Career Path Decisions and Influencing Factors Among Medical Students in Tanzania.

Introduction: Career path decisions among medical students are crucial for strengthening health systems, particularly in Tanzania, where physician shortages persist despite increasing medical graduate numbers. While many studies have focused on specialty preferences, few have examined whether students nearing graduation intend to remain in clinical medicine. In Tanzania, this decision is shaped by intrinsic motivation, poor learning environments, limited job opportunities, and systemic challenges. This study assesses the proportion of students intending to remain in the profession and identifies key influencing factors. Methods: An analytical cross-sectional study was conducted among 292 medical students from Tanzanian medical universities between September and December 2024. Stratified random sampling was employed. Data were collected through an online structured questionnaire. Variables included demographics, initial motivations, and theory of planned behavior (TPB) constructs. Data analysis involved descriptive statistics, chi-square tests, and binary logistic regression. Results: Of the participants, most were male (64.0%) and those aged 21-25 years old (77.7%). Precisely, 64.7% intended to remain in the medical profession, while 35.3% considered alternative careers. Intrinsic motivations such as a desire to help others (odds ratio [OR] = 2.90, Conclusion: A significant portion of final-year medical students in Tanzania (over one-third) consider leaving the clinical field. This underscores the critical role of intrinsic motivation and perceived behavioral control in shaping career intentions. To enhance the retention of medical professionals, stakeholders should prioritize strategies that strengthen intrinsic drivers, reinforce self-efficacy, and improve supportive training environments.