Longitudinal rural clerkships: increased likelihood of more remote rural medical practice following graduation.

Denese E Playford,Ian B Puddey,Geoffrey J Riley,Asha Nicholson

doi:10.1186/s12909-015-0332-3

Abstract

BackgroundExtended rural clerkships clearly increase the likelihood of rural practice post-graduation. What has not been determined is whether such rural interventions increase the likelihood of graduates practicing in more remote, versus inner regional, locations.MethodsThe Australian Health Practitioner Regulation Agency database was used to identify the current workplace of every graduate of the Medical School of Western Australia, 1980 to 2011. There were 324 graduates working in a primary practice location defined by the Australian Standard Geographical Classification as inner regional to very remote. They were divided into 3 groups - 200 graduates who entered medical school before commencement of the Rural Clinical School of Western Australia (RCSWA), 63 who entered after the RCSWA had started, but not participated in RCSWA, and 61 who participated in the RCSWA. The RCSWA offers a longitudinal rural clinical clerkship throughout level 5 of the MBBS course.ResultsThe two groups not participating in the RCSWA had 45.5% and 52.4% of subjects in outer regional/very remote locations, respectively. In comparison, 78.7% of those who had participated in the RCSWA were currently practicing in outer regional/very remote locations. When the 3 groups were compared, the significant predictors of working in a more remote practice compared to working in an inner regional area were being female (OR 1.75 95% CI 1.13, 2.72, P = 0.013) and participating in the RCSWA (OR 4.42, 95% CI 2.26, 8.67, P < 0.001). In multivariate logistic regression that corrected for gender and remoteness of rural address before entry to medical school, participation in the RCSWA still predicted a more than 4-fold increase in the odds of practicing in a more remote area (OR 4.11, 95% CI 2.04, 8.30, P < 0.001).ConclusionExtended rural clinical clerkship during an undergraduate MBBS course is related to a much greater likelihood of practicing in more remote, under-serviced rural locations.

Highlights

Extended rural clerkships clearly increase the likelihood of rural practice post-graduation
Of the 3282 graduates of the University of Western Australia Medical School who entered from 1980 and had completed the course by 2011, 3020 were able to be tracked on the Australian Health Practitioner Regulation Agency (AHPRA) register of medical practitioners between February and April of 2014, 5 were known to have deceased, 257 (7.8%) could not be found
Since 2002, when the Rural Clinical School of Western Australia (RCSWA) commenced, there has been an increase in the number of females, an increase in age at completion of the course and as indicated by the Australian Standard Geographical Classification - Remoteness Area (ASGC-RA) for town of origin, an increase in those from rural backgrounds, and a significant trend towards recruitment of students from more remote areas

Summary

Introduction

Extended rural clerkships clearly increase the likelihood of rural practice post-graduation. Various initiatives aimed at correcting this disparity have been implemented, including opportunities for medical students to have prolonged rural clinical immersions through the establishment of Rural Clinical Schools [3]. The goal of these initiatives is primarily to increase the likelihood that medical graduates. Indications are that Rural Clinical Schools may be having an independent positive effect on urban-background students whose intentions without a Rural Clinical School experience are more likely to be for urban practice [7]

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Discussion

Conclusion