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Factors influencing medical students' motivation to practise in rural areas in low-income and middle-income countries: a systematic review
  1. Shyam Sundar Budhathoki1,
  2. Prisca A C Zwanikken2,
  3. Paras K Pokharel1,
  4. Albert J Scherpbier3
  1. 1School of Public Health & Community Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
  2. 2Royal Tropical Institute, Amsterdam, The Netherlands
  3. 3Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands
  1. Correspondence to Dr Shyam Sundar Budhathoki; ss.budhathoki{at}


Objectives There is a shortage of doctors working in rural areas all over the world, especially in low-income and middle-income countries. The choice to practise medicine in a rural area is influenced by many factors. Motivation developed as a medical student is one key determinant of this choice. This study explores influences on medical students' motivation to practise in rural areas of low-income and middle-income countries following graduation.

Design A systematic review was conducted to identify influences on medical students' motivation to work in rural areas in low-income and middle-income countries. Papers reporting influences on motivation were included, and content analysis was conducted to select the articles. Articles not published in English were excluded from this review.

Results A rural background (ie, being brought up in a rural area), training in rural areas with a community-based curriculum, early exposure to the community during medical training and rural location of medical school motivate medical students to work in rural areas. Perceived lack of infrastructure, high workload, poor hospital management and isolation are among the health facility factors that demotivate medical students for medical practice in rural areas.

Conclusions Medical school selection criteria focusing on a rural background factor and medical education curriculum focusing on rural area are more relevant factors in low-income and middle-income countries. The factors identified in this review may assist the planners, medical educators and policymakers in low-income and middle-income countries in designing relevant interventions to positively influence rural choices where the shortage of rural physicians is an ongoing and increasing concern.

  • medical students
  • rural health
  • Motivation
  • low and middle income countries

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors SSB, PACZ, PKP and AJS all contributed to the conception of the study. SSB, PACZ and AJS analysed and interpreted the data of the work. Drafting of the manuscript and revising it critically for the important intellectual content was done by SSB and PACZ. Manuscript preparation, editing and finalising of the version to be published is the work of SSB, PACZ, PKP and AJS. All authors agree to be accountable for all aspects of the work related to the integrity of the work.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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