Doctors' rural practice self-efficacy is associated with current and intended small rural locations of practice.

Megan Bentley,Lucie Walters,Nadine Dummond,Heidi Hodge,Vivian Isaac

doi:10.1111/ajr.12486

Abstract

ObjectiveKey factors which positively influence recruitment and retention of doctors to rural practice include rural background and positive rural training experience. Despite this knowledge, there is no well‐established conceptual framework to explain how these factors influence intention. The aim of this study was to consider rural practice self‐efficacy and its influence on rural career choice by doctors. Questions relating to self‐efficacy were formulated using Bandura's four proposed sources of self‐efficacy, which include mastery experiences, vicarious experience, social persuasion and emotional and physical response to experiences.DesignCross‐sectional study.Setting and participantsMedical school graduates from Flinders University, who completed a rural year as a part of the clinical component of the course between 1997 and 2015.Main outcome measuresRural self‐efficacy; current and intended location of practice in small rural communities (<25 000 people).ResultIt was found that 28.5% of participants were currently working in communities of <25 000 people. Levels of intent for future small town rural practice were consistent across career stages after internship. Higher rural practice self‐efficacy scores were found in doctors working in smaller towns (<25 000) and small communities (<10 000). Higher self‐efficacy was also associated with rural background, more senior career status, earlier speciality decision time and smaller expectation‐experience gap.ConclusionAn independent association exists between rural self‐efficacy and intention to remain or return to small rural practice. The article offers rural clinical schools the opportunity to consider how they can influence future rural career outcomes.

Highlights

Recruitment and retention of medical practitioners in rural Australia is an ongoing challenge
This study explores the relationship between rural practice self‐efficacy and rural careers in alumni from one Australian RCS
Considering demographics known to be associated with rural practice, 42 (41.6%) reported a rural background, with the majority of these having had >8 years of rural upbringing (n = 38, 37.3%) and 50 (49%) reporting that they had a partner with a rural background

Summary

Introduction

Recruitment and retention of medical practitioners in rural Australia is an ongoing challenge. Two consistent factors associated with rural medical practice intention are rural background and positive rural training experiences.[2,3]. Some studies suggest these factors have additive effects,[4] not all students take-up rural careers.[5]. A longitudinal cohort study argues that nature (pre‐existing rural career interest), rather than nurture (during undergraduate rural clinical school [RCS]), affects the likelihood of choosing a rural medical career.[6]. Medical students’ first preference for rural placements and overall wellbeing during these placements correlate with increased rural career interest.[7,8]. Despite new understanding that medical education can transform students’ world view and influence their career trajectories,[9] there is no well‐established conceptual framework to explain how positive rural experiences influence intention Medical students’ first preference for rural placements and overall wellbeing during these placements correlate with increased rural career interest.[7,8] Despite new understanding that medical education can transform students’ world view and influence their career trajectories,[9] there is no well‐established conceptual framework to explain how positive rural experiences influence intention

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Discussion

Conclusion