Evaluating the impact of the Adelaide Rural Clinical School longitudinal clinical placement on the rural medical workforce: A retrospective cohort study of graduates, 2004-2019.

Abstract

To evaluate the contribution of the Adelaide Rural Clinical School (ARCS) longitudinal integrated clerkship to the rural medical workforce. Design: Retrospective cohort study. Practice location data were sourced from the Australian Health Practitioner Regulation Agency (AHPRA, January 2021) and matched using university records. University of Adelaide medical school alumni graduating between 2004 and 2019 (ARCS alumni who completed a full year of rural training [n = 423], metropolitan-trained peers [n = 1655]). The proportions of medical graduates working in a rural location (Modified Monash Model [MMM3-7] or Australian Statistical Geography Standard [ASGS-RA2-5] classifications). Logistic regression was used to examine the association between ARCS training and working rurally, and the influence of rural background and sociodemographic factors. Working in a rural location was almost three times more frequent among ARCS alumni than their metropolitan-trained peers, using the MMM3-7 (14.7% vs. 5.3%) classification; forASGS-RA2-5 classification (21.3% vs. 8.9%). In adjusted analysis, working rurally (MMM3-7) was associated with having a rural/remote residence on enrolment (OR 8.29, 95% CI 4.22-16.26) and was 3.1 times more likely for ARCS alumni (OR 3.06, 95% CI 2.06-4.53) than their peers. The magnitude of the effects of ARCS training on whether they are working rurally was similar among those with metropolitan or rural background (p-value for interaction 0.873). Similar associations were observed using ASGS-RA2-5 classifications. Extended rural placements through the Adelaide Rural Clinical School increased the rural medical workforce, with a similar impact among those with a rural or metropolitan background.