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What is a literature review?

Systematic reviews vs literature reviews, literature reviews - articles, writing literature reviews, frequently used journal article databases.

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The literature review is the qualitative summary of evidence on a topic using informal or subjective methods to collect and interpret studies.The literature review can inform a particular research project or can result in a review article publication.

• Aaron L. Writing a literature review article. Radiol Technol. 2008 Nov-Dec; 80(12): 185-6.
• Gasparyan AY, Ayvazyan L, Blackmore H, Kitas GD. Writing a narrative biomedical review: considerations for authors, peer reviewers, and editors. Rheumatol Int. 2011 Nov; 31(11): 1409-17.
• Matharu GS, Buckley CD. Performing a literature review: a necessary skill for any doctor. Student BMJ. 2012; 20:e404. Requires FREE site registration
• Literature Reviews The Writing Center at University of North Carolina at Chapel Hill has created a succinct handout that explains what a literature review is and offer insights into the form and construction of a literature review in the humanities, social sciences, and sciences.
• Review Articles (Health Sciences) Guide Identifies the difference between a systematic review and a literature review. Connects to tools for research, writing, and publishing.

• Systematic Approaches to a Successful Literature Review by Andrew Booth; Diana Papaioannou; Anthea Sutton Call Number: Norris Medical Library, Upper Level, LB 1047.3 B725s 2012
• Documenting your search This resource provides guidance on how to document and save database search strategies.
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• Last Updated: Nov 1, 2023 3:17 PM
• URL: https://libguides.usc.edu/healthsciences/spc

Home » Office of Curriculum » Medical Student Scholarship » III Scholarship Start Here » Scholarship of Integration » Key Steps in a Literature Review

Key Steps in a Literature Review

The 5 key steps  below are most relevant to narrative reviews. Systematic reviews include the additional step of using a standardized scoring system to assess the quality of each article. More information on  Step 1 can be found  here  and Step 5  here .

• Consider the purpose and rationale of a review
• Clearly articulate the components of the question
• The research question and purpose of your review should guide the development of your search strategy (i.e. which databases to search and which search terms to use)
• Justify any limitations you create for your search,
• Determine inclusion and exclusion criteria.
• Start by reviewing abstracts for relevant articles. Once this is complete, then begin a full text review of the remaining articles.
• Develop a data-charting form to extract data from each article. Update this form as needed if you find there is more information worth collecting.
• The resulting forms will serve as a summary of each article that will facilitate the process of synthesizing your results (i.e. the selected articles).
• In your analysis, include a numerical summary of studies included, an evidence table summarizing included articles, and a qualitative summary of the results.
• Report the results in the context of the overall purpose or research question.
• Consider the meaning of your results. Discuss limitations and implications for future research, practice, and/or policy.

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• How to Write a Literature Review | Guide, Examples, & Templates

How to Write a Literature Review | Guide, Examples, & Templates

Published on January 2, 2023 by Shona McCombes . Revised on September 11, 2023.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates, and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, other interesting articles, frequently asked questions, introduction.

• Quick Run-through
• Step 1 & 2

When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and its scholarly context
• Develop a theoretical framework and methodology for your research
• Position your work in relation to other researchers and theorists
• Show how your research addresses a gap or contributes to a debate
• Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

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Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research problem and questions .

Make a list of keywords

Start by creating a list of keywords related to your research question. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list as you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some useful databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can also use boolean operators to help narrow down your search.

Make sure to read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models, and methods?
• Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible , and make sure you read any landmark studies and major theories in your field of research.

You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It is important to keep track of your sources with citations to avoid plagiarism . It can be helpful to make an annotated bibliography , where you compile full citation information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly visual platforms like Instagram and Snapchat—this is a gap that you could address in your own research.

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.

Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, you can follow these tips:

• Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically evaluate: mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts

In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

Scribbr slides are free to use, customize, and distribute for educational purposes.

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If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

• Sampling methods
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• Reproducibility

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Research bias

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A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarize yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

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• Types of Literature Reviews
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• Conceptual recommendations for selecting the most appropriate knowledge synthesis method to answer research questions related to complex evidence | Journal of Clinical Epidemiology, 2016
• Methods for knowledge synthesis: an overview | Heart & Lung: The Journal of Critical Care, 2014
• Not sure what type of review to conduct? Brief descriptions of each type plus tools to help you decide

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• An Introduction to Writing Narrative and Systematic Reviews - Tasks, Tips and Traps for Aspiring Authors | Heart, Lung, and Circulation, 2018

• The Literature Review: A Foundation for High-Quality Medical Education Research | Journal of Graduate Medical Education, 2016
• Writing an effective literature review : Part I: Mapping the gap | Perspectives on Medical Education, 2018
• Writing an effective literature review : Part II: Citation technique | Perspectives on Medical Education, 2018
• Last Updated: Mar 7, 2024 6:43 AM
• URL: https://guides.lib.utexas.edu/medicine

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Literature review

Literature reviews are a way of identifying what is already known about a research area and what the gaps are. To do a literature review, you will need to identify relevant literature, often through searching academic databases, and then review existing literature. Most often, you will do the literature review at the beginning of your research project, but it is iterative, so you may choose to change the literature review as you move through your project.

Searching the literature

The University of Melbourne Library has some resources about searching the literature. Leonie spoke about how she met with a librarian about searching the literature. You may also want to meet face-to-face with a librarian or attend a class at the library to learn more about literature searching. When you search the literature, you may find journal articles, reports, books and other materials.

Filing, categorising and managing literature

In order to manage the literature you have identified through searches, you may choose to use a reference manager. The University of Melbourne has access to RefWorks and Endnote. Further information about accessing this software is available through the University of Melbourne Library .

Writing a literature review

The purpose of the literature review is to identify what is already known about a particular research area and critically analyse prior studies. It will also help you to identify any gaps in the research and situate your research in what is already known about a particular topic.

• Aveyard, H. (2010). Doing a literature review in health and social care: A practical guide . London, UK: McGraw-Hill Education. Retrieved from Proquest https://ebookcentral.proquest.com/lib/unimelb/detail.action?docID=771406
• Reeves, S., Koppel, I., Barr, H., Freeth, D., Hammick, M. (2002). Twelve tips for undertaking a systematic review. Medical Teacher . 24(4), 358-363 .
• Grant, M.J. and Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal .
• Jesson, J., & Lacey, F. (2006). How to do (or not to do) a critical literature review. Pharmacy Education , 6(2), 139-148 .
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The use of drugs and medical students: a literature review

Affiliations.

• 1 4Th-year Medical Students fo the State University of Ponta Grossa (PR), Brazil.
• 2 Master in Science and Technology Teaching; Associate Professor of the Medical Program of the State University of Ponta Grossa (PR), Brazil.
• 3 PhD in Internal Medicine; Adjunct Professor of Medicine at the Ponta Grossa State University (UEPG), Ponta Grossa (PR), Brazil.
• PMID: 30304147
• DOI: 10.1590/1806-9282.64.05.462

Introduction: The consumption and abuse of alcohol and other drugs are increasingly present in the lives of university students and may already be considered a public health problem because of the direct impacts on the physical and mental health of these individuals. The requirements of the medical program play a vital role in the increasing rate of drug users.

Objectives: To carry out a systematic review of the literature on the use of drugs, licit or not, in Brazilian medical students.

Methods: A descriptive-exploratory study, in which the SciELO and MEDLINE databases were used. A total of 99 articles were found, of which 16 were selected for this review.

Results: Alcohol and tobacco were the most frequently used licit drugs among medical students. The most consumed illicit drugs were marijuana, solvents, "lança-perfume" (ether spray), and anxiolytics. The male genre presented a tendency of consuming more significant amounts of all kinds of drugs, with the exception of tranquilizers. It was found an increasing prevalence of drug consumption in medical students, as the program progressed, which may result from the intrinsic stress from medical school activities. Students who do not use psychoactive drugs are more likely to live with their parents, to disapprove drugs consumption, to practice religious beliefs and to be employed.

Conclusion: The prevalence of licit and illicit drug use among medical students is high, even though they understand the injuries it may cause.

Publication types

• Systematic Review
• Alcohol Drinking / epidemiology
• Brazil / epidemiology
• Illicit Drugs
• Marijuana Smoking / epidemiology
• Sex Factors
• Smoking / epidemiology
• Students, Medical / psychology*
• Substance-Related Disorders / epidemiology*

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Literature review

A general guide on how to conduct and write a literature review.

Please check course or programme information and materials provided by teaching staff, including your project supervisor, for subject-specific guidance.

What is a literature review?

A literature review is a piece of academic writing demonstrating knowledge and understanding of the academic literature on a specific topic placed in context.  A literature review also includes a critical evaluation of the material; this is why it is called a literature review rather than a literature report. It is a process of reviewing the literature, as well as a form of writing.

To illustrate the difference between reporting and reviewing, think about television or film review articles.  These articles include content such as a brief synopsis or the key points of the film or programme plus the critic’s own evaluation.  Similarly the two main objectives of a literature review are firstly the content covering existing research, theories and evidence, and secondly your own critical evaluation and discussion of this content. 

Usually a literature review forms a section or part of a dissertation, research project or long essay.  However, it can also be set and assessed as a standalone piece of work.

What is the purpose of a literature review?

…your task is to build an argument, not a library. Rudestam, K.E. and Newton, R.R. (1992) Surviving your dissertation: A comprehensive guide to content and process. California: Sage, p49.

In a larger piece of written work, such as a dissertation or project, a literature review is usually one of the first tasks carried out after deciding on a topic.  Reading combined with critical analysis can help to refine a topic and frame research questions.  Conducting a literature review establishes your familiarity with and understanding of current research in a particular field before carrying out a new investigation. After doing a literature review, you should know what research has already been done and be able to identify what is unknown within your topic.

When doing and writing a literature review, it is good practice to:

• summarise and analyse previous research and theories;
• identify areas of controversy and contested claims;
• highlight any gaps that may exist in research to date.

Conducting a literature review

Focusing on different aspects of your literature review can be useful to help plan, develop, refine and write it.  You can use and adapt the prompt questions in our worksheet below at different points in the process of researching and writing your review.  These are suggestions to get you thinking and writing.

Developing and refining your literature review (pdf)

Developing and refining your literature review (Word)

Developing and refining your literature review (Word rtf)

Writing a literature review has a lot in common with other assignment tasks.  There is advice on our other pages about thinking critically, reading strategies and academic writing.  Our literature review top tips suggest some specific things you can do to help you submit a successful review.

Literature review top tips (pdf)

Literature review top tips (Word rtf)

Our reading page includes strategies and advice on using books and articles and a notes record sheet grid you can use.

Reading at university

The Academic writing page suggests ways to organise and structure information from a range of sources and how you can develop your argument as you read and write.

Academic writing

The Critical thinking page has advice on how to be a more critical researcher and a form you can use to help you think and break down the stages of developing your argument.

Critical thinking

As with other forms of academic writing, your literature review needs to demonstrate good academic practice by following the Code of Student Conduct and acknowledging the work of others through citing and referencing your sources.  

Good academic practice

As with any writing task, you will need to review, edit and rewrite sections of your literature review.  The Editing and proofreading page includes tips on how to do this and strategies for standing back and thinking about your structure and checking the flow of your argument.

Editing and proofreading

Guidance on literature searching from the University Library

The Academic Support Librarians have developed LibSmart I and II, Learn courses to help you develop and enhance your digital research skills and capabilities; from getting started with the Library to managing data for your dissertation.

Searching using the library’s DiscoverEd tool: DiscoverEd

Finding resources in your subject: Subject guides

The Academic Support Librarians also provide one-to-one appointments to help you develop your research strategies.

1 to 1 support for literature searching and systematic reviews

Advice to help you optimise use of Google Scholar, Google Books and Google for your research and study: Using Google

Managing and curating your references

A referencing management tool can help you to collect and organise and your source material to produce a bibliography or reference list. 

Referencing and reference management

Information Services provide access to Cite them right online which is a guide to the main referencing systems and tells you how to reference just about any source (EASE log-in may be required).

Cite them right

Published study guides

There are a number of scholarship skills books and guides available which can help with writing a literature review.  Our Resource List of study skills guides includes sections on Referencing, Dissertation and project writing and Literature reviews.

Study skills guides

• Research article
• Open access
• Published: 17 January 2018

What motivates medical students to select medical studies: a systematic literature review

• Sonu Goel 1 ,
• Federica Angeli 2 , 3 ,
• Nonita Dhirar 1 ,
• Neetu Singla 1 &
• Dirk Ruwaard 4  

BMC Medical Education volume  18 , Article number:  16 ( 2018 ) Cite this article

17k Accesses

60 Citations

23 Altmetric

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There is a significant shortage of health workers across and within countries. It is of utmost importance to determine the factors that motivate students to opt for medical studies. The objective of this study is to group and review all the studies that investigated the motivational factors that underpin students’ selection of medical study in recent years.

The literature search was carried out by two researchers independently in PubMed, Google Scholar, Wiley and IndMED databases for articles published from year 2006 till 2016. A total of 38 combinations of MeSH words were used for search purpose. Studies related to medical students and interns have been included. The application of inclusion and exclusion criteria and PRISMA guidelines for reporting systematic review led to the final selection of 24 articles.

The majority of the studies ( n  = 16; 66.6%) were from high-income countries followed by an equal number from upper-middle and lower-middle income countries ( n  = 4,16.7%). None of the studies were from low-income countries. All of the studies were cross-sectional in nature. The main motivating factors that emerged were scientific (interest in science / medicine, social interest and academia, flexible work hours and work independence), societal (prestige, job security, financial security) and humanitarian (serving the poor and under priviledged) in high-, upper-middle and lower-middle income countries, respectively. The findings were comparable to Maslow’s hierarchy of needs theory of motivation.

This systematic review identifies the motivational factors influencing students to join medical studies in different parts of the globe. These factors vary per country depending on the level of income. This study offers cues to policy makers and educators to formulate policy in order to tackle the shortage of health workers, i.e. medical doctors. However, more research is needed to translate health policy into concrete and effective measures.

Peer Review reports

The world is currently facing a dual problem of shortage and inequitable distribution of health workers, especially in middle- and low-income countries [ 1 ]. The World Health Organization (WHO) estimated a need for an additional 4.3 million health workers in 57 countries to fulfill the Millennium Development Goals [ 2 ]. In addition, 83 countries (44.6%) do not currently meet the 2006 World Health Report threshold of 22.8 skilled health professionals per 10,000 population [ 3 ]. Among many, the main reasons cited for shortage of health workers in rural areas include poor working conditions, lack of accommodation, lack of transport, poor pay structure, overburden with additional administrative responsibility and political interference [ 4 ]. In middle- and low-income countries, the situation is more critical because of migration of doctors to high-income (developed) countries whereas inequitable distribution of health workers between urban and rural areas is primarily due to poor motivation of health workers to work in rural areas [ 5 ].

The choice of medical study depends upon various factors such as interest in the medical field, good job opportunities, a desire to serve others, medical background of the parents and many more [ 6 , 7 ]. In literature, no review has been conducted in the last ten years about motivation factors of students to select medical studies. The existing reviews have either been conducted before ten years or with different objectives [ 8 , 9 ]. One review by Puertas et al. [ 8 ] published in 2013 was conducted to review the factors influencing medical student’s choice in primary care while another one by Brissette and Howes [ 9 ] published in 2010 was conducted on the articles available till 2008. Brisstte and Howes identified that motivation to take up medical studies lies in addressing learner’s needs for competence, autonomy, and relatedness. Providing optimal challenge and positive performance feedback, choice and opportunity for self-direction, and a sense of belongingness and connection to the medical profession can all be focused on to address the above mentioned motivators [ 9 ]. The review has given points for educators to act upon.The lacunae left by the previous review studies need to be addressed in a finer manner in context with the current challenge of the global workforce.

In last few years, human resources for health has attracted substantial scholarly attention. Over the last decade, there have been advancement in different fields of medical sciences, from prevention, patient care to laboratory workup and management of severe diseases and palliation. With the growing population and improving health care owing to better technologies, it is gravely important to improve the medical workforce, mostly doctors.

Globally, several health-related goals and programs are giving priority to human resource development in the health sector. The major health related initiatives like Sustainable Development Goals [ 10 ] and WHO’s six building blocks [ 11 ] focus on human resource development for achieving universal health coverage. The National health programs, like the National Health Mission in India, focuses on increasing human resources to upbring the health care services in the country.

The prospective medical students form a significant pool of health care workers that can help overcome the shortage globally. Therefore, understanding the current common motivational factors is essential and a summary of the factors through a review of these studies would derive a clearer picture. A strong predictor for any student to take up a career in any field is the motivation or drive from within. Motivation is defined as the process that initiates, guides, and maintains goal-oriented behaviors. It involves the biological, emotional, social, and cognitive forces that activate behavior. Fulfillment of needs results in some type of behavior, which can be either intrinsic or extrinsic [ 7 ]. Understanding motivation is very important in the medical sector because a motivated individual is willing to exert and maintain an effort to provide good-quality health services.

The objective of this study is to group and review all the studies that investigated the motivational factors that underpin students’ selection of medical study in recent years.

Search strategy

The literature search was carried out with the purpose to identify the perceptions of medical students to enter medical studies. The search was carried out by two researchers (NS and ND) independently in PubMed, Google Scholar, Wiley and IndMED databases for original studies conducted from 2006 to 2016. This time frame was chosen as many studies were done during this period to identify the motivational factors. MeSH and free-text terms “(Motivat*) AND (select* OR choice OR choose) AND (medical student* OR medical school* OR interns) have been used. Internship in the period of practical application of theoretical (mostly) knowledge of the previous medical school years, hence interns were also made a part of the search strategy. Search terms and keywords were altered as per specification of individual databases. A total of 38 combinations were used for search purpose.

An initial search identified thousands of related records from the Google scholar, PubMed, Ind Med and Wiley online library databases. The articles which were not related to motivation were excluded at the first step. Then search results were imported to Microsoft Excel and duplications were removed by sorting the titles of articles. The selected studies were then screened by reading the title and abstract resulting in shortlisting 91 articles. Of these, 62 articles were excluded based on eligibility criteria. The remaining 29 full-text articles were further assessed, and five were excluded because the articles were in Korean, Spanish and Chinese. A total of 24 studies were selected. Any differences of opinion were debated and consensus was reached. Further differences were resolved by the third researcher (SG). PRISMA guidelines were strictly followed during the study. Figure  1 represents the flow chart leading to sample selection.

Flow chart of selection and exclusion of studies for the systematic review

Selection criteria and sample

All studies carried out and published from year 2006 till 2016 were included in the review. Inclusion criteria were studies describing motivation to study medicine, conducted among medical students and interns and available in English language. Exclusion criteria were those studies done before 2006, published in languages other than English, and those not related to motivation or medical students and interns.

Data analysis

A thematic analysis of selected papers was performed, wherein two research assistants coded the papers independently and reached consensus on relevant themes [ 12 ]. They also extracted details of the final articles using a standardized abstraction form that collected information on: the author, the journal, the year of publication, location, study objectives, study design, major findings, limitations, and observations. In this paper, we systematically review the literature related to medical education with the goal of identifying the motivating factors influencing the medical students to join medical studies.

The results of the studies’ review were categorized under different heads viz. scientific factors, social factors and humanitarian factors based upon criteria devised by Goel S et al. in their study on development and validation of the motivations for selection of medical study in India [ 13 ]. In this study a ‘Motivation of Selection of Medical Study (MSMS)’ tool was developed using extensive literature review followed by Delphi technique. The three domains and the issues that emerged are shown in Table  1 .

Ethical considerations

The study was granted ethical approval from the Institute’s Ethical Committee, PGIMER, Chandigarh (PGI/IEC/2012/810–1 P-154). Since the study is a systematic review of studies and individual level data is neither obtained nor presented, the consent.

The characteristics of the studies included in the systematic review are shown in Table  2 . The assessment of factors of motivations for medical students to select medical studies was based on the World Bank categorization of low-, middle- and high-income countries [ 14 ].The low-income, lower middle-income, upper middle-income and high-income economies are defined as those with a Gross National Income (GNI) per capita of $1005 or less, between $1006 and $3955, between $3956 and $12,235 and $12,236 or more, respectively in the year 2016. The majority of the studies ( n  = 16, 66.6%) were from high-income countries followed by an equal number from upper middle and lower middle income countries ( n  = 4,16.7%). None of the studies were from low-income countries. All of the studies were cross sectional in nature ( n  = 24). Figure  2 shows the geographic distribution of the different studies.

Geographical distribution of the different studies across the globe (used a web page https://mapchart.net which is free of cost and specifically designed for making customised maps)

Predominance of motivating factors according to income group

Results reported for motivation to select medicine by medical students changes in the context of place (see Fig.  3 and Table  3 ). The choice of medical study among students differs between students in high-income countries, and those in upper-middle and lower–middle-income countries. The individual motivation factors that emerged are presented in Table  4 .

Categorization of motivation factors across different income country groups

High-income countries

In most of the high-income counties, scientific and humanitarian factors were described as the main motivators to select medicine by medical students [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Most of the high income countries including Spain, Croatia, Poland, UK, Hungary, Germany and South Korea reported similar type of motivators to motivate the medical students for choosing medicine: interest in science/medicine, social interest, flexible work hours and work independence. Results reported by Kim et al.(2016) [ 16 ], Becker et al. (2015) [ 29 ], Wouters (2014) [ 19 ] emphasized on the scientific factors. Societal factors were also reported in most of these studies but fell lower in hierarchy.

Uppermiddle income countries

The main motivators to select medicine by medical students of upper-middle income countries include the societal and scientific factors [ 30 , 31 , 32 , 33 ]. A study by Kavousipour et al. (2015) [ 30 ] conducted in Iran explains that the factors which were most significant to motivate the students were family attitudes, getting good jobs in future, respect for themselves, the ability to learn, believing their role in victory and defeat and the tendency toward optimism about themselves. Pagnin et al. (2013) [ 32 ] also concluded similar findings. Social and professional status of the job, healthcare-people factor, others’ recommendation and advices, personal interest and nature of occupation, occupational experience and personal life had been identified as main factors of motivation. The findings reported by Korkmaz et al. (2013) [ 31 ] also found societal and scientific factors to be more significant motivators.

Lower-middle -income

In low-middle income countries, students have mixed responses for the choice of medical studies. [ 34 , 35 , 36 , 37 ]. Humanitarian and societal factors had been reported as main influences to join medicine.

Few studies conducted in various parts of India had reported almost similar results. A study conducted in Madhya Pradesh, India by Diwan et al. (2013) [ 35 ] concluded that reasons for entering medical education included personal ambition, parental desire, prestigious profession, altruistic reasons and pecuniary incentives. Similar to these findings were those reported by Kuriakose (2015) [ 34 ], Seetharaman et al. (2012) [ 36 ] and Lal et al. in 2007 [ 37 ]. The main reasons that motivate the medical students were to serve the sick and society and having a high status in society.

To our knowledge, this is the first systematic review of motivational factors for choosing medical studies by medical students globally. Earlier reviews were related to factors influencing student rating in undergraduate medical education course evaluations and factors that influence a career choice in primary care among medical students from high-, middle- and low-income countries [ 8 ]. The present systematic review, which has analyzed 24 studies in detail, is important as it identifies the motivational factors influencing the medical students to join medical studies in different parts of the globe along with the variations among the factors in lower-middle, upper-middle and high-income countries. As such, it provides essential insights into how students could be motivated, and how this varies across countries. No study was found from low-income countries. The limited research on this topic in low-income countries could be related to the lack of interest in this particular area, or to an overall deficit in research in developing nations, or both. These countries could identify the issues and intervene according to the research done in lower-middle and upper-middle income countries.

Several theories of motivation have been described in relation to career choice among student including intrinsic and extrinsic factors as described by Brissette and Howe [ 9 ] and by Maslow [ 38 ],. Taylor, McClelland and Herzberg [ 39 ]. However, Maslow’s theory remains to be the most detailed and frequently used theory [ 38 ]. The Maslow’s hierarchy of needs describes motivational factors under five broad segments: the physiological needs, the needs for safety and security, the needs for love and belonging, the needs for esteem, and the need to actualize the self, in that order [ 38 ]. Physiological needs are the basic needs required by an individual, such as food, water, sleep, etc. Once these needs are met, the second segment of needs comes into picture making safety, stability, protection the prime concerns. Following these factors the third segment consists of desires to marry, have a family, become a part of their community etc. The fourth segment of esteem has two versions as described by Maslow. The need for respect, prestige, prominence, magnificence, appreciation, attention, status, self-esteem, and dominance forms the lower version while the higher form involves the need for self-respect which includes feelings as self-confidence, capability, accomplishment, mastery, and freedom. The last segment is the phase of self-actualization which is a desire for self-fulfillment [ 38 ].

In low-middle income countries, students are still striving to fulfill primary basic needs and safety and security of employment, family, health. They fall under the first two segments of the pyramid comprising of basic needs, safety stability and protection and hence the predominant motivational factors are humanitarian in this group. In some areas where these needs are fulfilled, the higher segment of self-esteem also come into picture, hence societal factors are also seen in lower-middle income countries. The prime reasons for selecting medical studies among students in low-income countries were parental desire, respected profession and economic incentives, respect in society, high societal status and to serve the sick. The desire to serve the poor is deeply ingrained in this society. Most of the students belong to lower or middle socio-economic groups and understand the miseries of poor well and these factors lead them to serve the humanity and poor people. Here medical students are more sensitive to the social needs of population. The very reasons identified to take up medical career in these countries can be used to encourage students to take up medical studies. Mainly, the respect and feeling of altruism, followed by the monetary and social benefits are a driving force that can be used to attract the students into medical profession, hence improving the workforce. As the motivational factors are mostly innate, their further interest in medical studies and serving the nation will remain significant.

In the upper-middle income countries the factors as described by the middle zone in the Maslow’s hierarchy of needs pyramid were identified. The majority of studies identified societal factors as better predictors as compared to humanitarian and scientific factors. The main motivators to select medicine by medical students of upper-middle income countries are job security, social status, and parental wish. The reason behind this is that, to become a doctor is one of the highest ambition of many school-going students and their parents in middle- and low-income countries, along with the fact that the medical profession is preferred by the students due to its high prospect of financial security and high social status. Being a respected profession with high social status and higher salaries has been found to be motivating factor for students. The students in these countries have mostly met their basic needs and are more attracted towards a better lifestyle and income. Security in all fronts is a strong predictor for picking medical studies, and this can help enroll more students into this career. Excelling in their medical education may act as a strong target as their competition decides their future prospects.

The motivational factors commonly reported by most of the studies in high-income countries were the third and fourth segments of the Maslow’s hierarchy of needs pyramid. The scientific factors were the main motivators to select medicine by students. This may be due to the fact that the students in high-income countries chose medicine or science, who have prime interest in these subjects. The interest in science is usually developed during their school times to become medical school academics in a well-developed education system and with advanced technologies (modern laboratory facilities). The availability of good technologies and advanced education helps in developing specialized skills through the medical school years and beyond. In addition, the ability to earn well, pay their debts and live comfortably are strong motivators as well.

There are various strengths of the study. Firstly, the review was done on a sizeable number of 24 studies across the globe, hence generating stronger evidence. Secondly, the study relates the motivational factors across different countries with the Maslow’s hierarchy of needs theory [ 38 ]. This helps to understand the motivational factors of medical students to work in rural areas with respect to the innate motivational factors of a human being.

This review has a few limitations. Despite our efforts to identify all relevant studies by searching four different databases and using a fairly large number of search terms, we might have missed relevant studies. Additionally, unpublished studies from low- and middle-income countries were not represented (publication bias). The exclusion of articles published before 2006 may have omitted literature that could have provided valuable information. However, our review supplement two existing reviews published earlier [ 8 , 9 ].

In conclusion, this systematic review investigated the reasons that affect students’ decisions to join medical profession. The motivational factors are being classified in scientific factors (e.g. ‘interest in medicine’), societal factors (e.g. ‘respect/prestige’) and humanitarian factors (e.g.‘desire to help others’). The predominance of factors varied among students in high-, upper-middle and lower-middle income countries. Hence, this study offers cues to policy makers and educators in different countries to understand the motivational factors as a first step to formulate policy in order to tackle the shortage of health workers to improve the status of human resources across nations. However, more research on the subject would assist in promoting as well as translating health policy into concrete and effective measures at the local, national, regional and global levels in low- and middle- income countries.

Abbreviations

Motivation of selection of Medical Study

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

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Conceptualization: SG FA. Data curation: SG ND NS. Formal analysis: SG ND NS. Funding acquisition: SG. Investigation: SG. Methodology: SG FA DR. Project administration: SG. Resources: SG. Software: NS, ND. Supervision: SG. Validation: SG ND. Writing original draft: ND NS. Writing review & editing: SG FA DR. All authors have read and approved the final version of the manuscript.

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Goel, S., Angeli, F., Dhirar, N. et al. What motivates medical students to select medical studies: a systematic literature review. BMC Med Educ 18 , 16 (2018). https://doi.org/10.1186/s12909-018-1123-4

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A day in the life of a medical student from Ukraine

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In our series taking you to meet medical students from across the globe from the comfort of your own home, BMJ student spoke to a medical student who has made a truly international curriculum for herself and her peers in the wake of war and destruction in her home country

You have just set off from home to attend your placement or to meet your friends for a cocktail or a cup of coffee. Life goes on as usual, until it doesn’t. When you hear the bomb alarm, life as you know it stops. You make your way back to your bathroom at home, your local subway station, or wherever else martial law has dictated is your closest safe place. “You don’t go to medical school: you wait until it ends. It might be 30 minutes; it might be five hours.”

Natalia Pidmurniak is a final year medical student in Ukraine. When she began her studies in Kyiv aged 17, she had an ordinary university experience in “a very European city.” The latter years of her studies have been anything but ordinary.

Before she became a medical student, Natalia was aware of the work of the Ukrainian Medical Students’ Association—even using their example of a large community of medical students to convince her parents to approve of her move to the capital city. She never thought that one day she would be the organisation’s president. She started out as assistant to the organisation’s national exchange officer. In this role “I worked tirelessly to make the path to my dream [international] internship clearer and more straightforward.”

When the national exchange officer’s term ended, Natalia assumed his role and was part of the Ukrainian delegation to the European Regional Meeting of the International Federation of Medical Students’ Associations (IFMSA) in Portugal in April 2022. As the war against Ukraine had already started, Natalia was the only delegate from Ukraine who was able to attend.

“Although I was the only one from our team communicating with other countries as part of my job responsibilities, I had no experience representing a country, especially conveying the theme of war, just two months since the beginning of the full scale invasion. The experience I gained, however, is difficult to put into words.

‘‘I faced resistance from the management team, who argued that the IFMSA is non-political, and we should not consider such topics. Only with the support of other European countries, I managed to step onto the stage and deliver a statement on everything that was happening [in Ukraine].”

On her return to Ukraine, Natalia was asked to take on the role of president of the Ukrainian Medical Students’ Association because her predecessor was struggling with the pressure of leading the organisation as her husband had been sent to the front lines.

“I understood that there was no alternative [person] for the position. I was fortunate to be born in a relatively safe area and had experience in international collaborations with other countries within IFMSA. Therefore, I agreed. This conversation took place in August, and in November I was elected president.”

Under Natalia’s leadership, the Ukrainian Medical Students’ Association advocates for Ukrainian medical students through arranging international placements in various specialties to try to mitigate the upheaval and disruption to their studies the war has caused. It also facilitates public health education in Ukraine. For example, one campaign tried to recruit bone marrow donors to the nationwide bone marrow bank and educate the public on the process and benefits of such a donation.

Her platform has enabled Natalia to share her story with medical students around the world. Weeks before her first international conference, in Portugal, Natalia was woken in the early hours of the morning by a message from a family member telling her to pack up and leave Kyiv. The invasion had begun and the city was under attack. She has since attended conferences in Portugal, Bosnia, Estonia, and, most recently, in India—but getting to the conferences is not easy. The skies above Ukraine remain closed for civil aviation, and with so many people leaving the country each day, buses are crowded and travel is difficult and tedious. When she last left Kyiv, Natalia recalls waiting for 30 hours on a bus to cross the border.

Natalia emphasised that Ukraine is a huge country, that there is not one universal experience of studying medicine in Ukraine since the war began. Many cities in the west of the country have maintained in-person teaching throughout the war, whereas for those closer to the front lines, teaching remains online to date. Back in Kyiv, Natalia’s medical school is slowly returning to in-person teaching, but for her the UK is home for the next three years. After completing her studies online, and completing placements across the world, Natalia will embark on a global health internship she has earnt at Imperial College London.

After the war began, there was an urgent need to understand its effects on training for Ukrainian medical students. The Ukrainian Medical Students’ Association, under the guidance of Natalia, distributed surveys to students across the country. They used these surveys to capture an idea of the spread and type of disruption to Ukrainian students, as well as to assess the needs and priorities of the students. One of the priorities Natalia identified among Ukrainian students was a demand for international placements. Currently, placements across 38 countries are available for students displaced by the war. Natalia, with the support of connections made through the IFMSA, has been instrumental in the development of these placements. Without them, Natalia—and many of her peers—would not have been offered the opportunity to complete a clinical placement since the beginning of the covid-19 pandemic in 2020.

At the Ukraine Health Summit in London, her plea to UK doctors was: “If you have the opportunity to accept a [Ukrainian] student in your department, please do that.”

Another priority was resources for medical students from Ukraine. Many of Natalia’s professors and lecturers were displaced and unable to find academic roles in their places of refuge because of differences in university and medical systems. Although Natalia and her female contemporaries are able to leave the country to complete placements, martial law dictates that her male peers must not cross the Ukrainian border in case they are drafted into the war effort. These students, still in Ukraine, asked the organisation for simulation suites to enable them to learn and practise their clinical skills, even when they were unable to be taught in the hospitals. Natalia spoke candidly of an experience of a neurosurgery placement in Kyiv placing her and her fellow colleagues in an ethical dilemma about the role of medical students during war. How fair is it to students as well as patients to host placements in those environments?

“We had a neurosurgery class, and the professor told us, ‘You will learn a lot about brain injuries and traumas. This may be the best time to see all of this because in peaceful times you’re not going to see traumas caused by bullets or because of the other injuries. But you must understand, these patients are young guys. It’s going to be a very difficult for 13 students to see them in this vulnerable position. Try to understand them. It’s going to be hard for these young guys to get back to being normal because they’re never going to be normal again.’”

Back in Kyiv, life is slowly returning to the streets. Natalia remembers returning to a city cloaked in dark grey, unrecognisable from the city she moved to at age 17. Natalia talks of the courage of the Ukrainian people, who live relatively normal lives despite the constant shelling. “We have restaurants, we have bars.” When the bomb alarms sound, life stops, people still find themselves searching for shelters. But bombings end and people return to their cocktails. “We find the strength within ourselves to live as society does in times of peace.”

So what is next for this remarkable medical student? Natalia wants to work clinically and academically, but it is her dedication to global health that will take her to London. Helping to promote medical education in war zones, such as Sudan and Gaza, is a priority for Natalia as she continues her academic career.

Competing interests: EL is a medical student enrolled at Lancaster University 2019-26.

Read more about the Ukrainian Medical Students Association here: https://ukrmsa.com/

Find out more about the work of the Crisis Rescue Fund, and donate here: https://www.crisisrescuefoundation.co.uk

Acknowledgement: The author wishes to thank Natalia Pidmurniak for her contribution to this article.

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What motivates medical students to select medical studies: a systematic literature review

1 School of Public Health, PGIMER, Sector-12, Chandigarh, 160012 India

Federica Angeli

2 Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

3 Department of Organization Studies, School of Social and Behavioural Sciences, Tilburg University, Tilburg, the Netherlands

Nonita Dhirar

Neetu singla, dirk ruwaard.

4 Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

Associated Data

The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

There is a significant shortage of health workers across and within countries. It is of utmost importance to determine the factors that motivate students to opt for medical studies. The objective of this study is to group and review all the studies that investigated the motivational factors that underpin students’ selection of medical study in recent years.

The literature search was carried out by two researchers independently in PubMed, Google Scholar, Wiley and IndMED databases for articles published from year 2006 till 2016. A total of 38 combinations of MeSH words were used for search purpose. Studies related to medical students and interns have been included. The application of inclusion and exclusion criteria and PRISMA guidelines for reporting systematic review led to the final selection of 24 articles.

The majority of the studies ( n  = 16; 66.6%) were from high-income countries followed by an equal number from upper-middle and lower-middle income countries ( n  = 4,16.7%). None of the studies were from low-income countries. All of the studies were cross-sectional in nature. The main motivating factors that emerged were scientific (interest in science / medicine, social interest and academia, flexible work hours and work independence), societal (prestige, job security, financial security) and humanitarian (serving the poor and under priviledged) in high-, upper-middle and lower-middle income countries, respectively. The findings were comparable to Maslow’s hierarchy of needs theory of motivation.

This systematic review identifies the motivational factors influencing students to join medical studies in different parts of the globe. These factors vary per country depending on the level of income. This study offers cues to policy makers and educators to formulate policy in order to tackle the shortage of health workers, i.e. medical doctors. However, more research is needed to translate health policy into concrete and effective measures.

The world is currently facing a dual problem of shortage and inequitable distribution of health workers, especially in middle- and low-income countries [ 1 ]. The World Health Organization (WHO) estimated a need for an additional 4.3 million health workers in 57 countries to fulfill the Millennium Development Goals [ 2 ]. In addition, 83 countries (44.6%) do not currently meet the 2006 World Health Report threshold of 22.8 skilled health professionals per 10,000 population [ 3 ]. Among many, the main reasons cited for shortage of health workers in rural areas include poor working conditions, lack of accommodation, lack of transport, poor pay structure, overburden with additional administrative responsibility and political interference [ 4 ]. In middle- and low-income countries, the situation is more critical because of migration of doctors to high-income (developed) countries whereas inequitable distribution of health workers between urban and rural areas is primarily due to poor motivation of health workers to work in rural areas [ 5 ].

The choice of medical study depends upon various factors such as interest in the medical field, good job opportunities, a desire to serve others, medical background of the parents and many more [ 6 , 7 ]. In literature, no review has been conducted in the last ten years about motivation factors of students to select medical studies. The existing reviews have either been conducted before ten years or with different objectives [ 8 , 9 ]. One review by Puertas et al. [ 8 ] published in 2013 was conducted to review the factors influencing medical student’s choice in primary care while another one by Brissette and Howes [ 9 ] published in 2010 was conducted on the articles available till 2008. Brisstte and Howes identified that motivation to take up medical studies lies in addressing learner’s needs for competence, autonomy, and relatedness. Providing optimal challenge and positive performance feedback, choice and opportunity for self-direction, and a sense of belongingness and connection to the medical profession can all be focused on to address the above mentioned motivators [ 9 ]. The review has given points for educators to act upon.The lacunae left by the previous review studies need to be addressed in a finer manner in context with the current challenge of the global workforce.

In last few years, human resources for health has attracted substantial scholarly attention. Over the last decade, there have been advancement in different fields of medical sciences, from prevention, patient care to laboratory workup and management of severe diseases and palliation. With the growing population and improving health care owing to better technologies, it is gravely important to improve the medical workforce, mostly doctors.

Globally, several health-related goals and programs are giving priority to human resource development in the health sector. The major health related initiatives like Sustainable Development Goals [ 10 ] and WHO’s six building blocks [ 11 ] focus on human resource development for achieving universal health coverage. The National health programs, like the National Health Mission in India, focuses on increasing human resources to upbring the health care services in the country.

The prospective medical students form a significant pool of health care workers that can help overcome the shortage globally. Therefore, understanding the current common motivational factors is essential and a summary of the factors through a review of these studies would derive a clearer picture. A strong predictor for any student to take up a career in any field is the motivation or drive from within. Motivation is defined as the process that initiates, guides, and maintains goal-oriented behaviors. It involves the biological, emotional, social, and cognitive forces that activate behavior. Fulfillment of needs results in some type of behavior, which can be either intrinsic or extrinsic [ 7 ]. Understanding motivation is very important in the medical sector because a motivated individual is willing to exert and maintain an effort to provide good-quality health services.

The objective of this study is to group and review all the studies that investigated the motivational factors that underpin students’ selection of medical study in recent years.

Search strategy

The literature search was carried out with the purpose to identify the perceptions of medical students to enter medical studies. The search was carried out by two researchers (NS and ND) independently in PubMed, Google Scholar, Wiley and IndMED databases for original studies conducted from 2006 to 2016. This time frame was chosen as many studies were done during this period to identify the motivational factors. MeSH and free-text terms “(Motivat*) AND (select* OR choice OR choose) AND (medical student* OR medical school* OR interns) have been used. Internship in the period of practical application of theoretical (mostly) knowledge of the previous medical school years, hence interns were also made a part of the search strategy. Search terms and keywords were altered as per specification of individual databases. A total of 38 combinations were used for search purpose.

An initial search identified thousands of related records from the Google scholar, PubMed, Ind Med and Wiley online library databases. The articles which were not related to motivation were excluded at the first step. Then search results were imported to Microsoft Excel and duplications were removed by sorting the titles of articles. The selected studies were then screened by reading the title and abstract resulting in shortlisting 91 articles. Of these, 62 articles were excluded based on eligibility criteria. The remaining 29 full-text articles were further assessed, and five were excluded because the articles were in Korean, Spanish and Chinese. A total of 24 studies were selected. Any differences of opinion were debated and consensus was reached. Further differences were resolved by the third researcher (SG). PRISMA guidelines were strictly followed during the study. Figure  1 represents the flow chart leading to sample selection.

Flow chart of selection and exclusion of studies for the systematic review

Selection criteria and sample

All studies carried out and published from year 2006 till 2016 were included in the review. Inclusion criteria were studies describing motivation to study medicine, conducted among medical students and interns and available in English language. Exclusion criteria were those studies done before 2006, published in languages other than English, and those not related to motivation or medical students and interns.

Data analysis

A thematic analysis of selected papers was performed, wherein two research assistants coded the papers independently and reached consensus on relevant themes [ 12 ]. They also extracted details of the final articles using a standardized abstraction form that collected information on: the author, the journal, the year of publication, location, study objectives, study design, major findings, limitations, and observations. In this paper, we systematically review the literature related to medical education with the goal of identifying the motivating factors influencing the medical students to join medical studies.

The results of the studies’ review were categorized under different heads viz. scientific factors, social factors and humanitarian factors based upon criteria devised by Goel S et al. in their study on development and validation of the motivations for selection of medical study in India [ 13 ]. In this study a ‘Motivation of Selection of Medical Study (MSMS)’ tool was developed using extensive literature review followed by Delphi technique. The three domains and the issues that emerged are shown in Table  1 .

Domains and issues that emerge as main motivational factors

Ethical considerations

The study was granted ethical approval from the Institute’s Ethical Committee, PGIMER, Chandigarh (PGI/IEC/2012/810–1 P-154). Since the study is a systematic review of studies and individual level data is neither obtained nor presented, the consent.

The characteristics of the studies included in the systematic review are shown in Table  2 . The assessment of factors of motivations for medical students to select medical studies was based on the World Bank categorization of low-, middle- and high-income countries [ 14 ].The low-income, lower middle-income, upper middle-income and high-income economies are defined as those with a Gross National Income (GNI) per capita of $1005 or less, between $1006 and $3955, between $3956 and $12,235 and $12,236 or more, respectively in the year 2016. The majority of the studies ( n  = 16, 66.6%) were from high-income countries followed by an equal number from upper middle and lower middle income countries ( n  = 4,16.7%). None of the studies were from low-income countries. All of the studies were cross sectional in nature ( n  = 24). Figure  2 shows the geographic distribution of the different studies.

Characteristics of the studies included in the systematic review ( n  = 24)

Geographical distribution of the different studies across the globe (used a web page https://mapchart.net which is free of cost and specifically designed for making customised maps)

Predominance of motivating factors according to income group

Results reported for motivation to select medicine by medical students changes in the context of place (see Fig.  3 and Table  3 ). The choice of medical study among students differs between students in high-income countries, and those in upper-middle and lower–middle-income countries. The individual motivation factors that emerged are presented in Table  4 .

Categorization of motivation factors across different income country groups

Factors affecting motivations of medical students to select medicine across different country income groups

Most commonly cited motivational factors among all the studies analyzed ( N  = 24)

High-income countries

In most of the high-income counties, scientific and humanitarian factors were described as the main motivators to select medicine by medical students [ 15 – 29 ]. Most of the high income countries including Spain, Croatia, Poland, UK, Hungary, Germany and South Korea reported similar type of motivators to motivate the medical students for choosing medicine: interest in science/medicine, social interest, flexible work hours and work independence. Results reported by Kim et al.(2016) [ 16 ], Becker et al. (2015) [ 29 ], Wouters (2014) [ 19 ] emphasized on the scientific factors. Societal factors were also reported in most of these studies but fell lower in hierarchy.

Uppermiddle income countries

The main motivators to select medicine by medical students of upper-middle income countries include the societal and scientific factors [ 30 – 33 ]. A study by Kavousipour et al. (2015) [ 30 ] conducted in Iran explains that the factors which were most significant to motivate the students were family attitudes, getting good jobs in future, respect for themselves, the ability to learn, believing their role in victory and defeat and the tendency toward optimism about themselves. Pagnin et al. (2013) [ 32 ] also concluded similar findings. Social and professional status of the job, healthcare-people factor, others’ recommendation and advices, personal interest and nature of occupation, occupational experience and personal life had been identified as main factors of motivation. The findings reported by Korkmaz et al. (2013) [ 31 ] also found societal and scientific factors to be more significant motivators.

Lower-middle -income

In low-middle income countries, students have mixed responses for the choice of medical studies. [ 34 – 37 ]. Humanitarian and societal factors had been reported as main influences to join medicine.

Few studies conducted in various parts of India had reported almost similar results. A study conducted in Madhya Pradesh, India by Diwan et al. (2013) [ 35 ] concluded that reasons for entering medical education included personal ambition, parental desire, prestigious profession, altruistic reasons and pecuniary incentives. Similar to these findings were those reported by Kuriakose (2015) [ 34 ], Seetharaman et al. (2012) [ 36 ] and Lal et al. in 2007 [ 37 ]. The main reasons that motivate the medical students were to serve the sick and society and having a high status in society.

To our knowledge, this is the first systematic review of motivational factors for choosing medical studies by medical students globally. Earlier reviews were related to factors influencing student rating in undergraduate medical education course evaluations and factors that influence a career choice in primary care among medical students from high-, middle- and low-income countries [ 8 ]. The present systematic review, which has analyzed 24 studies in detail, is important as it identifies the motivational factors influencing the medical students to join medical studies in different parts of the globe along with the variations among the factors in lower-middle, upper-middle and high-income countries. As such, it provides essential insights into how students could be motivated, and how this varies across countries. No study was found from low-income countries. The limited research on this topic in low-income countries could be related to the lack of interest in this particular area, or to an overall deficit in research in developing nations, or both. These countries could identify the issues and intervene according to the research done in lower-middle and upper-middle income countries.

Several theories of motivation have been described in relation to career choice among student including intrinsic and extrinsic factors as described by Brissette and Howe [ 9 ] and by Maslow [ 38 ],. Taylor, McClelland and Herzberg [ 39 ]. However, Maslow’s theory remains to be the most detailed and frequently used theory [ 38 ]. The Maslow’s hierarchy of needs describes motivational factors under five broad segments: the physiological needs, the needs for safety and security, the needs for love and belonging, the needs for esteem, and the need to actualize the self, in that order [ 38 ]. Physiological needs are the basic needs required by an individual, such as food, water, sleep, etc. Once these needs are met, the second segment of needs comes into picture making safety, stability, protection the prime concerns. Following these factors the third segment consists of desires to marry, have a family, become a part of their community etc. The fourth segment of esteem has two versions as described by Maslow. The need for respect, prestige, prominence, magnificence, appreciation, attention, status, self-esteem, and dominance forms the lower version while the higher form involves the need for self-respect which includes feelings as self-confidence, capability, accomplishment, mastery, and freedom. The last segment is the phase of self-actualization which is a desire for self-fulfillment [ 38 ].

In low-middle income countries, students are still striving to fulfill primary basic needs and safety and security of employment, family, health. They fall under the first two segments of the pyramid comprising of basic needs, safety stability and protection and hence the predominant motivational factors are humanitarian in this group. In some areas where these needs are fulfilled, the higher segment of self-esteem also come into picture, hence societal factors are also seen in lower-middle income countries. The prime reasons for selecting medical studies among students in low-income countries were parental desire, respected profession and economic incentives, respect in society, high societal status and to serve the sick. The desire to serve the poor is deeply ingrained in this society. Most of the students belong to lower or middle socio-economic groups and understand the miseries of poor well and these factors lead them to serve the humanity and poor people. Here medical students are more sensitive to the social needs of population. The very reasons identified to take up medical career in these countries can be used to encourage students to take up medical studies. Mainly, the respect and feeling of altruism, followed by the monetary and social benefits are a driving force that can be used to attract the students into medical profession, hence improving the workforce. As the motivational factors are mostly innate, their further interest in medical studies and serving the nation will remain significant.

In the upper-middle income countries the factors as described by the middle zone in the Maslow’s hierarchy of needs pyramid were identified. The majority of studies identified societal factors as better predictors as compared to humanitarian and scientific factors. The main motivators to select medicine by medical students of upper-middle income countries are job security, social status, and parental wish. The reason behind this is that, to become a doctor is one of the highest ambition of many school-going students and their parents in middle- and low-income countries, along with the fact that the medical profession is preferred by the students due to its high prospect of financial security and high social status. Being a respected profession with high social status and higher salaries has been found to be motivating factor for students. The students in these countries have mostly met their basic needs and are more attracted towards a better lifestyle and income. Security in all fronts is a strong predictor for picking medical studies, and this can help enroll more students into this career. Excelling in their medical education may act as a strong target as their competition decides their future prospects.

The motivational factors commonly reported by most of the studies in high-income countries were the third and fourth segments of the Maslow’s hierarchy of needs pyramid. The scientific factors were the main motivators to select medicine by students. This may be due to the fact that the students in high-income countries chose medicine or science, who have prime interest in these subjects. The interest in science is usually developed during their school times to become medical school academics in a well-developed education system and with advanced technologies (modern laboratory facilities). The availability of good technologies and advanced education helps in developing specialized skills through the medical school years and beyond. In addition, the ability to earn well, pay their debts and live comfortably are strong motivators as well.

There are various strengths of the study. Firstly, the review was done on a sizeable number of 24 studies across the globe, hence generating stronger evidence. Secondly, the study relates the motivational factors across different countries with the Maslow’s hierarchy of needs theory [ 38 ]. This helps to understand the motivational factors of medical students to work in rural areas with respect to the innate motivational factors of a human being.

This review has a few limitations. Despite our efforts to identify all relevant studies by searching four different databases and using a fairly large number of search terms, we might have missed relevant studies. Additionally, unpublished studies from low- and middle-income countries were not represented (publication bias). The exclusion of articles published before 2006 may have omitted literature that could have provided valuable information. However, our review supplement two existing reviews published earlier [ 8 , 9 ].

In conclusion, this systematic review investigated the reasons that affect students’ decisions to join medical profession. The motivational factors are being classified in scientific factors (e.g. ‘interest in medicine’), societal factors (e.g. ‘respect/prestige’) and humanitarian factors (e.g.‘desire to help others’). The predominance of factors varied among students in high-, upper-middle and lower-middle income countries. Hence, this study offers cues to policy makers and educators in different countries to understand the motivational factors as a first step to formulate policy in order to tackle the shortage of health workers to improve the status of human resources across nations. However, more research on the subject would assist in promoting as well as translating health policy into concrete and effective measures at the local, national, regional and global levels in low- and middle- income countries.

Acknowledgements

This study did not receive any funding.

Availability of data and materials

Abbreviations, authors’ contributions.

Conceptualization: SG FA. Data curation: SG ND NS. Formal analysis: SG ND NS. Funding acquisition: SG. Investigation: SG. Methodology: SG FA DR. Project administration: SG. Resources: SG. Software: NS, ND. Supervision: SG. Validation: SG ND. Writing original draft: ND NS. Writing review & editing: SG FA DR. All authors have read and approved the final version of the manuscript.

Ethics approval and consent to participate

The study was granted ethical approval from the Institute’s Ethical Committee, PGIMER, Chandigarh (PGI/IEC/2012/810–1 P-154). The anonymity and confidentiality of participants in the studies were ensured. Since the study is a systematic review of studies and individual level data is not obtained, the consent was not required.

Consent for publication

Since individual level data is not presented, the consent for publication of data was not required.

Competing interests

The authors declare that they have no competing interests.

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Contributor Information

Sonu Goel, Phone: 0172-2755215, Email: ni.oc.oohay@700leogunos .

Federica Angeli, Email: [email protected] , Email: [email protected] .

Nonita Dhirar, Email: moc.oohay@381atinon .

Neetu Singla, Email: [email protected] .

Dirk Ruwaard, Email: [email protected] .