Understanding How Regional Quota Medical Students in Okinawa Develop Their Specialty Preferences: A Qualitative Study of Career Development and Professional Identity Formation.

Introduction Japan's Regional Quota System (ChiikiWaku) was established to address physician shortages in rural areas by supporting medical students with scholarships in exchange for service commitments. However, the specialty choices of quota students sometimes diverge from the regional healthcare needs. This study explored how specialty preferences change during medical education among regional quota students at the University of the Ryukyus in the Okinawa Prefecture, a region facing persistent healthcare disparities. Methods A qualitative study using semi-structured interviews was conducted with regional quota students across different academic years at the University of the Ryukyus. Semi-structured interviews were selected for their flexibility and ability to capture in-depth experiences. Participants were purposively sampled to capture diverse perspectives. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically by a multidisciplinary research team, including quota and non-quota students, to enhance reflexivity and credibility. Results Thematic analysis identified four central themes: (1) developing interests in various specialties through studying medicine, (2) hope and anxiety toward diverse futures, (3) dilemma between specialty limitations and the desire for career diversity, and (4) ambivalence toward general practice and its professional identity. The students' specialty preferences evolved through educational exposure, personal experiences, and negotiation between aspirations and systemic obligations. General practice was seen with both appreciation and uncertainty, reflecting the complex interplay between personal and policy-driven career trajectories. Conclusion Regional quota students' specialty choices are dynamic and influenced by multiple factors during their medical education. Tailored support, including mentorship and early exposure to community-relevant specialties, may help better align the evolving aspirations of the students with the healthcare needs of underserved regions.