Medical students' characteristics as predictors of career practice location: retrospective cohort study tracking graduates of Nepal's first medical college.
OBJECTIVE
To determine, in one low income country (Nepal), which characteristics of medical students are associated with graduate doctors staying to practise in the country or in its rural areas.


METHODS
Observational cohort study.


METHODS
Medical college registry, with internet, phone, and personal follow-up of graduates.


METHODS
710 graduate doctors from the first 22 classes (1983-2004) of Nepal's first medical college, the Institute of Medicine.


METHODS
Career practice location (foreign or in Nepal; in or outside of the capital city Kathmandu) compared with certain pre-graduation characteristics of medical student.


RESULTS
710 (97.7%) of the 727 graduates were located: 193 (27.2%) were working in Nepal in districts outside the capital city Kathmandu, 261 (36.8%) were working in Kathmandu, and 256 (36.1%) were working in foreign countries. Of 256 working abroad, 188 (73%) were in the United States. Students from later graduating classes were more likely to be working in foreign countries. Those with pre-medical education as paramedics were twice as likely to be working in Nepal and 3.5 times as likely to be in rural Nepal, compared with students with a college science background. Students who were academically in the lower third of their medical school class were twice as likely to be working in rural Nepal as those from the upper third. In a regression analysis adjusting for all variables, paramedical background (odds ratio 4.4, 95% confidence interval 1.7 to 11.6) was independently associated with a doctor remaining in Nepal. Rural birthplace (odds ratio 3.8, 1.3 to 11.5) and older age at matriculation (1.1, 1.0 to 1.2) were each independently associated with a doctor working in rural Nepal.


CONCLUSIONS
A cluster of medical students' characteristics, including paramedical background, rural birthplace, and lower academic rank, was associated with a doctor remaining in Nepal and with working outside the capital city of Kathmandu. Policy makers in medical education who are committed to producing doctors for underserved areas of their country could use this evidence to revise their entrance criteria for medical school.
Nick Simons Institute, Box 8975, EPC 1813, Kathmandu, Nepal. markz@nsi.edu.np
Mark
M
Zimmerman
Rabina
R
Shakya
Bharat M
BM
Pokhrel
Nir
N
Eyal
Basista P
BP
Rijal
Ratindra N
RN
Shrestha
Arun
A
Sayami
D000293:Adolescent; D000328:Adult; D000368:Aged; D002321:Career Choice; D003625:Data Collection / Q000379:methods; D004516:Education, Premedical / Q000706:statistics & numerical data; D004522:Educational Status; D004641:Emigration and Immigration / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal; D016017:Odds Ratio; D010820:Physicians / Q000706:statistics & numerical data*; D011365:Professional Practice Location / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012423:Rural Health / Q000706:statistics & numerical data; D013337:Students, Medical / Q000523:psychology* / Q000706:statistics & numerical data; D014504:Urban Health / Q000706:statistics & numerical data; D055815:Young Adult