Purpose
Medical specialty choice is a critical component of career and professional development for medical students, influencing future workforce distribution and healthcare quality. However, in many low- and middle-income countries (LMICs), including The Gambia, little is known about the factors motivating these choices. This study applies Expectancy-Value Theory (EVT) to identify motivational drivers of specialty selection among Gambian medical students, with the aim to inform career counseling and curriculum strategies that empower educators and students in resource-limited settings.

Methods
A cross-sectional survey was conducted among clinical-year medical students in Gambia. The instrument measured five EVT constructs: expectancy (self-confidence), intrinsic value (interest), attainment value (importance), utility value (career outcomes), and perceived cost (barriers). Descriptive and inferential statistics were used to identify significant predictors and gender-specific trends in specialty preference.

Results
Data from 150 respondents indicated that expectancy and utility value, including job security and income potential, are significant predictors of specialty preference. Intrinsic and attainment values, such as intellectual challenge and specialty prestige, also contribute to decision-making. Social influences, including family expectations and mentorship, disproportionately affect female students’ choices. Perceived costs such as length of training and work-life balance concerns were barriers to choosing primary care and other specialties.

Conclusion
This theory-driven study enhances understanding of medical specialty choice in an LMIC context, offering actionable insights for curriculum design and career development initiatives. By empowering educators with knowledge of students’ motivational profiles, medical schools in The Gambia and similar settings can better support professional identity formation and address workforce challenges.