Trainees' preferences regarding choice of place of work after completing medical training in traditional or problem-based learning/community-based education and service curricula: A study in Ghanaian medical schools

Introduction: Career choices, recruitment and subsequent retention of healthcare professionals in the rural areas are a major worldwide concern and challenge to the health sector, leading to human resource shortages, resulting in poor quality health care for rural communities. Medical education has integrated communityoriented medical education strategies in undergraduate medical training to help address the challenges of health care in rural communities. These strategies are likely to impact the strategies of delivering the content of undergraduate medical curricula. This study explored medical trainees' preferences regarding place of work and choice of specialty after completing training using either the traditional or mixed problem-based learning/communitybased education and service (PBL/COBES) curriculum in Ghanaian medical schools. Method: This study was a cross-sectional descriptive design using a questionnaire consisting of 25 open- and close-ended questions. The questionnaire was administered to first-, third- and sixth-year students of two medical schools in Ghana: University of Ghana School of Medicine and Dentistry (UG-SMD) and University for Development Studies, School of Medicine and Health Sciences (UDS-SMHS). UG-SMD uses the traditional method of teaching and learning, whilst UDS-SMHS uses PBL/COBES curriculum in the training of their students. Associations between gender, type of curriculum, choice of specialty and practice location were assessed using the χ test. Logistic regression analysis was performed to determine the association between medical school and curriculum type and students' preparation for rural practice while controlling all other factors. Qualitative data analysis of answers to openended questions was performed, applying the principles of thematic analysis. Results: Of the students from PBL/COBES track, 64.2% were male, and from the traditional track 52.0%. The majority (74.1%) of students from PBL/COBES track indicated that their medical school curriculum adequately prepared them for rural practice as compared to those from the traditional track (35.1%). The willingness of third-year students at UDS-SMHS to choose to practise in rural areas after graduation decreases as compared to their colleagues in first and sixth years. Students from the traditional track were 80% less likely to state that their medical school curriculum adequately prepared them for rural practice compared to students from the PBL/COBES track (odds ratio=0.19, confidence interval=0.13-0.28, p=0.001). Students following the PBL/COBES curriculum stated that the program was very useful and could influence their choice of future practice location. Students following the traditional curriculum called for the introduction of innovative teaching methodology incorporating rural outreach programs as part of the medical curriculum. Conclusion: Students using the PBL/COBES curriculum indicated that their curriculum adequately prepared them for future rural practice. Students following the traditional curriculum called for the introduction of an innovative teaching methodology incorporating rural outreach programs. This, they believed, would help them cultivate an interest for rural practice and also increase their willingness to choose rural practice after graduation from medical school.