Motivations and Challenges in Choosing Ophthalmology: A Systematic Review of Global Evidence
DOI:
https://doi.org/10.57125/FEM.2026.03.30.03Keywords:
Ophthalmology, Postgraduate Education, Specialty Choice, Career Motivation, Medical Education.Abstract
Aims: To systematically synthesize global evidence on the motivational drivers, perceived advantages, challenges, and systemic factors influencing the choice of ophthalmology as a postgraduate medical specialty.
Study Design: Systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.
Place and Duration of Study: This review represents a synthesis of global literature rather than a geographically bounded investigation. Studies published between January 2000 and December 2025 was included to capture evolving trends in postgraduate ophthalmology training and workforce development.
Methodology: A comprehensive literature search was performed across PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar. Quantitative, qualitative, and mixed-method studies examining career motivation, mentorship, gender equity, educational exposure, and professional satisfaction in ophthalmology were included. Two independent reviewers conducted screening, data extraction, and quality appraisal using validated tools (Newcastle–Ottawa Scale, CASP, and AMSTAR-2). Narrative synthesis was undertaken due to heterogeneity in study designs and outcome measures.
Results: Sixty studies met inclusion criteria for qualitative synthesis, with twenty-five contributing quantitative data. Ophthalmology was consistently associated with high intrinsic motivation, intellectual stimulation, surgical precision, and patient-centered outcomes. Key facilitators included early educational exposure, structured mentorship, and research engagement, while barriers comprised limited curricular representation, gender inequities, and inconsistent institutional support. Studies emphasizing mentorship and equity-oriented policies demonstrated improved recruitment and retention across diverse settings.
Conclusion: The choice of ophthalmology as a postgraduate specialty is shaped by an interplay of intrinsic motivation, mentorship, educational exposure, and systemic support. Targeted educational reforms, mentorship frameworks, and equity-driven policies are essential to sustain a diverse and motivated ophthalmology workforce globally.
References
SJ, Budenz DL, Haft P, Tielsch JM, Lee Y. Factors influencing career choices among graduating ophthalmology residents. Ophthalmology. 2005;112(7):1244-50. doi: 10.1016/j.ophtha.2005.02.009
Chen X, Zafar S, Srikumaran D. Factors influencing postgraduate career decisions of ophthalmology residents. Semin Ophthalmol. 2020;35(6):338-45. doi: 10.1055/s-0040-1715808
Yang Y, Li J, Wu X, Wang J, Li W, Zhu Y, et al. Factors influencing subspecialty choice among medical students: a systematic review and meta-analysis. BMJ Open. 2019;9(3):e022097. doi: 10.1136/bmjopen-2018-022097
Dutt DCS, Razavi H, Carr SE. Self-determination theory in ophthalmology education: factors influencing autonomy, competence and relatedness in medical students. Med Educ Online. 2023;28(1):2258633. doi: 10.1080/10872981.2023.2258633
Aljerian K. Factors influencing residents' speciality choices and satisfaction: the impact of gender, career motivation, and life goals. J Surg Educ. 2022;79(3):601-10. doi: 10.1016/j.jsurg.2021.09.006
Gameiro GR, Darcie ALF, Hazaki D. Why ophthalmology? Analysis of motivating factors influencing career choice among generations in Brazil. Clinics (Sao Paulo). 2019;74:e1013. doi: 10.6061/clinics/2019/e1013
Almulhim A, Thirunavukkarasu A, Alanazi B. Career choice of Saudi medical students: opting for ophthalmology residency programs—perceptions and sociodemographic influencing factors. BMC Med Educ. 2024;24:1453. doi: 10.1186/s12909-024-06496-7
Das A, Smith D, Mathew RG. Predictors of ophthalmology career success (POCS) study. BMJ Open Ophthalmol. 2021;6(1):e000735. doi: 10.1136/bmjophth-2021-000735
Cui D, Wingert AM, Scott IU. Factors influencing specialty choice among ophthalmology and non-ophthalmology applicants. J Acad Ophthalmol. 2021;13(2):115-23. doi: 10.1055/s-0041-1728644
Gedde AY, Huertas L, Sridhar J. Career decisions and satisfaction among underrepresented ophthalmologists. J Acad Ophthalmol. 2024;16(1):97-106. doi: 10.1055/s-0044-1786928
Bourke L, Conway C, Abdalla ME. Mentorship in surgical training: a systematic scoping review to inform a mentorship framework for ophthalmology trainees. BMC Med Educ. 2025;25:373. doi: 10.1186/s12909-025-06901-9
Yu Y, Ding Y, Paulus YM, Jiang H. Attitudes toward ophthalmology as a career among preclinical medical students in China. BMC Med Educ. 2023;23:4518. doi: 10.1186/s12909-023-04518-4
Peel JK, Schlachta CM, et al. Factors affecting the choice of surgery as a career: a systematic review. Can J Surg. 2018;61(1):58-67. doi: 10.1503/cjs.0058
Schoon B, Kotter T. Intracurricular factors influencing specialty choice: a systematic review. Adv Med Educ Pract. 2024;15:901-13. doi: 10.2147/AMEP.S491008
Yen AJ, Webb EM, Jordan EJ, Kallianos K. Stability of factors influencing specialty choice. J Am Coll Radiol. 2018;15(11):1634-41. doi: 10.1016/j.jacr.2018.06.011
Borges NJ, Savickas ML. Personality and medical specialty choice. J Career Assess. 2002;10:362-80. doi: 10.1177/10672702010003006
Wright B, Scott I, Woloschuk W, Brenneis F. Career choice of new medical students. CMAJ. 2004;170(13):1920-4. doi: 10.1503/cmaj.1031111
Patel MS, Lypson ML, Davis MM. Medical student perceptions of health systems education. Acad Med. 2009;84(9):1301-6. doi: 10.1097/ACM.0b013e3181b17e3e
Nawaiseh MB, Haddadin RR, Al Droubi B, et al. Personality traits and specialty preference among medical students. Psychol Res Behav Manag. 2020;13:599-607. doi: 10.2147/PRBM.S262062
Creed PA, Searle J, Rogers ME. Specialty prestige and lifestyle preferences. Soc Sci Med. 2010;71(6):1084-8. doi: 10.1016/j.socscimed.2010.06.027
Dorsey ER, Jarjoura D, Rutecki GW. Controllable lifestyle and specialty choice. Acad Med. 2005;80(9):791-6. doi: 10.1097/00001888-200509000-00002
Evans J, Goldacre MJ, Lambert TW. Flexible and part-time working in medicine. Med Educ. 2000;34(5):355-62. doi: 10.1046/j.1365-2923.2000.00620.x
van der Horst K, Siegrist M, Orlow P, Giger M. Reasons for specialty choice. Med Educ. 2010;44(6):595-602. doi: 10.1111/j.1365-2923.2010.03631.x
Shanafelt TD, Balch CM, Bechamps GJ, et al. Burnout and career satisfaction among surgeons. Ann Surg. 2009;250(3):463-71. doi: 10.1097/SLA.0b013e3181ac4dfd
Shanafelt TD. Physician well-being 2.0. Mayo Clin Proc. 2021;96(10):2682-93. doi: 10.1016/j.mayocp.2021.06.005
Toubassi D, Schenker C, Roberts M, Forte M. Professional identity formation and well-being. Adv Health Sci Educ Theory Pract. 2023;28(1):305-18. doi: 10.1007/s10459-022-10146-2
Ryan RM, Deci EL. Intrinsic and extrinsic motivations in education. Contemp Educ Psychol. 2000;25(1):54-67. doi: 10.1006/ceps.1999.1020
Sambunjak D, Straus SE, Marusic A. Mentoring in academic medicine: a systematic review. JAMA. 2006;296(9):1103-15. doi: 10.1001/jama.296.9.1103
Frei E, Stamm M, Buddeberg-Fischer B. Mentoring programs for medical students: a review of the literature. BMC Med Educ. 2010;10:32. doi: 10.1186/1472-6920-10-32
Jackson VA, Palepu A, Szalacha L, Caswell C, Carr PL, Inui T. "Having the right chemistry": a qualitative study of mentoring in academic medicine. Acad Med. 2003;78(3):328-34. doi: 10.1097/00001888-200303000-00020
Straus SE, Johnson MO, Marquez C, Feldman MD. Characteristics of successful mentoring relationships: a qualitative study across two academic health centers. Acad Med. 2013;88(1):82-9. doi: 10.1097/ACM.0b013e31827647a0
Neufeld A, Huschi Z, Ames A, Trinder K, Malin G, McKague M. Peers United in Leadership and Skills Enhancement: a near-peer mentoring program. Can Med Educ J. 2020;11(6):e145-8. doi: 10.36834/cmej.69920
Sambunjak D, Straus SE, Marusic A. Mentoring in academic medicine: a systematic review. JAMA. 2006;296(9):1103-15. doi: 10.1001/jama.296.9.1103
Cho CS, Ramanan RA, Feldman MD. Defining the ideal qualities of mentorship: a qualitative analysis. Am J Med. 2011;124(5):453-8. doi: 10.1016/j.amjmed.2010.12.007
Kashiwagi DT, Varkey P, Cook DA. Mentoring programs for physicians in academic medicine. Acad Med. 2013;88(7):1029-37. doi: 10.1097/ACM.0b013e318294f368
Carr PL, Raj A, Kaplan SE, Terrin N, Breeze JL, Freund KM. Gender differences in academic medicine: retention, rank, and leadership. Acad Med. 2018;93(11):1694-9. doi: 10.1097/ACM.0000000000002146
Beech BM, Calles-Escandon J, Hairston KG. Mentoring programs for underrepresented minorities. Acad Med. 2013;88(4):541-9. doi: 10.1097/ACM.0b013e31828589e3
Alwazzan L, Al-Angari SS. Women's leadership in academic medicine: a systematic review. BMJ Open. 2020;10(1):e032232. doi: 10.1136/bmjopen-2019-032232
Jagsi R, Guancial EA, Worobey CC, Henault LE, Chang Y, Starr R, et al. The gender gap in authorship of academic medical literature. N Engl J Med. 2006;355(3):281-7. doi: 10.1056/NEJMsa053910
Levine RB, Lin F, Kern DE, Wright SM, Carrese J. Early-career women physicians leaving academic medicine. Acad Med. 2011;86(6):752-8. doi: 10.1097/ACM.0b013e318217e83b
Jensen NM. Physicians and implicit bias. J Gen Intern Med. 2014;29(5):707. doi: 10.1007/s11606-014-2793-1
El Arnaout N, Chehab RF, Rafii B, Alameddine M. Gender equity in human resources for health: a scoping review. Hum Resour Health. 2019;17(1):52. doi: 10.1186/s12960-019-0391-3
Rochon PA, Davidoff F, Levinson W. Women in academic medicine leadership: has anything changed? Acad Med. 2016;91(8):1053-6. doi: 10.1097/ACM.0000000000001281
Nocco SE, Larson AR. Promotion of women physicians in academic medicine. J Womens Health (Larchmt). 2021;30(6):864-71. doi: 10.1089/jwh.2019.7992
Hentschel T, Heilman ME, Peus CV. Multiple dimensions of gender stereotypes. Front Psychol. 2019;10:11. doi: 10.3389/fpsyg.2019.00011
Edmunds LD, Ovseiko PV, Shepperd S, Greenhalgh T, Frith P, Roberts NW, et al. Why do women choose or reject academic medicine? Lancet. 2016;388(10062):2948-58. doi: 10.1016/S0140-6736(15)01091-0
Strong EA, De Castro R, Sambuco D, Stewart A, Ubel PA, Griffith KA, et al. Work-life balance in academic medicine. J Gen Intern Med. 2013;28(12):1596-603. doi: 10.1007/s11606-013-2521-2
Files JA, Blair JE, Mayer AP, Ko MG. Facilitated peer mentorship for female faculty. J Womens Health (Larchmt). 2008;17(6):1009-15. doi: 10.1089/jwh.2007.0647
DeCastro R, Sambuco D, Ubel PA, Stewart A, Jagsi R. Mentor networks in academic medicine. Acad Med. 2013;88(4):488-96. doi: 10.1097/ACM.0b013e318285d302
Carnes M, Morrissey C, Geller SE. Women's leadership in academic medicine. J Womens Health (Larchmt). 2008;17(9):1453-62. doi: 10.1089/jwh.2007.0688
Ranieri V, Barratt H, Fulop N, Rees G. Career progression among clinical academics: a scoping review. BMJ Open. 2016;6(10):e013523. doi: 10.1136/bmjopen-2016-013523
Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction among US physicians. Arch Intern Med. 2012;172(18):1377-85. doi: 10.1001/archinternmed.2012.3199
Borges NJ, Manuel RS, Duffy RD, Fedyna D, Jones BJ. Influences on specialty choice. Med Teach. 2009;31(12):1086-8. doi: 10.3109/01421590903183787
Pagnin D, de Queiroz V. Quality of life of medical students. Educ Health (Abingdon). 2015;28(3):209-12. doi: 10.4103/1357-6283.178599
O'Brien BC, Poncelet AN. Transition to clerkship courses. Acad Med. 2010;85(12):1862-9. doi: 10.1097/ACM.0b013e3181fa2353
Malik AS, Malik RH. Developing an integrated curriculum. Med Teach. 2011;33(2):99-104. doi: 10.3109/0142159X.2010.507711
Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century. Lancet. 2010;376(9756):1923-58. doi: 10.1016/S0140-6736(10)61854-5
Harden RM. Outcome-based education: the future is today. Med Teach. 2007;29(7):625-9. doi: 10.1080/01421590701729930
Yadav NK, Mishra N, Mehrotra B, Kaur A. Kimura's disease: a mysterious orbital mass. BMJ Case Rep. 2024;17(12):e262899. doi: 10.1136/bcr-2024-262899
Yadav NK, Joshi D, Priya P, Kaur A, Srivastava AK. Dacryocystorhinostomy with silicone tube intubation and mitomycin-C in failed chronic dacryocystitis. Indian J Clin Exp Ophthalmol. 2025;11(4):655-63. doi: 10.18231/j.ijceo.10956.1758524481
Gruppen LD, Mangrulkar RS, Kolars JC. Competency-based education and global health. Hum Resour Health. 2012;10:43. doi: 10.1186/1478-4491-10-43
Cook DA, West CP. Conducting systematic reviews in medical education: a stepwise approach. Med Educ. 2012;46(10):943-52. doi: 10.1111/j.1365-2923.2012.04328.x
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