Emotional Engagement as a Push Factor in Medical Student Migration Intentions
Abstract
Introduction: Migration intentions among medical students signal potential loss of future health workforce capacity and are often interpreted through push–pull frameworks. While structural drivers are well known, individual-level factors within the educational environment remain underexplored. Emotional engagement, reflecting a sense of belonging and identification with the learning context, may act as a push factor influencing migration intentions.
Methods: In 2025, we conducted a cross-sectional study among 512 third-year medical students attending the Faculty of Medicine, University of Belgrade. Sociodemographic data were collected. Student engagement was assessed using the University Student Engagement Inventory (USEI), conceptualized as a higher-order construct with behavioral, emotional, and cognitive dimensions, measured by 15 items on a five-point Likert scale.
Results: Participants were mostly female (72.7%), with a mean age of 21.7±1.29 years. A substantial proportion reported intentions to work abroad (43.2% moderate, 28.9% high, and 8.0% actively planning). Engagement scores indicated high behavioral (3.64±0.7) and cognitive (3.82±0.82), but moderate emotional engagement (3.09±0.72). Lower emotional engagement was associated with higher odds of migration intentions (p = 0.016, OR = 1.659; 95% CI 1.099–2.504), whereas behavioral and cognitive engagement had no significant association. Students without a physician parent had a higher likelihood of migration intentions (p = 0.041, OR = 0.606; 95% CI, 0.375–0.979).
Conclusions: In our study, lower emotional engagement functions as an individual-level push factor shaping migration intentions. A reduced sense of belonging and professional identification may weaken early attachment to the local health system. Interventions that strengthen emotional engagement during training could represent an upstream strategy to support health workforce retention.
Key messages: • Lower emotional engagement among medical students is associated with higher migration intentions, indicating a potential early push factor for future health workforce loss.
• Students without a physician parent are more likely to report migration intentions, suggesting that the absence of professional role models may influence workforce retention.
Related
- Improving medical missions: A student and trainee tool for ethical engagement
- Localized Debriefing Assessment for Simulation in Healthcare (DASH): Medical Student Engagement and Debriefing Assessment Validity
- Public Health Cinema: Drivers of Medical Student Engagement in an Extracurricular Initiative
- Evaluating the associations of learning environment with student engagement and learning gains among undergraduate students at a medical university in western China
- Cardiovascular and psycho-emotional changes among completers of a medical student cohort with high loss to follow-up
BibTeX
@article{rajovic2026emotional,
title = {{Emotional Engagement as a Push Factor in Medical Student Migration Intentions}},
author = {N Rajovic and A Stevanovic and M Zdujic and O Milicevic and K Markovic and V Pavlovic and A Despotovic and J Todorovic},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1385},
url = {https://doi.org/10.1093/eurpub/ckag169.1385},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Emotional Engagement as a Push Factor in Medical Student Migration Intentions
AU - N Rajovic
AU - A Stevanovic
AU - M Zdujic
AU - O Milicevic
AU - K Markovic
AU - V Pavlovic
AU - A Despotovic
AU - J Todorovic
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1385
UR - https://doi.org/10.1093/eurpub/ckag169.1385
AB - Introduction: Migration intentions among medical students signal potential loss of future health workforce capacity and are often interpreted through push–pull frameworks. While structural drivers are well known, individual-level factors within the educational environment remain underexplored. Emotional engagement, reflecting a sense of belonging and identification with the learning context, may act as a push factor influencing migration intentions. Methods: In 2025, we conducted a cross-sectional study among 512 third-year medical students attending the Faculty of Medicine, University of Belgrade. Sociodemographic data were collected. Student engagement was assessed using the University Student Engagement Inventory (USEI), conceptualized as a higher-order construct with behavioral, emotional, and cognitive dimensions, measured by 15 items on a five-point Likert scale. Results: Participants were mostly female (72.7%), with a mean age of 21.7±1.29 years. A substantial proportion reported intentions to work abroad (43.2% moderate, 28.9% high, and 8.0% actively planning). Engagement scores indicated high behavioral (3.64±0.7) and cognitive (3.82±0.82), but moderate emotional engagement (3.09±0.72). Lower emotional engagement was associated with higher odds of migration intentions (p = 0.016, OR = 1.659; 95% CI 1.099–2.504), whereas behavioral and cognitive engagement had no significant association. Students without a physician parent had a higher likelihood of migration intentions (p = 0.041, OR = 0.606; 95% CI, 0.375–0.979). Conclusions: In our study, lower emotional engagement functions as an individual-level push factor shaping migration intentions. A reduced sense of belonging and professional identification may weaken early attachment to the local health system. Interventions that strengthen emotional engagement during training could represent an upstream strategy to support health workforce retention. Key messages: • Lower emotional engagement among medical students is associated with higher migration intentions, indicating a potential early push factor for future health workforce loss. • Students without a physician parent are more likely to report migration intentions, suggesting that the absence of professional role models may influence workforce retention.
SN - 1101-1262
SN - 1464-360X
ER -