摘要：Background: The health care system of Ethiopia is facing a serious shortage of health workforce. While a number
of strategies have been developed to improve the training and retention of medical doctors in the country,
understanding the perceptions and attitudes of medical students towards their training, future practice and intent
to migrate can contribute in addressing the problem. This study was carried out to assess the attitudes of Ethiopian
medical students towards their training and future practice of medicine, and to identify factors associated with the
intent to practice in rural or urban settings, or to migrate abroad.
Methods: A cross-sectional study was conducted in June 2009 among 600 medical students (Year I to Internship
program) of the Faculty of Medicine at Addis Ababa University in Ethiopia. A pre-tested self-administered structured
questionnaire was used for data collection. Descriptive statistics were used for data summarization and
presentation. Degree of association was measured by Chi Square test, with significance level set at p < 0.05.
Bivariate and multivariate logistic regression analyses were used to assess associations.
Results: Only 20% of the students felt ‘excellent’ about studying medicine; followed by ‘very good’ (19%), ‘good’
(30%), ‘fair’ (21%) and ‘bad’ (11%). About 35% of respondents responded they felt the standard of medical
education was below their expectation. Only 30% of the students said they would like to initially practice medicine
in rural settings in Ethiopia. However, students with rural backgrounds were more likely than those with urban
backgrounds to say they intended to practice medicine in rural areas (adjusted OR = 2.50, 95% CI = 1.18-5.26).
Similarly, students in clinical training program preferred to practice medicine in rural areas compared to pre-clinical
students (adjusted OR = 1.83, 95% CI = 1.12-2.99). About 53% of the students (57% males vs. 46% females, p = 0.017)
indicated aspiration to emigrate following graduation, particularly to the United States of America (42%) or
European countries (15%). The attitude towards emigration was higher among Year IV (63%) and Internship (71%)
students compared to Year I to Year III students (45-54%). Male students were more likely to say they would
emigrate than females (adjusted OR = 1.57, 95% CI = 1.10-2.29). Likewise, students with clinical training were more
likely to want to emigrate than pre-clinical students, although the difference was marginally significant (adjusted
OR = 1.58, 95% CI = 1.00-2.49).
Conclusions: The attitudes of the majority of Ethiopian medical students in the capital city towards practicing
medicine in rural areas were found to be poor, and the intent to migrate after completing medical training was
found to be very high among the study participants, creating a huge potential for brain drain. This necessitates the
importance of improving the quality of education and career choice satisfaction, creating conducive training and
working conditions including retention efforts for medical graduates to serve their nation. It follows that recruiting
altruistic and rural background students into medical schools is likely to produce graduates who are more likely to
practice medicine in rural settings.
