Determinants of educational and career decisions as well as educational migration based on the example of medical students at the Medical University of Lodz

Career decisions are most often made when taking up higher education. This is particularly true for medical students, especially medical practice students. Many factors inﬂ uence the decisions made by young people. The subject literature mainly points to the importance of one’s own predisposition and interests, but also to the role of remuneration and the situation of a particular profession in the labor market. The case of people who take up the medical practice course of the


Introduction
The dynamics of the socio-economic changes currently taking place are forcing potential students to make well thought-out decisions regarding their future careers (Kubiciel-Lodzińska, 2014).This is particularly true for people who are planning to pursue medical professions, especially those intending to practice medicine in the future.As a rule, they are guided by a number of factors when deciding on their educational and career paths.Foreign literature, in particular, has demonstrated that they are generally guided by their interests and predispositions.The decision-making process of young people regarding the choice of university and educational migration (Rokita-Poskart, 2019;Rokita-Poskart, 2021;Rokita-Poskart and Adamska, 2022), i.e. the university city in which young medical students pursue their education, has also caught researchers' attention.Of particular interest are the motivations guiding young people in their decisions on the course of study, the university, and the university city when entering only the Polish Ministry of National Defense (MND) medical practice course provided by the Medical University of Lodz.The purpose of this paper is to demonstrate the motivations behind the educational and migration decisions of third-year students of the MND medical practice course provided as part of the quota of the MND at the Medical University of Lodz.These motivations were identifi ed during the pilot study carried out in late spring 2023.The choice of this particular course is justifi ed, because it is the only medical practice course in Poland provided as part of the MND quota, and students are treated as performing military service, with all the associated privileges (e.g. military emoluments, offi cer ranks upon graduation) and obligations (e.g.having to serve out free medical studies).The study was carried out using the diagnostic survey method in the form of a survey questionnaire consisting of over a dozen questions.They addressed many factors, including those related to the paper's objectives, i.e. factors related to choosing the medical practice course, determinants aff ecting the students' choice of the Medical University of Lodz and the city in which they continue their education.
The paper consists of several sections.The fi rst section presents a theoretical framework based on a review of the literature on educational and career decisions, as well as on the motivations behind the choice of a particular university center.The following section describes the research methodology and research tool, followed by a presentation of the main research results related to the paper's objectives.The paper is concluded with a brief summary.

Theoretical framework of the research
The literature highlights several important factors that infl uence the choice of the course of study, the university, and the university city.The analysis of the existing literature concerning the motivations for choices of studies demonstrates that interests are the primary determinant (Gardocka-Jałowiec, 2021;Jarecki, 2008;Michno and Lib, 2019).However, secondary school graduates increasingly pay attention not only to their interests and predispositions, but also to the opportunities in the labor market off ered by particular degrees (Heathcote et al., 2020;Hou and Lu, 2017;Nurul Liyana et al., 2019;Sedahmed and Noureldien, 2019).Other factors, such as advice from family and friends, also play a signifi cant role in choosing a course of study (Afaq Ahmed et al., 2017;Aryani and Umar, 2020;Duku et al., 2021).Similar conclusions can be drawn from the analysis of the most important factors that determine the choice of medical studies.The majority of the existing research points to the importance of career interests and predispositions (Gyimah et al., 2018), but also to prestige, development opportunities, and salary expectations (Kelleher et al., 2016;Subait et al., 2017).Family traditions and past experiences of family and friends are also important when deciding to pursue medicine-related courses (Kelleher et al., 2016;Subait et al., 2017;Verulava, 2022).
Researchers also emphasize the factors that determine the choice of university.They usually distinguish between two groups of determinants: one related to endogenous factors and the other to exogenous factors.The level of individual educational aspirations and examination results are listed among the most important endogenous factors (Adília and José, 2021).In general, the key motivations classifi ed as exogenous factors are those related to the university's reputation (its prestige), its placement in international rankings (Tamtekin Aydın, 2015), but also the availability of particular courses of study (Sedahmed and Noureldien, 2019).
It is also important to mention the available academic infrastructure, related to both studying (lecture rooms, laboratory equipment) and non-academic activities.In this case, the literature points to access to the accommodation off ered by universities, and less frequently to access to student canteens (Sedahmed and Noureldien, 2019;Tamtekin Aydın, 2015).
A review of the existing scientifi c literature demonstrated that the topic of the motivations behind the choice of educational migration is extremely rarely addressed.The choice of a specifi c university city is mostly analyzed in studies focusing on the choice of a particular university.However, the limited number of publications indicates that the choice of educational migration is aff ected by factors related to the city's features and its proximity to the place of residence (Li, 2020).The most important city features that aff ect the choice of a university city include its economic attractiveness, i.e., career opportunities and access to a developed labor market (Aryani and Umar, 2020;Li, 2020) as well as the city's appeal derived from the availability of culture, entertainment, and recreational areas (Li, 2020).Studies indicate that the university city's location in relation to the place of residence is extremely important (Li, 2020).Other authors also highlight factors such as the availability of student accommodation (Wilkins et al., 2012), the costs of living, and the city's academic atmosphere (Ahmad and Buchanan, 2017;Tamtekin Aydın, 2015).

Research methodology
The pilot study, which results are presented in the article, was conducted among students of the Medical University of Lodz.It preceded the main study and aimed to initially identify the determinants of the migration of medical practice students, but also to verify the validity of the survey questionnaire and its wording.The study organization procedure consisted of three stages: a literature analysis, development of the survey questionnaire in the second stage, and carrying out the study in the third stage.The pilot study took place in April 2023 and involved 29 third-year students of the MND medical practice course at the Medical University of Lodz (medical practice course as part of the quota set out by the Minister of National Defense).The study was conducted with the use of the diagnostic survey method in the form of a survey questionnaire consisting of 14 multiple-choice questions.In each question, the respondents had the option to provide their own answers, which would serve to complete the range of answers in the main study.A fi ve-point Likert scale was used for most of the questions in the questionnaire to assess the importance of a particular motivation to the respondent.The respondents evaluated each factor in a way that corresponded to their subjective feelings, i.e. from complete rejection to complete acceptance, while indicating whether the listed factors were "very important," "fairly important," "moderately important," "not very important" or "completely irrelevant."The survey questions addressed factors related to the students' choice of the course of study, determinants aff ecting their choice of the Medical University of Lodz and the city in which they continued their education.The respondents were also asked about their post-graduation plans regarding their place of work and residence, as well as the importance of particular factors in their planned internal and external migration.Additionally, the respondents were asked about their fi nancial expectations.
The study was carried out using the PAPI (pen and paper personal interview) technique, which involved a personal interview with respondents, using a paper questionnaire with the answers marked with a pen.The respondents surveyed during the study were selected using the snowball method.As mentioned earlier, the main objective of the pilot study was to verify the research issue, which concerned the main determinants of educational and professional choices as well as the internal and external migration of the students of the analyzed course of study.An additional objective was to study the respondents' reactions to the research issue and topic, verify the correct wording of the survey questions, detect any errors and verify the accuracy of the instructions for the respondents.

Determinants of educational migration
In this paper, only three of the survey questionnaire's questions were analyzed: the reasons for choosing the course of study, choosing the Medical University of Lodz, and the university city of Łódź (table 1).
The metrics section of the survey contained, among others, questions about the respondents' gender, age, and year of study.An analysis of this section showed that 59% of the respondents were women (17 persons), while 41% were men (12 persons).More than half, i.e., 59% of the respondents were aged 21-22 and 41% were aged 23-24.All respondents represented the third year of the MND medical practice course in Łódź, which resulted from the way the students were selected for the study.

Determinants of the choice of course of study
The analysis of the study's results regarding the reasons for choosing the course of study revealed that the interests of the respondents were the most important factor: a total of 86% of the respondents (25 persons) declared that interests were a very important factor for choosing the medical practice course, while 14% (4 persons) declared that interests were fairly important.Additionally, nearly 80% of the respondents (23 persons) declared that the physician's remuneration was a very important and fairly important factor, with only one person declaring this determinant as completely irrelevant.Regarding predisposition, 38% of the respondents (11 people) viewed it as a very important determinant for choosing the medical practice course, while 35% (10 people) declared that this factor was fairly important and 21% (6 people) declared it to be moderately important.The physician profession's prestige was considered by as many as 62% of the respondents (18 people) as a very important and fairly important factor, and only 14% (4 people) declared it to be not very important or completely irrelevant.As many as 83% of the respondents (24 people) declared that family traditions were completely irrelevant to them when choosing the course of study.The results of the pilot study confi rmed the previous research available in the literature on the reasons for choosing the course of study, where interests, predisposition, remuneration and the physician profession's prestige were among the key factors.All the answers obtained during the study, regarding the reasons respondents chose their courses of study are presented on a chart in Figure 1.Due to: 1) the high-quality learning facilities 2) the university's prestige -its high position in rankings 3) the MND medical practice course 4) high level of teaching 5) family/friends studied at the university in the past 6) family pressure 7) lower admission threshold at the MND medical practice course 8) the opportunity to be granted a scholarship 3 Why did you decide to take up studies in Łódź?
Due to: 1) the university 2) desire to study in close proximity to one's place of residence 3) the academic atmosphere in the city 4) studies taken by friends in the past 5) not being admitted to a university in a diff erent city 6) family living in the city 7) size of Łódź 8) lower living costs than in most academic centers Source: based on own research.

Determinants of the choice of university
The results of the pilot study clearly indicate that the main reason for choosing the Medical University of Lodz was the availability of the MND medical practice course at that university.This result is not surprising, because the study was carried out among students of this particular course.It is worth noting that the Medical University of Lodz is the only university in Poland that educates military physicians within the quota of the Ministry of Defense.During the MND medical practice course in Łódź, students are accommodated and fed free of charge at the Military Medical Training Center.All costs related to studies, accommodation and catering during the course are covered by the Ministry of National Defense.As many as 93% of the respondents (i.e., 27 out of 29 persons) declared that the existence of the MND medical practice course was of great importance to them when choosing a university, while the remaining 7% (2 respondents) considered it fairly important.Respondents also highly rated the learning facilities, the university's prestige (high position in rankings), the quality of teaching, and the opportunity to receive scholarships or emoluments.For 55% of the respondents (16 individuals), the possibility of receiving scholarships or emoluments was considered very important or fairly important.It is worth noting that in addition to covering the costs of accommodation, meals, and uniforms for MND medical practice course students, the Ministry of National Defense also provides them with a monthly basic emolument in accordance with the applicable fi nancial regulations (Medical University of Lodz, n.d.; www.wojsko-polskie.pl).
In addition to the nine defi ned answers in the questionnaire, one respondent provided their own answer in the "other" section: that it was very important to them to have free accommodation during the course.Although this factor likely holds greater importance, it is not yet possible to draw defi nitive conclusions at this stage of the study.Further analysis in the main survey would be necessary to examine this factor more extensively.Another important determinant in choosing the Medical University of Lodz was the lower admission threshold for the MND medical practice course compared to other prestigious medical universities in Poland.This diff erence in threshold is due to the more complex recruitment process for the MND medical practice course.Candidates applying for the Ministry of Defense's medical practice course must fulfi ll several requirements, including meeting formal criteria, passing a medical examination to receive a positive certifi cate from the military medical commission, obtaining a positive psychological certificate, and passing an English exam if the candidate did not take it during their secondary school fi nal exams.Additionally, candidates must successfully complete a fi tness test and an interview.At the initial stage of recruitment, a large selection of candidates is accepted and the results of the secondary school fi nal exams are not yet taken into account.After passing the fi rst stage of the recruitment process, the selected candidates undergo the second part based on the requirements of the Medical University of Lodz (Polish Army, 2023).It should be noted that civilian medical practice students only attend the fi nal part of the recruitment process.Furthermore, 28% of the respondents (8 people) declared that a very important and fairly important factor for choosing the Medical University of Lodz was that they weren't admitted to a diff erent university.The analysis of other answers in the survey shows that factors related to family pressure were not very important or 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% were completely irrelevant to the students, and the reason related to their friends or family having studied at the university in the past here was also completely irrelevant to them.The reasons for choosing the university are illustrated in detail on the chart in Figure 2.

Determinants of choosing Łódź as the university city
The pilot study revealed that the specifi c university was the primary reason for choosing the university city, according to the respondents.As many as 69% of the respondents (20 individuals) declared that this was a very important and fairly important reason for their decision.Although the survey did not include a separate answer for the question "choice of university city due to the MND medical practice course," 17% of the respondents (5 people) mentioned that the uniqueness of the MND medical practice course in Poland was the most important factor in selecting the university city.Furthermore, 38% (8 individuals) stated that not being admitted to a university in a diff erent city was a very important or fairly important reason for choosing the current university city.Additionally, 24% (7 individuals) considered studying close to their place of residence as a very important or fairly important factor.Other reasons for selecting the university city were deemed completely irrelevant, not very important or moderately important.The results of the pilot study clearly show that the respondents chose Łódź because of the Medical University and the MND medical practice course.Indeed, the answers provided by the respondents, who were exclusively MND medical practice course students, refl ect their specifi c goal of studying this particular course.It is highly probable that the responses to these questions would diff er if a group of civilian medical students were included in the sample for the main study.Civilian medical students may have diff erent motivations and considerations when choosing their universities and university cities, which could lead to varying responses.

Discussion
This study examines the factors infl uencing students' decision-making in the area of choices: the fi eld of medicine, the Medical University of Lodz, and the reasons for studying in the city of Łódź.The results of the authors' research indicate that several important issues are the dominant motivators of students' decisions.Although this pilot study had a relatively small sample size of 29 medical students at the Medical University of Lodz, the analysis of certain results confi rms fi ndings by other researchers on this topic.
As a rule, people who intend to pursue the medical profession are primarily guided by their interests and professional aptitude, but the prestige of the medical profession and the salary in this fi eld are also important (Heathcote et al., 2020;Hou and Lu, 2017;Nurul Liyana et al., 2019;Sedahmed and Noureldien, 2019).While our study found some similar important decision-making factors to those reported in the literature, some diff erences were also identifi ed (Kelleher et al., 2016;Subait et al., 2017;Verulava, 2022).The results of the survey conducted among medical students at the Medical University of Lodz indicate that family traditions were of little importance when they were deciding on their choice of major.
The most important factor for respondents in choosing the Medical University of Lodz is that it is the only medical school in Poland affi liated with the MND.The high-quality teaching facilities, prestige, ranking, and education level at the Medical University of Lodz were of key importance to respondents in choosing to attend the university.The results align with other studies available in the literature which similarly found these factors to be signifi cant in students' selection of a university (Tamtekin Aydın, 2015, Sedahmed andNoureldien, 2019).For some respondents, the lower admission threshold for the MND medical program was a signifi cant factor.
The primary reason why the respondents chose the city of Łódź was the specific university, likely because it hosts Poland's only MND medical program.Other factors impacting the choice of this university city were much less important to respondents.Unlike conclusions drawn in other studies, mainly from foreign literature, the results of this study on factors infl uencing the choice of academic city diff ered (Aryani and Umar, 2020;Li, 2020).It will be very interesting to see whether the results of this pilot study are confi rmed in larger follow-up research conducted on a bigger sample of medical students in Łódź.

Conclusions
The division of factors determining the choice of university into endogenous and exogenous determinants is a common approach in research.The pilot study shows that the most important exogenous determinants declared by the respondents included the availability of the specifi c course of study, the university's prestige, and its high position in rankings.The economic factor, i.e. the opportunity of being granted a scholarship/emolument, was also fairly important.On the other hand, the study also found that endogenous determinants including interests and predisposition, were crucial factors for the respondents.
The results of the pilot study indicate that economic factors played a relatively limited role in the respondents' educational and career choices as well as their decision to pursue educational migration.The importance of economic reasons was primarily observed in two aspects: the remuneration associated with the physician profession and the opportunity of being granted an emolument at the chosen university.
The fi ndings of the pilot study suggest that the reasons for choosing the MND medical practice course and Łódź as the university city were mostly the same.The choice of Łódź was basically only dictated by the existence of the MND medical practice course or (more rarely) not being admitted to the same course at a diff erent university.What might be the implications of such a situation for a university city?It seems that taking care to launch a prestigious or unique but desirable course of study brings considerable benefi ts.A city policy should therefore strongly emphasize the role of the university as an important stakeholder in local development, and the city authorities should actively participate in lobbying for the launch of prestigious courses and in creating the right climate for a university city.
The pilot study successfully achieved its additional objective of studying the respondents' reactions to the research issue and verifying the survey questionnaire.The feedback received from the respondents in the form of comments under each question provided valuable insights into the need for additional criteria to be included in the survey questionnaire.
The results obtained from the extended study, which includes both military and civilian medical students, can provide a more comprehensive understanding of the factors that infl uence the choice of university and university city.This insight can guide city authorities in actively supporting and promoting the development of such courses to attract students and foster local development.

Figure 1 .
Figure 1.Determinants of the choice of medical practice course Source: own elaboration based on own research.

Figure 2 .
Figure 2. Determinants of choosing the Medical University of Lodz as a place to study Source: own elaboration based on own research.

Figure 3 .
Figure 3. Determinants of choosing Łódź as the university city Source: own elaboration based on own research.

Table 1 .
Selected questions and answers contained in the survey