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Member Research and Reports

Member Research and Reports

UNC: Who Gets Admitted to Medical Education in Low- and Middle-income Countries?

Recent studies have found that doctors and nurses in low- and middle-income countries are often absent from work, sometimes seek unauthorized payments for services, and may treat patients in disrespectful or abusive ways.

A recent commentary in Human Resources for Health points out that while improving work environments might improve the overall situation, that solution isn’t always feasible in low-resource settings.

Instead, the authors suggest reforming medical education practices to focus on admitting students who are primarily motivated by intrinsic motivation — a strong desire to serve the needs of their community — rather than by receiving external rewards. These providers are, per the authors, less likely to engage in negative behaviors and more likely to deliver high quality care even in less than ideal circumstances.

Co-author Dr. Katherine Tumlinson is an assistant professor of maternal and child at the University of North Carolina Gillings School of Global Public Health and a faculty fellow at the Carolina Population Center. Co-author Dr. Dilshad Jaff is an adjunct assistant professor of maternal and child health and the Gillings Humanitarian Fellow.

The researchers go on to recommend strategies for reforming admissions to increase the likelihood of enrolling students with strong intrinsic motivation. These strategies include loosening rigid exam requirements and actively seeking individuals from remote locations.

They also suggest ways to expand the medical curriculum to foster greater intrinsic motivation during training. Their ideas include shifting cultural norms within medical education and developing metrics to hold institutions accountable for the proportion of their graduates who accept and stay in rural posts.

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