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Table 4 Reasons for pursuing postgraduate specialization training outside of Malawi

From: Specialization training in Malawi: a qualitative study on the perspectives of medical students graduating from the University of Malawi College of Medicine

Reason

Explanation

Quotes

Acquire new experiences

Students desired to have exposure to new clinical settings and different cultures to gain broader knowledge and experience

“I have never been outside of Malawi. I would like to see other things, how people do things outside.”

“You get more exposure to what’s out there, the differences, and you get to widen your knowledge.”

“[Outside Malawi] you don’t just read about it, you get to see it.”

“…also cultural experiences and meeting new people. It broadens your mind and helps you be a holistic doctor.”

Improve medical care in Malawi

Students believed that training elsewhere and returning would better equip them to advance the medical field in Malawi

“I want to see what else is out there so I can work alongside with that and see what I can bring back from there that will be helpful for Malawi.”

Train in specialty not offered in Malawi

Students expressed the aspiration for further training in specialties not currently offered in Malawi

“The only thing that would not keep me here is the lack of the learning opportunity.”

“There are a lot fields, like Psychiatry for example, that are not offered under the College of Medicine.”

Earn more money

Students did not think that the salaries of registrars was adequate to support their families

“Financial security becomes a problem. If I was to have an option to earn more than I can earn here as a junior doctor, I will choose that. [Elsewhere] the pay is much better than here.”

“Patriotism does not pay in Malawi…How can I pay my kids’ school fees? It is not right that my father gave me an education and then in the name of patriotism my children suffer.”

Obtain a better education

Students perceived training in other countries as higher quality that training in Malawi

“I think Malawians should not get second class anything. I want to get decent training and give them the best care. If I am teaching medical students, if I did my postgraduate training [outside Malawi], the way I teach that topic will be different…We need quality specialists.”

“The most obvious choice for anyone would be to leave Africa and go a place that’s offering a better education.”

Leave the country

Many students viewed training in another country as a means to leave Malawi

“Most people that have grown up here think it hasn’t been much fun growing up in Malawi. It’s been tough, so you want to see something different.”

“If I was to specialize, let’s say in Australia, then I could work anywhere in the world, not just in Malawi.”