Abstract
This study is based on the metaphor of the 'rural pipeline' into medical practice. The four stages of the rural pipeline are: (1) contact between rural secondary schools and the medical profession; (2) selection of rural students into medical programs; (3) rural exposure during medical training; and (4) measures to address retention of the rural medical workforce. Using the rural pipeline template we conducted a literature review, analysed the selection methods of Australian graduate entry medical schools and interviewed 17 interns about their medical career aspirations. The literature was reviewed to assess the effectiveness of selection practices to predict successful gradation and the impact of rural pipeline components on eventual rural practice. Undergraduate academic performance is the strongest predictor of medical course academic performance. The predictive power of interviews is modest. There are limited data on the predictive power of other measures of non-cognitive performance or the content of the undergraduate degree. Prior rural residence is the strongest predictor of choice of a rural career but extended rural exposure during medical training also has a significant impact. The most significant influencing factors are: professional support at national, state and local levels; career pathway opportunities; contentedness of the practitioner's spouse in rural communities; preparedness to adopt a rural lifestyle; educational opportunities for children; and proximity to extended family and social circle. Analysis of selection methods: Staff involved in student selection into 9 Australian graduate entry medical schools were interviewed. Four themes were identified: (1) rurality as a factor in student selection; (2) rurality as a factor in student selection interviews; (3) rural representation on student selection interview panels; (4) rural experience during the medical course. Interns' career intentions: Three themes were identified: (1) the efficacy of the rural pipeline; (2) community connectedness through the rural pipeline; (3) impediments to the effect of the rural pipeline, the most significant being a partner who was not committed to rural life Based on the literature review and interviews, 11 strategies are suggested to increase the number of graduates choosing a career in rural medicine, and one strategy for maintaining practitioners in rural health settings after graduation.
Highlights
This study is based on the metaphor of the ‘rural pipeline’ into medical practice
The literature review was structured in two dimensions: (i) a review of the literature on the power of selection practices to predict successful graduation; and (ii) a review of the literature on the impact of the components of the rural pipeline, including student selection, on the choice of rural practice as a career
The predictive power of interviews for student academic performance is modest but there is some evidence that their predictive potential can be enhanced by refinements that include clarity for applicants and interviewers on the role of interviews in the overall selection process[12], the use of the multiple mini-interview (MMI) format[13,14], less structured one-on-one interviews[15], broader interview panel membership[16,17] and pre-interview training for panel members to prevent bias[18]
Summary
This study is based on the metaphor of the ‘rural pipeline’ into medical practice. The four stages of the rural pipeline are: (1) contact between rural secondary schools and the medical profession; (2) selection of rural students into medical programs; (3) rural exposure during medical training; and (4) measures to address retention of the rural medical workforce. Methods: Using the rural pipeline template we conducted a literature review, analysed the selection methods of Australian graduate entry medical schools and interviewed 17 interns about their medical career aspirations. This article reports on research conducted in 2007 to 2008 that assessed international and national best practice in the selection of students for graduate entry medical courses, to investigate correlations between medical student selection procedures and exposure to rural medical practice during medical training with choice of careers in rural medicine. Current medical student selection processes and medical course training experiences have failed to deliver sufficient medical practitioners with a commitment to rural medical practice. The critical gaze of the study was, on those selection processes and within-training experiences deemed to promote the likelihood that, on graduation, medical students would pursue a medical career in rural communities
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