Pre-service medical education course completion and dropout rates | Health Human Resources

“Global strategy of human resources for health: Workforce of 2030” was adopted by the 69th World Health Assembly. Among the goals is strengthening data on health human resources. These data include course completion and dropout rates which are important indices that medical education and training institutions, and WHO member countries, should pay attention to to inform mechanisms that support recruitment and retention.

In addition to the shortage of health workers seen in most countries, exacerbated by the phenomenon of emigration, course completion and dropout rates among medical students and students in related health professions, are having a significant economic impact. A high dropout rate can cause significant economic loss for a country, as public investments made in the education and training of students before they drop out are wasted. Despite the fact that high dropout rates can negatively affect the image of affected institutions, affected students and their families may suffer from problems of psychosocial rejection and reduced self-esteem, as well as the opportunity costs and financial investments made in their schools. own study.

While the education of various cadres of health professionals through existing health education and training institutions remains a fundamental factor in HRH development, there are limited data on course completion rates and dropout rates of medical students and students in medical-related professions. Although this study looked for data across groups of health professionals and health workers, only data for pre-service medical education/medical students were obtained. Unlike those found in the cases of New Zealand, Australia, United States (US) and United Kingdom (UK), with platforms for data collection and performance tracking of medical students, this study found a substantial lack of effective and efficient platforms and mechanisms for data collection. such in most institutions and countries where data is sought. Whereas little or no difficulties were experienced in accessing secondary data from New Zealand and Australia [6]limited period for this study coupled with the fact that data is not publicly accessible in some countries due to some restrictions and requirements for data application (sometimes within a narrow application window period) complicates access of secondary data from the United States Royal Medical Education Database (UKMED) [7]Association of American Medical Colleges (AAMC) Student Records System (SRS) database [8]and the Organization for Economic Co-operation and Development (OECD) database [9].

It can be seen from the available literature and the data analyzed that course completion and drop-out rates of medical students vary from country to country. Data are not available to determine whether there is further variation within countries, or within or across occupations. Analysis of publicly available data on pre-service medical students sourced from the Dean of Medicine in New Zealand [6], between 2014 and 2020, reveals relatively stable completion of high course and low dropout rates. Similarly, a study of publicly available data on pre-service medical students sourced from the Dean of Medicine in Australia [6] between 2014 and 2020 also revealed relatively stable completion of tertiary courses and low dropout rates, although rates for Australia were relatively more stable compared to medical students in New Zealand. Some dropout rate is expected; this could be due to personal life choices, health reasons, insufficient academic progress or fitness reasons to train. The reasons for the variations found in course completion and dropout rates among pre-service medical students in New Zealand and Australia were not immediately known. In the United States, a study conducted among three (3) cohorts of matriculation classes of medical students and followed for 10 years each, revealed relatively high course completion rates and low dropout rates. Among all medical students in the 3 cohorts, it was reported that only 1.4% of medical students graduated from medical school. [10]. The findings of this study are similar to findings in another study of course completion and drop-out rates of US medical students, sourced from the Association of American Medical Colleges (AAMC) Student Records System (SRS) website. [8]. The AAMC study found that the medical school graduation rate for students pursuing Doctor of Medicine (MD) medical degree programs remained stable from 1993–1994 to 2012–2013, with 4-year graduation rates ranging from 81.6 to 83.4% and with a total national dropout rate of 3.3%. It was also found that 6 years after matriculation, the average pass rate was 95.9% for MD students who were not enrolled in co-ed degree programs. This translates to a dropout rate of 4.1%. These findings are similar to those from a 2004 cross-sectional study of students admitted to the Faculty of Medicine, King Saud University, Saudi Arabia. A study over 5 academic years (1994–1998) revealed a low dropout rate of 3.8% [11]. Similarly, a retrospective descriptive study of medical school attrition over a 10 year period (2001-2011) conducted at University College Cork, revealed an overall dropout rate of 5.7%. [12]while another study conducted by Heublein et al. [13] on the drop-out rate among medical students in Germany found a 10% drop-out rate. In contrast to the approximately 10.0% dropout rate and high course completion rate (approximately 90.0%) found in a comparative study conducted among 4-year undergraduate and postgraduate medical students graduating in 2007 and 2008 from the University of Nottingham, English [14]a dropout rate of 14% was found in a retrospective study of medical student records between 1983 and 1992 at Leeds School of Medicine, England [15]. The variation in the UK studies may be due to variations in the number of cohorts, categories, and number of medical students studied, and the different interventions introduced over the time period. An earlier study of 396 medical students in Pakistan conducted over a 6 year period (1996-2001), showed a dropout rate of 16%. [16]

While it is difficult to obtain primary and secondary data from low and middle income countries (LMIC) largely due to the absence of an institutional platform for routine checks of such important data, medical student data from medical schools in Nigeria is sourced via the Medical and Dental Council of Nigeria (MDCN) platform. ) which regulates the medical and dental professions in Nigeria [17]. The data obtained reveals a contrast from data obtained from New Zealand and Australia with an average course completion rate of 88.3%, and an average dropout rate of 11.7%. When the findings from New Zealand and Australia are compared with those from Nigeria, we appreciate the variation in course completion and dropout rates between countries. Compared to the rates obtained for New Zealand and Australia, the observed higher dropout rates and lower course completion rates among medical students in Nigeria, particularly in 2019 (20.8% dropout rate) and 2020 respectively (down -out rate of 15.8%) deserves further questioning. The recorded higher dropout rates can be attributed to periods of stagnation in some medical schools in Nigeria due to the suspension of the accreditation status of some medical schools, disruptions in the academic calendar caused by frequent industrial actions by university academic staff, industrial actions by medical doctors and officers. other health, as well as disruptions due to the COVID-19 pandemic (particularly during the first wave of COVID-19 in Nigeria in 2020) [18,19,20,21,22,23]. Differences in admissions policies, duration of study, curricula, and adopted teaching and training methods may also explain differences in dropout rates between countries. [24] due to the type of traditional curriculum used in Nigeria. Furthermore, as observed in the literature review conducted by Arulsamy Anand [25] regarding reasons for dropping out of medical school, another possible reason for the high dropout rate is the lack of motivation and weak academic ability of some medical students, health challenges, and financial constraints experienced by some medical students (especially those from poor socio-economic backgrounds) ) compounded by the absence of student loans and scholarships. Another factor may be the availability of student welfare services including academic advisory and counseling services, as well as the increasing emigration of families from Nigeria to other developed countries, with medical students withdrawing from school to allow them to emigrate with their families. [26, 27]


There are major difficulties in accessing data on course completion and dropout rates from medical education training institutions/medical schools, principally due to the absence of an institutional platform and mechanism for collection of such data, and in some cases, restrictions imposed on public access to such data. . This significantly limited the data that could be directly sourced during this study. Another limitation is the fact that most of the available literature on course completion and dropout rates involves studies conducted in developed and high-income countries, a fact which makes comparative analysis difficult. The non-uniform number and cohort of medical students studied in this paper and most of the literature found on course completion and dropout rates, as well as the limited number of countries studied, are limitations on the generalizability of the research findings. . Another limitation is the non-segregation into public and private medical schools in most of the publicly available data. Disaggregating the data will help evaluate if there is any variation in course completion and dropout rates between public and private medical schools.