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BMJ Open. 2017 Feb 22;7(2):e013501. doi: 10.1136/bmjopen-2016-013501.

Factors influencing medical students' motivation to practise in rural areas in low-income and middle-income countries: a systematic review.

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School of Public Health & Community Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal.
Royal Tropical Institute, Amsterdam, The Netherlands.
Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands.



There is a shortage of doctors working in rural areas all over the world, especially in low-income and middle-income countries. The choice to practise medicine in a rural area is influenced by many factors. Motivation developed as a medical student is one key determinant of this choice. This study explores influences on medical students' motivation to practise in rural areas of low-income and middle-income countries following graduation.


A systematic review was conducted to identify influences on medical students' motivation to work in rural areas in low-income and middle-income countries. Papers reporting influences on motivation were included, and content analysis was conducted to select the articles. Articles not published in English were excluded from this review.


A rural background (ie, being brought up in a rural area), training in rural areas with a community-based curriculum, early exposure to the community during medical training and rural location of medical school motivate medical students to work in rural areas. Perceived lack of infrastructure, high workload, poor hospital management and isolation are among the health facility factors that demotivate medical students for medical practice in rural areas.


Medical school selection criteria focusing on a rural background factor and medical education curriculum focusing on rural area are more relevant factors in low-income and middle-income countries. The factors identified in this review may assist the planners, medical educators and policymakers in low-income and middle-income countries in designing relevant interventions to positively influence rural choices where the shortage of rural physicians is an ongoing and increasing concern.


MEDICAL EDUCATION & TRAINING; Motivation; low and middle income countries; medical students; rural health

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