Assessing Medical Students’ Preferences for Rural Internships Using a Discrete Choice Experiment: A Case Study of Medical Students in a Public University in the Western Cape

Abstract

As new graduates are crucial in providing healthcare services in rural areas, this study aimed to identify and describe the rural facility attributes that attract medical students to apply for rural internships. A literature review and focus groups informed a discrete choice experiment conducted amongst graduating medical students at one public university in South Africa. One main effect using a mixed logit model and another main effect plus interaction model was estimated. Females (130/66.33%) of urban origin (176/89.80%) with undergraduate exposure to rural facilities (110/56.12%) were the majority. The main effects only model showed advanced practical experience, hospital safety, correctly fitting personal protective equipment, and the availability of basic resources were the strongest predictors of rural internship uptake. Respondents were willing to forgo 66% of rural allowance (ZAR 2645.92, 95% CI: 1345.90; 3945.94) for a facility offering advanced practical experience. In contrast, increased rural allowance and housing provision were weak predictors of rural work uptake. Based on the interaction model, females and those not intending to specialise preferred hospital safety compared to advanced practical experience. To improve internship recruitment, rural facility managers should provide staff with supervision, safety, and protection from occupational exposure to contractible illnesses.