Emigration plans after graduation of clinical medical students of ebonyi state university Abakaliki, Nigeria: Implications for policy.

OBJECTIVE: To determine the emigration plans after graduation of clinical medical students of Ebonyi State University Abakaliki, Nigeria. METHODS: A descriptive cross-sectional study design was used. All clinical medical students of the University willing to participate were included. Information was obtained using a pre-tested self-administered questionnaire. Outcome measure included proportion of students willing to emigrate and those willing to practice in rural areas after graduation. RESULTS: A total of 285 students participated in the study, (response rate, 92.5%). Majority, 93.3% intend to pursue specialist training after graduation. Minor proportion, 13.9% intend to specialize in Nigeria, whereas 74.4% prefer to specialize outside Nigeria. Major reasons for preferring specialist training abroad included good equipment/facilities, 33.8%, better remuneration/quality of life, 27.8%; and improved skills, 18.7%. Countries of interest for training outside Nigeria included Canada, 28.3%; United Kingdom, 23.2%; and the United States of America, 18.2%. Minor proportion, 17.2% intend to practice in rural area after graduation. Predictors of willingness to emigrate included being in 400 level class, (adjusted odds ratio (AOR) =2.0, 95% CI = 1.1-4.1), being single, AOR = 4.0, 95% CI = 1.2-13.3) and having decided on specialty of choice, (AOR = 2.6, 95% CI = 1.5-4.5). Predictors of willingness to serve in rural area included family residence in urban area, (AOR = 0.2, 95% CI = 0.2-0.8) and intention to specialize in Nigeria, (AOR = 3.7, 95% CI = 1.6-8.5). CONCLUSIONS: Majority of students intend to pursue specialist training and prefer training abroad. Minor proportions were willing to specialize in Nigeria and serve in rural areas. The students may have perceived medical practice in Nigeria as serving in rural areas hence students willing to work in rural areas were more likely to specialize in Nigeria. This may adversely affect health service delivery in Nigeria if left unchecked. Nigerian authorities should ensure that medical graduates willing to practice in Nigeria are not deterred. Also, plans to encourage doctors to practice in Nigeria should receive desired attention.

[Rural medical practice at the beginning of the 20th century. Martínez Saldise (1855-1937), honorary member of Paediatric Society of Madrid in 1927]. / La medicina rural a principios de siglo XX. A propósito de Martínez Saldise (1855-1937), socio de honor de la Sociedad de Pediatría de Madrid en 1927.

INTRODUCTION: On the centenary of the foundation of the Paediatrics Society of Madrid, a tribute is presented to rural medical practice of that time, although there are few documents on the history of rural medicine. The main objective is to describe the context of the rural medical practice in the late 19th and beginning 20th century, while presenting a historical biographical review of Manuel Martínez Saldise, who was medical specialist from Cazalegas (Toledo). He was appointed an Honorary Member by the Paediatrics Society of Madrid in 1927. MATERIAL AND METHODS: A search was carried out in repositories of digitized media, web portals of history of medicine, PubMed, IME files of local councils and medical colleges. The family archives were reviewed with the collaboration of his descendants. RESULTS: The hiring of rural doctors was carried out by the municipalities, and the salary largely depended on private practice as well as "retainers". Specialist physicians took part in epidemics, legal medicine, and in hygiene measures. They also had disputes with mayors, chiefs, with colleagues and with protectionism. A summary of the biography and occupational activity of Manuel Martínez Saldise is presented. COMMENTS: Rural doctors were subjected to the society of their time, with the issues that arose, denouncing the shortcomings of the local administrations, dedicated efforts to their family and the most disadvantaged.

Training a Fit-For-Purpose Rural Health Workforce for Low- and Middle-Income Countries (LMICs): How Do Drivers and Enablers of Rural Practice Intention Differ Between Learners From LMICs and High Income Countries?

Equity in health outcomes for rural and remote populations in low- and middle-income countries (LMICs) is limited by a range of socio-economic, cultural and environmental determinants of health. Health professional education that is sensitive to local population needs and that attends to all elements of the rural pathway is vital to increase the proportion of the health workforce that practices in underserved rural and remote areas. The Training for Health Equity Network (THEnet) is a community-of-practice of 13 health professional education institutions with a focus on delivering socially accountable education to produce a fit-for-purpose health workforce. The THEnet Graduate Outcome Study is an international prospective cohort study with more than 6,000 learners from nine health professional schools in seven countries (including four LMICs; the Philippines, Sudan, South Africa and Nepal). Surveys of learners are administered at entry to and exit from medical school, and at years 1, 4, 7, and 10 thereafter. The association of learners' intention to practice in rural and other underserved areas, and a range of individual and institutional level variables at two time points-entry to and exit from the medical program, are examined and compared between country income settings. These findings are then triangulated with a sociocultural exploration of the structural relationships between educational and health service delivery ministries in each setting, status of postgraduate training for primary care, and current policy settings. This analysis confirmed the association of rural background with intention to practice in rural areas at both entry and exit. Intention to work abroad was greater for learners at entry, with a significant shift to an intention to work in-country for learners with entry and exit data. Learners at exit were more likely to intend a career in generalist disciplines than those at entry however lack of health policy and unclear career pathways limits the effectiveness of educational strategies in LMICs. This multi-national study of learners from medical schools with a social accountability mandate confirms that it is possible to produce a health workforce with a strong intent to practice in rural areas through attention to all aspects of the rural pathway.