Abstract
Introduction Medical schools today are being challenged to educate doctors who are willing and able to practice in areas of poverty and workforce need. In many countries, there is a shortage of doctors practicing in rural and remote communities. There is evidence that locating undergraduate medical education in rural areas increases the likelihood that graduates will choose to practice in underserved areas. Through its Parallel Rural Community Curriculum (PRCC), Flinders University School of Medicine (FUSM) now enables over 25% of its students to undertake an entire clinical year based in small rural communities supervised principally by rural family physicians. Objective The PRCC was conceived to provide a high quality educational intervention that would result in an increased number of students choosing to practice in rural and remote Australia. It was also designed to test the hypothesis that small rural and remote practices were capable of facilitating a full year of medical training at a standard comparable to that provided at a major tertiary hospital. Intervention Starting with eight students in four towns in 1997, the PRCC now places 30 students across 18 towns in rural Australia. The students simultaneously learn the disciplines of medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry, and family medicine. At the end of the year, all Flinders students, regardless of training location, take the same comprehensive exam. Outcomes PRCC students improved their academic performance in comparison to their tertiary trained peers. This improvement has been consistent over the ten years studied. Seventy percent of the PRCC students have chosen to practice in rural locations, compared to 18 percent of tertiary-trained students. Over twelve years, the program has proved to be sustainable in a private practice environment with a workforce shortage. Conclusions Evaluation of the PRCC indicates that a rural community-based clinical education can provide a high quality academic experience for students as well as a sustainable solution to rural medical workforce maldistribution.
Highlights
Medical schools today are being challenged to educate doctors who are willing and able to practice in areas of poverty and workforce need
In Australia, as in most countries of the world, there is a significant disparity in health outcomes between those who live in major cities and those who live in rural and remote regions:[1] the more remote, the greater the disparity and lower the proportion of doctors in relation to the population
A longitudinal integrated clerkship can enable medical students to complete an entire clinical year based in rural primary care
Summary
Medical schools today are being challenged to educate doctors who are willing and able to practice in areas of poverty and workforce need. The Four Streams First, there is clear evidence that increasing the number of rural origin students admitted to medical school, combined with provision of high quality rural experiences during undergraduate education, increases the percentage of graduates who will choose to practice in a rural or remote community.[4,5] In particular, there is accumulating evidence that longer rural exposure in the latter years of training is a more effective intervention.[6] reviewing selection processes to reverse any discrimination against rural origin students, along with moving substantial components of clinical education into rural locations, is a responsible, evidencebased approach. What form should this medical education take? This requires further evidence from the other streams
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