Exploring factors influencing medical specialty choice among undergraduates in The Gambia: a situated expectancy-value theory approach

The selection of a medical specialty is a critical juncture in the professional development of medical students, with implications for individual career satisfaction and for the distribution of the national health workforce. In low-resource settings such as The Gambia, aligning students’ specialty choices with healthcare needs is essential for addressing persistent shortages in key areas. Situated-Expectancy-Value Theory (SEVT) offers a robust framework to understand how expectations of success and the perceived value of different specialties influence decision-making. This study applies SEVT to explore contemporary factors shaping specialty choice among Gambian medical students. A cross-sectional survey was conducted among clinical-year medical students at two medical schools in The Gambia: the University of The Gambia and the American International University. A structured questionnaire, developed using the Expectancy-Value Theory framework, assessed 19 motivational factors across expectancy, value, and cost domains. Data were analyzed using SPSS software. The Fisher–Freeman–Halton test was conducted to identify associations between demographic variables and specialty preferences. A total of 150 students participated in the study, with 58.7% female and 41.3% male participants. Aggregation of participants’ first to third specialty choices showed that surgery was most frequently selected (n = 94), followed by internal medicine (n = 78) and obstetrics and gynaecology (n = 51). Radiology, Ear, Nose, and Throat (ENT), and pathology had similarly low preferences, while Basic sciences and psychiatry recorded the lowest frequency as first-choice specialties. Based on the expectancy-value theory framework, significant motivating factors were intrinsic (P = 0.049) and attainment/perceived meaningfulness (P = 0.047). The Fisher–Freeman–Halton test also revealed a statistically significant association between gender and specialty choice(P = 0.012). The student’s academic level also significantly influenced specialty selection (p < 0.001). No significant association was found between socio-demographic characteristics such as parental income, education, age, nationality, or area of residence and specialty choice. This study identifies internal medicine, surgery, obstetrics, and gynaecology as the most preferred specialties, with gender and level of clinical exposure emerging as key factors influencing medical specialty choice. Our findings further reveal that specialty decisions are shaped by intrinsic motivation, such as intellectual challenges in the specialty, and desire to provide community service, and by attainment values, including role models in the selected specialty and perceived prestige of the specialty. The study provides insight into how students’ personal values, sociocultural expectations, and educational context in The Gambia shapes their career aspirations. It also highlights gendered patterns in specialty preferences. We propose that aligning students’ interests through early exposure and culturally responsive teaching beyond traditional career counselling could better support informed specialty choices and contribute to workforce planning. Implications for policy implementation and workforce planning are discussed.