Practice intentions at entry to and exit from medical schools aspiring to social accountability: findings from the Training for Health Equity Network Graduate Outcome Study

Larkins, Sarah, Johnston, Karen, Hogenbirk, John C., Willems, Sara, Elsanousi, Salwa, Mammen, Marykutty, Van Roy, Kaatje, Iputo, Jehu, Cristobal, Fortunato L., Greenhill, Jennene, Labarda, Charlie, and Neusy, André-Jacques (2018) Practice intentions at entry to and exit from medical schools aspiring to social accountability: findings from the Training for Health Equity Network Graduate Outcome Study. BMC Medical Education, 18. 261.

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Background: Understanding the impact of selection and medical education on practice intentions and eventual practice is an essential component of training a fit-for-purpose health workforce distributed according to population need. Existing evidence comes largely from high-income settings and neglects contextual factors. This paper describes the practice intentions of entry and exit cohorts of medical students across low and high income settings and the correlation of student characteristics with these intentions.

Methods: The Training for Health Equity Network (THEnet) Graduate Outcome Study (GOS) is an international prospective cohort study tracking learners throughout training and ten years into practice as part of the longitudinal impact assessment described in THEnet’s Evaluation Framework. THEnet is an international community of practice of twelve medical schools with a social accountability mandate. Data presented here include cross-sectional entry and exit data obtained from different cohorts of medical students involving eight medical schools in six countries and five continents. Binary logistic regression was used to create adjusted odds ratios for associations with practice intent.

Results: Findings from 3346 learners from eight THEnet medical schools in 6 countries collected between 2012 and 2016 are presented. A high proportion of study respondents at these schools come from rural and disadvantaged backgrounds and these respondents are more likely than others to express an intention to work in underserved locations after graduation at both entry and exit from medical school. After adjusting for confounding factors, rural and low income background and regional location of medical school were the most important predictors of intent to practice in a rural location. For schools in the Philippines and Africa, intention to emigrate was more likely for respondents from high income and urban backgrounds.

Conclusions: These findings, from a diverse range of schools with social accountability mandates in different settings, provide preliminary evidence for the selection and training of a medical workforce motivated to meet the needs of underserved populations. These respondents are being followed longitudinally to determine the degree to which these intentions translate into actual practice.

Item ID: 56147
Item Type: Article (Research - C1)
ISSN: 1472-6920
Keywords: medical education, health workforce, social accountability, learner characteristics, practice intention
Copyright Information: Copyright © © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.or/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Funders: Atlantic Philanthropies (AP), Arcadia Foundation, Ministry of Health and Long-Term Care, Ontario, Canada
Date Deposited: 18 Nov 2018 22:33
FoR Codes: 42 HEALTH SCIENCES > 4206 Public health > 420602 Health equity @ 100%
SEO Codes: 92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920506 Rural Health @ 50%
92 HEALTH > 9202 Health and Support Services > 920205 Health Education and Promotion @ 50%
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