Medical and nursing students' intentions to work abroad or in rural areas: a cross-sectional survey in Asia and Africa.
OBJECTIVE
To assess medical and nursing students' intentions to migrate abroad or practice in rural areas.


METHODS
We surveyed 3199 first- and final-year medical and nursing students at 16 premier government institutions in Bangladesh, Ethiopia, India, Kenya, Malawi, Nepal, the United Republic of Tanzania and Zambia. The survey contained questions to identify factors that could predict students' intentions to migrate. Primary outcomes were the likelihoods of migrating to work abroad or working in rural areas in the country of training within five years post-training. We assessed predictors of migration intentions using multivariable proportional odds models.


RESULTS
Among respondents, 28% (870/3156) expected to migrate abroad, while only 18% (575/3158) anticipated a rural career. More nursing than medical students desired professions abroad (odds ratio, OR: 1.76; 95% confidence interval, CI: 1.25-2.48). Career desires before matriculation correlated with current intentions for international (OR: 4.49; 95% CI: 3.21-6.29) and rural (OR: 4.84; 95% CI: 3.52-6.66) careers. Time spent in rural areas before matriculation predicted the preference for a rural career (20 versus 0 years: OR: 1.53, 95% CI: 1.19-1.98) and against work abroad (20 versus 0 years: OR: 0.69, 95% CI: 0.50-0.96).


CONCLUSIONS
A significant proportion of students surveyed still intend to work abroad or in cities after training. These intentions could be identified even before matriculation. Admissions standards that account for years spent in rural areas could promote greater graduate retention in the country of training and in rural areas.
Vanderbilt University Institute for Global Health, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 750, Nashville, Tennessee, 37203, United States of America (USA).
David M
DM
Silvestri
Vanderbilt University Institute for Global Health, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 750, Nashville, Tennessee, 37203, United States of America (USA).
Meridith
M
Blevins
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh .
Arfan R
AR
Afzal
Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia .
Ben
B
Andrews
Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia .
Miliard
M
Derbew
Department of Physiology, Maulana Azad Medical College, New Delhi, India .
Simran
S
Kaur
University of Malawi College of Medicine, Blantyre, Malawi .
Mwapatsa
M
Mipando
Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania .
Charles A
CA
Mkony
Department of Human Anatomy, University of Nairobi, Nairobi, Kenya .
Philip M
PM
Mwachaka
Department of Anatomy, Tribhuvan University Institute of Medicine, Kathmandu, Nepal .
Nirju
N
Ranjit
Vanderbilt University Institute for Global Health, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 750, Nashville, Tennessee, 37203, United States of America (USA).
Sten
S
Vermund
D000328:Adult; D017954:Africa South of the Sahara; D001210:Asia, Southeastern; D002321:Career Choice; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D033182:Intention; D008297:Male; D019035:Rural Health Services; D013337:Students, Medical / Q000523:psychology*; D013338:Students, Nursing / Q000523:psychology*; D011795:Surveys and Questionnaires; D000078329:Workforce