Interest, barriers, and motivators for pursuing hematology electives among fourth-year Caribbean medical students: A cross-sectional survey

Abstract Background: The evolving complexity of hematology necessitates early engagement of medical students to sustain a skilled and diverse workforce. Caribbean medical schools supply a substantial number of medical trainees to U.S. medical residency programs, many of whom pursue careers in internal medicine, pediatrics, and subspecialties where hematology expertise is critical. Despite this, little is known about what drives fourth-year students at Caribbean medical schools to pursue hematology electives. Existing literature has largely focused on hematologist recruitment or early-stage exposure in U.S. allopathic programs, leaving a gap in understanding the unique motivators and barriers for Caribbean-trained students. Identifying these factors could guide curriculum design, mentorship programs, and exposure strategies to strengthen the hematology pipeline and ensure adequate representation across subspecialties. Methods: An anonymous, 19-question, skip-logic survey was distributed to fourth-year medical students at four Caribbean medical schools between January and March 2025. The survey included Likert-scale, multiple-choice, and free-text items. Core domains included: (1) likelihood of pursuing a hematology elective (n = 2), (2) interest in malignant vs benign hematology (n = 4), (3) perceived preparedness and confidence (n = 4), (4) anticipated emotional and cognitive barriers (n = 4), and (5) potential incentives for elective participation (n = 5). Additional questions assessed prior exposure to hematology in preclinical and clinical years, research involvement, and mentorship experience. Invitations were distributed via institutional listservs, student organizations, and academic advisors. Chi-square tests compared the proportion of students with strong interest (Likert ≥4) across intended career paths (internal medicine, pediatrics, surgical specialties, others). Mann-Whitney U tests compared median scores for perceived complexity, confidence in laboratory data interpretation (e.g., peripheral smear, flow cytometry, coagulation panels), and comfort discussing end-of-life issues between high-interest and low-interest groups. Results: Of 114 respondents, 29% expressed strong interest in pursuing a hematology elective, while 12% had completed or scheduled one. Students planning to enter internal medicine or pediatrics were significantly more likely to report strong interest (38%) than those pursuing surgical specialties (11%, p = 0.015). Interest in malignant hematology was notably higher (73% of high-interest group) than benign hematology (52%, p = 0.041), with stem cell transplantation cited as the most attractive subspecialty component. Perceived barriers included limited clinical exposure to hematology cases (63%), difficulty interpreting complex laboratory results (59%), emotional burden in managing terminal hematologic malignancies (46%), and lack of mentorship (39%). Students with prior shadowing or research experience in hematology (n = 31) were significantly more likely to express strong interest (p = 0.021). Free-text analysis revealed three dominant themes: (1) personal or family experience with hematologic diseases (n = 22), (2) fascination with bone marrow transplant medicine and cellular therapies (n = 28), and (3) perceptions of hematology as an intellectually rigorous but lifestyle-compatible specialty (n = 24). Students reporting high perceived complexity scored lower on elective interest (p = 0.034), whereas those with prior exposure during core clerkships reported higher confidence interpreting hematologic laboratory data (p = 0.029).Conclusions: Interest in hematology electives among Caribbean medical students is moderate but varies significantly by intended specialty and prior exposure. Malignant hematology generates more enthusiasm than benign subspecialties, likely driven by the perceived impact of advanced therapies and transplantation. Key modifiable barriers include perceived complexity, limited early exposure, and lack of structured mentorship. Strategies to address these gaps may include earlier integration of hematology content into preclinical curricula, targeted laboratory interpretation workshops, structured shadowing experiences, and research engagement opportunities.