Abstract Background Critical workforce shortages in primary care (PC) and academic medicine (AM) persist in many low- and middle-income countries (LMICs). China hosts approximately 68,000 international medical students (IMSs), primarily from LMICs, constituting a potential workforce solution. However, little is known about factors shaping their intentions towards PC and AM. This study investigates these influences using established career-choice frameworks in the Chinese context. Methods An exploratory sequential mixed-methods study was conducted following the instrument development model. Qualitative interviews ( n = 20) identified influencing factors, which informed a quantitative survey distributed to IMSs at 17 Chinese institutions. Responses from LMIC-origin IMSs were analysed. Principal component analysis (PCA) extracted viewpoint components, and hierarchical logistic regression examined the effects of individual, institutional, and viewpoint factors on students’ intentions toward PC and AM. Results Qualitative findings revealed IMSs’ career intentions were shaped by multiple interacting factors across home- and host-country contexts. Among the 961 surveyed IMSs, 15.6% ( n = 150) chose PC specialties, and 36.3% ( n = 349) preferred AM. PCA identified three components from viewpoint factors: “personal needs to satisfy”, “perceptions of work characteristics”, and “social needs to satisfy” (Kaiser–Meyer–Olkin index 0.946, p < 0.001, 60.5% of variance explained). Regression models showed PC preference was positively associated with older age and rural/regional origin, and negatively associated with personal needs to satisfy. AM preference was positively associated with older age, lower study year, originating from the African region compared to other nationalities, and higher-ranked institutions. Conclusion IMSs’ intentions towards PC and AM are shaped by student characteristics, personal needs, and institutional environments, offering valuable insights for LMIC workforce planning. Chinese institutions can strengthen this potential by embedding targeted PC and AM modules, expanding research and mentorship opportunities, refining admissions to prioritise likely candidates, and supporting cross-cultural training. These strategies align international medical education with LMIC health priorities and inform career guidance and tailored support for globally trained physicians.
Li et al. (Wed,) studied this question.