Medical students' rural practice intention: Academic performance matters

Area of Science:

• Medical Education Research
• Rural Health Workforce Studies
• Socioeconomic Determinants of Health

Background:

• Policies encouraging medical students towards rural practice are common.
• Previous research focused on individual and structural factors for rural practice intention.
• The impact of academic performance on rural practice intention remains under-explored.

Purpose of the Study:

• To investigate the relationship between academic performance in medical school and rural practice intention.
• To address a gap in understanding career decision-making factors for rural health.

Main Methods:

• Cross-sectional survey of 13,123 medical students from 60 rural order directed (ROD) programs in China (2021).
• Data collected on rural practice intention, socio-demographics, and academic performance (GPA rank, awards, leadership).
• Univariate analyses and multilevel logistic regression models were used to assess associations.

Main Results:

• A statistically significant inverse relationship was found between academic performance and rural practice intention.
• Higher academic performers demonstrated a lower likelihood of intending to practice rurally (ORs: 0.65-0.78).
• This association persisted across all performance metrics and in students with a rural upbringing.

Conclusions:

• This study is the first to establish a link between medical school academic performance and rural practice intention.
• Findings suggest higher-achieving students may prioritize career utility, leading to reduced rural practice intent.
• Results offer insights for medical schools and planners to refine rural training, recruitment, and retention strategies.