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Rural internship job preferences of final year medical students in South Africa: a discrete choice experiment
To achieve Sustainable Development Goal 3 in developing countries, Good health and wellbeing for all, the health workforce is vital however the unpopularity of rural medical practice results in widening healthcare inequalities between urban and rural areas. This study determined the heterogeneity in...
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| Format: | Thesis |
| Language: | English |
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2020
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| _version_ | 1867614245527486464 |
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| access_status_str | Open Access |
| author | Jose, Maria |
| author2 | Alaba, Olufunke |
| author_browse | Alaba, Olufunke Jose, Maria |
| author_facet | Alaba, Olufunke Jose, Maria |
| author_sort | Jose, Maria |
| collection | Thesis |
| description | To achieve Sustainable Development Goal 3 in developing countries, Good health and wellbeing for all, the health workforce is vital however the unpopularity of rural medical practice results in widening healthcare inequalities between urban and rural areas. This study determined the heterogeneity in valuations for rural facility attributes by final year medical students at one South African public university to inform cost-effective recruitment policy recommendations. Focus groups conducted identified facility attributes, a D-efficient design was generated with 15 choice sets, each with two rural hospital alternatives and no opt-out option. An online, unlabelled discrete choice experiment (DCE) was conducted, the results effects coded, and mixed logit models applied. The final sample size was 193 (86,16% of the class), majority female 130 (66.33%), with urban origins 176 (89.80%), unmarried 183 (93.37%) and without children 193 (98.47%). Most had undergraduate rural medicine exposure 110 (56.12%) and intended to specialise 109 (55.61%). The main-effects mixed logit found advanced practical experience, hospital safety, correctly fitted personal protective equipment (PPE) and availability of basic resources the highest weighted attributes with their mean utilities increasing by 0.82, 0.64, 0.62 and 0.52 respectively (p=0.000). In contrast, increases in rural allowance and the provision of housing provided smaller mean utility increases of 0.001 (p<0.01) and 0.09 (p<0.05) respectively. The interaction terms; female, general practise and prior rural medicine exposure, were associated with higher weighting for hospital safety, mean utility increases 1.59, 1.82, 1.42 respectively (p=0.000). Participants were willing to pay ZAR 2636.45 monthly (95%CI: 1398.55;3874.355) to gain advanced practical experience (equivalent to 65.91% of current rural allowance). Medical students’ facility preferences have been found to be influenced by their gender, career aspirations and prior experienced with rural medicine. The policy recommendations derived from this research include publicising rural health facility “draw-cards” among medical graduates, such as the opportunity to gain practical experience, improving the physical and occupational safety at rural health facilities and providing greater transparency about rural facility attributes to medical graduates. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/31215 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:48:58.914Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2020 |
| publishDateRange | 2020 |
| publishDateSort | 2020 |
| publisher | Unknown Department |
| publisherStr | Unknown Department |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/31215 Rural internship job preferences of final year medical students in South Africa: a discrete choice experiment Jose, Maria Alaba, Olufunke Discrete choice experiment human resources for health rural medicine medical student To achieve Sustainable Development Goal 3 in developing countries, Good health and wellbeing for all, the health workforce is vital however the unpopularity of rural medical practice results in widening healthcare inequalities between urban and rural areas. This study determined the heterogeneity in valuations for rural facility attributes by final year medical students at one South African public university to inform cost-effective recruitment policy recommendations. Focus groups conducted identified facility attributes, a D-efficient design was generated with 15 choice sets, each with two rural hospital alternatives and no opt-out option. An online, unlabelled discrete choice experiment (DCE) was conducted, the results effects coded, and mixed logit models applied. The final sample size was 193 (86,16% of the class), majority female 130 (66.33%), with urban origins 176 (89.80%), unmarried 183 (93.37%) and without children 193 (98.47%). Most had undergraduate rural medicine exposure 110 (56.12%) and intended to specialise 109 (55.61%). The main-effects mixed logit found advanced practical experience, hospital safety, correctly fitted personal protective equipment (PPE) and availability of basic resources the highest weighted attributes with their mean utilities increasing by 0.82, 0.64, 0.62 and 0.52 respectively (p=0.000). In contrast, increases in rural allowance and the provision of housing provided smaller mean utility increases of 0.001 (p<0.01) and 0.09 (p<0.05) respectively. The interaction terms; female, general practise and prior rural medicine exposure, were associated with higher weighting for hospital safety, mean utility increases 1.59, 1.82, 1.42 respectively (p=0.000). Participants were willing to pay ZAR 2636.45 monthly (95%CI: 1398.55;3874.355) to gain advanced practical experience (equivalent to 65.91% of current rural allowance). Medical students’ facility preferences have been found to be influenced by their gender, career aspirations and prior experienced with rural medicine. The policy recommendations derived from this research include publicising rural health facility “draw-cards” among medical graduates, such as the opportunity to gain practical experience, improving the physical and occupational safety at rural health facilities and providing greater transparency about rural facility attributes to medical graduates. 2020-02-21T08:57:06Z 2020-02-21T08:57:06Z 2019 2020-02-20T09:23:19Z Master Thesis Masters MPH http://hdl.handle.net/11427/31215 eng application/pdf Unknown Department Faculty of Health Sciences |
| spellingShingle | Discrete choice experiment human resources for health rural medicine medical student Jose, Maria Rural internship job preferences of final year medical students in South Africa: a discrete choice experiment |
| thesis_degree_str | Master's |
| title | Rural internship job preferences of final year medical students in South Africa: a discrete choice experiment |
| title_full | Rural internship job preferences of final year medical students in South Africa: a discrete choice experiment |
| title_fullStr | Rural internship job preferences of final year medical students in South Africa: a discrete choice experiment |
| title_full_unstemmed | Rural internship job preferences of final year medical students in South Africa: a discrete choice experiment |
| title_short | Rural internship job preferences of final year medical students in South Africa: a discrete choice experiment |
| title_sort | rural internship job preferences of final year medical students in south africa a discrete choice experiment |
| topic | Discrete choice experiment human resources for health rural medicine medical student |
| url | http://hdl.handle.net/11427/31215 |
| work_keys_str_mv | AT josemaria ruralinternshipjobpreferencesoffinalyearmedicalstudentsinsouthafricaadiscretechoiceexperiment |