title: Attitudes of undergraduate medical students of Addis Ababa University towards medical practice and migration, Ethiopia.
abstract: BACKGROUND
  The health care system of Ethiopia is facing a serious shortage of health workforce. While a number of strategies have been developed to improve the training and retention of medical doctors in the country, understanding the perceptions and attitudes of medical students towards their training, future practice and intent to migrate can contribute in addressing the problem. This study was carried out to assess the attitudes of Ethiopian medical students towards their training and future practice of medicine, and to identify factors associated with the intent to practice in rural or urban settings, or to migrate abroad.
  
  
  METHODS
  A cross-sectional study was conducted in June 2009 among 600 medical students (Year I to Internship program) of the Faculty of Medicine at Addis Ababa University in Ethiopia. A pre-tested self-administered structured questionnaire was used for data collection. Descriptive statistics were used for data summarization and presentation. Degree of association was measured by Chi Square test, with significance level set at p < 0.05. Bivariate and multivariate logistic regression analyses were used to assess associations.
  
  
  RESULTS
  Only 20% of the students felt 'excellent' about studying medicine; followed by 'very good' (19%), 'good' (30%), 'fair' (21%) and 'bad' (11%). About 35% of respondents responded they felt the standard of medical education was below their expectation. Only 30% of the students said they would like to initially practice medicine in rural settings in Ethiopia. However, students with rural backgrounds were more likely than those with urban backgrounds to say they intended to practice medicine in rural areas (adjusted OR = 2.50, 95% CI = 1.18-5.26). Similarly, students in clinical training program preferred to practice medicine in rural areas compared to pre-clinical students (adjusted OR = 1.83, 95% CI = 1.12-2.99). About 53% of the students (57% males vs. 46% females, p = 0.017) indicated aspiration to emigrate following graduation, particularly to the United States of America (42%) or European countries (15%). The attitude towards emigration was higher among Year IV (63%) and Internship (71%) students compared to Year I to Year III students (45-54%). Male students were more likely to say they would emigrate than females (adjusted OR = 1.57, 95% CI = 1.10-2.29). Likewise, students with clinical training were more likely to want to emigrate than pre-clinical students, although the difference was marginally significant (adjusted OR = 1.58, 95% CI = 1.00-2.49).
  
  
  CONCLUSIONS
  The attitudes of the majority of Ethiopian medical students in the capital city towards practicing medicine in rural areas were found to be poor, and the intent to migrate after completing medical training was found to be very high among the study participants, creating a huge potential for brain drain. This necessitates the importance of improving the quality of education and career choice satisfaction, creating conducive training and working conditions including retention efforts for medical graduates to serve their nation. It follows that recruiting altruistic and rural background students into medical schools is likely to produce graduates who are more likely to practice medicine in rural settings.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. deressaw@yahoo.com
authors.forename: Wakgari
authors.initials: W
authors.lastname: Deressa
authors.forename: Aklilu
authors.initials: A
authors.lastname: Azazh
mesh_terms: D000328:Adult; D001240:Aspirations, Psychological; D001291:Attitude of Health Personnel; D002321:Career Choice; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004504:Education, Medical, Undergraduate / Q000592:standards*; D004641:Emigration and Immigration; D005260:Female; D058006:General Practice / Q000193:education; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D033182:Intention; D007396:Internship and Residency / Q000592:standards; D008297:Male; D008507:Medically Underserved Area; D010820:Physicians / Q000600:supply & distribution; D012423:Rural Health; D012577:Schools, Medical / Q000592:standards; D013337:Students, Medical / Q000523:psychology*; D014504:Urban Health