied, yielding a minimum required sample size of 91 students. A total of 109 students participated in the study, resulting in a response rate of 90%, which is considered adequate for cross-sectional research and enhances the validity and generalizability of the findings.

Ethics approval and informed consent

Ethical approval was obtained from the Majmaah University Ethical Committee (Approval Number:MUREC-April.14/COM-2021/32-1). The initial section of the questionnaire was dedicated to obtaining informed consent from participants. The participants had the freedom to choose whether to complete the questionnaire, and there were no coercive measures or negative consequences associated with deciding not to participate. Furthermore, to ensure the privacy of participants, they were provided the opportunity to complete the questionnaire anonymously using their own mobile devices, thereby affording them full autonomy in participation.

Results

Participant Characteristics

A total of 109 medical students aged 22–26 years participated in the study, yielding a response rate of 90%. The majority were fourth-year students (65.1%), followed by fifth-year students (22%). Most participants (84.4%) had enrolled in medical school immediately after completing high school, and 65.1% reported having no relatives in the medical profession (Table 1).

Awareness and Understanding of Postgraduate Pathways

Regarding knowledge of entrance examinations for specialty medical education, 25.3% of students reported limited understanding of the syllabus, while only 16.8% had good knowledge. Similarly, only 8.3% felt well-informed about residency training application procedures, with 38% indicating a lack of knowledge in this area. When asked about awareness of specific postgraduate specialties, only 13.9% were aware of their intended specialty, 23.1% had poor knowledge, and 63% responded neutrally. In terms of self-awareness, 25.2% reported accurately identifying their own weaknesses, while 10.3% found it difficult to assess their shortcomings (Figure 1).

Perceptions of Medical School Preparation

A significant proportion of students (92.6%) believed that residency positions were insufficient. Only 13% reported that their medical school had contributed adequately to preparing them for license examinations, whereas 38% expressed dissatisfaction with their school’s efforts in this area. Additionally, 47.2% agreed that the problem-based learning (PBL) approach played a positive role in preparing them for clinical practice.

Specialty Preferences and Career Planning

When asked about specialty selection, 32.1% of participants reported having limited options to choose from, and 22% felt it was too early to decide on a postgraduate specialty. Only 14.7% had made a definitive decision. Despite this, 56.5% indicated they had plans to pursue postgraduate training in a specialty of their choice, and 26.4% had already taken active steps toward applying.

Academic and Professional Development Activities

In terms of study habits, 29.3% regularly used recommended textbooks, while 22.9% rarely consulted them (Table 2). A majority of students were engaged in self-improvement activities: 57.4% participated in extracurricular activities to enhance their residency training prospects; 61.1% reported making deliberate efforts to improve their English language skills; and 57.4% had worked on improving their research abilities (Figure 3).

Table 2. Participants academic decisions

Discussion

This study assessed the readiness of medical students and their perceptions toward postgraduate training. Unlike a similar study conducted in another Saudi Arabian university, where more than half of the respondents were junior students, mainly in their first year16, most of the respondents in the present survey were fourth-year students. This difference may partially explain variations in the outcomes; while junior students showed a stronger preference for general surgical specialties in the earlier study16, no clear inclination toward a specific specialty was noted in our cohort. It is possible that with more clinical exposure, senior students develop a more cautious or uncertain approach to specialty selection, reflecting a shift from early enthusiasm to more realistic planning as they better understand the competitiveness and structure of residency programs.

Our study revealed that most students joined medical school immediately after high school and many were unable to assess their own strengths and weaknesses. Furthermore, the majority had no relatives engaged in the medical profession. This may have contributed to a lack of awareness regarding available postgraduate specialties, the application process, and the syllabus for entrance examinations. While similar knowledge gaps have been reported in other Saudi studies, our findings may reflect more localized institutional differences in career counseling and mentoring programs. Compared to settings where mentorship and structured guidance are introduced earlier, our respondents may have had fewer opportunities to receive informed advice on postgraduate planning.

A notable finding in our study was the high proportion of neutral responses in certain items, with up to 63% of participants selecting the neutral option. This trend reflects underlying uncertainty or limited awareness regarding specific aspects of postgraduate medical education. Neutrality in this context should not be interpreted as indifference but rather as a lack of confidence in one’s understanding. This finding may also highlight the need for more structured and accessible academic advising systems that provide timely information about postgraduate pathways.

To pursue a medical career, students must consider several career decisions, which can be complicated and confusing14. In our survey, an overwhelming majority reported a dearth of seats for residency training—similar to previous findings—but this perception could be influenced by recent national changes in training positions, and may vary across institutions. Less than half of the respondents affirmed the contribution of PBL in preparing them for their clinical careers. While prior studies reported similar views15, this consistency across institutions raises questions about whether PBL is effectively integrated into exam preparation or if its role is more beneficial for clinical reasoning rather than standardized assessments.

A study from Japan introduced a two-career model in which medical graduates first train in hospital-based specialties and later transition to outpatient practice18 . While this model is not directly applicable to Saudi Arabia, the comparison raises important questions about the long-term flexibility and planning in postgraduate medical pathways. Furthermore, previous literature has shown that students often report poor English proficiency as a barrier to academic progress19.20. In our study, many students expressed a desire to improve their English skills, suggesting increased awareness of language as a key factor in accessing high-quality training programs and academic resources. This aligns with prior research emphasizing the role of extracurricular activities in enhancing communication skills and reducing language-related anxiety21.

Strengths and Limitations

The successful completion of medical education is a complex and prolonged journey in which students are prepared to meet the health needs of society. Therefore, early and informed decision-making is critical for shaping their future career paths.

A major strength of this study is its focus on clinical-year medical students in a rural university setting, using a previously validated questionnaire tool. This approach offers valuable insights into a distinct student population—those who are approaching critical career decisions and who are often underexplored in national-level educational research. In contrast to earlier studies conducted in urban universities and involving students from all academic levels, our study specifically targets students in the final phase of their medical training. Given that Saudi Arabia has over 25 medical colleges with diverse geographical and curricular contexts, our findings add meaningful perspective and help fill a significant gap in the literature.

However, the study also has several limitations. First, the participants may not represent a fully unbiased or diverse sample of medical students, given the limited sample size from a single institution. Second, the rigid structure of the study design, while necessary for standardization, may have constrained the scope of the data collected. Once the survey was distributed, researchers were unable to modify the preset questions in response to emerging themes or unforeseen areas of interest. This limitation may have restricted the depth and flexibility of the data.

Future research should include more comprehensive, multi-institutional surveys to better understand medical students’ awareness of licensing exams, residency applications, and specialty selection. These studies should aim to identify the root causes of knowledge gaps and propose actionable solutions. Collaboration with medical educators, career advisors, and policymakers will be essential to develop targeted strategies that support students in making informed, confident choices about their postgraduate training.

Educational implications

The understanding, outlook, and conduct of medical students concerning their induction into postgraduate training may be associated with several factors, such as thought process, experience,

values, professional integrity, and clinical overview. These statistics provide valuable insights into

the preferences and readiness for postgraduate specialty selection of the surveyed individuals. This

ultimately shapes the crucial transformation from graduation to applying for postgraduate training. A thorough examination of the issues surrounding students lack of knowledge in crucial areas of

postgraduate medical education can lead to the development of informed strategies and resources

to better prepare students for their medical careers.

Conclusion

This study explored the challenges and perceptions of medical students regarding postgraduate training, revealing limited awareness of residency pathways, uncertainty in specialty preferences, and a strong desire to improve English language skills. These findings suggest a need for enhanced career guidance and support during undergraduate training. While the study reflects the perspectives of students from a single institution, the results may serve as a foundation for further multi-center research and discussion aimed at improving student preparedness for postgraduate medical education.

Supplementary material

File name: Additional file 1.docx

Title of data: Understanding, Outlook, and Conduct of Medical Students Concerning Application for Postgraduate Training: A Questionnaire Survey

Declarations

Ethics approval and consent to participate

Ethical approval was obtained from Majmaah University Ethical Committee (Approval Number:

MUREC-April.14/COM-2021/32-1). The initial section of the questionnaire was dedicated to

obtaining informed consent from participants. The participants had the freedom to choose whether

to complete the questionnaire, and there were no coercive measures or negative consequences

associated with deciding not to participate. Furthermore, to ensure the privacy of participants, they

were provided the opportunity to complete the questionnaire anonymously using their own mobile

devices, thereby affording them full autonomy in participation.

Consent for publication

Not applicable.

Availability of data and materials

The dataset supporting the conclusions of this article is available upon reasonable request from the

author.

Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Funding

Not applicable.

Authors' contributions

AAA: Conceptualization, Data curation, Funding acquisition, Investigation, Methodology, Project

administration, Supervision, Visualization, Writing - original draft, Writing - review & editing. The main author read and approved the final manuscript.

Acknowledgements

Manuscript writing assistance was provided by Dr. Priyanka Biswas Karmakar and Ms. Shaswati

Das, Turacoz Healthcare Solutions. Editing assistance was provided by Editage.

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Figure legends

Figure 1 Students’ awareness of the license exam curriculum, residency training application,

different postgraduate disciplines, and their own shortcomings

Figure 2 Students’ perspectives on seat availability, medical license exams, the role of

problem-based learning, and inclination toward postgraduate training

Figure 3 Students’ inclination toward selecting a specialty, engaging in extracurricular activities, and improving their English language skills and research abilities