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Motivational factors influencing the choice of oncology as a specialty among French medical students

BMC Medical Education volume 25, Article number: 447 (2025) Cite this article

Abstract

Background

There is limited data regarding what motivations are behind the choice of oncology (both medical oncology and radiation oncology) as a specialty among medical students. Therefore, the aim of this study is to identify the factors that motivate medical students to choose oncology as a specialty.

Methods

Medical students of classes 2022 and 2023 in the Universities of Lille and Amiens (North of France) were enrolled in a quantitative online survey. Chi-square automatic interaction detection (CHAID) and binary and multiple linear regressions were performed to identify the factors that determine the choice of specialty among the students.

Results

Among 563 respondents (response rate: 45%) who participated in the survey, 14, 13, and 14 were considering oncology as their first (2.5%), second (2.3%), and third (2.5%) specialty choices, respectively. The CHAID analysis retained two factors: “rotation in the medical oncology unit” (p < .0001) and “identification with a physician practicing the desired specialty” (p = 0.049). The factors identified in the multivariate regression analysis (weighted according to first, second, or third choices) differed according to sex. In men, rotation in a radiation oncology unit (β = 0.190; p < 0.001) or a medical oncology unit (β = 0.227; p = 0.010) and interest in fundamental research (β = 0.063; p < 0.001) were positively associated with choosing oncology as a specialty, whereas working in rural areas (β=-0.094; p = 0.014) was negatively associated with choosing oncology as a specialty. In women, rotation in a medical oncology unit (β = 0.289; p < 0.001), interest in cultivating a long-term relationship with patients (β = 0.129; p < 0.001), and interest in a hospital-based career (β = 0.214;p < 0.001) were positively associated with choosing oncology as a specialty; whereas desire to see the results of treatments quickly (β=-0.143; p = 0.018) and working in rural areas (β=-0.153; p  = 0.006) were negatively associated with choosing oncology as a specialty.

Conclusions

Experience during hospital rotations plays a crucial role in the specialty choices made by medical students. The motivations behind choosing oncology as a specialty differ according to gender. Intrinsic motivations (interests in fundamental research or in cultivating a long-term relationship with patients) and contextual factors (rural life or interest in a hospital-based career) influence the specialty choices of medical students.

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Background

In Europe, the number of cancer cases recorded globally is expected to double by 2040 [1]. Today, cancer already affects 4 million Europeans [2], kills 1.9 million Europeans [2] and costs €199 billion [3]. Although very precise data regarding burden and cost related to cancer in Europe are available, data on the number of medical personnel specialized in cancer treatment, such as oncologists, are limited and unclear [4]. Given the complexity of care pathways and the improvement in life expectancy, the number of medical personnel specialized in cancer care must increase with the expected increase in the incidence of cancer.

Appropriate and sufficient resources are required for the management of cancer. From this perspective, training future medical personnel who will treat and care for patients with cancer is critical. In this vein, it will be beneficial to identify what motivates medical students to choose oncology as a specialty (including both medical oncology and radiation oncology) [5,6,7,8,9,10,11,12,13].

In France, there are 68 million inhabitants, 390,000 incident cases of cancer and 150,000 annual deaths from cancer [14]. The overall cancer expenditure is €16 billion, which is 10% of the national social security expenditure [14]. In 2021, the national density of oncologists in France was 2.1/100,000 inhabitants, i.e., 1401 oncologists. After the national medical ranking exam conducted every year, 120 (1.2%) of the 9,500 medical students in France choose one of the open positions in oncology among the 44 specialties offered. The oncology residency lasts five years, and the residents are required to choose either medical oncology or radiation oncology at the end of the first year. The training of oncology residents includes theoretical training organized at both local and national level (with face-to-face courses but also distance courses, the latter representing approximately 120 hours in the first year). The practical training of medical oncology residents necessarily includes 6 months in radiation oncology, 6 months in hematology, and at least 5 semesters in medical oncology. The practical training of interns in radiation oncology includes 2 semesters in medical oncology, one semester in medical imaging and at least 5 semesters in radiation oncology.

Currently the literature data is poor on this subject and does not allow a clear understanding of the motivation of medical students regarding oncology [5,6,7,8,9,10,11,12,13]. Understanding the motivation behind choosing oncology as a medical specialty will allow for the implementation of appropriate orientation programs to encourage medical students to select oncology as a specialty and facilitate the development of strategies to address any future personnel shortfalls. Therefore, we conducted a survey to identify and analyze the factors behind the choice of oncology as a specialty among medical students.

Methods

Design

We conducted an inductive survey of students from University of Lille and University of Amiens in the last two years of the second cycle of medical studies. The students were sent a questionnaire via email from the offices of the deans at the University of Lille and University of Amiens. The emails were sent only once without any additional reminders. The students were required to respond voluntarily and anonymously via Qualtrics (Qualtrics, Provo, UT), an experience management survey tool. Data were collected between May and June 2023.

Questionnaire

The questionnaire sent to the students is presented in the appendix. It included a section on the demographic information of the students (closed questions) and their specialty choices (first, second, and third choices). The second part of the questionnaire included a list of factors that could motivate the selection of a specialty. The students were required to provide responses using a 5-point Likert scale, with possible responses ranging from ‘not at all important’ to ‘very important’. The questionnaire was derived from that developed by Wright et al. [15] and its French versions [16, 17]. The Wright questionnaire is used for identifying the motivation for choosing general medicine as a specialty. Although our questionnaire was based on the Wright questionnaire, we added items specific to oncology and items tailored to the French system of teaching medical students.

Statistical analysis

All statistical analyses were performed using IBM SPSS Statistics 29.0.2.0 software. The characteristics of the study population were described using classical statistical measures, including counts and percentages, means and standard deviations, and medians and extreme values. Principal component analysis was performed for the segmentation of the population and the internal consistency of the questionnaire dimensions was analyzed using Cronbach’s α. In addition, we performed clustering analysis to identify homogeneous groups of students with common motivations. The ability of the questionnaire items to predict the choice of specialty was analyzed using neural networks (perceptron) and by calculating areas under the curve (AUC). Univariate analysis with chi-squared and Fisher’s exact tests (categorical data) or linear regression (for Likert-scales data) were used to identify the factors that influence the choice of oncology as a specialty. The students' choices were weighted by creating a score that corresponds to the choices: oncology as the first choice was scored 3 points, oncology as the second choice was scored 2 points; oncology as the third choice was scored 1; and any other choice was scored 0 point. Multivariate linear regression models were constructed using the parameters identified in the univariate analysis. In addition, we generated decision trees using the chi-square automatic interaction detection (CHAID) method. We carried out 2 successive CHAID analyses; the first without selection of criteria; and the 2nd by removing curriculum-related factors in order to bring out more intrinsic motivation factors. Statistical significance was set at p < 0.005.

Ethical considerations

The students were required to respond voluntarily and anonymously to the questionnaire. This study was conducted in accordance with the best practice recommendations and general data protection regulations. In addition, the study was validated by the LUMEN Lab committee.

Results

Study population

The survey email was sent to 1250 medical students at the Universities of Amiens and Lille. Of these, 563 responded (response rate: 45%, 563/1250). The average age of the participants was 23 years (standard deviation: 2 years), their median age was 23 (range, 19–30) years, and 63% of them were women. Regarding the specialty choices, only 14 students considered oncology as their first specialty choice (2.5%), 13 students considered oncology as their second choice (2.3%), and 14 considered it as their third choice (2.5%).

Internal consistency of the questionnaire

Wright's questionnaire includes five domains, and Cronbach’s α of the different domains in the present study were as follows: lifestyle and work-life balance, 0.852; societal orientation, 0.844; prestige, 0.792; work at the hospital, 0.789; and medical training, 0.602 (Supplementary Table 1). The internal consistency of the questionnaire indicated that it had good reliability (α > 0.7), except for the medical training domain (0.602). The items added to the Wright questionnaire did not modify the α values.

Factors influencing the choice of speciality in general

The principal component analysis (PCA) stressed four main domains similar to those initially described by Wright: (i) prestige and income, (ii) working hours, (ii) career in university hospital, and (iv) relationships with patients (Supplementary Figure 1). The parallel clustering analysis performed to identify homogeneous groups of students with common motivations identified only two clusters: the first cluster comprised mainly students who were leaning towards selecting other specialties than general medicine as their first choice, whereas the second cluster mainly comprised students more inclined to choose general medicine (Supplementary Table 2). Most of the students who were considering oncology as their first choice were in the first cluster (13/14).

Ability to predict specialty choice

The ability of the questionnaire to explain the motivation for selecting each specialty as a first choice varied greatly (poor for rheumatology or hematology, but very good for oncology or general medicine). The AUC for predicting oncology as a first choice was 0.927 (95% CI: 0.917–0.938). However, the questionnaire poorly predicted the second (AUC 0.555) and third choices (AUC 0.521), regardless of the specialty (Supplementary Table 3). This probably means that the determinism of the choice is more important for the first choice and decreases afterwards. This justified weighting the students’ choices in order of preference (first, second, or third choice).

Factors associated with selection of oncology as a specialty: univariate analyses

The univariate analysis indicated that the categorical data significantly associated with the choice of oncology as a specialty were sex (p  = 0.0256), rotation in a medical oncology unit/department (p < 0.001) and rotation in a radiation oncology unit/department (p < 0.0001) (Table 1). In other words, students who completed a rotation in a medical oncology unit during their second cycle of study were nine times more likely to choose oncology as a specialty than those who did not (odds ratio: 9.4, 95% CI: 4.8–18.4, p < 0.0001). Similarly, students who completed a rotation in a radiation oncology unit during their second cycle of study were five times more likely to choose oncology as a specialty than those who did not (odds ratio: 5.1, 95% CI: 1.7–16.7, p  = 0.0066).

Table 1 Categorical factors associated with the choice of oncology as a specialty (as a first, second, or third choice)
Full size table

The motivational factors ranked in decreasing order of importance based on the opinions of the 563 respondents are listed in Table 2. The average scores were compared between students who plan to choose oncology and those who intend to select other specialties. The univariate linear regression indicated that choice of oncology as a specialty was positively associated with interests in long-term relationships with patients (p  = 0.038), hospital care (p < 0.001), clinical research (p < 0.001), and fundamental or technological research (p < 0.001), and negatively associated with desire for immediate results of treatments (p  = 0.002), interest in emergency care (p < 0.001), and desire for less difficult preparation for national ranking exam (p  = 0.002) (Supplementary Table 4).

Table 2 Comparison of mean scores of the potential motivation factors
Full size table

Factors associated with selection of oncology as a specialty: multivariate analyses by sex

As sex seemed to influence the choice of oncology as a specialty, we conducted two multivariate analyses according to sex (Table 3). These motivational factors differed by sex.

Table 3 Sex-specific multivariate analysis of experiences and motivation for choosing oncology
Full size table

Interaction between motivational factors

We conducted two CHAID analyses to explore how the motivational factors interact. The first decision tree (Fig. 1A) indicated interactions between choice of oncology as a specialty and curriculum-based factors, rotation in a medical oncology unit (p  = 0.0001), and identification with a physician practicing the desired specialty (p  = 0.049). We carried out a 2nd CHAID analysis by removing the curriculum-related items, in order to bring out the intrinsic motivation factors. The second decision tree (Fig. 1B) depicted the interaction between choice of oncology as a specialty and lack of interest in focusing on emergency care (p  = 0.036) and desire to work in a university hospital (p  = 0.006).

Fig. 1
figure 1

Decision trees. A Decision tree for curriculum-based factors. B Decision tree for motivational factors

Full size image

Discussion

Of the 563 students that participated in this survey, 41 (7.3%) considered choosing oncology as their first, second, or third specialty choice. The questionnaire used in this study showed excellent prediction of oncology as a first-choice specialty (AUC 0.927). Students who leaned towards choosing oncology were mostly in a cluster of students who were not oriented towards choosing general medicine as a specialty. The analyses indicated that the interactions between the motivational factors are complex. Notably, we found that the factors that motivated the students to choose oncology differed according to sex. In addition, we observed that experience during rotations plays a major role in the choice of oncology as a specialty.

In France, approximately 120 oncology resident positions are opened each year after the national ranking exam. This represents 1.3% of all the residency positions offered. In the present study, 2.4% of the students surveyed considered oncology as their first choice. This percentage is slightly higher, but indicative of the choices made by the students (subject to classification rank constraints). However, we cannot exclude the possibility of selection bias in the study population (which represents 45% of the targeted students).

Overall, the students' specialty choices were based on four main categories of motivational factors: (i) working hours, (ii) prestige and income, (iii) career in a university hospital, and (iv) relationships with patients. These categories are slightly different from the domains identified by Wright et al., which are as follows: (i) medical lifestyle and work–life balance, (ii) societal orientation, (ii) prestige, (iv) working in a hospital, and (v) training. However, it should be noted that our survey and that of Wright et al. were focused on different specialties of interest (oncology versus general medicine) and were conducted at different times (2023 versus 2001) and in different countries (France versus Canada) with different training systems. Notably, the data of both studies are consistent; however, the difference in study populations may explain the variations in α values ​​observed. In the present study, we found that the five main motivation factors are those related to work–life balance and constraints associated with professional practice (Table 2). These factors had a major impact on the choices of all the students; however, their scores did not differ between those who choose oncology as a specialty and those who did not (Table 2).

Rotation in an oncology unit plays a significant role in the choice of oncology as a specialty. After a rotation in a medical oncology unit/department, the odds ratio for choosing oncology is 9, which is considerable. After a rotation in a radiation oncology unit/department, the odds ratio for choosing oncology is also very high (around 5).

Identifying with a doctor practicing a chosen specialty was one of the factors identified in the CHAID analysis (Fig. 1A). The notions of modeling and identification were observed in numerous studies on the motivations for choosing specialties conducted in Canada [18, 19] and Australia [20] and even in a recent meta-analysis [21]. A survey of oncology residents conducted in 2007 by Loriot et al. highlighted the importance of rotation in oncology units (83% of the oncology residents surveyed had previously completed an oncology rotation) [8]. Several studies indicated the importance of effects of vicarious learning experiences acquired during rotations, such as first contact with the specialty, role modeling, exposure to a vicarious environment [8, 18,19,20,21,22].

We observed that the factors identified in this study differed according to sex. The influence of sex in the choice of specialty has been highlighted in other studies [19, 23]. In the study by Gillissen et al. conducted in Germany, the authors observed that women prioritize work–life balance [19]. In the present study, we noted that among the women, the desire to have long-term relationships with patients was one of the motivations behind the choice of oncology as a specialty (β = 0.129, p  = 0.021, Table 3). Oncology, particularly medical oncology, involves long-term follow-up, which is consistent with not necessarily wanting to see immediate results from the treatments administered (β=−0.143; p  = 0.018). To go beyond these quantitative data, it would be necessary to be able to conduct a qualitative analysis. For women, oncology could be associated with rejection factors: very technical aspect, poor work-life balance, and in opposite associated with attractive factors linked to long-term follow-up of patients and the expression of empathy.

This study has limitations. This is an inductive quantitative study to generate hypotheses. Certain complex or subtle notions explaining motivation will need to be explored through additional qualitative research. This study was carried out in a French region of 6 million inhabitants. The generalizability of the observed results remains questionable. Finally, the questionnaire return rate is 45%; we cannot exclude a selection bias.

Conclusions

Very few medical students choose oncology. The motivations behind choosing oncology as a specialty vary according to sex. Experience during hospital rotations plays a crucial role in the specialty choices made by medical students. Some intrinsic motivations (interest in cultivating a long-term relationship with patients) and contextual factors (rural life) influence the specialty choices of medical students.

The identification of these motivating factors makes it possible to consider targeted communications campaigns to promote oncology. Indeed, these information campaigns on specialties are crucial. The work of Zisk-Rony et al. have clearly demonstrated that medical oncology students carry out a market analysis approach with analysis of potential income and prospects for available positions [24]. Aware of the expectations of the medical students, the same team worked on what could improve the image of less chosen specialties by targeted information campaigns [25].

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

All students for their participation in the study. Séverine Marchant for editing assistance.

Funding

There is no funding for this work.

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Authors and Affiliations

  1. Centre Oscar Lambret, Department of Medical Oncology, Lille University, 3 rue Combemale, Lille, 59020, France

    Nicolas Penel & Pierre-Yves Cren

  2. Department of Medical Oncology, Centre Oscar-Lambret, ULR-2694 - Metrics : évaluation des technologies de santé et des pratiques médicales, CHU de Lille, University of Lille, Lille, France

    Nicolas Penel

  3. Department of Teaching Sciences, ULR-4354 – CIREL: Centre Interuniversitaire de Recherche en Education de Lille Laboratoire des sciences de l’éducation, University of Lille, Lille, France

    Christophe Ducroq

  4. Department of Management, ULR-4999 – LUMEN: Lille university Management, Lille, France

    Estelle M. N. Laurent & Dominique Crie

  5. Department of Nephrology, Internal Medicine, Dialysis and Transplantation, CHU Amiens, Jules Verne University of Picardie, Amiens, France

    Gabriel Choukroun

  6. EA7517, MP3CV Laboratory, Jules Verne University of Picardie, Amiens, France

    Gabriel Choukroun

  7. Department of Nephrology, Kidney Transplantation and Dialysis, CHU Lille, University of Lille, Lille, France

    Marc Hazzan

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Contributions

NP and EL have built the survey and collected data. GC and MH have helped to contact residents. NP and DC analysed and interpreted the data. NP have written the 1st draft of manuscript. All authors read, corrected and approved the final manuscript.

Corresponding author

Correspondence to Nicolas Penel.

Ethics declarations

Ethics approval and consent to participate

Study have been approved by Lille University (ULR-4999 – LUMEN). All students participated freely and voluntarily in the survey. This study complies with the “reference methodology” MR0004 adopted by the National Commission on Informatics and Liberty, CNIL.

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Not applicable.

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The authors declare no competing interests.

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Supplementary Information

12909_2025_6811_MOESM1_ESM.docx

Additional file 1: Supplementary Figure 1. Principal component analysis. Supplementary Table 1. Supplementary Table 2. Clustering of the students. Supplementary Table 3. Analysis of the ability of the questionnaire to predict the choice of oncology and general medicine as a specialty.

Additional file 2. Appendix.

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Penel, N., Cren, PY., Ducroq, C. et al. Motivational factors influencing the choice of oncology as a specialty among French medical students. BMC Med Educ 25, 447 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12909-025-06811-w

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