title: Enhancing future acceptance of rural placement in Tanzania through peripheral hospital rotations for medical students.
abstract: BACKGROUND
  Mal-distribution of health care workers is a global health challenge that exacerbates health disparities, especially in resource-limited settings. Interventions to mitigate the problem have targeted qualified personnel with little focus on medical students. However, studies have demonstrated that rural rotations positively influence students to practice in rural settings upon graduation. To evaluate the influence of peripheral rotations in a resource-limited setting, the Kilimanjaro Christian Medical University College introduced a 12-week clerkship rotation in peripheral hospitals for third-year medical (MD3) students in 2012. We administered an end-of-rotation survey to assess student perceptions, and attitudes toward rural practice after graduation.
  
  
  METHODS
  Questionnaires were voluntarily and anonymously administered to MD3 students in April 2014. The questions assessed perceptions of the experience, and attitudes towards rural practice upon graduation. The perceptions were assessed using strength of consensus measures (sCns). The effect of the experience on likelihood for rural practice was assessed using Crude Odds Ratio (COR), and predictors using Adjusted Odds Ratio (AOR) with 95 % Confidence Intervals (CI) tested at a 5 % level of significance. Variation was assessed using Hosmer and Lemeshow test Chi-square.
  
  
  RESULTS
  111 out of 148 MD3 students participated; 62 % were male; 62 % <25 years old; and 72 % matriculated directly from secondary school. Overall, 81 % of MD3 students were satisfied with rural rotations (sCns = 83 %). The likelihood of accepting rural practice deployment after graduation was predicted by satisfaction with the peripheral hospital rotation program (AOR, 4.32; 95 % CI, 1.44-12.96; p, 0.009) and being male (AOR, 2.73; 95 % CI, 1.09-6.84; p, 0.032). Students admitted in medical school after health-related practice trended toward a higher likelihood of accepting rural practice after graduation compared to those enrolled directly from secondary school, although the difference was not significant (AOR, 4.99; 95 % CI, 0.88-28.41; p, 0.070). The Hosmer and Lemeshow test p-value was 0.686, indicating a good fit of the model. No significant differences in satisfaction between these two groups were observed, and also no significant differences between students born in rural areas compared to those born in urban areas existed.
  
  
  CONCLUSIONS
  Results indicate that satisfaction with rural rotations is associated with increased likelihood of rural practice after graduation. We conclude that opportunities may exist to reduce mal-distribution of healthcare workers through interventions that target medical students.
authors: Kilimanjaro Christian Medical University College, Moshi, Tanzania. nsokolo2005@yahoo.co.uk.
authors: Gibson Erick
authors: GE
authors: Kapanda
authors: Duke Global Health Institute, Durham, NC, USA. charles.muiruri@duke.edu.
authors: Charles
authors: C
authors: Muiruri
authors: Kilimanjaro Christian Medical University College, Moshi, Tanzania. ahaz47@gmail.com.
authors: Ahaz T
authors: AT
authors: Kulanga
authors: Kilimanjaro Christian Medical University College, Moshi, Tanzania. cintya086@yahoo.com.
authors: Chrispina N
authors: CN
authors: Tarimo
authors: Kilimanjaro Christian Medical University College, Moshi, Tanzania. estherlisasi@yahoo.co.uk.
authors: Esther
authors: E
authors: Lisasi
authors: Kilimanjaro Christian Medical University College, Moshi, Tanzania. lucymimano@gmail.com.
authors: Lucy
authors: L
authors: Mimano
authors: Kilimanjaro Christian Medical University College, Moshi, Tanzania. akamteta@hotmail.com.
authors: Kien
authors: K
authors: Mteta
authors: Kilimanjaro Christian Medical University College, Moshi, Tanzania. john.bartlett@dm.duke.edu.|Duke Global Health Institute, Durham, NC, USA. john.bartlett@dm.duke.edu.|Duke University School of Medicine, Durham, NC, USA. john.bartlett@dm.duke.edu.
authors: John A
authors: JA
authors: Bartlett
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002321:Career Choice; D016009:Chi-Square Distribution; D002982:Clinical Clerkship / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D004504:Education, Medical, Undergraduate / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010820:Physicians / Q000600:supply & distribution*; D011365:Professional Practice Location / Q000706:statistics & numerical data*; D012044:Regression Analysis; D019035:Rural Health Services; D013337:Students, Medical / Q000523:psychology*; D013636:Tanzania; D000078329:Workforce; D055815:Young Adult