Shaping medical student\u2019s understanding of and approach to rural practice through the undergraduate years: a longitudinal study

Robin A Ray,Louise Young,Daniel Lindsay

doi:10.1186/s12909-018-1229-8

Abstract

BackgroundOver the last two decades medical schools have increased rural practice learning opportunities for students in an effort to improve recruitment to the rural workforce. James Cook University’s (JCU) medical school was established in northern Australia in 2000 with a specific focus on meeting the health needs of people in rural and remote areas.As part of a longitudinal study this paper explores the situational and motivational learning factors contributing to the development of JCU’s medical students’ understanding of and approaches to rural medical practice.MethodsAfter completing each consecutive, compulsory rural clinical placement in Year Two, Four and Six of their MBBS program, JCU medical students were asked to complete a survey about their rural learning experiences. The survey consisted of a combination of single choice, Guttman and Likert scales and open response questions. Data from two open response questions were coded and thematically analysed. Content analysis enabled the predominant value of each theme to be calculated.ResultsCollation of the survey data revealed 680 answers to both questions resulting in 1322 comments for analysis. Nine themes were categorized into clinical practice issues and person issues. The evolution of scope of practice across the years, the importance of inspirational mentors, access to urban areas and a sense of community were key findings. Positive rural clinical placement experiences inclusive of supportive ongoing learning opportunities and rural community living contribute positively to medical students’ interest in future rural medical practice. However, the ability to work for periods of time in both rural and urban settings suggested a possible need for a new additional model of practice.ConclusionClear links between a sense of community and belonging both professionally and socially as well as combined rural-urban practice options were important factors in the education and development of future rural practitioners. Ways to establish and support practice models incorporating both rural and urban locations needs to be investigated.

Highlights

Over the last two decades medical schools have increased rural practice learning opportunities for students in an effort to improve recruitment to the rural workforce
Setting James Cook University’s medical school was established in northern Australia in 2000 with a specific focus on meeting the health needs of underserved populations
Aim As part of a longitudinal cohort study of medical students’ evolving intention to practice rurally, this paper explores the situational and motivational factors that contribute to the formation of future rural practitioners, as expressed by students following their consecutive rural and remote clinical placement experiences

Summary

Introduction

Over the last two decades medical schools have increased rural practice learning opportunities for students in an effort to improve recruitment to the rural workforce. In response to the recognized imbalance of available health care between urban and rural locations, medical schools have increased rural practice learning opportunities for students in an effort to improve recruitment and retention of the rural health workforce. Studies from Canada and Australia identify the influence of clinical experiences and the availability of further training as contributors to intention to practice in rural and remote locations [11, 12]. A critical review based on North American medical schools questioned whether the clinical experience motivated interest in rural practice or whether it reinforced a pre-existing interest [13]. Tolhurst et al [14] suggest that rural practice experiences can engender urban origin students’ interest towards rural practice

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Results

Discussion

Conclusion