The overall response rate was 84%. The response rate from first-year students was higher than subsequent cohorts (1st year: 246/254 (97%); 4th year: 188/263 (71%); 6th year: 163/195 (84%)).Overall, there were slightly more female than male respondents. Nearly all respondents were 20 to 29 years old (98% 4th year; 97% 6th year). Over two-thirds were Black students.
Table 1: General Characteristics
|
YEAR 1 N=246
|
YEAR 4
N=188
|
YEAR 6
N=163
|
Total
N=597
|
|
N
|
%
|
N
|
%
|
N
|
%
|
N
|
%
|
Sex
|
|
|
|
|
|
|
|
|
Male
|
N/A
|
|
82
|
45%
|
56
|
35%
|
138
|
40%
|
Female
|
N/A
|
|
100
|
55%
|
104
|
65%
|
204
|
60%
|
Race
|
|
|
|
|
|
|
|
|
Black
|
N/A
|
|
119
|
70%
|
115
|
72%
|
234
|
71%
|
Non-Black
|
N/A
|
|
52
|
30%
|
45
|
28%
|
97
|
29%
|
Home Language
|
|
|
|
|
|
|
|
|
English
|
40
|
16%
|
60
|
32%
|
48
|
30%
|
148
|
25%
|
Afrikaans
|
0
|
0%
|
1
|
1%
|
2
|
1%
|
3
|
1%
|
Indigenous
|
179
|
74%
|
126
|
67%
|
111
|
69%
|
416
|
70%
|
Other
|
24
|
10%
|
1
|
1%
|
1
|
1%
|
26
|
1%
|
Disadvantaged Background (as based on self-identification)
|
|
|
|
|
|
|
|
|
Yes
|
92
|
38%
|
137
|
24%
|
121
|
80%
|
350
|
61%
|
No
|
153
|
62%
|
44
|
76%
|
30
|
20%
|
227
|
39%
|
Home Community Size (population)
|
|
|
|
|
|
|
|
|
100 000+
|
51
|
21%
|
63
|
41%
|
52
|
33%
|
166
|
30%
|
10 000-99 999
|
130
|
53%
|
51
|
34%
|
44
|
28%
|
225
|
41%
|
<10 000
|
65
|
26%
|
38
|
25%
|
60
|
38%
|
213
|
29%
|
Practice Community Size (population)
|
|
|
|
|
|
|
|
|
100 000+
|
87
|
35%
|
87
|
48%
|
62
|
39%
|
236
|
40%
|
10 000-99 999
|
127
|
52%
|
66
|
37%
|
41
|
26%
|
234
|
40%
|
<10 000
|
32
|
13%
|
27
|
15%
|
55
|
35%
|
114
|
20%
|
Future Specialty
|
|
|
|
|
|
|
|
|
Primary Care
|
73
|
30%
|
66
|
39%
|
57
|
35%
|
196
|
34%
|
Family Medicine
|
33
|
13%
|
23
|
14%
|
6
|
4%
|
62
|
11%
|
Non-Primary Care
|
143
|
58%
|
70
|
42%
|
68
|
42%
|
281
|
49%
|
Undecided
|
30
|
12%
|
32
|
19%
|
36
|
22%
|
98
|
17%
|
N/A: Data not available
Source: Authors’ own work
3.1 Language Concordance
Most respondents spoke English as a second language. Slightly more than two-thirds of respondents (70%) were able to communicate with patients using an indigenous dialect. Few spoke Afrikaans.
3.2 Future Specialty
Overall, about one-third (34%) of respondents indicated an intention to go into primary care, with about one-third of these respondents (62/196, (32%)) stating an intention to go into FM. Intention to go into FM varied by cohort.
Among 4th and 6th year respondents, a similar proportion of Black (80/216, 37%) and non-Black (35/94, 37%) students selected primary care as their future specialty. Within those who selected primary care, more Black students selected FM as their future specialty (26%) compared to non-Black students (14%). However this difference was not significant (difference (Δ): 12%; 95% confidence interval (CI): -3%, 27%).
A similar proportion of female (66/184 (36%) and male respondents (47/123, 38%) indicated a plan to enter primary care. Among respondents selecting primary care, a similar proportion of female (14/66, 21%) and male (11/47, 23%) respondents indicated a plan to enter FM. More Black males selected FM (11/37, 30%) than non-Black males (0/10, 0%) (Δ: 30%; CI: -1%, 46%). A similar proportion of Black females (9/41, 22%) and non-Black females (5/25, 20%) selected FM.
Black respondents were more decisive than non-Black respondents regarding their future specialty. A higher proportion of non-Black respondents (30/94, 32%) did not know what specialty they would select after graduation compared to Black respondents (35/216, 16%) (Δ: 16%; CI: 6%, 27%).
Parental educational status did not affect whether a respondent intended to enter primary care or not in any of the cohorts.
3.3 Motivation for Medicine and the effect on future specialty
Table 2: Motivation for medicine and the effect on future specialty
|
|
|
Total
|
|
Primary Care
|
|
Family Medicine
|
|
Non-Primary Care
|
|
Don't Know
|
|
|
|
N
|
%
|
|
N
|
%
|
|
N
|
%
|
|
N
|
%
|
|
N
|
%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Altruistic
|
|
435
|
67%
|
|
153
|
78%
|
|
53
|
85%
|
|
214
|
58%
|
|
68
|
76%
|
|
Intrinsic
|
|
217
|
33%
|
|
42
|
22%
|
|
9
|
15%
|
|
153
|
42%
|
|
22
|
24%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year 1
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Altruistic
|
|
216
|
63%
|
|
68
|
93%
|
|
31
|
94%
|
|
125
|
52%
|
|
23
|
79%
|
|
Intrinsic
|
|
127
|
37%
|
|
5
|
7%
|
|
2
|
6%
|
|
116
|
48%
|
|
6
|
21%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year 4
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Altruistic
|
|
120
|
76%
|
|
50
|
76%
|
|
17
|
74%
|
|
47
|
78%
|
|
23
|
74%
|
|
Intrinsic
|
|
37
|
24%
|
|
16
|
24%
|
|
6
|
26%
|
|
13
|
22%
|
|
8
|
26%
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year 6
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Altruistic
|
|
99
|
65%
|
|
35
|
63%
|
|
5
|
83%
|
|
42
|
64%
|
|
22
|
73%
|
|
Intrinsic
|
|
53
|
35%
|
|
21
|
38%
|
|
1
|
17%
|
|
24
|
36%
|
|
8
|
27%
|
Source: Authors’ own work
Overall, those preferring primary care were more likely to be classified as altruistic (78%) compared to non-primary care (58%) (Δ: 20%; CI: 12%, 27%). Between cohorts, the percentage of students entering primary care remained constant (1st year: 30%, 4th year: 39%, 6th year: 35%, x2=1.89, df=2, p=0.389, Table 1) but FM decreased in later cohorts (1st year: 13%, 4th year: 14%, 6th year: 4%, x2=10.99, df=2, p=0.002, Table 1). Among respondents indicating primary care, the effect of altruism as a motivating factor was highest among the 1st year students and lower in subsequent cohorts (1st year: 93%, 4th year: 76%, 6th year: 63%, x2=18.05, df=2, p<0.001, Table 2).
3.4 Relationship of intended community size, home community size, and future specialty, by cohort. Where did they come from and where are they going and what motivates them
Table 3: Intended community size compared to home community size and future specialty
|
Less Urban
|
Same Size
|
More Urban
|
Total
|
Year 1
|
N
|
%
|
N
|
%
|
N
|
%
|
|
Primary Care
|
12
|
16%
|
29
|
40%
|
32
|
44%
|
73
|
Family Medicine
|
9
|
27%
|
11
|
33%
|
13
|
39%
|
33
|
Non-Primary Care
|
16
|
11%
|
60
|
42%
|
67
|
47%
|
143
|
Undecided
|
6
|
20%
|
9
|
30%
|
15
|
50%
|
30
|
Year 4
|
|
|
|
|
|
|
|
Primary Care
|
12
|
21%
|
22
|
39%
|
23
|
40%
|
57
|
Family Medicine
|
4
|
21%
|
6
|
32%
|
9
|
47%
|
19
|
Non-Primary Care
|
12
|
19%
|
29
|
46%
|
22
|
35%
|
63
|
Undecided
|
4
|
14%
|
18
|
64%
|
6
|
21%
|
28
|
Year 6
|
|
|
|
|
|
|
|
Primary Care
|
4
|
8%
|
23
|
43%
|
26
|
16%
|
53
|
Family Medicine
|
0
|
0%
|
5
|
83%
|
1
|
17%
|
6
|
Non-Primary Care
|
13
|
20%
|
23
|
35%
|
30
|
45%
|
66
|
Undecided
|
6
|
18%
|
17
|
50%
|
11
|
32%
|
34
|
Source: Authors’ own work
There was no relationship of home community size or intended practice community size and specialty intention in any cohort. We also looked at the change in community size (home vs. practice community). In all cohorts, students stated an intention to stay in the same size community or one more urban. This statement remains true, regardless of whether students reported they are from a disadvantaged background. We did not see any significant differences by specialty or cohort.
3.5 Staying or leaving?
Less than one-third of first-year students (27%) indicated they would go abroad after graduation. Similarly, 28% of 4th-year and 31% of 6th-year students indicated they were going to go abroad after their medical studies. Among 4th and 6th year students who indicated an intention to work abroad, the primary reason for leaving was to gain experience (4th: n=28, 54%; 6th: n=28, 56%) followed by the belief there were better opportunities overseas (4th: n=14, 27%; 6th: n=12, 24%).
Among 4th and 6th year students who indicated an intention to stay in South Africa, the reasons for staying were the belief that their country needs doctors (4th: n=32, 48%; 6th: n=29, 45%) and a preference to stay home close to home and family (4th: n=32, 46%; 6th: n=25, 38%).
Black African respondents were significantly less likely to state an intention to work abroad than other respondents (Black: 25%, non-Black: 39%, Δ: -14%; 95% CI: -25%, -3%). We did not see a significant association of parental education with an intention to work abroad (mother with college: 28% intend to work abroad vs mother without college: 29% (Δ: -1%; 95% CI: -8%, 7%); father with college: 30% intend to work abroad vs father without college: 27% (Δ: 3%; 95% CI: -5%, 10%)).