The field socialisation of future doctors, the process of the shaping of their professional identity, and identifying the factors which support this process, are all important research topics. Another important question is whether medical students’ successful identification with their future role is determined by their social and demographic characteristics or by the circumstances of their medical studies [16]. Insufficient field socialisation can result in dropout from a medical course, individual abandonment of the profession, or a shortage of doctors if this occurs on a wide scale. The difference in student dropout rates between course fields draws attention to the fact that those who choose different fields are affected by diverse factors when it comes to deciding whether to terminate or continue their studies. The early formation of professional identity is strengthened by attachments to disciplinary values and relationship networks, as well as the high level of admission requirements and the favourable positional possibilities. These factors can limit the proportion of dropout students [18, 19].
At the turn of the millennium, in order to respond to the emerging doctor shortage, the UK government increased the number of students admitted to courses and initiated special development and examinations to encourage their retention [5]. In other countries the incline of the dropout of medical students was examined in relation to the effects of the change in the structure of higher education, and it was stated that a temporal distortion of studies increases the risk of dropout [6]. High school results, admission scores and year of admission were proved to be good predicators of the likelihood of students graduating, and the admission score indicated in advance whether studies would be completed within a curriculum period [7]. However, longitudinal analyses came to the conclusion that the increase in the dropout rate can be explained by admission politics, the structure of the higher education curriculum, the proportion of theoretical and practical courses, and the increasing tuition fees [5, 8, 9]. Dropout is further influenced by the hardships caused by educational costs, the negative effects of taking jobs while studying, and the fear of being in debt due to course fees financed by loans [10, 11, 12, 13]. The effective ways of limiting dropout were the organised study support provided for students (frequent formative ratings, study methodology courses, group studying), an increase in the proportion of practical, problem-based study, and counselling to deal with time-management and stress [14].
There are many education systems around the world that feature tuition fees, peer sharing, and student and family contributions to peer support. Most European systems provide university education, with or without tuition. There is a significant level of indebtedness among early-stage doctors in fee-paying courses. At the same time, dropping out in all systems results in a severe loss of resources, and prolonged studies have a negative impact on the mental health and commitment of medical students and other health science students.
Although in Hungary higher education is financed by the state and tuition is free, 40% of BA students still leave higher education without a degree. A qualitative research study in 2018 examined those students who had started a course more than 10 years ago but did not graduate. Three significant groups of reasons lay behind their dropout: most of them dropped out due to material reasons, because the student and his/her family could not handle the travel and living costs of higher education. Others stated that learning hardships, the negative attitude of teachers and administrators, the lack of a helping hand and a lack of information caused dropout. According to the third group, the reasons for dropout were disillusionment with their major or institution, and the disappointment in practical experiences when compared to their expectations [16].
In the medical course in Hungary no multi-cycle courses were introduced, unlike other areas who joined the Bologna process at the turn of the millennium. So, for example while in Economics courses, combined BA and MA courses of 3+2 years were introduced, on the medical, legal and theology courses the single-cycle educational structure was retained. Teacher training courses became two-cycled in 2006, and in 2013 the combined course in this area was also redesigned. So future doctors study for 6 years to obtain a diploma. They start their internships and resident years after this so they can take their medical specialist exam at the end of their 3- to 5-year medical course. The extremely long course means students are held back in the process of becoming self-sufficient and starting a family. Optimistic future expectations are demolished by the high level of requirements, the extremely difficult studies and the high proportion of unsuccessful exams. The inadequate tempo of graduating causes labour shortages in certain areas, which is swelled by graduates quitting, going abroad and by the aging of the medical profession [1, 15]. In the outstandingly costly medical course, 20% of dropout represents a significant waste of resources on an individual and international level [3]. In the medical course in Hungary there are currently 3 groups of students, divided according to the financing of their course. Hungarian nationality students are financed by the state if they achieved the required scores at admittance and if they have not exceeded their limit of 7 years. Only some students who are on their second degrees or who did not achieve the necessary admittance scores study on self-financing courses, but these are only wealthy individuals. Most of the foreign students who come from European and Asian countries study on self-financed courses in the English language. The third group of students includes foreign students from poor countries outside Europe on the Stipenduim Hungaricum programme, whose studies are financed by the Hungarian state with scholarships. The topicality of our research is that the system of financing based on a student’s academic record was introduced in 2015 for Hungarian medical students who up to then had been studying free of charge. This new system monitors the academic development and grades of students, and those whose academic average does not reach 3 out of 5 or who do not get 36 credits a year lose state finance and have to pay 8,000 Euros annually, to refund their costs. Given the average income of families, this can mean a significant growth in dropout.