Willingness to work in rural areas and the role of intrinsic versus extrinsic professional motivations - a survey of medical students in Ghana

Abstract

BackgroundRetaining health workers in rural areas is challenging for a number of reasons, ranging from personal preferences to difficult work conditions and low remuneration. This paper assesses the influence of intrinsic and extrinsic motivation on willingness to accept postings to deprived areas among medical students in Ghana.MethodsA computer-based survey involving 302 fourth year medical students was conducted from May-August 2009. Logistic regression was used to assess the association between students' willingness to accept rural postings and their professional motivations, rural exposure and family parental professional and educational status (PPES).ResultsOver 85% of students were born in urban areas and 57% came from affluent backgrounds. Nearly two-thirds of students reported strong intrinsic motivation to study medicine. After controlling for demographic characteristics and rural exposure, motivational factors did not influence willingness to practice in rural areas. High family PPES was consistently associated with lower willingness to work in rural areas.ConclusionsAlthough most Ghanaian medical students are motivated to study medicine by the desire to help others, this does not translate into willingness to work in rural areas. Efforts should be made to build on intrinsic motivation during medical training and in designing rural postings, as well as favour lower PPES students for admission.

Motivation for studying medicine: assessing the similarities between UK and Ghanaian medical students

“…Vaglum and colleagues, 29 in a study on Norwegian medical students, showed that the balance between extrinsic and intrinsic motivation in medical students has a strong influence on their future career choices. Similar findings have occurred in a diverse range of countries such as Switzerland, 21 the West Indies, 30 Netherlands, 22 Hungary, 31 Ghana, 32 and Egypt. 33 As the Royal College of General Practitioners currently embarks upon a campaign to persuade UK medical students to choose GP as a career, 14 understanding the impact of underlying motivation would allow for better targeted interventions.…”

“…To achieve this, this study has replicated a previous survey performed by Agyei-Baffour and colleagues 32 on Ghanaian medical students, applying it to UK students. Within Ghana, policy makers have struggled with high rates of domestic and international health worker migration that have deeply impacted upon the health of the population.…”

“…The Ghanaian data was taken from results published by Agyei-Baffour and colleagues 32 Their research was performed on 4 th year medical students studying at two universities in Ghana. Medical students in Ghana undertake 3 years of basic science teaching followed by three years of clinical training and a two-year rotating housemanship.…”

“…Within Ghana, policy makers have struggled with high rates of domestic and international health worker migration that have deeply impacted upon the health of the population. 23 In their work, Agyei-Baffour and colleagues 32 used a questionnaire to analyze student's motivation to study medicine and its influence on their decision to work in a deprived area. In this study, UK medical students at a similar point in their studies were provided with the same questions.…”

Students’ opinions on working in rural practice in Slovenia

“…Additionally, similarities were found in a study on factors that would entice junior doctors to work in a rural practice: partner/family factors, professional support, career opportunities, specialty requirements and infrastructure and financial incentives [21]. A Ghanaian study found that students are motivated to study medicine by the desire to help others, but this does not translate into willingness to work in rural areas [22]. rural areas.…”