Preferences of Medical Students for Rural Medical Internships in South Africa: A Discrete Choice Experiment

Abstract Background: Globally the proportion of medical doctors to population in rural areas in low- and middle-income countries remains insufficient to address their health care needs. Therefore, it is imperative to design strategies that attract medical doctors to rural areas to reduce health inequalities and achieve universal health coverage. Methods: This study assessed preferences of medical students for rural internships using a discrete choice experiment. Attributes of rural job were identified through literature and focus group discussions. A D-efficient design was generated with 15 choice sets, each with forced binary, unlabelled, rural hospital alternatives. An online survey was conducted, and data analysed using mixed logit models of main effects only and main effects plus interaction terms. Results: Majority of the respondents were females (130/66.33%) and had urban origin (176/89.80%). The main effects only model showed advanced practical experience, hospital safety, correctly fitting personal protective equipment, and availability of basic resources as the most important attributes influencing take up of rural internship, respectively. Respondents were willing to pay ZAR 2645.92 monthly (95%CI: 1345.90; 3945.94) to gain advanced practical experience (equivalent to 66.15% of current rural allowance). In contrast, increases in rural allowance and the provision of housing were the least important attributes. Based on the interaction model, female respondents and those intending general practise associated higher weight for hospital safety over advanced practical experience. Conclusion: In the context of limited budgets and resource constraints, policy makers and rural health facility managers are advised to prioritise meaningful internship practise environments that offer supervised learning environment, safety from physical and occupational hazards and the provision of basic resources for healthcare system-wide benefits to both staff and rural health facility users alike.