St Georges University of London and Kingston University, Terrace, Cranmer SW17 ORE, London, UK.
BMC Med Educ. 2012 Sep 14;12:87. doi: 10.1186/1472-6920-12-87.
In 2004, the Malawian Ministry of Health declared a human resource crisis and launched a six year Emergency Human Resources Programme. This included salary supplements for key health workers and a tripling of doctors in training. By 2010, the number of medical graduates had doubled and significantly more doctors were working in rural district hospitals. Yet there has been little research into the views of this next generation of doctors in Malawi, who are crucial to the continuing success of the programme. The aim of this study was to explore the factors influencing the career plans of medical students and recent graduates with regard to four policy-relevant aspects: emigration outside Malawi; working at district level; private sector employment and postgraduate specialisation.
Twelve semi-structured interviews were conducted with fourth year medical students and first year graduates, recruited through purposive and snowball sampling. Key informant interviews were also carried out with medical school faculty. Recordings were transcribed and analysed using a framework approach.
Opportunities for postgraduate training emerged as the most important factor in participants' career choices, with specialisation seen as vital to career progression. All participants intended to work in Malawi in the long term, after a period of time outside the country. For nearly all participants, this was in the pursuit of postgraduate study rather than higher salaries. In general, medical students and young doctors were enthusiastic about working at district level, although this is curtailed by their desire for specialist training and frustration with resource shortages. There is currently little intention to move into the private sector.
Future resourcing of postgraduate training opportunities is crucial to preventing emigration as graduate numbers increase. The lesser importance put on salary by younger doctors may be an indicator of the success of salary supplements. In order to retain doctors at district levels for longer, consideration should be given to the introduction of general practice/family medicine as a specialty. Returning specialists should be encouraged to engage with younger colleagues as role models and mentors.
2004 年，马拉维卫生部宣布出现人力资源危机，并启动了为期六年的紧急人力资源计划。该计划包括为关键卫生工作者提供工资补贴，并将培训中的医生人数增加两倍。到 2010 年，医学生人数增加了一倍，在农村地区医院工作的医生人数也大大增加。然而，对于马拉维的这一代年轻医生的观点几乎没有研究，他们对该计划的持续成功至关重要。本研究旨在探讨影响医学生和应届毕业生职业规划的因素，重点关注与四项政策相关的方面：移民到马拉维以外的国家、在地区一级工作、在私营部门就业和研究生专业。
通过有针对性和滚雪球抽样，对四年级医学生和一年级毕业生进行了 12 次半结构式访谈。还对医学院教师进行了重点人物访谈。使用框架方法对录音进行了转录和分析。
研究生培训机会成为参与者职业选择的最重要因素，专业化被视为职业发展的关键。所有参与者都打算在国外工作一段时间后，长期在马拉维工作。对几乎所有参与者来说，这是为了追求研究生学习，而不是更高的工资。总的来说，医学生和年轻医生热衷于在地区一级工作，尽管他们渴望接受专科培训，并对资源短缺感到沮丧。目前，他们很少有意愿进入私营部门。
随着研究生人数的增加，未来为研究生培训机会提供资金至关重要。年轻医生对工资的重视程度较低，这可能是工资补贴成功的一个指标。为了让医生在地区一级工作更长时间，应考虑将普通科/家庭医学作为一个专业。应鼓励返回的专科医生与年轻同事接触，成为榜样和导师。
