FACTORS ASSOCIATED WITH MEDICAL STUDENTS’ PURSUIT OF POSTGRADUATE TRAINING: A CROSS-SECTIONAL SURVEY AT SPHMMC

Abstract

Abstract Background: Medical students' postgraduate training choices significantly impact healthcare workforce distribution in Ethiopia. Evidence from institutions like St. Paul’s Hospital Millennium Medical College (SPHMMC) on these determinants is limited. Objective: To assess factors associated with medical students’ pursuit of postgraduate training at SPHMMC. Methods: This cross-sectional study at SPHMMC surveyed 422 medical students (100.0% response rate) to evaluate specialty preferences and predictors. Data analysis included descriptive statistics, chi-square tests, and binary logistic regression. Ethical approval and informed consent were obtained, with strict data anonymization. Results: Mean age was 24.3 ± 2.28 years; 54.5% were clinical-year students, 89.8% from urban areas. High educational debt-related stress was reported by 73.9%. Only 14.9% intended to pursue residency in Ethiopia, while 53.1% planned to leave and 32.0% were undecided. A significant 89.8% perceived current residency stipends as inadequate, with a median required salary of ~65,000 ETB/month for rural service. High educational debt-related stress was the sole significant factor associated with lower intent to pursue residency in Ethiopia (AOR = 0.41; 95% CI: 0.18–0.93; p < 0.05). Conclusion: SPHMMC medical students face substantial educational debt, contributing to stress and negatively impacting their intent for domestic residency. Financial considerations, including inadequate stipends and future income expectations, critically shape career decisions. Addressing educational debt and improving financial incentives are crucial for enhancing domestic residency enrollment and fostering a sustainable medical workforce. Keywords: Medical education, specialty choice, workforce retention, Ethiopia, debt stress, residency training.