Factors that influence a career choice in primary care among medical students from high-, middle-, and low-income countries: a systematic review/Factores que influyen en la eleccion de una carrera en atencion primaria entre estudiantes de medicina de paises de ingresos altos, medianos y bajos: una revision sistematica

Objective. To determine which factors influence a medical student's decision to choose a career in primary care; and to establish if these factors are similar or different among students in high-, middle- and low-income countries. Methods. An extensive search was done of PubMed, Google Scholar, and Virtual Library of Health for articles on primary care careers published in 2003-2013 in English, Spanish, and/or Portuguese. Initially, 600 records were identified; 74 full-text articles were assessed for eligibility and 55 were selected (42 from high-income countries; 13 from middle- and low-income). These were assessed to identify intrinsic and extrinsic factors that influence career choice among medical students from high-, middle-, and low-income countries. Results. A comparison framework with common and specific factors that influence career choice in primary care among medical students from high-, middle- and low-income was developed. Factors were classified as extrinsic or intrinsic, and as facilitators or barriers. Several factors common to all countries were identified: facilitators were exposure to rural location, role models, working conditions; barriers were low income, prestige, and medical school environment. Some factors specific to middle- and low-income countries were: understanding of rural needs and intellectual challenge. Other factors specific to high-income countries were: attitude towards social problems, voluntary work, influence of family, and length of residency. Conclusions. Further studies on the subject are needed, especially in low- and middleincome countries. Identifying factors as barriers or facilitators for career choice will promote a better understanding of the reasons behind the shortage of primary care professionals and will contribute to policy building, improved training, and recruitment and retention of these professionals. Key words Career choice; students, medical; primary health care; human resources. Objetivo. Determinar los factores que influyen en la decision de un estudiante de medicina de dedicarse profesionalmente a la atencion primaria; y establecer si estos factores son similares o diferentes entre estudiantes de paises de ingresos altos, medianos y bajos. Metodos. Se llevo a cabo una extensa busqueda en PubMed, en Google Academico y en la Biblioteca Virtual en Salud de articulos sobre seleccion de carrera en atencion primaria publicados entre 2003 y 2013 en ingles, espanol o portugues. Inicialmente, se selecc