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Am J Trop Med Hyg. 2017 Jun;96(6):1512-1520. doi: 10.4269/ajtmh.16-0756.

Nonacademic Attributes Predict Medical and Nursing Student Intentions to Emigrate or to Work Rurally: An Eight-Country Survey in Asia and Africa.

Author information

Vanderbilt University Institute for Global Health, Nashville, Tennessee.
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
Vanderbilt University School of Nursing, Nashville, Tennessee.
Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada.
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia.
Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia.
Department of Physiology, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India.
Department of Physiology, Maulana Azad Medical College, Bahadur Shah Zafar Marg, Delhi, India.
University of Malawi College of Medicine, Blantyre, Malawi.
Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.
Department of Anatomy, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal.
Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.


AbstractWe sought to identify independent, nonacademic predictors of medical and nursing student intent to migrate abroad or from rural to urban areas after graduation in low- and middle-income countries (LMIC). This was a cross-sectional survey of 3,199 first- and final-year medical and nursing students at 16 training institutions in eight LMIC. Questionnaires assessed demographics, career intentions, and preferences regarding selected career, location, and work-related attributes. Using principal component analysis, student preferences were reduced into four discrete categories of priorities: 1) work environment resources, 2) location livability, 3) altruistic job values, and 4) individualistic job values. Students' preferences were scored in each category. Using students' characteristics and priority scores, multivariable proportional odds models were used to derive independent predictors of intentions to emigrate for work outside the country, or to work in a rural area in their native country. Students prioritizing individualistic values more often planned international careers (adjusted odds ratio [aOR] = 1.44, 95% confidence interval [CI] = 1.16-1.78), whereas those prioritizing altruistic values preferred rural careers (aOR = 1.82, 95% CI = 1.50-2.21). Trainees prioritizing high-resource environments preferentially planned careers abroad (aOR = 1.38, 95% CI = 1.12-1.69) and were unlikely to seek rural work (aOR = 0.60, 95% CI = 0.49-0.73). Independent of their priorities, students with prolonged prior rural residence were unlikely to plan emigration (aOR = 0.67, 95% CI = 0.50-0.90) and were more likely to plan a rural career (aOR = 1.53, 95% CI = 1.16-2.03). We conclude that use of nonacademic attributes in medical and nursing admissions processes would likely increase retention in high-need rural areas and reduce emigration "brain drain" in LMIC.

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