The influence of international medical electives on career preference for primary care and rural practice.

Iain R Law,Lucie Walters

doi:10.1186/s12909-015-0483-2

Abstract

BackgroundPrevious studies have demonstrated a correlation between medical students who undertake international medical electives (IMEs) in resource poor settings and their reported career preference for primary care in underserved areas such as rural practice. This study examines whether a similar correlation exists in the Australian medical school context.MethodsData was extracted from the Medical Schools Outcomes Database (MSOD) of Australian medical students that completed commencing student and exit questionnaires between 2006 and 2011. Student responses were categorized according to preferred training program and preferred region of practice at commencement. The reported preferences at exit of students completing IMEs in low and middle income countries (LMIC) were compared to those completing electives in high income countries (HIC).ResultsThe effect of elective experience for students expressing a preference for primary care at commencement was non-significant, with 40.32 % of LMIC and 42.11 % of HIC students maintaining a preference for primary care. Similarly there were no significant changes following LMIC electives for students expressing a preference for specialist training at commencement with 11.81 % of LMIC and 10.23 % of HIC students preferring primary care at exit. The effect of elective experience for students expressing a preference for rural practice at commencement was non-significant, with 41.51 % of LMIC and 49.09 % of HIC students preferring rural practice at exit. Similarly there were no significant changes following LMIC electives for students expressing a preference for urban practice at commencement, with 7.84 % of LMIC and 6.70 % of HIC students preferring rural practice at exit.ConclusionsThis study did not demonstrate an association between elective experience in resource poor settings and a preference for primary care or rural practice. This suggests that the previously observed correlation between LMIC electives and interest in primary care in disadvantaged communities is likely dependent on student and elective program characteristics and supports the need for further research and critical examination of elective programs at Australian medical schools.

Highlights

Previous studies have demonstrated a correlation between medical students who undertake international medical electives (IMEs) in resource poor settings and their reported career preference for primary care in underserved areas such as rural practice
There was no significant difference between low and middle income countries (LMIC) and high income countries (HIC) respondents in preference for primary care at Exit Questionnaire (EQ) for any of the Commencing Medical Student Questionnaire (CMSQ) preference categories, including primary care (χ2 = 0.065, df = 1, p = 0.80), Table 1 Change in preferred training program between CMSQ and EQ
There was no significant difference between LMIC and HIC respondents in preference for rural practice at EQ in either of the CMSQ categories, including rural (χ2 = 2.781, df = 1, p = 0.10) and urban (χ2 = 0.885, df = 1, p = 0.35)

Summary

Introduction

Previous studies have demonstrated a correlation between medical students who undertake international medical electives (IMEs) in resource poor settings and their reported career preference for primary care in underserved areas such as rural practice. A recent literature review suggested that IME experience in resource poor settings is associated with a preference for primary care and work with underserved populations [2]. Godkin and Savageau found that students undertaking IMEs were more likely than their colleagues to express interest in primary care and working with underserved populations [4]. Compared to non-travelling colleagues, trainee doctors completing IMEs during training were more likely to work with underserved populations and at risk groups; work in rural areas; have a public health degree; and to switch from a sub-specialty into general medicine [5, 6]

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Results

Discussion

Conclusion