Emigration intentions of Egyptian medical students and early career physicians and their association with workplace violence

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Elkholi, Hajer Azzam, Rodayna Elnaggar, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9250179/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 17 You are reading this latest preprint version Abstract Background Egypt faces a critical physician shortage, exacerbated by emigration. It also reports one of the highest Workplace Violence (WPV) rates among Healthcare Workers (HCWs) in Africa (61.9%), with adverse effects on healthcare quality. However, the link between emigration intentions and WPV remains underexplored. This study aimed to determine the prevalence of emigration intentions among Egyptian medical students and early-career physicians and their association with WPV exposure. Methods A multicentric, cross-sectional study was conducted across 35 Egyptian universities. Data was collected from June to December 2024 using an online questionnaire covering sociodemographics, WPV, and emigration intentions. Participants were recruited through convenience sampling. Association between WPV and emigration intentions was tested using Chi-square test and multivariate binary logistic regression. Results Among 1,134 participants, 68.7% expressed emigration intentions. WPV exposure was reported by 72.3% of early-career physicians (n = 553) and 35.6% of medical students (n = 581). For medical students, emigration intentions were associated with witnessing WPV perpetrated by patients and senior physicians (both p < 0.05). Among early-career physicians, emigration intentions were linked to feelings of unsafety and exposure to WPV by patients and other HCWs ( p < 0.05). Significant predictors of emigration intentions included students’ witnessing of senior-perpetrated WPV (AOR: 1.69) and early-career physicians’ exposure to HCWs-perpetrated WPV (AOR: 1.82). Conclusion This study found a high prevalence of WPV exposure and emigration intentions among Egyptian medical students and early-career physicians. The significant association between WPV and emigration intentions necessitates WPV preventive measures to decrease emigration rates and the strain on Egypt’s healthcare system. Emigration and immigration Brain drain workplace violence physicians medical students Introduction Over the past decades, a significant number of healthcare workers (HCWs) have emigrated from their home countries in pursuit of better living standards, raising considerable concerns regarding the long-term consequences for developing nations, which often struggle to retain skilled health professionals [1]. The term "Brain Drain" consequently emerged to describe this critical phenomenon [2]. Brain drain significantly contributes to the global disparity in the distribution of HCWs, resulting in a critical shortage in regions burdened by high disease prevalence [3]. This shortage adversely impacts the functionality of public health systems, leading to the overburdening of healthcare staff, lowering the quality of healthcare services, and impairing health systems reforms and sustainability [3]. In Egypt, the rate of physician emigration is alarming: in 2020, the Egyptian Medical Syndicate announced that 56% of its registered physicians work abroad, and approximately 7,000 physicians emigrated in 2023 [4, 5]. This high emigration rate further exacerbated the existing physician shortage. Between 2016 and 2018, more than 5,000 Egyptian physicians resigned from the Ministry of Health and Population (MOHP), causing Egypt to lose around five percent of its workforce at the time. Concerningly, the number of resignations steadily increased over the years. In 2022 alone, 4621 physicians resigned from MOHP [5, 6]. Multiple studies identified the push and pull factors motivating HCWs, including physicians, to emigrate. Such factors included higher salaries, better working conditions, better career and training opportunities, access to resources and advanced technology, safer environment, improved living standards, and enhanced quality of life [4, 7, 8]. A factor that has been identified but not thoroughly studied yet is exposure to workplace violence (WPV). The Occupational Safety and Health Administration (OSHA) defines WPV as “any act or threat of physical violence, harassment, intimidation, or other threatening behavior that occurs at the work site. It ranges from threats and verbal abuse to physical assaults and even homicide” [9]. WPV is endemic in the healthcare setting around the globe. A previous systematic review found that 45.6% to 90% of primary HCWs were exposed to WPV [10]. Another umbrella review revealed that 58.7% of HCWs faced WPV [11]. In Africa the prevalence of WPV against HCWs ranges from 9% to 100%, with Egypt having the second highest WPV prevalence (ranging from 59.7% to 86.1%) [12]. The prevalence of WPV exposure is usually the highest among physicians [10, 13], and the commonest type of WPV is verbal violence [10, 11, 13–15]. Emergency setting is the site with the highest rates of WPV incidents [12, 15]. The majority of WPV incidents are perpetrated by patients and their relatives [10, 12–15]. The causes behind WPV usually are miscommunication between HCWs and patients, dissatisfaction with the medical service, healthcare staff shortage, patients’ culture, and lack of adequate security measures [14, 15]. WPV has a threatening impact on HCWs and healthcare systems. It decreases job productivity and job satisfaction, increases absenteeism and turnover intentions, leads to lower quality of care, increases the practice of defensive medicine, causes poor psychological well-being and burnout, and can result in physician injuries and, in severe cases, death [10, 12, 16, 17]. Nevertheless, there remains a significant underreporting of WPV incidents due to several factors, such as acceptance of WPV, fear of repercussion, lack of knowledge, absence of a reporting system, and lack of actions taken by authorities [18, 19]. Despite the abundance of research exploring brain drain and its driving factors, there is a scarcity of research specifically examining the relationship between WPV and emigration intentions. Previous studies have examined this relationship in the broader contexts of HCWs [20–22], but to the best of our knowledge, there has been no such research specifically conducted on physicians and only one study conducted on medical students [23]. Thus, the aim of this study is to measure emigration intentions prevalence and their association with WPV among medical students and early-career physicians (interns and residents) in Egypt. Methodology Study Setting and Design A multicentric descriptive cross-sectional study with an analytical component was conducted across 35 Egyptian universities between June 2024 and January 2025. The sampled universities represented the three university institutional types in Egypt: public universities, private universities, and Al-Azhar universities. Universities were selected based on the availability of research assistants to collect the data. Study Participants Participants were medical students in their clinical years (3rd, 4th, and 5th grades) and early-career physicians (interns and residents) affiliated with university hospitals. Exclusion criteria included medical students in pre-clinical years, specialists, consultants, and other healthcare professionals not encompassed by the aforementioned categories. Recruitment was done using a convenience sampling method where each selected university had at least one research assistant who disseminated the questionnaire through universities’ official communication channels (official university chat groups) and non-official communication channels (students' groups on social media platforms). Sample Size Sample size was calculated using Epi Info version 7.2.6. based on a population of 121,320 medical students and 57,224 interns and residents for the year 2022–2023 [24]. The calculation assumed a 5% margin of error, a 95% confidence level, and the prevalence of emigration intentions among our pilot study subjects (46.7% among students and 58% among early-career physicians). Consequently, the minimum calculated sample size was 381 students and 372 early-career physicians. In consideration of a potential 20% dropout rate, the final target sample size was adjusted to 458 medical students and 447 early-career physicians to ensure adequate statistical power. Data Collection Tools Data was collected using a structured questionnaire administered electronically via Google Forms. The questionnaire was based on a thorough literature search of previous studies conducted on WPV [25–27] and brain drain [26–28]. An English version of the questionnaire is provided as a supplementary file [see Online Resource 1]. The questionnaire comprised three main sections: sociodemographics, WPV exposure, and emigration intentions. The first section asked about socio-demographic characteristics, including gender, marital status, type and location of the university, current employment status, income levels from governmental sources, and additional income sources. The second section assessed participants’ exposure to WPV. In the study, WPV exposure was defined according to OSHA as “any act or threat of physical violence, harassment, intimidation, or other threatening behavior that occurs at the work site. It ranges from threats and verbal abuse to physical assaults and even homicide” [9]. Based on previous research on WPV [25–27] and the sociocultural context of Egyptian society, participants were asked whether they were exposed to the following WPV categories: WPV perpetrated by patients and relatives and WPV perpetrated by colleagues, seniors, or other HCWs. WPV perpetrated by patients and relatives included verbal violence (such as shouting, threatening, or insulting), physical violence (such as punching and kicking), sexual violence (including harassment and assault), equipment and tool damage, and attack with weapons or objects. WPV perpetrated by colleagues, seniors, or other HCWs included verbal violence, physical violence, sexual violence, prejudice (or negative attitude), discrimination, bullying, emotional manipulation, and retaliation. Finally, an “other” option was added for those who may have experienced a form of WPV that does not fall under the aforementioned WPV types. Questions administered to students slightly differed from those administered to early-career physicians. Undergraduate students reported whether they experienced WPV and the frequency of such experience, whether they witnessed WPV perpetrated by the patients or their relatives against early-career physicians and the type of this violence, and whether they witnessed WPV perpetrated by other HCWs against early-career physicians and the type of this violence. Early-career physicians reported their self-experienced WPV incidents, detailing types of violence, frequency of such incidents, nature of perpetrators, and the effect of WPV exposure. The third section was emigration intentions, which explored participants' intentions to emigrate, motivations for these intentions, any steps undertaken toward initiating the emigration process, the relationship between WPV exposure and their emigration intentions, their own perception of the relationship between WPV exposure and emigration intentions, and their suggestions on how to decrease emigration. A public health professional reviewed the questionnaire to evaluate its composition, comprehensiveness, and clarity. A pilot study was conducted on 30 undergraduate medical students and 31 early-career physicians. Feedback from this pilot study informed minor revisions to the questionnaire's wording and format, leading to the final version. The pilot data was not included in the analysis Statistical Analysis Statistical analysis was conducted using IBM SPSS software. Frequencies and percentages were used to summarize sociodemographics, exposure to WPV, and emigration intentions. Chi-square test was conducted to assess the significance of associations between emigration intentions and WPV as well as sociodemographic factors. Binary logistic regression was conducted to identify predictors of intention to emigrate. Crude and adjusted odds ratios and their 95% CI were calculated. A significance level was set at p -value < 0.05. Ethical considerations Our study protocol was approved by the Research Ethics Committee (REC) for human and animal research at the Faculty of Medicine, Helwan University (Serial: 81-2023). The study followed the standards of later modifications of the 1964 Declaration of Helsinki. The online form of the questionnaire collected informed consent from all the participants at its beginning. They were allowed to refuse to continue, and their data was used for research purposes only. Results Sociodemographic characteristics The study received complete responses from 1,134 respondents, of whom 581 were students and 553 were early-career physicians. Table 1 summarizes the sociodemographic characteristics of the 1,134 participants. More than half of the participants (56.7%) identified as female. The majority were single (86.5%), were enrolled in governmental universities (79%), and resided in urban governorates (42.2%). Among early-career physicians, 83.9% earned a monthly income between 2,000 and 10,000 EGP while a small proportion (1.1%) reported earning over 10,000 EGP per month. Furthermore, 27.8% of the participants acknowledged having additional sources of income. Table 1 Sociodemographic characteristics of students and early-career physicians (N = 1134) Sex Students (n = 581)* Early-career Physicians (n = 553)* Total (N = 1134)* Male 249 (42.9%) 242 (43.8%) 491 (43.3%) Female 332 (57.1%) 311 (56.2%) 643 (56.7%) Marital status Single 560 (96.4%) 421 (76.1%) 981 (86.5%) Engaged 17 (2.9%) 55 (9.9%) 72 (6.3%) Married 4 (0.7%) 72 (13.0%) 76 (6.7%) Divorced 0 (0%) 5 (0.9%) 5 (0.4%) University Governmental 417 (71.8%) 480 (86.8%) 897 (79.1%) Private 135 (23.2%) 33 (6.0%) 168 (14.8%) Azhar 29 (5.0%) 40 (7.2%) 69 (6.1%) Regions** Urban Governorates 247 (42.5%) 232 (42.0%) 479 (42.2%) Lower Egypt 168 (28.9%) 162 (29.3%) 330 (29.1%) Upper Egypt 166 (28.6%) 159 (28.8%) 325 (28.7%) Current monthly income from the government < 2000 EGP ( 10,000 EGP (> 213 USD) — 6 (1.1%) 6 (0.5%) Other sources of income Yes — 154 (27.8%) 154 (13.6%) No — 399 (72.2%) 399 (35.2%) *Percents are column-wise ** Lower Egypt is northern Egypt, and Upper Egypt is southern Egypt. Urban governorates refer to the four governorates with no rural agricultural areas: Cairo, Alexandria, Port Said, and Suez. WPV exposure Table 2 characterizes medical students' exposure to WPV [see Online Resource 2]. 67.6% witnessed violence perpetrated by patients or their relatives against physicians, and 60.4% observed violence committed by senior physicians against junior physicians. Verbal violence was the most reported form of WPV in both incidents committed by patients or their relatives and incidents committed by senior physicians as observed by 63.2% and 42.6% of medical students respectively. The second most prevalent WPV type was physical violence (27.5%) in case of incidents perpetrated by patients or their relatives and bullying (22.3%), closely followed by emotional manipulation (20.2%), in case of incidents perpetrated by senior physicians. It is noteworthy that the majority of students (64.4%) did not report any personal experiences of violence, and only 9.4% experienced WPV frequently (on a daily or weekly basis). Among those who experienced WPV, verbal violence was the commonest form (25.8%) followed by discrimination (10.2%). Table 3 details early-career physicians' personal experience of WPV [see Online Resource 2]. More than a third of the early-career physicians (38.3%) felt unsafe or very unsafe in their work setting, and more than a fourth (27.1%) expressed feeling intimidated or threatened with no tangible form of violence. Confirming students’ observations, a significant portion (72.3%) reported personally experiencing violence from patients or their relatives, and similarly a substantial 69.3% were subjected to violence from their colleagues, superiors, or other HCWs. In case of WPV incidents perpetrated by patients or their relatives, the most commonly experienced form of WPV was verbal abuse (64.2%) followed by physical violence (14.3%), matching students’ testimonies. A considerable number (22.8%) were exposed to WPV on a daily or weekly basis. Meanwhile, the commonest forms of WPV employed by other physicians and HCWs against early-career physicians were verbal violence (69.3%), adverse attitude (42.0%), and emotional manipulation (26.0%), again mirroring students' reports. Furthermore, 57.9% reported being compelled to work overtime. Expectedly, WPV adversely affected performance; 34.7% of early-career physicians admitted a decrease in their work efficiency, 21.7% experienced feelings of shame and guilt, and 11.2% missed some workdays. Only 5% sustained injuries. Emigration intentions Table 4 presents both medical students’ and early-career physicians’ emigration intentions as well as their emigration-related experiences and emigration attitudes [see Online Resource 2]. Regarding intentions to emigrate, 68.7% of the respondents considered leaving Egypt to pursue a healthcare career overseas. The majority (38.9%) had not determined the length of their stay abroad, and 22.2% did not intend to return to Egypt. Notably, 27.5% of participants reported having taken concrete steps toward emigration. Among those intending to emigrate, the most frequently cited motivations included the desire to improve future career prospects (85.4%), obtain better financial conditions (85.2%), enhance working conditions (82.5%), access training and development opportunities (64.4%), and improve lifestyle (56.5%). WPV was cited as a major reason for emigration by 25.2% of participants while 39% accounted it a contributing factor to their emigration decision. As for emigration-related experiences, 22.6% reported previous traveling experiences, primarily to attend conferences or seminars (27.7%), engage in exchange programs (27%), or participate in medical training (26.6%). Furthermore, 57.5% had future plans to undertake medical training or internship abroad. Regarding participants’ emigration attitudes, 73.5% believed that violence contributes to the physicians’ emigration. The majority of participants (82.7%) suggested improving working conditions and increasing salaries to decrease physicians’ emigration rates. Other recommended measures included enhancing education, training, and research opportunities (67.4%) and implementing WPV prevention policies (65.3%). Factors associated with emigration intentions Table 5 illustrates the association between medical students’ sociodemographics as well as WPV exposure with their emigration intentions, and Table 6 lists the significant predictors of their emigration intentions. Sex (p = 0.01), enrollment in governmental universities (p = 0.001) and private universities (p = 0.003), and residency in urban governorates (p = 0.02) and Upper Egypt (p < 0.001) were significantly associated with the presence of emigration intentions. Notably, while medical students’ emigration intentions were significantly linked to their witnessing of physicians’ exposure to WPV by patients or their relatives (p = 0.04) and senior physicians (p = 0.01), medical students’ personal experience of WPV was not (p = 0.06). As shown in Table 6 , however, upon performing multivariate binary regression, only the region of residency and the witnessing of junior physicians’ exposure to WPV by senior physicians were the significant predictors of emigration intentions. Residency in urban governorate (p < 0.001) and Lower Egypt (p = 0.01) were associated with higher likelihood of having emigration intentions as evidenced by an adjusted odds ratio (AOR) of 2.18 (95% CI: 1.43–3.34) and 1.85 (CI: 1.17–2.94), respectively. Medical students who witnessed senior physicians inflicting WPV on their junior colleagues were 1.69 times (95% CI: 1.17–2.42) more likely to intend to emigrate (p = 0.01). Despite bivariate regression analysis revealing witnessing of physicians’ exposure to WPV by patients or their relatives as a significant predictor of medical students’ emigration intentions, this significance was lost in multivariate binary regression. Table 5 Relation between sociodemographic factors and exposure to WPV on emigration intentions among students (N = 581) Presence of intention to work abroad (emigration intention) Yes No/No decision yet p -value N (%) N (%) Sociodemographic characteristics Sex 0.01* Male 188 (46.5%) 61 (34.5%) Female 216 (53.5%) 116 (65.5%) Marital status 0.1 Single 386 (95.5%) 174 (98.3%) Engaged/Married 18 (4.5%) 3 (1.7%) University 0.003* Governmental 273 (67.6%) 144 (81.4%) 0.001* Private 108 (26.7%) 27 (15.3%) 0.003* Azhar 23 (5.7%) 6 (3.4%) 0.24 Regions 0.001* Urban Governorates 185 (45.8%) 62 (35.0%) 0.02* Lower Egypt 122 (30.2%) 46 (26.0%) 0.3 Upper Egypt 97 (24.0%) 69 (39.0%) < 0.001* WPV exposure Personal witnessing of WPV incidents perpetrated by patients or their relatives against physicians 0.04* Yes 284 (70.3%) 109 (61.6%) No 120 (29.7%) 68 (38.4%) Personal witnessing of WPV incidents perpetrated by senior physicians towards junior physicians 0.01* Yes 259 (64.1%) 92 (52.0%) No 145 (35.9%) 85 (48.0%) Personal experience of any sort of WPV perpetrated by patients, their relatives, or other HCWs 0.06 Yes 154 (38.1%) 53 (29.9%) No 250 (61.9%) 124 (70.1%) *Significant ℅ calculated by column Table 6 Regression analysis of significant predictors of emigration intentions among students (N = 581) Variable Bivariate Regression Logistic Regression COR CI p -value AOR CI p -value Sex Male 1.655 1.147–2.388 0.01 Female ref ref ref Regions Urban Governorates 2.12 1.39–3.24 < 0.001 2.18 1.43–3.34 < 0.001 Lower Egypt 1.89 1.19–2.98 0.01 1.85 1.17–2.94 0.01 Upper Egypt ref ref ref ref ref ref Personal witnessing of WPV incidents perpetrated by patients or their relatives against physicians Yes 1.48 1.02–2.14 0.04 No ref ref ref Personal witnessing of WPV incidents perpetrated by senior physicians towards junior physicians Yes 1.65 1.15–2.36 0.01 1.69 1.17–2.42 0.01 No ref ref ref ref ref ref *Significant ref: reference Table 7 demonstrates the relationship between early-career physicians’ sociodemographics as well as their WPV experience with emigration intentions, and Table 8 lists the significant predictors of their emigration intentions. Significant factors influencing their emigration intentions included sex (p < 0.001), residency in urban governorates (p = 0.01) and Upper Egypt (p = 0.01), and additional sources of income (p < 0.001). The presence of emigration intentions was significantly related to feelings of unsafety (p = 0.01), feelings of intimidation (p = 0.004), experience of WPV from patients or their relatives (p = 0.001), working overtime (p = 0.01), and experience of WPV from other physicians and HCWs (p < 0.001). As shown in Table 8 , sex, additional source of income, and experience of WPV by other physicians and HCWs were the only significant predictors of early-career physicians’ emigration intentions. Male physicians and physicians with additional sources of income exhibited a significantly higher likelihood of intending to emigrate, quantified by an AOR of 1.82 (95% CI: 1.23–2.69, p = 0.003) and 1.98 (95% CI: 1.25–3.12, p = 0.004), respectively. Moreover, exposure to WPV from colleagues, seniors, or other HCWs was linked to an increased probability of emigration intentions in the adjusted model, with an AOR of 1.82 (95% CI: 1.21–2.73, p = 0.004), though this effect was slightly less pronounced than the one in the unadjusted model, which reported a crude odds ratio (COR) of 1.99 (95% CI: 1.37–2.91, p < 0.001). While region of residency, feelings of unsafety and intimidation, exposure to WPV by patients or their relatives, and working overtime were linked to an increased likelihood of emigration intentions in the unadjusted model, their effects lost significance in the adjusted model. Table 7 Relation between sociodemographic factors and exposure to WPV on emigration intentions among early-career physicians (N = 553) Presence of intention to work abroad (emigration intention) Yes No/No decision yet p -value N (%) N (%) Sociodemographic characteristics Sex < 0.001* Male 184 (49.1%) 58 (32.6%) Female 191 (50.9%) 120 (67.4%) Marital status 0.28 Single 282 (75.2%) 139 (78.1%) Engaged 35 (9.3%) 20 (11.2%) Married or previously married 58 (15.5%) 19 (10.7%) University 0.34 Governmental 320 (85.3%) 160 (89.9%) Private 25 (6.7%) 8 (4.5%) Azhar 30 (8.0%) 10 (5.6%) Regions 0.02* Urban Governorates 171 (45.6%) 61 (34.3%) 0.01* Lower Egypt 109 (29.1%) 53 (29.8%) 0.86 Upper Egypt 95 (25.3%) 64 (36.0%) 0.01* Current monthly income from the government 0.66 < 5000 EGP ( 5000 EGP (> 106 USD) 110 (29.3%) 49 (27.5%) Other sources of income < 0.001* Yes 122 (32.5%) 32 (18.0%) No 253 (67.5%) 146 (82.0%) WPV exposure Perception of safety in your current healthcare setting 0.01* Very unsafe 69 (18.4%) 18 (10.1%) 0.012* Unsafe 93 (24.8%) 32 (18.0%) 0.07 Neutral 136 (36.3%) 75 (42.1%) 0.18 Safe 58 (15.5%) 36 (20.2%) 0.16 Very safe 19 (5.1%) 17 (9.6%) .046* Feelings of intimidation or threats in your workplace without direct physical or verbal violence 0.004* Yes 117 (31.2%) 33 (18.5%) 0.002* No 122 (32.5%) 76 (42.7%) 0.02* Uncertain 136 (36.3%) 69 (38.8%) 0.57 Personal exposure to any sort of WPV perpetrated by patients or their relatives 0.001* Yes 287 (76.5%) 113 (63.5%) No 88 (23.5%) 65 (36.5%) Experience of working overtime against your will 0.01* Yes 232 (61.9%) 88 (49.4%) No 143 (38.1%) 90 (50.6%) Personal exposure to any sort of WPV perpetrated by colleagues, seniors, or other HCWs < 0.001* Yes 278 (74.1%) 105 (59.0%) No 97 (25.9%) 73 (41.0%) *Significant ℅ calculated by column Table 8 Regression analysis of significant predictors of emigration intentions among early-career physicians (N = 553) Variable Bivariate Regression Logistic Regression COR CI p -value AOR CI p -value Sex Male 1.99 1.37–2.90 < 0.001 1.82 1.23–2.69 0.003 Female ref ref ref ref ref ref Regions Urban Governorates 1.89 1.23–2.91 0.004 Upper Egypt ref ref ref Other sources of income Yes 2.20 1.42–3.41 < 0.001 1.98 1.25–3.12 0.004 No ref ref ref ref ref ref Perception of safety in your current healthcare setting Very unsafe 3.43 1.49–7.91 0.004 Unsafe 2.60 1.21–5.60 0.02 Very safe ref ref ref Feelings of intimidation or threats in your workplace without direct physical or verbal violence Yes 2.21 1.37–3.57 0.001 No ref ref ref Personal exposure to any sort of WPV perpetrated by patients or their relatives Yes 1.88 1.27–2.76 0.001 No ref ref ref Experience of working overtime against your will Yes 1.66 1.16–2.38 0.01 No ref ref ref Personal exposure to any sort of WPV perpetrated by colleagues, seniors, or other HCWs Yes 1.99 1.37–2.91 < 0.001 1.82 1.21–2.73 0.004 No ref ref ref ref ref ref *Significant ref: reference Discussion This study examined the relationship between WPV exposure and emigration intentions among medical students and early-career physicians. The majority of early-career physicians were personally subjected to various types of WPV, and most of the students witnessed such incidents. On the other hand, around a third of students have personally experienced WPV. Commonest form of WPV was verbal violence in both incidents perpetrated by patients or their relatives and incidents perpetrated by colleagues, seniors, or other HCWs. Exposure to WPV was associated with decreased productivity and feelings of shame and guilt among early-career physicians. The majority of participants, both students and physicians, expressed their desire to leave the country and pursue a medical career abroad, and a similarly significant number stated that WPV contributed to their decision. WPV perpetrated by colleagues and seniors played a bigger role in motivating physicians to emigrate than WPV perpetrated by patients or their relatives. Collectively, these findings revealed a high exposure of medical students and early-career physicians to WPV in the healthcare setting in Egypt, an equally high prevalence of emigration intentions amongst them, and a significant association between the two phenomena. In the current study, 72.3% of early-career physicians reported experiencing violence from patients or their relatives, and 69.3% reported experiencing violence from their colleagues or seniors. Our findings complement previous studies from Nepal [27], India [31], Saudi Arabia [25], China [32], and the USA [33], which reported a high prevalence of WPV among physicians—62.9%, 72%, 76%, 90.4%, and 96%, respectively. This demonstrates the high prevalence of WPV amongst physicians worldwide, regardless of socioeconomic status, necessitating interventions against this phenomenon. In Egypt, a multicentric study reported a WPV prevalence of 82.5% [34]. Other studies in the Egyptian cities of Tanta, Assiut, and Mansoura showed a prevalence of 56.4%, 78.2%, and 92.6%, respectively [26, 35, 36]. Therefore, these results highlight the high prevalence of WPV in the healthcare setting in Egypt, with a noticeable variation among different cities. Moreover, our results showed that the most common type of WPV perpetrated by patients or their relatives was verbal abuse (64.2%), followed by physical violence (14.3%). These results are slightly lesser than those reported in past research in Egypt, where verbal violence accounted for 76.5% to 88% of WPV incidents, while physical violence accounted for 21.4% to 60.3% [26, 34, 36, 37]. Similar trends have been observed in other countries, where 67% to 93.2% of physicians experienced verbal violence, while 3.2% to 48.24% of physicians experienced physical violence [25, 27, 31, 32]. On the contrary, a cross-sectional study at Multan, Pakistan, found that 34.75% of its subjects (HCWs) experienced physical violence, and 25% experienced verbal abuse [38]. Underlying causes behind patients perpetrating violence were usually poor communication, long waiting times, dissatisfaction with the medical service, and financial struggles [31, 32] Furthermore, the present findings revealed that 69.3% of physicians have experienced violence from colleagues or superiors, encompassing forms such as verbal abuse, bullying, or discrimination. This high prevalence is supported by earlier evidence demonstrating the rampancy of bullying, discrimination, and harassment in the healthcare setting across the globe [39, 40]. For example, a multicentric study on emergency department physicians found that 34.1% of its participants experienced violence from other healthcare staff [41]. Additionally, a national survey in the USA revealed that 85% of nurses experienced peer violence [42]. The violence committed by HCWs against each other can be attributed to the upholding of medical hierarchy, administration autocratic leadership style, stressful work environment, normalization of tough working conditions and bullying, and lack of workplace regulations enforcement [39, 43] Workplace violence negatively affected the performance, efficiency, and well-being of physicians. 34.7% of this study’s subjects reported a decrease in their work efficiency, and 21.7% experienced feelings of guilt related to these incidents. This aligns with previous research results in which exposure to WPV was associated with lower job performance and quality of care, work absenteeism, resignation or transfer to another workplace, lowered self-esteem, worsened mental health, and increased aggression toward patients [15, 27, 41]. Evidence from our analysis revealed that 67.6% of medical students witnessed violence directed at doctors from patients or their relatives, whilst 60.4% witnessed violence directed at junior doctors from the senior staff, and 35.6% personally experienced violence. Studies in Vietnam [44], China [45], Turkey [46], the USA [47], and Nigeria [48] yielded similar results. The exposure rates of medical students to WPV were 31.6%, 35.2%, 36.0%, 47.0%, and 62.5%. Accordingly, this exposure to violence could lead to depression symptoms, anxiety symptoms, suicidal ideation, alcohol dependence, excessive stress, fatigue, daytime sleepiness, academic burnout, and dropout [44, 49]. Approximately two-thirds of this study’s participants (68.7%) considered leaving Egypt for a healthcare career abroad, supporting a previous study in Egypt where 66.4% of physicians intended to work abroad [50]. Another study examining Egyptian medical students’ emigration intentions yielded similar results as 85.7% of its subjects desired to travel abroad for training, work, and research opportunities [29]. A third study conducted at Tanta and Kafrelsheikh medical schools in Egypt revealed that 89.4% of senior medical students and residents were willing to migrate [28]. Correspondingly, other studies in Low and Middle Income Countries (LMICs) revealed that 53% to 84.7% of medical students and 50% to 66% of physicians had emigration intentions [30, 51–56]. These findings are alarming since high emigration rates could lead to physician shortages, strain on the healthcare system, decreased quality of care, increased disease burden, and even economic losses in billions [3, 57, 58]. Of the study participants, 64.2% stated that WPV contributed to their emigration intentions. Specifically, emigration intentions among our sample were significantly associated with feelings of lack of safety; intimidation; exposure to WPV from patients, their relatives, colleagues, or senior physicians; and witnessing such incidents. In line with previous research, a study on medical students and residents in Egypt revealed that 55.5% of its subjects cited verbal violence and 35.4% cited physical assault as motivators for emigration [28]. In South Africa, 41.6% of medical students reported violence as one of the influencing factors on their emigration intentions, whilst in Turkey, 87% of medical students in a cross-sectional study listed verbal and physical violence as motivating factors to work abroad [52, 59]. Another study examining the push and pull factors of emigration intentions found that fear of violence was one of the main reasons behind emigration intentions for 68.3% of physicians [60]. Similar findings were reported in studies on other HCWs; for example, a cross-sectional study on 592 Ghanaian nurses discovered that nurses exposed to any type of violence were on average 2 times more likely to express intentions to emigrate [20]. Two other studies in Turkey revealed a positive significant association between WPV and intentions to emigrate among HCWs [21, 22]. On the contrary, a study examining the pull and push factors of brain drain among Egyptian physicians found no link between WPV exposure and migration intentions [50]. Furthermore, a study amongst HCWs in Turkey documented that individuals with a high fear of violence showed a reduced tendency for emigration. [61]. This paradoxical reduction can be attributed to the uncertainties and risks associated with migration itself. Specifically, HCWs with a greater fear of violence often prioritize remaining in the country because they recognize that while security threats may be temporary and manageable through the development of adaptive behaviors, the economic difficulties of emigration carry a long-term and ongoing impact. Consequently, financial concerns and economic conditions were found to exert a far greater influence on the brain drain phenomenon rather than security concerns alone [61]. Hence, the impact of WPV on emigration intentions is multifactorial; rather than a simple linear driver of brain drain, the economic and logistical risks of migration might supersede the desire to escape WPV. In the regression analysis unadjusted model, both violence from patients or relatives and violence from colleagues or seniors significantly predicted emigration intentions among early-career physicians. Interestingly, WPV perpetrated by colleagues or seniors was the more influencing factor as the crude odds ratio for colleague-perpetrated violence (COR 1.99) was higher than that for patient-perpetrated violence (COR 1.88). However, after adjustment for potential confounders, only violence perpetrated by colleagues or seniors remained a significant predictor. A similar pattern emerged among medical students in regression analysis; witnessing patient-perpetrated WPV and WPV perpetrated by senior physicians were both significant predictors of emigration intentions. The crude odds ratio for witnessing senior physician-perpetrated WPV (COR 1.65) exceeded that for witnessing patient-perpetrated WPV (COR 1.48). After adjustment, however, only witnessing senior physician-perpetrated WPV remained statistically significant. Accordingly, these findings indicate that WPV perpetrated by HCWs was a stronger driver of emigration intentions compared to WPV perpetrated by patients or relatives. This finding is unexpected given that patients and relatives account for the majority of WPV incidents in Egypt [34, 37]. One possible explanation is that physicians might have normalized patient-perpetrated violence, which often stems from rigid societal beliefs and norms. On the other hand, colleague-perpetrated violence may be perceived as more avoidable (stemming from unethical practices and weak policy enforcements) and therefore more compelling as a driver of emigration. In the current study, other reasons for emigration intentions included improving a future career (85.4%), better working conditions (82.5%), better financial conditions (85.2%), training and development opportunities (64.4%), and lifestyle considerations (56.2%). Similar motives for emigration were outlined in previous Egyptian studies, such as inadequate salary, increased workload, and better education and research opportunities [28, 50]. Research in other countries yielded similar results, where the most common causes of emigration intentions were difficult working conditions, inadequate pay, low quality of life, occupational health hazards, low quality of education, and lack of career-related opportunities [30, 52, 56, 62]. Thus, effective reduction of emigration intentions requires interventions targeting WPV in healthcare settings to be integrated with broader policy measures aiming to improve working conditions, salaries, educational opportunities, career development, and the availability of professional resources. To effectively prevent and mitigate WPV, previous research has recommended the addition of conflict management training into the undergraduate curricula and hospital training programs, improvement of communication HCWs and patients, conduction of public education, installation of strict security measures, reinforcement of reporting systems, and legislation and enforcement of deterrent laws [25, 27, 31]. Research conducted in Egypt emphasized the need for prompting public education and awareness campaigns about WPV, strengthening the security system, and training the healthcare staff [26, 36, 37]. To holistically decrease emigration intentions and tackle brain drain, numerous studies suggested several strategies, including strengthening education and training, improving working conditions, raising wages, offering career advancement opportunities, supporting medical research, involving HCWs in policy development, and fostering international collaborations [4, 57, 58, 64, 63]. Future research should focus on assessing and comparing the efficacy, efficiency, and sustainability of the aforementioned measures. Limitations and strengths This study acknowledges some potential limitations. Firstly, as this study focused on participants’ experiences and needed highly tailored questions, no validated questionnaires or scales were used. Secondly, participants’ response rate could not be documented because of the online nature of data collection where the questionnaire was sent through communication channels to an unspecified number. Thirdly, the study relied on self-reported data, which might have introduced recall bias or misunderstandings of the survey questions. Participants might have also provided socially desirable responses to create a favorable impression. Fourthly, convenience sampling may have introduced selection bias, as individuals with direct experiences of violence or strong views on emigration may have been more likely to participate, which could render our sample less representative of the targeted population limiting the generalizability of our findings. Fifthly, the cross-sectional design of this study captures data at a single point in time, limiting our ability to assess the long-term effects of violence on individuals or to track their migration experiences and outcomes post-migration. Additionally, this cross-sectional nature of the study restricts the establishment of a causal relationship between WPV and emigration intentions. Hence, incorporating a longitudinal approach could enhance the impact and depth of future research and enable the confirmation of cause-effect relationship. Despite the limitations, this study has several notable strengths. Being a multicentric study with a large sample size from different geographical regions enhances the generalizability of our findings. Secondly, our comprehensive questionnaire allowed for a deeper insight into the impact of WPV on physicians and how it relates to their choice of emigration. Thirdly, the inclusion of three target groups (medical students, interns, and residents) offered a holistic view of WVP and emigration intentions across successive professional stages of medicine in Egypt. Conclusion In conclusion, this study demonstrated a significant association between WPV exposure and emigration intentions among Egyptian medical students and early-career physicians. Among those affected, WPV emerged as a prominent driver of emigration intentions alongside financial and career prospects. These findings highlight the need for targeted institutional reforms that tackle WPV incidents. Such reforms should include strict security measures, robust safe reporting mechanisms, HCW training program, and law enforcement. These reforms should be coupled with strategies that aim to retain the healthcare workforce such as increasing wages and improving working conditions, ultimately leading to a safer, more stable, and more sustainable healthcare system. Additionally, further research using a more representative sample and longitudinal design is needed to establish a causal relationship between WPV and emigration intentions Declarations Ethical approval The Research Ethics Committee (REC) for human and animal research at the Faculty of Medicine, Helwan University gave ethical permission to conduct this study (Serial: 81-2023), and the Helsinki Declaration was adhered to throughout the study. Competing interest The authors have no competing interests to declare that are relevant to the content of this article. Funding No funding or sponsorship was received from any companies, groups, individuals, organizations, or any other entities. Data Availability The data of this study is available from the corresponding author upon reasonable request. Consent for publication Not applicable. Clinical trial number Not applicable Acknowledgements The authors would like to sincerely thank Mahmoud Abdelnaeim, Salma Magdy, Naomii Mohamed, Mariam Ahmed, and Nada Osama for their contribution in conceptualizing this research study. We offer our gratitude to Professor Abdel-Hady El-Gilany for his guidance in statistical analysis and results interpretation. We are also highly appreciative of Professor Abdel-Hady El-Gilany’s and Yusof Mohamed Omar’s revision of this manuscript. The authors are immensely grateful for the IFMSA-Egypt team of collaborators for collecting the data for this study. The members of the group are Ghofran Hamza, Mohamed Shokry, Nouran Sharaf, Osama Elsayed Mohammed, Taha Hafiz Ahmad, Rodina Elkhouly, Mai Al.Tijani Ahmed, Mahmoud Basha, Aya Elfar, Rana Attallah, Ziad Hamada, Hagar Ramadan, Jana Sadek, Mariam Saad, Yomna Abdalla, Mena Alemam, Antonios Gerges Takla, Eslam Elsaeed, Omar Magdy, Mahmoud Gomaa, and Aliaa Medhat Mahmoud. Author contributions The conception and initial research design of the study were done by Rowaydah Alaa. Final research design and protocol writing were done by Rowaydah Alaa, Menna A. Elkholi, Hajer Azzam, Rodayna Elnaggar, Yehia Nabil, Ahmed Hamed, Nareman Mohamed, and Nada Ali Omar. Questionnaire design and formulation was done by Rowaydah Alaa, Menna A. Elkholi, Hajer Azzam, Rodayna Elnaggar, Yehia Nabil, Ahmed Hamed, Nareman Mohamed, and Nada Ali Omar. Acquisition of data was done by IFMSA-Egypt team of collaborators. Data analysis and interpretation were done by Menna A. Elkholi and Hajer Azzam. The initial manuscript draft was written by Hajer Azzam, Rodayna Elnaggar, Yehia Nabil, Ahmed Hamed, and Nareman Mohamed. Final drafting and revision of the manuscript critically for important intellectual content was done by Rowaydah Alaa, Menna A. Elkholi, Hajer Azzam, Rodayna Elnaggar, and Yehia Nabil. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9250179","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":623363132,"identity":"f5c79e19-b906-4306-b77a-cd7e12136152","order_by":0,"name":"Rowaydah Alfiqi","email":"","orcid":"","institution":"Helwan University","correspondingAuthor":false,"prefix":"","firstName":"Rowaydah","middleName":"","lastName":"Alfiqi","suffix":""},{"id":623363133,"identity":"443df2c0-0b65-4715-9f7c-fe493ec5863c","order_by":1,"name":"Menna A. Elkholi","email":"data:image/png;base64,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","orcid":"","institution":"Mansoura University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Menna","middleName":"A.","lastName":"Elkholi","suffix":""},{"id":623363138,"identity":"3cc51180-23e4-4596-8498-4d0febe6a5a6","order_by":2,"name":"Hajer Azzam","email":"","orcid":"","institution":"Mansoura University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hajer","middleName":"","lastName":"Azzam","suffix":""},{"id":623363139,"identity":"934014c4-8823-474b-808e-ca5cc0756779","order_by":3,"name":"Rodayna Elnaggar","email":"","orcid":"","institution":"New Giza University","correspondingAuthor":false,"prefix":"","firstName":"Rodayna","middleName":"","lastName":"Elnaggar","suffix":""},{"id":623363140,"identity":"86473508-9ea2-4fd5-864b-4e67c2dafeb0","order_by":4,"name":"Yehia Nabil","email":"","orcid":"","institution":"Zagazig University","correspondingAuthor":false,"prefix":"","firstName":"Yehia","middleName":"","lastName":"Nabil","suffix":""},{"id":623363141,"identity":"eec6c552-c429-444d-a9e0-366e1a7ed65f","order_by":5,"name":"Ahmed Hamed","email":"","orcid":"","institution":"Cairo 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of","lastName":"collaborators","suffix":""},{"id":623363148,"identity":"d24dee63-52a2-4aba-87fa-bd42946e4038","order_by":9,"name":"Nelly Hegazy","email":"","orcid":"","institution":"Helwan University","correspondingAuthor":false,"prefix":"","firstName":"Nelly","middleName":"","lastName":"Hegazy","suffix":""}],"badges":[],"createdAt":"2026-03-28 06:24:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9250179/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9250179/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107059793,"identity":"b589dead-0e8e-427b-9e3a-47975a6f8172","added_by":"auto","created_at":"2026-04-16 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09:57:53","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":27371,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineResource2.docx","url":"https://assets-eu.researchsquare.com/files/rs-9250179/v1/493e5d078320094b2ed82517.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Emigration intentions of Egyptian medical students and early career physicians and their association with workplace violence","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOver the past decades, a significant number of healthcare workers (HCWs) have emigrated from their home countries in pursuit of better living standards, raising considerable concerns regarding the long-term consequences for developing nations, which often struggle to retain skilled health professionals [1]. The term \"Brain Drain\" consequently emerged to describe this critical phenomenon [2]. Brain drain significantly contributes to the global disparity in the distribution of HCWs, resulting in a critical shortage in regions burdened by high disease prevalence [3]. This shortage adversely impacts the functionality of public health systems, leading to the overburdening of healthcare staff, lowering the quality of healthcare services, and impairing health systems reforms and sustainability [3].\u003c/p\u003e \u003cp\u003eIn Egypt, the rate of physician emigration is alarming: in 2020, the Egyptian Medical Syndicate announced that 56% of its registered physicians work abroad, and approximately 7,000 physicians emigrated in 2023 [4, 5]. This high emigration rate further exacerbated the existing physician shortage. Between 2016 and 2018, more than 5,000 Egyptian physicians resigned from the Ministry of Health and Population (MOHP), causing Egypt to lose around five percent of its workforce at the time. Concerningly, the number of resignations steadily increased over the years. In 2022 alone, 4621 physicians resigned from MOHP [5, 6].\u003c/p\u003e \u003cp\u003eMultiple studies identified the push and pull factors motivating HCWs, including physicians, to emigrate. Such factors included higher salaries, better working conditions, better career and training opportunities, access to resources and advanced technology, safer environment, improved living standards, and enhanced quality of life [4, 7, 8]. A factor that has been identified but not thoroughly studied yet is exposure to workplace violence (WPV).\u003c/p\u003e \u003cp\u003eThe Occupational Safety and Health Administration (OSHA) defines WPV as \u0026ldquo;any act or threat of physical violence, harassment, intimidation, or other threatening behavior that occurs at the work site. It ranges from threats and verbal abuse to physical assaults and even homicide\u0026rdquo; [9]. WPV is endemic in the healthcare setting around the globe. A previous systematic review found that 45.6% to 90% of primary HCWs were exposed to WPV [10]. Another umbrella review revealed that 58.7% of HCWs faced WPV [11]. In Africa the prevalence of WPV against HCWs ranges from 9% to 100%, with Egypt having the second highest WPV prevalence (ranging from 59.7% to 86.1%) [12].\u003c/p\u003e \u003cp\u003eThe prevalence of WPV exposure is usually the highest among physicians [10, 13], and the commonest type of WPV is verbal violence [10, 11, 13\u0026ndash;15]. Emergency setting is the site with the highest rates of WPV incidents [12, 15]. The majority of WPV incidents are perpetrated by patients and their relatives [10, 12\u0026ndash;15]. The causes behind WPV usually are miscommunication between HCWs and patients, dissatisfaction with the medical service, healthcare staff shortage, patients\u0026rsquo; culture, and lack of adequate security measures [14, 15].\u003c/p\u003e \u003cp\u003eWPV has a threatening impact on HCWs and healthcare systems. It decreases job productivity and job satisfaction, increases absenteeism and turnover intentions, leads to lower quality of care, increases the practice of defensive medicine, causes poor psychological well-being and burnout, and can result in physician injuries and, in severe cases, death [10, 12, 16, 17]. Nevertheless, there remains a significant underreporting of WPV incidents due to several factors, such as acceptance of WPV, fear of repercussion, lack of knowledge, absence of a reporting system, and lack of actions taken by authorities [18, 19].\u003c/p\u003e \u003cp\u003eDespite the abundance of research exploring brain drain and its driving factors, there is a scarcity of research specifically examining the relationship between WPV and emigration intentions. Previous studies have examined this relationship in the broader contexts of HCWs [20\u0026ndash;22], but to the best of our knowledge, there has been no such research specifically conducted on physicians and only one study conducted on medical students [23]. Thus, the aim of this study is to measure emigration intentions prevalence and their association with WPV among medical students and early-career physicians (interns and residents) in Egypt.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Setting and Design\u003c/h2\u003e \u003cp\u003eA multicentric descriptive cross-sectional study with an analytical component was conducted across 35 Egyptian universities between June 2024 and January 2025. The sampled universities represented the three university institutional types in Egypt: public universities, private universities, and Al-Azhar universities. Universities were selected based on the availability of research assistants to collect the data.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Participants\u003c/h3\u003e\n\u003cp\u003eParticipants were medical students in their clinical years (3rd, 4th, and 5th grades) and early-career physicians (interns and residents) affiliated with university hospitals. Exclusion criteria included medical students in pre-clinical years, specialists, consultants, and other healthcare professionals not encompassed by the aforementioned categories. Recruitment was done using a convenience sampling method where each selected university had at least one research assistant who disseminated the questionnaire through universities\u0026rsquo; official communication channels (official university chat groups) and non-official communication channels (students' groups on social media platforms).\u003c/p\u003e\n\u003ch3\u003eSample Size\u003c/h3\u003e\n\u003cp\u003eSample size was calculated using Epi Info version 7.2.6. based on a population of 121,320 medical students and 57,224 interns and residents for the year 2022\u0026ndash;2023 [24]. The calculation assumed a 5% margin of error, a 95% confidence level, and the prevalence of emigration intentions among our pilot study subjects (46.7% among students and 58% among early-career physicians). Consequently, the minimum calculated sample size was 381 students and 372 early-career physicians. In consideration of a potential 20% dropout rate, the final target sample size was adjusted to 458 medical students and 447 early-career physicians to ensure adequate statistical power.\u003c/p\u003e\n\u003ch3\u003eData Collection Tools\u003c/h3\u003e\n\u003cp\u003eData was collected using a structured questionnaire administered electronically via Google Forms. The questionnaire was based on a thorough literature search of previous studies conducted on WPV [25\u0026ndash;27] and brain drain [26\u0026ndash;28]. An English version of the questionnaire is provided as a supplementary file [see Online Resource 1].\u003c/p\u003e \u003cp\u003eThe questionnaire comprised three main sections: sociodemographics, WPV exposure, and emigration intentions. The first section asked about socio-demographic characteristics, including gender, marital status, type and location of the university, current employment status, income levels from governmental sources, and additional income sources.\u003c/p\u003e \u003cp\u003eThe second section assessed participants\u0026rsquo; exposure to WPV. In the study, WPV exposure was defined according to OSHA as \u0026ldquo;any act or threat of physical violence, harassment, intimidation, or other threatening behavior that occurs at the work site. It ranges from threats and verbal abuse to physical assaults and even homicide\u0026rdquo; [9]. Based on previous research on WPV [25\u0026ndash;27] and the sociocultural context of Egyptian society, participants were asked whether they were exposed to the following WPV categories: WPV perpetrated by patients and relatives and WPV perpetrated by colleagues, seniors, or other HCWs. WPV perpetrated by patients and relatives included verbal violence (such as shouting, threatening, or insulting), physical violence (such as punching and kicking), sexual violence (including harassment and assault), equipment and tool damage, and attack with weapons or objects. WPV perpetrated by colleagues, seniors, or other HCWs included verbal violence, physical violence, sexual violence, prejudice (or negative attitude), discrimination, bullying, emotional manipulation, and retaliation. Finally, an \u0026ldquo;other\u0026rdquo; option was added for those who may have experienced a form of WPV that does not fall under the aforementioned WPV types.\u003c/p\u003e \u003cp\u003eQuestions administered to students slightly differed from those administered to early-career physicians. Undergraduate students reported whether they experienced WPV and the frequency of such experience, whether they witnessed WPV perpetrated by the patients or their relatives against early-career physicians and the type of this violence, and whether they witnessed WPV perpetrated by other HCWs against early-career physicians and the type of this violence. Early-career physicians reported their self-experienced WPV incidents, detailing types of violence, frequency of such incidents, nature of perpetrators, and the effect of WPV exposure.\u003c/p\u003e \u003cp\u003eThe third section was emigration intentions, which explored participants' intentions to emigrate, motivations for these intentions, any steps undertaken toward initiating the emigration process, the relationship between WPV exposure and their emigration intentions, their own perception of the relationship between WPV exposure and emigration intentions, and their suggestions on how to decrease emigration.\u003c/p\u003e \u003cp\u003eA public health professional reviewed the questionnaire to evaluate its composition, comprehensiveness, and clarity. A pilot study was conducted on 30 undergraduate medical students and 31 early-career physicians. Feedback from this pilot study informed minor revisions to the questionnaire's wording and format, leading to the final version. The pilot data was not included in the analysis\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was conducted using IBM SPSS software. Frequencies and percentages were used to summarize sociodemographics, exposure to WPV, and emigration intentions. Chi-square test was conducted to assess the significance of associations between emigration intentions and WPV as well as sociodemographic factors. Binary logistic regression was conducted to identify predictors of intention to emigrate. Crude and adjusted odds ratios and their 95% CI were calculated. A significance level was set at \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003eOur study protocol was approved by the Research Ethics Committee (REC) for human and animal research at the Faculty of Medicine, Helwan University (Serial: 81-2023). The study followed the standards of later modifications of the 1964 Declaration of Helsinki. The online form of the questionnaire collected informed consent from all the participants at its beginning. They were allowed to refuse to continue, and their data was used for research purposes only.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic characteristics\u003c/h2\u003e \u003cp\u003eThe study received complete responses from 1,134 respondents, of whom 581 were students and 553 were early-career physicians. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the sociodemographic characteristics of the 1,134 participants. More than half of the participants (56.7%) identified as female. The majority were single (86.5%), were enrolled in governmental universities (79%), and resided in urban governorates (42.2%). Among early-career physicians, 83.9% earned a monthly income between 2,000 and 10,000 EGP while a small proportion (1.1%) reported earning over 10,000 EGP per month. Furthermore, 27.8% of the participants acknowledged having additional sources of income.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of students and early-career physicians (N\u0026thinsp;=\u0026thinsp;1134)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudents (n\u0026thinsp;=\u0026thinsp;581)*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEarly-career Physicians (n\u0026thinsp;=\u0026thinsp;553)*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;1134)*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e249 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e242 (43.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e491 (43.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e332 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e311 (56.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e643 (56.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e560 (96.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e421 (76.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e981 (86.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEngaged\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (9.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72 (6.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (13.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUniversity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernmental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e417 (71.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e480 (86.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e897 (79.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e135 (23.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (6.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e168 (14.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAzhar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (5.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (7.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69 (6.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRegions**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban Governorates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e247 (42.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e232 (42.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e479 (42.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower Egypt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e168 (28.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e162 (29.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e330 (29.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper Egypt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e166 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e159 (28.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e325 (28.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCurrent monthly income from the government\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2000 EGP (\u0026lt;\u0026thinsp;43 USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83 (7.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2000\u0026ndash;5000 EGP (43\u0026ndash;106 USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e311 (56.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e311 (27.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5000-10,000 EGP (106\u0026ndash;213 USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e153 (27.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e153 (13.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10,000 EGP (\u0026gt;\u0026thinsp;213 USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (1.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther sources of income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e154 (27.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e154 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e399 (72.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e399 (35.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e*Percents are column-wise\u003c/p\u003e \u003cp\u003e** Lower Egypt is northern Egypt, and Upper Egypt is southern Egypt. Urban governorates refer to the four governorates with no rural agricultural areas: Cairo, Alexandria, Port Said, and Suez.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eWPV exposure\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;2 characterizes medical students' exposure to WPV [see Online Resource 2]. 67.6% witnessed violence perpetrated by patients or their relatives against physicians, and 60.4% observed violence committed by senior physicians against junior physicians. Verbal violence was the most reported form of WPV in both incidents committed by patients or their relatives and incidents committed by senior physicians as observed by 63.2% and 42.6% of medical students respectively. The second most prevalent WPV type was physical violence (27.5%) in case of incidents perpetrated by patients or their relatives and bullying (22.3%), closely followed by emotional manipulation (20.2%), in case of incidents perpetrated by senior physicians. It is noteworthy that the majority of students (64.4%) did not report any personal experiences of violence, and only 9.4% experienced WPV frequently (on a daily or weekly basis). Among those who experienced WPV, verbal violence was the commonest form (25.8%) followed by discrimination (10.2%).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;3 details early-career physicians' personal experience of WPV [see Online Resource 2]. More than a third of the early-career physicians (38.3%) felt unsafe or very unsafe in their work setting, and more than a fourth (27.1%) expressed feeling intimidated or threatened with no tangible form of violence. Confirming students\u0026rsquo; observations, a significant portion (72.3%) reported personally experiencing violence from patients or their relatives, and similarly a substantial 69.3% were subjected to violence from their colleagues, superiors, or other HCWs. In case of WPV incidents perpetrated by patients or their relatives, the most commonly experienced form of WPV was verbal abuse (64.2%) followed by physical violence (14.3%), matching students\u0026rsquo; testimonies. A considerable number (22.8%) were exposed to WPV on a daily or weekly basis. Meanwhile, the commonest forms of WPV employed by other physicians and HCWs against early-career physicians were verbal violence (69.3%), adverse attitude (42.0%), and emotional manipulation (26.0%), again mirroring students' reports. Furthermore, 57.9% reported being compelled to work overtime. Expectedly, WPV adversely affected performance; 34.7% of early-career physicians admitted a decrease in their work efficiency, 21.7% experienced feelings of shame and guilt, and 11.2% missed some workdays. Only 5% sustained injuries.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eEmigration intentions\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;4 presents both medical students\u0026rsquo; and early-career physicians\u0026rsquo; emigration intentions as well as their emigration-related experiences and emigration attitudes [see Online Resource 2]. Regarding intentions to emigrate, 68.7% of the respondents considered leaving Egypt to pursue a healthcare career overseas. The majority (38.9%) had not determined the length of their stay abroad, and 22.2% did not intend to return to Egypt. Notably, 27.5% of participants reported having taken concrete steps toward emigration. Among those intending to emigrate, the most frequently cited motivations included the desire to improve future career prospects (85.4%), obtain better financial conditions (85.2%), enhance working conditions (82.5%), access training and development opportunities (64.4%), and improve lifestyle (56.5%). WPV was cited as a major reason for emigration by 25.2% of participants while 39% accounted it a contributing factor to their emigration decision.\u003c/p\u003e \u003cp\u003eAs for emigration-related experiences, 22.6% reported previous traveling experiences, primarily to attend conferences or seminars (27.7%), engage in exchange programs (27%), or participate in medical training (26.6%). Furthermore, 57.5% had future plans to undertake medical training or internship abroad. Regarding participants\u0026rsquo; emigration attitudes, 73.5% believed that violence contributes to the physicians\u0026rsquo; emigration. The majority of participants (82.7%) suggested improving working conditions and increasing salaries to decrease physicians\u0026rsquo; emigration rates. Other recommended measures included enhancing education, training, and research opportunities (67.4%) and implementing WPV prevention policies (65.3%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with emigration intentions\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e5\u003c/span\u003e illustrates the association between medical students\u0026rsquo; sociodemographics as well as WPV exposure with their emigration intentions, and Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e6\u003c/span\u003e lists the significant predictors of their emigration intentions. Sex (p\u0026thinsp;=\u0026thinsp;0.01), enrollment in governmental universities (p\u0026thinsp;=\u0026thinsp;0.001) and private universities (p\u0026thinsp;=\u0026thinsp;0.003), and residency in urban governorates (p\u0026thinsp;=\u0026thinsp;0.02) and Upper Egypt (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly associated with the presence of emigration intentions. Notably, while medical students\u0026rsquo; emigration intentions were significantly linked to their witnessing of physicians\u0026rsquo; exposure to WPV by patients or their relatives (p\u0026thinsp;=\u0026thinsp;0.04) and senior physicians (p\u0026thinsp;=\u0026thinsp;0.01), medical students\u0026rsquo; personal experience of WPV was not (p\u0026thinsp;=\u0026thinsp;0.06).\u003c/p\u003e \u003cp\u003eAs shown in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e6\u003c/span\u003e, however, upon performing multivariate binary regression, only the region of residency and the witnessing of junior physicians\u0026rsquo; exposure to WPV by senior physicians were the significant predictors of emigration intentions. Residency in urban governorate (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and Lower Egypt (p\u0026thinsp;=\u0026thinsp;0.01) were associated with higher likelihood of having emigration intentions as evidenced by an adjusted odds ratio (AOR) of 2.18 (95% CI: 1.43\u0026ndash;3.34) and 1.85 (CI: 1.17\u0026ndash;2.94), respectively. Medical students who witnessed senior physicians inflicting WPV on their junior colleagues were 1.69 times (95% CI: 1.17\u0026ndash;2.42) more likely to intend to emigrate (p\u0026thinsp;=\u0026thinsp;0.01). Despite bivariate regression analysis revealing witnessing of physicians\u0026rsquo; exposure to WPV by patients or their relatives as a significant predictor of medical students\u0026rsquo; emigration intentions, this significance was lost in multivariate binary regression.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelation between sociodemographic factors and exposure to WPV on emigration intentions among students (N\u0026thinsp;=\u0026thinsp;581)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePresence of intention to work abroad (emigration intention)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo/No decision yet\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSociodemographic characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.01*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e188 (46.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (34.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e216 (53.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116 (65.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e386 (95.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e174 (98.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEngaged/Married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUniversity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.003*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernmental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e273 (67.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e144 (81.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (15.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.003*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAzhar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (5.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.24\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRegions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban Governorates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e185 (45.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (35.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.02*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower Egypt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (30.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (26.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper Egypt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (24.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (39.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWPV exposure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePersonal witnessing of WPV incidents perpetrated by patients or their relatives against physicians\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.04*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e284 (70.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (61.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120 (29.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (38.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePersonal witnessing of WPV incidents perpetrated by senior physicians towards junior physicians\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.01*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e259 (64.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92 (52.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e145 (35.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85 (48.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePersonal experience of any sort of WPV perpetrated by patients, their relatives, or other HCWs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154 (38.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (29.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e250 (61.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124 (70.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e*Significant\u003c/p\u003e \u003cp\u003e℅ calculated by column\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRegression analysis of significant predictors of emigration intentions among students (N\u0026thinsp;=\u0026thinsp;581)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBivariate Regression\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eLogistic Regression\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.147\u0026ndash;2.388\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRegions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban Governorates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.39\u0026ndash;3.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.43\u0026ndash;3.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower Egypt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.19\u0026ndash;2.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.17\u0026ndash;2.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper Egypt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePersonal witnessing of WPV incidents perpetrated by patients or their relatives against physicians\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.02\u0026ndash;2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePersonal witnessing of WPV incidents perpetrated by senior physicians towards junior physicians\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.15\u0026ndash;2.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.17\u0026ndash;2.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e*Significant\u003c/p\u003e \u003cp\u003eref: reference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e7\u003c/span\u003e demonstrates the relationship between early-career physicians\u0026rsquo; sociodemographics as well as their WPV experience with emigration intentions, and Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e8\u003c/span\u003e lists the significant predictors of their emigration intentions. Significant factors influencing their emigration intentions included sex (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), residency in urban governorates (p\u0026thinsp;=\u0026thinsp;0.01) and Upper Egypt (p\u0026thinsp;=\u0026thinsp;0.01), and additional sources of income (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The presence of emigration intentions was significantly related to feelings of unsafety (p\u0026thinsp;=\u0026thinsp;0.01), feelings of intimidation (p\u0026thinsp;=\u0026thinsp;0.004), experience of WPV from patients or their relatives (p\u0026thinsp;=\u0026thinsp;0.001), working overtime (p\u0026thinsp;=\u0026thinsp;0.01), and experience of WPV from other physicians and HCWs (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eAs shown in Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e8\u003c/span\u003e, sex, additional source of income, and experience of WPV by other physicians and HCWs were the only significant predictors of early-career physicians\u0026rsquo; emigration intentions. Male physicians and physicians with additional sources of income exhibited a significantly higher likelihood of intending to emigrate, quantified by an AOR of 1.82 (95% CI: 1.23\u0026ndash;2.69, p\u0026thinsp;=\u0026thinsp;0.003) and 1.98 (95% CI: 1.25\u0026ndash;3.12, p\u0026thinsp;=\u0026thinsp;0.004), respectively. Moreover, exposure to WPV from colleagues, seniors, or other HCWs was linked to an increased probability of emigration intentions in the adjusted model, with an AOR of 1.82 (95% CI: 1.21\u0026ndash;2.73, p\u0026thinsp;=\u0026thinsp;0.004), though this effect was slightly less pronounced than the one in the unadjusted model, which reported a crude odds ratio (COR) of 1.99 (95% CI: 1.37\u0026ndash;2.91, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eWhile region of residency, feelings of unsafety and intimidation, exposure to WPV by patients or their relatives, and working overtime were linked to an increased likelihood of emigration intentions in the unadjusted model, their effects lost significance in the adjusted model.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelation between sociodemographic factors and exposure to WPV on emigration intentions among early-career physicians (N\u0026thinsp;=\u0026thinsp;553)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePresence of intention to work abroad (emigration intention)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo/No decision yet\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSociodemographic characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e184 (49.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (32.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e191 (50.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120 (67.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e282 (75.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139 (78.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEngaged\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (11.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried or previously married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (10.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUniversity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernmental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e320 (85.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e160 (89.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAzhar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (8.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRegions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.02*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban Governorates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e171 (45.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (34.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.01*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower Egypt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109 (29.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (29.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper Egypt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95 (25.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (36.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.01*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCurrent monthly income from the government\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5000 EGP (\u0026lt;\u0026thinsp;106 USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e265 (70.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129 (72.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5000 EGP (\u0026gt;\u0026thinsp;106 USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110 (29.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (27.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther sources of income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (32.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e253 (67.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146 (82.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWPV exposure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerception of safety in your current healthcare setting\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.01*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery unsafe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (18.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (10.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.012*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnsafe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93 (24.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e136 (36.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (42.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSafe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery safe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (5.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (9.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.046*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFeelings of intimidation or threats in your workplace without direct physical or verbal violence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.004*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117 (31.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (18.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (32.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76 (42.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.02*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUncertain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e136 (36.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (38.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePersonal exposure to any sort of WPV perpetrated by patients or their relatives\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e287 (76.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113 (63.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88 (23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65 (36.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExperience of working overtime against your will\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.01*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e232 (61.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (49.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e143 (38.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (50.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePersonal exposure to any sort of WPV perpetrated by colleagues, seniors, or other HCWs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e278 (74.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105 (59.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (25.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73 (41.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e*Significant\u003c/p\u003e \u003cp\u003e℅ calculated by column\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRegression analysis of significant predictors of emigration intentions among early-career physicians (N\u0026thinsp;=\u0026thinsp;553)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBivariate Regression\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eLogistic Regression\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.37\u0026ndash;2.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.23\u0026ndash;2.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRegions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban Governorates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.23\u0026ndash;2.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper Egypt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther sources of income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.42\u0026ndash;3.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.25\u0026ndash;3.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerception of safety in your current healthcare setting\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery unsafe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.49\u0026ndash;7.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnsafe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.21\u0026ndash;5.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery safe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFeelings of intimidation or threats in your workplace without direct physical or verbal violence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.37\u0026ndash;3.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePersonal exposure to any sort of WPV perpetrated by patients or their relatives\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.27\u0026ndash;2.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExperience of working overtime against your will\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.16\u0026ndash;2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePersonal exposure to any sort of WPV perpetrated by colleagues, seniors, or other HCWs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.37\u0026ndash;2.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.21\u0026ndash;2.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e*Significant\u003c/p\u003e \u003cp\u003eref: reference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined the relationship between WPV exposure and emigration intentions among medical students and early-career physicians. The majority of early-career physicians were personally subjected to various types of WPV, and most of the students witnessed such incidents. On the other hand, around a third of students have personally experienced WPV. Commonest form of WPV was verbal violence in both incidents perpetrated by patients or their relatives and incidents perpetrated by colleagues, seniors, or other HCWs. Exposure to WPV was associated with decreased productivity and feelings of shame and guilt among early-career physicians. The majority of participants, both students and physicians, expressed their desire to leave the country and pursue a medical career abroad, and a similarly significant number stated that WPV contributed to their decision. WPV perpetrated by colleagues and seniors played a bigger role in motivating physicians to emigrate than WPV perpetrated by patients or their relatives. Collectively, these findings revealed a high exposure of medical students and early-career physicians to WPV in the healthcare setting in Egypt, an equally high prevalence of emigration intentions amongst them, and a significant association between the two phenomena.\u003c/p\u003e \u003cp\u003eIn the current study, 72.3% of early-career physicians reported experiencing violence from patients or their relatives, and 69.3% reported experiencing violence from their colleagues or seniors. Our findings complement previous studies from Nepal [27], India [31], Saudi Arabia [25], China [32], and the USA [33], which reported a high prevalence of WPV among physicians\u0026mdash;62.9%, 72%, 76%, 90.4%, and 96%, respectively. This demonstrates the high prevalence of WPV amongst physicians worldwide, regardless of socioeconomic status, necessitating interventions against this phenomenon. In Egypt, a multicentric study reported a WPV prevalence of 82.5% [34]. Other studies in the Egyptian cities of Tanta, Assiut, and Mansoura showed a prevalence of 56.4%, 78.2%, and 92.6%, respectively [26, 35, 36]. Therefore, these results highlight the high prevalence of WPV in the healthcare setting in Egypt, with a noticeable variation among different cities.\u003c/p\u003e \u003cp\u003eMoreover, our results showed that the most common type of WPV perpetrated by patients or their relatives was verbal abuse (64.2%), followed by physical violence (14.3%). These results are slightly lesser than those reported in past research in Egypt, where verbal violence accounted for 76.5% to 88% of WPV incidents, while physical violence accounted for 21.4% to 60.3% [26, 34, 36, 37]. Similar trends have been observed in other countries, where 67% to 93.2% of physicians experienced verbal violence, while 3.2% to 48.24% of physicians experienced physical violence [25, 27, 31, 32]. On the contrary, a cross-sectional study at Multan, Pakistan, found that 34.75% of its subjects (HCWs) experienced physical violence, and 25% experienced verbal abuse [38]. Underlying causes behind patients perpetrating violence were usually poor communication, long waiting times, dissatisfaction with the medical service, and financial struggles [31, 32]\u003c/p\u003e \u003cp\u003eFurthermore, the present findings revealed that 69.3% of physicians have experienced violence from colleagues or superiors, encompassing forms such as verbal abuse, bullying, or discrimination. This high prevalence is supported by earlier evidence demonstrating the rampancy of bullying, discrimination, and harassment in the healthcare setting across the globe [39, 40]. For example, a multicentric study on emergency department physicians found that 34.1% of its participants experienced violence from other healthcare staff [41]. Additionally, a national survey in the USA revealed that 85% of nurses experienced peer violence [42]. The violence committed by HCWs against each other can be attributed to the upholding of medical hierarchy, administration autocratic leadership style, stressful work environment, normalization of tough working conditions and bullying, and lack of workplace regulations enforcement [39, 43]\u003c/p\u003e \u003cp\u003eWorkplace violence negatively affected the performance, efficiency, and well-being of physicians. 34.7% of this study\u0026rsquo;s subjects reported a decrease in their work efficiency, and 21.7% experienced feelings of guilt related to these incidents. This aligns with previous research results in which exposure to WPV was associated with lower job performance and quality of care, work absenteeism, resignation or transfer to another workplace, lowered self-esteem, worsened mental health, and increased aggression toward patients [15, 27, 41].\u003c/p\u003e \u003cp\u003eEvidence from our analysis revealed that 67.6% of medical students witnessed violence directed at doctors from patients or their relatives, whilst 60.4% witnessed violence directed at junior doctors from the senior staff, and 35.6% personally experienced violence. Studies in Vietnam [44], China [45], Turkey [46], the USA [47], and Nigeria [48] yielded similar results. The exposure rates of medical students to WPV were 31.6%, 35.2%, 36.0%, 47.0%, and 62.5%. Accordingly, this exposure to violence could lead to depression symptoms, anxiety symptoms, suicidal ideation, alcohol dependence, excessive stress, fatigue, daytime sleepiness, academic burnout, and dropout [44, 49].\u003c/p\u003e \u003cp\u003eApproximately two-thirds of this study\u0026rsquo;s participants (68.7%) considered leaving Egypt for a healthcare career abroad, supporting a previous study in Egypt where 66.4% of physicians intended to work abroad [50]. Another study examining Egyptian medical students\u0026rsquo; emigration intentions yielded similar results as 85.7% of its subjects desired to travel abroad for training, work, and research opportunities [29]. A third study conducted at Tanta and Kafrelsheikh medical schools in Egypt revealed that 89.4% of senior medical students and residents were willing to migrate [28]. Correspondingly, other studies in Low and Middle Income Countries (LMICs) revealed that 53% to 84.7% of medical students and 50% to 66% of physicians had emigration intentions [30, 51\u0026ndash;56]. These findings are alarming since high emigration rates could lead to physician shortages, strain on the healthcare system, decreased quality of care, increased disease burden, and even economic losses in billions [3, 57, 58].\u003c/p\u003e \u003cp\u003eOf the study participants, 64.2% stated that WPV contributed to their emigration intentions. Specifically, emigration intentions among our sample were significantly associated with feelings of lack of safety; intimidation; exposure to WPV from patients, their relatives, colleagues, or senior physicians; and witnessing such incidents. In line with previous research, a study on medical students and residents in Egypt revealed that 55.5% of its subjects cited verbal violence and 35.4% cited physical assault as motivators for emigration [28]. In South Africa, 41.6% of medical students reported violence as one of the influencing factors on their emigration intentions, whilst in Turkey, 87% of medical students in a cross-sectional study listed verbal and physical violence as motivating factors to work abroad [52, 59]. Another study examining the push and pull factors of emigration intentions found that fear of violence was one of the main reasons behind emigration intentions for 68.3% of physicians [60]. Similar findings were reported in studies on other HCWs; for example, a cross-sectional study on 592 Ghanaian nurses discovered that nurses exposed to any type of violence were on average 2 times more likely to express intentions to emigrate [20]. Two other studies in Turkey revealed a positive significant association between WPV and intentions to emigrate among HCWs [21, 22].\u003c/p\u003e \u003cp\u003eOn the contrary, a study examining the pull and push factors of brain drain among Egyptian physicians found no link between WPV exposure and migration intentions [50]. Furthermore, a study amongst HCWs in Turkey documented that individuals with a high fear of violence showed a reduced tendency for emigration. [61]. This paradoxical reduction can be attributed to the uncertainties and risks associated with migration itself. Specifically, HCWs with a greater fear of violence often prioritize remaining in the country because they recognize that while security threats may be temporary and manageable through the development of adaptive behaviors, the economic difficulties of emigration carry a long-term and ongoing impact. Consequently, financial concerns and economic conditions were found to exert a far greater influence on the brain drain phenomenon rather than security concerns alone [61]. Hence, the impact of WPV on emigration intentions is multifactorial; rather than a simple linear driver of brain drain, the economic and logistical risks of migration might supersede the desire to escape WPV.\u003c/p\u003e \u003cp\u003eIn the regression analysis unadjusted model, both violence from patients or relatives and violence from colleagues or seniors significantly predicted emigration intentions among early-career physicians. Interestingly, WPV perpetrated by colleagues or seniors was the more influencing factor as the crude odds ratio for colleague-perpetrated violence (COR 1.99) was higher than that for patient-perpetrated violence (COR 1.88). However, after adjustment for potential confounders, only violence perpetrated by colleagues or seniors remained a significant predictor. A similar pattern emerged among medical students in regression analysis; witnessing patient-perpetrated WPV and WPV perpetrated by senior physicians were both significant predictors of emigration intentions. The crude odds ratio for witnessing senior physician-perpetrated WPV (COR 1.65) exceeded that for witnessing patient-perpetrated WPV (COR 1.48). After adjustment, however, only witnessing senior physician-perpetrated WPV remained statistically significant. Accordingly, these findings indicate that WPV perpetrated by HCWs was a stronger driver of emigration intentions compared to WPV perpetrated by patients or relatives. This finding is unexpected given that patients and relatives account for the majority of WPV incidents in Egypt [34, 37]. One possible explanation is that physicians might have normalized patient-perpetrated violence, which often stems from rigid societal beliefs and norms. On the other hand, colleague-perpetrated violence may be perceived as more avoidable (stemming from unethical practices and weak policy enforcements) and therefore more compelling as a driver of emigration.\u003c/p\u003e \u003cp\u003eIn the current study, other reasons for emigration intentions included improving a future career (85.4%), better working conditions (82.5%), better financial conditions (85.2%), training and development opportunities (64.4%), and lifestyle considerations (56.2%). Similar motives for emigration were outlined in previous Egyptian studies, such as inadequate salary, increased workload, and better education and research opportunities [28, 50]. Research in other countries yielded similar results, where the most common causes of emigration intentions were difficult working conditions, inadequate pay, low quality of life, occupational health hazards, low quality of education, and lack of career-related opportunities [30, 52, 56, 62]. Thus, effective reduction of emigration intentions requires interventions targeting WPV in healthcare settings to be integrated with broader policy measures aiming to improve working conditions, salaries, educational opportunities, career development, and the availability of professional resources.\u003c/p\u003e \u003cp\u003eTo effectively prevent and mitigate WPV, previous research has recommended the addition of conflict management training into the undergraduate curricula and hospital training programs, improvement of communication HCWs and patients, conduction of public education, installation of strict security measures, reinforcement of reporting systems, and legislation and enforcement of deterrent laws [25, 27, 31]. Research conducted in Egypt emphasized the need for prompting public education and awareness campaigns about WPV, strengthening the security system, and training the healthcare staff [26, 36, 37]. To holistically decrease emigration intentions and tackle brain drain, numerous studies suggested several strategies, including strengthening education and training, improving working conditions, raising wages, offering career advancement opportunities, supporting medical research, involving HCWs in policy development, and fostering international collaborations [4, 57, 58, 64, 63]. Future research should focus on assessing and comparing the efficacy, efficiency, and sustainability of the aforementioned measures.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and strengths\u003c/h2\u003e \u003cp\u003eThis study acknowledges some potential limitations. Firstly, as this study focused on participants\u0026rsquo; experiences and needed highly tailored questions, no validated questionnaires or scales were used. Secondly, participants\u0026rsquo; response rate could not be documented because of the online nature of data collection where the questionnaire was sent through communication channels to an unspecified number. Thirdly, the study relied on self-reported data, which might have introduced recall bias or misunderstandings of the survey questions. Participants might have also provided socially desirable responses to create a favorable impression. Fourthly, convenience sampling may have introduced selection bias, as individuals with direct experiences of violence or strong views on emigration may have been more likely to participate, which could render our sample less representative of the targeted population limiting the generalizability of our findings. Fifthly, the cross-sectional design of this study captures data at a single point in time, limiting our ability to assess the long-term effects of violence on individuals or to track their migration experiences and outcomes post-migration. Additionally, this cross-sectional nature of the study restricts the establishment of a causal relationship between WPV and emigration intentions. Hence, incorporating a longitudinal approach could enhance the impact and depth of future research and enable the confirmation of cause-effect relationship.\u003c/p\u003e \u003cp\u003eDespite the limitations, this study has several notable strengths. Being a multicentric study with a large sample size from different geographical regions enhances the generalizability of our findings. Secondly, our comprehensive questionnaire allowed for a deeper insight into the impact of WPV on physicians and how it relates to their choice of emigration. Thirdly, the inclusion of three target groups (medical students, interns, and residents) offered a holistic view of WVP and emigration intentions across successive professional stages of medicine in Egypt.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study demonstrated a significant association between WPV exposure and emigration intentions among Egyptian medical students and early-career physicians. Among those affected, WPV emerged as a prominent driver of emigration intentions alongside financial and career prospects. These findings highlight the need for targeted institutional reforms that tackle WPV incidents. Such reforms should include strict security measures, robust safe reporting mechanisms, HCW training program, and law enforcement. These reforms should be coupled with strategies that aim to retain the healthcare workforce such as increasing wages and improving working conditions, ultimately leading to a safer, more stable, and more sustainable healthcare system. Additionally, further research using a more representative sample and longitudinal design is needed to establish a causal relationship between WPV and emigration intentions\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Research Ethics Committee (REC) for human and animal research at the Faculty of Medicine, Helwan University gave ethical permission to conduct this study (Serial: 81-2023), and the Helsinki Declaration was adhered to throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding or sponsorship was received from any companies, groups, individuals, organizations, or any other entities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data of this study is available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to sincerely thank Mahmoud Abdelnaeim, Salma Magdy, Naomii Mohamed, Mariam Ahmed, and Nada Osama for their contribution in conceptualizing this research study. We offer our gratitude to Professor Abdel-Hady El-Gilany for his guidance in statistical analysis and results interpretation. We are also highly appreciative of Professor Abdel-Hady El-Gilany’s and Yusof Mohamed Omar’s revision of this manuscript. The authors are immensely grateful for the IFMSA-Egypt team of collaborators for collecting the data for this study. The members of the group are Ghofran Hamza, Mohamed Shokry, Nouran Sharaf, Osama Elsayed Mohammed, Taha Hafiz Ahmad, Rodina Elkhouly, Mai Al.Tijani Ahmed, Mahmoud Basha, Aya Elfar, Rana Attallah, Ziad Hamada, Hagar Ramadan, Jana Sadek, Mariam Saad, Yomna Abdalla, Mena Alemam, Antonios Gerges Takla, Eslam Elsaeed, Omar Magdy, Mahmoud Gomaa, and Aliaa Medhat Mahmoud.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe conception and initial research design of the study were done by Rowaydah Alaa. Final research design and protocol writing were done by Rowaydah Alaa, Menna A. Elkholi, Hajer Azzam, Rodayna Elnaggar, Yehia Nabil, Ahmed Hamed, Nareman Mohamed, and Nada Ali Omar. Questionnaire design and formulation was done by Rowaydah Alaa, Menna A. Elkholi, Hajer Azzam, Rodayna Elnaggar, Yehia Nabil, Ahmed Hamed, Nareman Mohamed, and Nada Ali Omar. Acquisition of data was done by IFMSA-Egypt team of collaborators. Data analysis and interpretation were done by Menna A. Elkholi and Hajer Azzam. The initial manuscript draft was written by Hajer Azzam, Rodayna Elnaggar, Yehia Nabil, Ahmed Hamed, and Nareman Mohamed. Final drafting and revision of the manuscript critically for important intellectual content was done by Rowaydah Alaa, Menna A. Elkholi, Hajer Azzam, Rodayna Elnaggar, and Yehia Nabil. Supervision and revision of protocol, questionnaire, statistical analysis, and final manuscript were done by Nelly Hegazy. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDodani S, LaPorte RE. Brain drain from developing countries: how can brain drain be converted into wisdom gain? J R Soc Med. 2005;98(11):487\u0026ndash;491. https://doi.org/10.1258/jrsm.98.11.487.\u003c/li\u003e\n\u003cli\u003eCarolina BM. The history of brain drain. Studi Emigrazione. 2004;41(156):775\u0026ndash;796.\u003c/li\u003e\n\u003cli\u003eKollar E, Buyx A. Ethics and policy of medical brain drain: a review. Swiss Med Wkly. 2013;143(4344):w13845. https://doi.org/10.4414/smw.2013.13845.\u003c/li\u003e\n\u003cli\u003eElBeheiry M. Determinants of Physicians\u0026apos; Brain Drain in Egypt [Master\u0026apos;s Thesis]. The American University in Cairo; 2025. Available from: https://fount.aucegypt.edu/etds/2420.\u003c/li\u003e\n\u003cli\u003eAmerican University in Cairo (AUC). 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Hum Resour Health. 2023;21:82. https://doi.org/10.1186/s12960-023-00868-8.\u003c/li\u003e\n\u003cli\u003eSahebi A, Golitaleb M, Moayedi S, Torres M, Sheikhbardsiri H. Prevalence of workplace violence against health care workers in hospital and pre-hospital settings: An umbrella review of meta-analyses. Front Public Health. 2022;10:895818. https://doi.org/10.3389/fpubh.2022.895818.\u003c/li\u003e\n\u003cli\u003eNjaka S, Edeogu OC, Oko CC, Goni MD, Nkadi N. Work place violence (WPV) against healthcare workers in Africa: A systematic review. Heliyon. 2020;6(9):e04800. https://doi.org/10.1016/J.HELIYON.2020.E04800.\u003c/li\u003e\n\u003cli\u003eElsaid NMAB, Ibrahim O, Abdel-Fatah ZF, Hassan HA, Hegazy MAH, Anwar MM, Soliman HH. Violence against healthcare workers during coronavirus (COVID-19) pandemic in Egypt: a cross-sectional study. Egypt J Forensic Sci. 2022;12:45. https://doi.org/10.1186/S41935-022-00304-3.\u003c/li\u003e\n\u003cli\u003eAssil AO, Salem AA, Mokhtar OA, Taha OH, Ramadan AM, Mansour AHR, Awad AAE, El-Hossainy AA, Khattab AA, Salem AM, Dalaab AEA, Azab SMS. Workplace violence at emergency departments, Ain Shams University Hospitals, Cairo, Egypt. BMC Health Serv Res. 2022;22:1437. https://doi.org/10.1186/s12913-022-08867-6.\u003c/li\u003e\n\u003cli\u003eAlhomoud F. \u0026lsquo;That\u0026rsquo;s enough\u0026rsquo; - Workplace violence against physicians, pharmacists, and nurses in Saudi Arabia: A Systematic Review of Prevalence, causes, and consequences. Risk Manag Healthc Policy. 2025;18:373\u0026ndash;408. https://doi.org/10.2147/rmhp.s509895.\u003c/li\u003e\n\u003cli\u003eVento S, Cainelli F, Vallone A. Violence Against Healthcare Workers: A Worldwide Phenomenon With Serious Consequences. 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Sci Rep. 2024;14: 10911 https://doi.org/10.1038/s41598-024-60857-2.\u003c/li\u003e\n\u003cli\u003eJavaid MM, Shahid RA, Rahim E, Khan IA, Hameed H, Mansoor E, Ahmed M, Mansoor A. Prevalence of workplace physical violence against healthcare professionals in hospital. Pak J Physiol. 2024;20(3):81\u0026ndash;83. https://doi.org/10.69656/pjp.v20i3.1738.\u003c/li\u003e\n\u003cli\u003eSamsudin EZ, Isahak M, Rampal S, Rosnah I, Zakaria MI. Organisational antecedents of workplace victimisation: The role of organisational climate, culture, leadership, support, and justice in predicting junior doctors\u0026rsquo; exposure to bullying at work. Int J Health Plann Manag. 2019;35(1):346\u0026ndash;367. https://doi.org/10.1002/hpm.2926.\u003c/li\u003e\n\u003cli\u003eHaskell TL, Stankovich J, Merridew NL. A new framework for Australian specialty colleges and other healthcare leaders to address bullying, discrimination, and harassment that involves doctors. Lancet Reg Health West Pac. 2024;48:101118. https://doi.org/10.1016/j.lanwpc.2024.101118.\u003c/li\u003e\n\u003cli\u003eVolz N, Fringer R, Walters B, Kowalenko T. Prevalence of horizontal violence among emergency attending physicians, residents, and physician assistants. West J Emerg Med. 2017;18(2):213\u0026ndash;218. https://doi.org/10.5811/westjem.2016.10.31385.\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Connell KM, Garbark RL, Nader KC. Cognitive rehearsal training to prevent lateral violence in a military medical facility. J Perianesth Nurs. 2019;34(3):645-653.e1. https://doi.org/10.1016/j.jopan.2018.07.003.\u003c/li\u003e\n\u003cli\u003eYoungblood SN. Bullying in the Nuclear Medicine Department and During Clinical Nuclear Medicine Education. J Nucl Med Technol. 2021;49(2):156\u0026ndash;63. https://doi.org/10.2967/jnmt.120.257204.\u003c/li\u003e\n\u003cli\u003eVu LG, Hoang LN, Ngoc MLV, Anh HNS, Nathan N, Dam VAT, Vu TMT, Latkin CA, Ho CS, Ho RC. Professional Preparedness Implications of Workplace Violence against Medical Students in Hospitals: A Cross-Sectional Study. INQUIRY J Health Care Organ Provis Financ. 2023;60:469580231179894. https://doi.org/10.1177/00469580231179894.\u003c/li\u003e\n\u003cli\u003eWang X, Peng P, Liu Y, Yang WF, Chen S, Wang Y, Liu T. Workplace violence inflicted by patients or their family members/visitors and its relationship with suicidal ideation among undergraduate medical students during clinical training in China. Ann Med. 2023;55(2):2295027. https://doi.org/10.1080/07853890.2023.2295027.\u003c/li\u003e\n\u003cli\u003eInce A, Torun P, Jadoo SAA. Workplace violence against medical students- A Turkish perspective. J Ideas Health. 2019;2(1):70\u0026ndash;74. https://doi.org/10.47108/jidhealth.vol2.iss1.12.\u003c/li\u003e\n\u003cli\u003eLowry B, Eck LM, Howe EE, Peterson J, Gibson CA. Workplace Violence: Experiences of internal medicine trainees at an academic medical center. South Med J. 2019;112(6):310\u0026ndash;314. https://doi.org/10.14423/smj.0000000000000984.\u003c/li\u003e\n\u003cli\u003eAderinto N, Olatunji G, Olaniyi P, Afolabi S, Ajagbe K, Yusuf IA, Jegede OS. Prevalence, pattern, and predictors of WPV against medical interns in Southwest Nigeria: a cross-sectional study. Ann Med. 2025;57(1):2470955. https://doi.org/10.1080/07853890.2025.2470955.\u003c/li\u003e\n\u003cli\u003ePeng P, Yang WF, Liu Y, Chen S, Wang Y, Yang Q, Liu T. High prevalence and risk factors of dropout intention among Chinese medical postgraduates. Med Educ Online. 2022;27(1):2058866. https://doi.org/10.1080/10872981.2022.2058866.\u003c/li\u003e\n\u003cli\u003eIsmail HA, Chun S. The brain drain of Egyptian physicians and its driving factors: A Cross-Sectional Study. Soc Sci. 2025;14(5):295. https://doi.org/10.3390/socsci14050295.\u003c/li\u003e\n\u003cli\u003eDeressa W, Azazh A. Attitudes of undergraduate medical students of Addis Ababa University towards medical practice and migration, Ethiopia. BMC Med Educ. 2012;12(1):68. https://doi.org/10.1186/1472-6920-12-68.\u003c/li\u003e\n\u003cli\u003eGeorge G, Reardon C. Preparing for export? Medical and nursing student migration intentions post-qualification in South Africa. Afr J Prim Health Care Fam Med. 2013;5(1):a483. https://doi.org/10.4102/phcfm.v5i1.483.\u003c/li\u003e\n\u003cli\u003eEser E, Cil E, Gundogan NES, Col M, Ozturk ENY, Thomas DT, Sunter AT, Arslan HN, Citil R, Onder Y, Picakciefe M, Dede B, Demirel C, Aydin N, Caglayan C, Aker AA, Borlu A, Durmus H, Can G, Turan M. Push and pull factors of why medical students want to leave T\u0026uuml;rkiye: a countrywide multicenter study. Teach Learn Med. 2023;36(5):588\u0026ndash;600. https://doi.org/10.1080/10401334.2023.2229810.\u003c/li\u003e\n\u003cli\u003eAl-Khalisi N. The Iraqi Medical Brain Drain: A Cross-Sectional Study. Int J Health Serv. 2013;43(2):363\u0026ndash;378. https://doi.org/10.2190/hs.43.2.j.\u003c/li\u003e\n\u003cli\u003eBalouch MS, Balouch MM, Balouch MS, Qayyum W, Zeb Z. CAREER ASPIRATIONS OF JUNIOR DOCTORS IN PAKISTAN: EXPLORING REASONS BEHIND THE BRAIN DRAIN. J Ayub Med Coll Abbottabad. 2022;34(3):500\u0026ndash;506. https://doi.org/10.55519/jamc-03-10549.\u003c/li\u003e\n\u003cli\u003eBener A, Ventriglio A, Almas F, Bhugra D. Determinants of brain drain among physicians in Turkey: Findings from a national exploratory study. Int J Soc Psychiatry. 2024;71(1):179\u0026ndash;187. https://doi.org/10.1177/00207640241285834.\u003c/li\u003e\n\u003cli\u003eAkinwale OE, George OJ. Personnel brain-drain syndrome and quality healthcare delivery among public healthcare workforce in Nigeria. Arab Gulf J Sci Res. 2023;41(1):18\u0026ndash;39. https://doi.org/10.1108/agjsr-04-2022-0022.\u003c/li\u003e\n\u003cli\u003eGrenier M. The impact of brain drain in underserved countries: implementing a global ethical leadership approach. Int J Migr Health Soc Care. 2015;11(3):218\u0026ndash;222. https://doi.org/10.1108/ijmhsc-08-2014-0031.\u003c/li\u003e\n\u003cli\u003eKaya AE, Akt\u0026uuml;rk BE, Aslan E. Factors predicting the motivation to study abroad in Turkish medical students: a causal investigation into the problem of brain drain. J Health Sci Med. 2023;6(2):526\u0026ndash;531. https://doi.org/10.32322/jhsm.1253308.\u003c/li\u003e\n\u003cli\u003eAmarat M, Akbolat M, Adıyaman O. A study on the push and pull factors affecting the international emigration intentions of Turkish physicians. J Health Nurs Manag. 2023;10(2):172\u0026ndash;179. https://doi.org/10.54304/shyd.2023.60251.\u003c/li\u003e\n\u003cli\u003eMutlu H, Bozkurt G, \u0026Ouml;ngel G. Fear of violence and brain drain analysis among healthcare workers in Turkey. BMC Health Serv Res. 2024;24(1):1666. https://doi.org/10.1186/s12913-024-12183-6.\u003c/li\u003e\n\u003cli\u003eHashish EA, Ashour H. Determinants and mitigating factors of the brain drain among Egyptian nurses: a mixed-methods study. J Res Nurs. 2020;25(8):699\u0026ndash;719. https://doi.org/10.1177/1744987120940381.\u003c/li\u003e\n\u003cli\u003eBenfifi T. Between \u0026ldquo;Here\u0026rdquo; and \u0026lsquo;There\u0026rsquo;: Toward Understanding Emigration Representations and Perceptions Among Algerian Physicians. Ital Sociol Rev. 2025;15(1):151. https://doi.org/10.13136/isr.v15i1.834.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Emigration and immigration, Brain drain, workplace violence, physicians, medical students","lastPublishedDoi":"10.21203/rs.3.rs-9250179/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9250179/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003cbr\u003e\nEgypt faces a critical physician shortage, exacerbated by emigration. It also reports one of the highest Workplace Violence (WPV) rates among Healthcare Workers (HCWs) in Africa (61.9%), with adverse effects on healthcare quality. However, the link between emigration intentions and WPV remains underexplored. This study aimed to determine the prevalence of emigration intentions among Egyptian medical students and early-career physicians and their association with WPV exposure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003cbr\u003e\nA multicentric, cross-sectional study was conducted across 35 Egyptian universities. Data was collected from June to December 2024 using an online questionnaire covering sociodemographics, WPV, and emigration intentions. Participants were recruited through convenience sampling. Association between WPV and emigration intentions was tested using Chi-square test and multivariate binary logistic regression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003cbr\u003e\nAmong 1,134 participants, 68.7% expressed emigration intentions. WPV exposure was reported by 72.3% of early-career physicians (n = 553) and 35.6% of medical students (n = 581). For medical students, emigration intentions were associated with witnessing WPV perpetrated by patients and senior physicians (both \u003cem\u003ep\u003c/em\u003e\u0026lt; 0.05). Among early-career physicians, emigration intentions were linked to feelings of unsafety and exposure to WPV by patients and other HCWs (\u003cem\u003ep\u003c/em\u003e\u0026lt; 0.05). Significant predictors of emigration intentions included students’ witnessing of senior-perpetrated WPV (AOR: 1.69) and early-career physicians’ exposure to HCWs-perpetrated WPV (AOR: 1.82).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003cbr\u003e\nThis study found a high prevalence of WPV exposure and emigration intentions among Egyptian medical students and early-career physicians. The significant association between WPV and emigration intentions necessitates WPV preventive measures to decrease emigration rates and the strain on Egypt’s healthcare system.\u003c/p\u003e","manuscriptTitle":"Emigration intentions of Egyptian medical students and early career physicians and their association with workplace violence","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-16 09:56:48","doi":"10.21203/rs.3.rs-9250179/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-15T06:03:48+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"319746652238626701530126032367645367317","date":"2026-04-14T13:24:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-14T08:59:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-13T19:24:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-13T11:25:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-13T06:39:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-12T02:57:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"199780983544975637961650635911857976523","date":"2026-04-10T07:08:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"32390468234459785649761715906988306963","date":"2026-04-10T02:37:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"24661271604277054715976774659528491444","date":"2026-04-09T08:27:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29382154566384695138115590930937652576","date":"2026-04-09T07:57:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"46425459464312097459504656453557282451","date":"2026-04-08T15:23:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-08T14:28:03+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-08T04:39:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-30T07:01:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-30T07:01:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2026-03-28T06:11:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"47e2e0c1-db63-4b68-a955-36d3e455bc25","owner":[],"postedDate":"April 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-16T12:08:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-16 09:56:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9250179","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9250179","identity":"rs-9250179","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}