Factors that influence the choice to work in rural township health centers among 4,669 clinical medical students from five medical universities in Guangxi, China

Abstract

Purpose:To produce competent undergraduate-level medical doctors for rural township health centers (THCs), the Chinese government mandated that medical colleges in Central and Western China recruit rural-oriented, tuition-waived medical students (RTMSs) starting in 2010. This study aimed to identify and assess factors that influence the choice to work in rural township health centers among both RTMSs and other students from five medical universities in Guangxi, China.Methods:An internet-based self-administered questionnaire survey was conducted with medical students in Guangxi province. Multinomial logistic regression was used to identify factors related to the attitudes toward work in a rural township health center. Results:Among 4,669 medical students, 1,523 (33%) had a positive attitude and 2,574 (55%) had a neutral attitude toward working in THCs. Demographic characteristics, personal job concerns, and knowledge of THCs were associated with the choice of a career in THCs. The factors related to a positive attitude included the following: three-year program, a rural-oriented medical program, being male, an expectation of working in a county or township, a focus on medical career development, some perceived difficulty of getting a job, having family support, sufficient knowledge of THCs, optimism toward THC development, seeking lower working pressure, and a lower expected monthly salary.Conclusion:Male students in a three-year program or a rural-oriented tuition-waived medical education program were more likely to work in THCs. Selecting medical students through interviews to identify their family support and intentions to work in THCs would increase recruitment and retention. Establishing favorable policies and financial incentives to improve living conditions and the social status of rural physicians is necessary.

A Qualitative Inquiry Into the Challenges of Medical Education for Retention of General Practitioners in Rural and Underserved Areas of Iran

“…Student selection criteria as a strategy for GPs retention in rural and underserved areas was highly debated in literature that could forecast retention. Several studies found that women are less positive about rural practice [14,18]. Rural origin also could be a good predictor for rural practice of GPs [19-21].…”

“…They do not consider rural practice after graduation in many cases. In fact Students’ perception about their personal career development is a factor that affects retention in rural area [14,27]. Personal and professional expectations also proved as a factor affecting on retention [23].…”

“…In fact, rural practice needs some skills that are not addressed properly in Iran. At first, medical curriculum in Iran is hospital-oriented; whereas, rural-oriented education increases intention of working in a rural area [14,31]. Though, the students are not getting familiar with skills needed for rural practice.…”

“…Hospital oriented education of GPs in Iran, does not make GPs ready for rural practice. Education approach shapes the expectations of GPs and if it is turned to rural-oriented education, we could expect more retention [14]. Community based education could improve quality as well as retention of GPs [34].…”

“…In fact GPs are not motivated to work in rural and underserved areas. In a study which is done in China, only one third of medical students have positive attitude toward working in rural and underserved areas [14]. As well, less than 18% of Japanese medical students are positively motivated for rural practice and more than 25% declared they will avoid rural practice [15].…”