Poster number 915 presented at #RCGPAC United Kingdom
Aim: This study sought to determine how barriers to medical students choosing a career in rural government primary care clinics could be overcome.
Content: A written survey of medical students throughout Patna Medical College, an urban Indian medical school, was undertaken. Internationally, many previous studies have attempted to determine the characteristics of students who are willing or unwilling to work in rural primary care. This study introduces a new concept – students who are “conditionally willing” provided certain criteria are met.
Relevance: In India, 26% of doctors work in rural areas but 72% of the population live there. As in many other areas of the world, the majority of medical students do not wish to work in rural primary care. The concept of “conditional willingness” could usefully be applied in other contexts internationally.
Outcomes: In total 394 students completed the questionnaire (response rate 92%). The willingness of medical students to work in rural primary care declined as they progressed through professional years of medical school. However, there was a commensurate increase (p<0.0001) in conditional willingness if certain conditions were met – the most cited were housing issues (including water and electricity, 83%), facilities for doctors’ children such as a good education (69%), and an improved starting salary (66%). Absolute unwillingness to work in a rural health centre remained low; 95% of such students cited the desire to undertake postgraduate studies as a reason.
Discussion: Policy makers wishing to increase the willingness of medical students to enter primary care should undertake context-relevant steps to bring about the reforms to encourage willingness.
Task Force on Medical Education for the National Rural Health Mission. Pages 9, 46, 72, Ministry of Health & Family Welfare; available at http://ideas.repec.org/p/ess/wpaper/id1082.html accessed 5 September, 2016
Bulletin of Rural Health Statistics in India (2011), Ministry of Health & Family Welfare, Government of India (now available online at https://data.gov.in/catalog/rural-health-statistics-india-2011)
Census of India (2011) Provisional Population Totals, Director of Census Operations, Bihar, Patna
Data on file http://www.statehealthsocietybihar.org/manpower_mgmt.html accessed 12 January 2013
Yadav RJ, Pandey A, Juneja A, Adhikari T. An assessment of PHC facility in demographically weak districts of some states in India. Health and Population – Perspectives and Issues. 2012; 35(1), 23-35; http://medind.nic.in/hab/t12/i1/habt12i1p23.pdf accessed 5 September 2016
Jutzi L, Vogt K, Drever E, Nisker J. Recruiting medical students to rural practice: perspectives of medical students and rural recruiters, Can Fam Physician. 2009 Jan;55(1):72-3, 73.e1-4
Shankar PR, Thapa TP. Student perception about working in rural Nepal after graduation: a study among first- and second-year medical students. Human Resources for Health 2012; 10:27 available on http://www.human-resources-health.com/content/10/1/27 accessed 5 September 2016
Sinha RK. Perception of Young Doctors towards Service to Rural Population in Bihar, J Ind Med Assoc.2012,110(8):530-4
Wakgari D, Aklilu A. Attitudes of undergraduate medical students of Addis Ababa University towards medical practice and migration, Ethiopia, BMC Med Educ. 2012; 12:68
Kaye DK, Mwanika A, Sekimpi P, Tugumisirize J, Sewankambo N. Perceptions of newly admitted undergraduate medical students on experiential training on community placements and working in rural areas of Uganda, BMC Med Educ. 2010; 10: 47
Tolhurst HM, Adams J, Stewart SM. An exploration of when urban background medical students become interested in rural practice, Rural and Remote Health 2006, 6:452
Henry JA, Edwards BJ, Crotty B. Why do medical graduates choose rural careers? Rural and Remote Health 2009; 9: 1083
Edmond G et al. Analysis of a survey on young doctors' willingness to work in rural Hungary. Human Resources for Health 2010, 8:13
Easterbrook M, Godwin M, Wilson R, et al. Rural background and clinical rural rotations during medical training: effect on practice location. Canadian Med Assoc J 1999 Apr20;160(8):1159-63
Bureau of Health Professions. Rural Health Professions Facts: Supply and Distribution of Health Professions in Rural America, Rockville, MD: Health Resources and Services Administration; 1992 (Newer edition)
Mack M, Maxwell H, Hogg D, Gillies J. Being Rural: exploring sustainable solutions for remote and rural healthcare; RCGP Scotland Policy Paper written by the Rural Strategy Group Scotland. 2014 available from http://www.rcgp.org.uk/rcgp-nations/~/media/Files/Policy/A-Z-policy/RCGP-Being-Rural-policy-paper-and-appendix-2014.ashx accessed 6 September 2016
British Medical Association Board of Science. Healthcare in a rural setting. 2005 available from http://www.nsdm.no/filarkiv/File/Eksterne_rapporter/BMA.pdf accessed 6 September 2016
McAuliffe T, Barnett F. Factors influencing occupational therapy students' perceptions of rural and remote practice, Rural Remote Health 2009;Jan-Mar; 9(1):1078
Richards HM, Farmer J, Selvaraj S. Sustaining the rural primary healthcare workforce: survey of healthcare professionals in the Scottish Highlands. Rural Remote Health 2005 Jan-Mar; 5(1):365
Goyal RC, Sachdeva NL. Role of GP in Primary health care. J Ind Med Assoc. 1996 Feb;94(2):60-1
Dr Prateek Nishant is a rotatory medical-surgical intern in Patna Medical College Hospital, interested in Community Medicine, Ophthalmology, Nanotechnology and Informatics. The poster is a result of further research on an STS project awarded a research grant by the Indian Council of Medical Research (ICMR)
Dr Rashmi Singh is Professor and Head of the Department of Community Medicine, Patna Medical College and was Dr Nishant's guide for the ICMR project.
Dr Helen Susan Crawley is an International Trainer with the Royal College of General Practitioners (RCGP). She is a regular visitor to Patna Medical College where she is working on a collaborative project to improve the training of Interns and Medical Officers. She was responsible for writing the content of the present poster.
Dr Ranjeet Kumar Sinha is Associate Professor in the Department of Community Medicine, Patna Medical College and was responsible for writing the content of the present poster.
Dr Sony Sinha is Assistant Professor in Ophthalmology , Patna Medical College and trained in Biostatistics from PD Hinduja Hospital, Mumbai. She was responsible for the data handling and biostatistical analysis for the ICMR project
Contact information:
This research was partly supported by a financial grant from Indian Council of Medical Research, read the story here
