Rural Practice Intentions Research Articles

Impact of rural and remote clinical placements on future intention to practice

Background: Living in rural and remote areas decreases health equity due to the health workforce shortages experienced in these locations; this is particularly experienced by our Indigenous population. To address this, there has been an increased number of students participating in rural and remote clinical placements. Aim: To identify factors that both encourage and limit students from participating in rural and remote healthcare placements whilst simultaneously assessing future intent to work in these areas. Methods: Australian students undertaking a degree in health completed an online survey distributed via the National Rural Health Student Network in 2021. Results: A total of 508 students from across 27 universities and 15 health disciplines completed the survey. More than half of the respondents had completed a placement in a rural or remote area. Most students were satisfied, or very satisfied, with the placement, which appears to be linked to an intention to return to rural and remote locations to work. Exposing students who had not considered practicing rurally to a rural or remote placement increased the odds of rural practice intention. Twenty-four students identifying as Aboriginal and/or Torres Strait Islander completed a rural or remote placement 12.5% of these students had an increased intention to undertake rural or remote practice. Discussion: This study added to the known body of evidence, that when health students enjoy their clinical placement experience, they have an increased intention to pursue rural or remote employment. Emerging evidence contrastingly corroborates that students who had the desire to return to rural and remote areas prior to their clinical placement didn’t have as strong motivation when compared to others without this intention.

Supporting nursing and allied health student placements in rural and remote Australia: a narrative review of publications by university departments of rural health.

University departments of rural health are Commonwealth-funded to improve recruitment and retention of the rural allied health and nursing (including midwifery) workforce, primarily through student placements. We examined publications by university departments of rural health that were focused on allied health and nursing students undertaking placements in rural Australia, to understand the characteristics, main findings and implications of the research conducted. Interprofessional learning was a key feature of placements and placement education, although other activities such as community engagement added to placement experiences. Factors such as quality supervision and being involved in the community contributed to a positive placement experience and increased rural practice intention. Tracking studies showed a relationship between rural placements, rural practice intention and rural practice. Rural placements occurred across a variety of settings and in locations consistent with the policy framework. Embedding university departments of rural health in rural communities enabled staff to build relationships and increase placement capacity.

Immersive Place-Based Attachments in Rural Australia: An Overview of an Allied Health Program and Its Outcomes

This paper describes a rural immersive attachment program for allied health students at an Australian University Department of Rural Health and its workforce outcomes. A mixed methods longitudinal cohort study, with data collected via end-of-placement and post-graduation surveys. Over 13 years, 311 allied health ‘year-long’ immersive rural attachments, as well as short-term placements, were supported. Pre- and post-placement rural practice intention ratings were paired (from 572 end of placement surveys) for 553 (96.7%) students. Students from metropolitan (49.4%, n = 273, p < 0.001), and rural origin (50.6%, n = 280, p < 0.001) showed a significant increase in rural practice intention. At 1 year post-graduation, 40.3% (n = 145) of graduates had worked in a rural or remote location in Australia, 39.9% at 3 years (n = 87) and 36.5% (n = 42) at 5 years. Longer-term rural attachments were found to be associated with rural practice location, independent of rural background. Those who had undertaken a longer rural attachment (≥18-weeks) were twice as likely to be working in a rural or remote area than those <18 weeks at 1 year (OR 2.018 95% CI 1.204–3.382) and 2.7 times as likely at 3 years (OR 2.727, 95% CI (1.325–5.614). Supporting students to undertake rural immersive attachments appears to be associated with greater rural practice intention and later rural practice.

Benefits and challenges to ophthalmology training via the Specialist Training Program.

The Specialist Training Program (STP) is a commonwealth funding initiative to support specialist medical training positions in regional, rural and remote areas, and in private settings. The program helps to improve the skills and distribution of the specialist medical workforce by providing trainees experience of a broader range of healthcare settings. To examine the benefits and challenges of ophthalmology training delivered by the STP in regional, rural, remote, and/or private settings across Australia. Qualitative design involving semi-structured in-depth interviews with thirty-two participants experienced in the delivery of ophthalmology training at STP posts including ophthalmology trainees (n=8), STP supervisors and clinical tutors (n=16), and other stakeholders (n=8). Training delivered at STP posts was reportedly beneficial for ophthalmology trainees, their supervisors and the broader community given it enabled exposure to regional, rural, remote and private settings, access to unique learning opportunities, provided workforce support and renewal, and affordable ophthalmic care. However, all participants also reported challenges including difficulties achieving work/life balance, unmet training expectations, a lack of professional support, and financial and administrative burden. Malalignment between trainee preferences for STP posts, low STP literacy and limited regional, rural and remote training experiences were also seen as missed opportunities to foster future rural ophthalmic workforce development. The STP improves access to ophthalmic care in underserved populations while enabling valuable rural and/or private practice exposure for medical specialist trainees and workforce support for supervising ophthalmologists. Efforts are needed to improve the quality of training experiences provided at STP posts and post sustainability. Although research is needed to investigate the longer-term benefits of the STP to rural and/or private workforce recruitment and retention, RANZCO should develop further regional, rural and remote STP posts to help realise future rural practice intention amongst ophthalmology trainees.

Medical students' rural practice intention: Academic performance matters.

Many countries are driving forward policies and practices to train medical students for later rural practice. Previous research has investigated individual (e.g., rural upbringing) and structural factors (e.g., curricular exposure) associated with rural practice intention. However, the relationship between academic performance in medical school and rural practice intention has been neglected, although optimisation theory suggests there may be a relationship. To address this gap, our aim was to identify the relationship between academic performance and rural practice intention. Data were collected via a cross-sectional (self-report) survey in 2021. Participants were students from 60 of the 96 rural order directed (RODs) medical programmes across China. We asked students their rural practice intention. We conducted univariate analyses to test for associations between rural practice intention and independent variables, including socio-demographics, ROD location, grade year and academic performance measures. We used multilevel logistic regression models to test whether students' academic performance in medical school could be used to predict rural practice intention, holding the other factors constant. There were 13 123 respondents, representing roughly 77.6% of the student population from the 60 schools. There was a statistically significant relationship between student (self)-reported academic performance in medical school and rural practice intention. Higher performers had a lower likelihood (ORs: 0.65-0.78) of rural practice intention. This held across all performance measures (GPA rank, academic awards and student leadership) and for the sub-group with rural upbringing (ORs: 0.68-0.78). This is the first study to identify a relationship between medical school performance and rural practice intention. The findings suggest that students maximise their utility when choosing career options, with higher performers having lower rural practice intention. These data provide insight into the complexity of medical career decision making and can be used by medical school and workforce planners to inform rural training, recruitment and retention strategies.

Effect of Rural Clinical Placements on Intention to Practice and Employment in Rural Australia: A Systematic Review.

Background: Supporting the provision of clinical placement (CP) experiences in rural areas is a strategy used worldwide to promote the rural health workforce. While there is international evidence for this intervention in medicine, there is limited understanding of the influence of rural CP for nursing, midwifery, allied health, and dentistry health professions in Australia, which have received substantial federal investment. This review examined the relationship between rural CP and non-medicine health students’ future rural practice intentions and workforce outcomes. Methods: Four databases were systematically searched; papers were screened using defined criteria and appraised using the mixed-methods appraisal tool (MMAT). Findings were synthesized using a critical narrative approach. Results: The methodological quality of the 29 eligible studies (13 quantitative non-randomized, 10 mixed method, 4 qualitative, 2 quantitative description) was appraised. Ten high-quality studies were identified. The review found that positive CP experiences may influence intention to practice rurally amongst undecided students and serve as a reinforcing experience for those students already interested in rural practice. There were mixed findings regarding the influence of CP length. The review also found that there is currently only evidence for the short-term effects of CP on students’ future practice outcomes in rural areas with focus thus far on early practice outcomes. Conclusions: Those looking to use rural CP to promote the rural health workforce should focus on supporting the quality of a large number of CP experiences that are undertaken in rural areas, as there are currently differing findings on the role of rural CP length. Future studies of rural CP should consider greater use of social and educational theories to guide them.

The Rural Nursing Workforce Hierarchy of Needs: Decision-Making concerning Future Rural Healthcare Employment.

Addressing nursing shortages in rural areas remains essential, and attracting nursing graduates is one solution. However, understanding what factors are most important or prioritized among nursing students contemplating rural employment remains essential. The study sought to understand nursing student decision-making and what aspects of a rural career need to be satisfied before other factors are then considered. A cross-sectional study over three years at an Australian university was conducted. All nursing students were invited to complete a Nursing Community Apgar Questionnaire to examine their rural practice intentions. Data were analyzed using principal component analysis, and mean scores for each component were calculated and ranked. Overall, six components encompassed a total of 35 items that students felt were important to undertake rural practice after graduating. Clinical related factors were ranked the highest, followed by managerial, practical, fiscal, familial, and geographical factors. Maslow’s Hierarchy of Needs provided a lens to examine nursing student decision-making and guided the development of the Rural Nursing Workforce Hierarchy of Needs model. Each element of the model grouped key factors that students considered to be important in order to undertake rural employment. In culmination, these factors provide a conceptual model of the hierarchy of needs that must be met in order to contemplate a rural career.

Delivering introductory physiotherapy clinical placements incorporating simulated learning experiences in rural settings.

To investigate the delivery, in rural settings, of introductory physiotherapy clinical placements incorporating simulation and describe the impact of these placements on the uptake of longer-term rural immersion opportunities. Retrospective cohort design. The University of Newcastle and the University of Newcastle Department of Rural Health (UONDRH), New South Wales, Australia. Data from undergraduate physiotherapy students were included. Second-year University of Newcastle physiotherapy students undertake an introductory placement which includes one week of simulated learning followed by a two-week traditional health care placement. Supervisor training and active promotion of placements were undertaken to increase the capacity of rural sites to deliver these placements, including both simulation and immersion components. Data relating to numbers of students undertaking introductory placements and final-year rural immersion experiences in the UONDRH between 2012 and 2020 were described. A simple review of the placement strategy was also undertaken. Introductory placements incorporating simulation were successfully implemented in the UONDRH settings and have continued annually. Physiotherapy staff in the UONDRH have been upskilled and have supported local clinicians to increase their supervisory capacity. The proportion of students undertaking introductory placements supported by the UONDRH has increased considerably as has the number of students completing full-year rural immersion experiences in the UONDRH. Delivering introductory physiotherapy placements incorporating simulation in rural settings was feasible and this strategy leads to increased placement capacity. Early rural clinical placement opportunities can increase students' uptake of longer-term rural immersion experiences which, in turn, can positively influence rural practice intentions.

Intention mutability and translation of rural intention into actual rural medical practice.

Rural intention and experience during medical school have been related to subsequent rural work. However, their relative contributions and the timing of their effects are not known. These data are critical to effective educational interventions able to improve rural medical workforce numbers, an international priority. Participants were graduates of an Australian MBBS degree between 2006 and 2016, who completed both entry and exit surveys approved by the Medical Deans of Australia, including workplace intention data. Rural/urban workplace intention changes from entry to exit were analysed using multinomial logistic regression. Binary logistic regression was used to assess actual rural versus urban work, obtained from a public practitioner registration website. Of 547 eligible undergraduates, 169 completed a year-long rural clinical school (RCS). A subset of 93 of the 547 graduates practiced rurally, of whom 42 had completed RCS. Both rural background and RCS predicted rural practice intention; both were also significantly related to actual rural work. Enduring rural intention was associated with nearly sevenfold odds of actually practicing rurally, compared with an enduring urban intention. Those who changed practice intention from entry to exit were more likely to practice in the region of their exit intention. Of special note: Rural Clinical School of Western Australia (RCSWA) exposure particularly affects urban origin students such that the odds of changing from an urban to a rural orientation immediately after their rural experience were more than fourfold higher than those not so participating. Both intention and RCSWA experience are associated with subsequent rural work. The impacts of RCSWA were able to be localised after the rural educational experience. Amongst those with mutable intention, exit intention was that most strongly related to actual work, suggesting this as the most reliable point to select for further rural training.

Training a Fit-For-Purpose Rural Health Workforce for Low- and Middle-Income Countries (LMICs): How Do Drivers and Enablers of Rural Practice Intention Differ Between Learners From LMICs and High Income Countries?

Equity in health outcomes for rural and remote populations in low- and middle-income countries (LMICs) is limited by a range of socio-economic, cultural and environmental determinants of health. Health professional education that is sensitive to local population needs and that attends to all elements of the rural pathway is vital to increase the proportion of the health workforce that practices in underserved rural and remote areas. The Training for Health Equity Network (THEnet) is a community-of-practice of 13 health professional education institutions with a focus on delivering socially accountable education to produce a fit-for-purpose health workforce. The THEnet Graduate Outcome Study is an international prospective cohort study with more than 6,000 learners from nine health professional schools in seven countries (including four LMICs; the Philippines, Sudan, South Africa and Nepal). Surveys of learners are administered at entry to and exit from medical school, and at years 1, 4, 7, and 10 thereafter. The association of learners' intention to practice in rural and other underserved areas, and a range of individual and institutional level variables at two time points—entry to and exit from the medical program, are examined and compared between country income settings. These findings are then triangulated with a sociocultural exploration of the structural relationships between educational and health service delivery ministries in each setting, status of postgraduate training for primary care, and current policy settings. This analysis confirmed the association of rural background with intention to practice in rural areas at both entry and exit. Intention to work abroad was greater for learners at entry, with a significant shift to an intention to work in-country for learners with entry and exit data. Learners at exit were more likely to intend a career in generalist disciplines than those at entry however lack of health policy and unclear career pathways limits the effectiveness of educational strategies in LMICs. This multi-national study of learners from medical schools with a social accountability mandate confirms that it is possible to produce a health workforce with a strong intent to practice in rural areas through attention to all aspects of the rural pathway.

What Australian Nursing Students Value as Important in Undertaking Rural Practice

Background: Rural health services in Australia are continually challenged by both the recruitment and retention of the nursing workforce. The aim of the study was to examine what nursing students consider the most important factors for undertaking a rural career in Australia. Methods: Nursing students (n=1,982) studying a three-year bachelor’s degree at an Australian University were invited to complete an online survey that examined their rural practice intentions. The questionnaire included demographic, rural background and career intentions, and a modified Nursing Community Apgar Questionnaire (NCAQ). Results: The factors identified most important among nursing students when considering rural practice include patient safety and high-quality care, having autonomy and respect from management, the establishment of positive relationships and good communication between different generations of nurses, and the work environment providing job satisfaction with good morale. Conclusions: This study provided insight for rural and regional universities and health services to better demonstrate what students indicate is important to take up rural practice, while highlighting unique challenges for the rural nursing workforce. Key elements are proposed that may be augmented at the university and health service level to guide recruitment and possibly retention. Rural recruitment and retention of new graduate nurses may be better achieved by addressing what nursing students feel are most important to them when considering rural practice, which are focused around management, decision-making, and practice environment factors rather than economic or community-based factors. The greatest importance to students is the ‘fit between’ them and the agency and much less about their ‘fit with’ the community into which they will be entering

Trends in practice intentions and preferences of clinical associate students: Implications for training and health services in South Africa

BackgroundThe University of Pretoria (UP) had its first intake of Bachelor of Clinical Medical Practice (BCMP) students in 2009. The objectives of this study were to examine the trends in geographical practice intentions and preferences of the first nine cohorts of BCMP students. We also assessed sector and level of care preferences of six BCMP cohorts.MethodsCross-sectional studies were conducted 2011, 2014 and 2017. First-, second- and third-year UP BCMP students were invited to complete a electronic questionnaire. Our analyses consisted of calculating proportions for the practice intentions and preferences for each surveys, and performing multiple logistic regression on the aggregated date to determine their associations with sociodemographic and training characteristics.ResultsThe proportion of participants intending to practise as a clinical associate in a rural area in South Africa directly after graduating was 62.5% in the 2014 survey and 69.7% in the 2017 survey, compared to 59.6% in the 2011 survey. The majority in all three surveys (53.4% in 2011, 56.6% in 2014 and 59.8% in 2017) indicated a preference for rural practice. Both rural practice intention and rural practice preference were found to be significantly associated with respondent’s self-description of having lived most of her/his life in a rural area, and rural district hospital exposure during training. In 2014 and 2017, approximately two-thirds of the participants selected a public sector option as their most preferred work setting. District hospitals were the most preferred setting of 30.3% participants in 2014 and 32.0% in 2017.ConclusionMost participants across the three surveys intended to work in rural settings. Considering that this could provide a sustainable solution to the shortage of health care workforce in rural areas, policy makers in both higher education and health need to promote and ensure the viability of the training of this category of health care providers.

Learning from follow-up of student placements in a remote community: a small qualitative study highlights personal and workforce benefits and opportunities

BackgroundThe maldistribution of the Australian health workforce contributes to restricted accessibility and poorer health outcomes for rural and remote populations, especially Aboriginal and Torres Strait Islander Australians. Student exposure to rural and remote settings is a long-term strategy that aims to reduce workforce shortages by encouraging rural career uptake, with well-supervised, positive placement experiences associated with rural practice intentions. Furthermore, placements can build students’ cultural capabilities and foster interest in working with disadvantaged and underserved Aboriginal communities. However, little is known about the translation of rural practice intentions to career paths, and the factors influencing employment decision-making and application of clinical and cultural content to professional practice.This in-depth study reports on the second stage of an investigation into the longer-term impact of remote placements. Stage One identified factors that contributed to students’ learning experiences and highlighted challenges encountered; Stage Two explored the impact on professional practice and employment decision-making amongst a subset of the original cohort.MethodsOf 12 interviews with participants who completed a remote placement in 2013/4 (Stage One), eight graduates were located four years later and seven were re-interviewed. Telephone interviews used a semi-structured schedule; each interview was recorded, transcribed and analysed for recurring themes and meanings.ResultsAt the time of interview, all participants were employed as health professionals and worked in Australia. The follow-up highlighted the enduring legacy of the student placement in terms of participants’ personal and professional growth. The majority were employed in rural settings; some were attracted by a rural lifestyle and employment opportunities while others were drawn by a desire to reduce rural health disparities. Regardless of setting, all actively applied clinical and cultural learnings acquired on placement to their professional practice. Rural job security, professional support and opportunities for professional development were all influences on continuing rural practice.ConclusionsDespite the challenges of qualitative longitudinal follow-up, the findings of this study provide valuable information, which can inform scaled-up investigations into the role of placements in developing an expanded, more stable and culturally respectful rural workforce.

Is nursing student personality important for considering a rural career?

Identifying and measuring personality traits assists to understanding professional career choices, however, what impact personality traits have on nursing student rural career choice remains absent. The purpose of this paper is to identify personality traits among nursing students that may be predictive of pursuing a rural career. A cross-sectional design was used to examine the importance Bachelor of Nursing students place on undertaking rural careers. All nursing students (n=1,982) studying a three-year bachelor's degree were invited to complete a questionnaire examining personality traits and rural practice intentions. Students who saw themselves working rurally after graduation had higher levels of conscientiousness than those who wanted metropolitan careers. Students with higher levels of agreeableness or open-mindedness were more likely to consider rural practice when individual community factors were carefully considered. Finally, students with higher levels of neuroticism were less likely to consider rural practice as a future career pathway. The cohort had high numbers of student from rural and regional settings, which may limit the ability to generalise the findings. In addition, student respondents of the survey may not be representative of the whole student cohort given the low response rate. Key personality traits are identifying factors that contribute to nursing student decision making regarding rural practice. Students who displayed higher levels of agreeableness and conscientiousness and open-mindedness have traits that are most likely to impact the consideration of rural practice across their nursing career, which gives additional insight into targeted recruitment strategies.

Doctors' rural practice self-efficacy is associated with current and intended small rural locations of practice.

ObjectiveKey factors which positively influence recruitment and retention of doctors to rural practice include rural background and positive rural training experience. Despite this knowledge, there is no well‐established conceptual framework to explain how these factors influence intention. The aim of this study was to consider rural practice self‐efficacy and its influence on rural career choice by doctors. Questions relating to self‐efficacy were formulated using Bandura's four proposed sources of self‐efficacy, which include mastery experiences, vicarious experience, social persuasion and emotional and physical response to experiences.DesignCross‐sectional study.Setting and participantsMedical school graduates from Flinders University, who completed a rural year as a part of the clinical component of the course between 1997 and 2015.Main outcome measuresRural self‐efficacy; current and intended location of practice in small rural communities (<25 000 people).ResultIt was found that 28.5% of participants were currently working in communities of <25 000 people. Levels of intent for future small town rural practice were consistent across career stages after internship. Higher rural practice self‐efficacy scores were found in doctors working in smaller towns (<25 000) and small communities (<10 000). Higher self‐efficacy was also associated with rural background, more senior career status, earlier speciality decision time and smaller expectation‐experience gap.ConclusionAn independent association exists between rural self‐efficacy and intention to remain or return to small rural practice. The article offers rural clinical schools the opportunity to consider how they can influence future rural career outcomes.

Rural self-efficacy measuring intent for rural practice among Japanese medical students

Introduction: In Japan, the community medicine clerkship was introduced in order to foster positive attitudes towards rural practice and encourage rural recruitment. The purpose of the present research was to elucidate self-efficacy for rural practice. Method: Medical students comprised 166 women aged 22±2 (mean±standard deviation) (range 19–34) years and 243 men aged 23±3 (range 18–41) years. The participants were from academic years 1–3 (60.9%) and 4–6 (39.1%). The authors conducted a cross-sectional survey to identify questionnaire items that measure self-efficacy of intent for rural practice based on the portfolio of students who experienced community medicine clerkships. Results: Using factor analysis, a rural self-efficacy scale of four factors consisting of 15 items was identified. The factors extracted were work preferences, evaluation of rural practice, evaluation of rural living and personal character. The Cronbach’s alpha coefficient for the questionnaire was 0.849, acceptable for newly developed scales. The scree plot indicated for factors explained 46.8% of the total variance. The average score was 43±6 for women and 44±6 for men, and was significantly increased with stronger intent for rural practice in each gender. The factors of work preferences, evaluation of rural practice and evaluation of rural living showed a significant and independently positive correlation with the intent for rural practice. Moreover, multiple linear regression analysis using rural self- efficacy score as an objective variable, adjusted for confounding factors as explanatory variables, showed that the following were also significantly and independently associated with rural self-efficacy score: encounter with a doctor as a role model and general medicine orientation, for both men and women; and lower grade academic year, graduation from public high school and not failed entrance exam, for men. Conclusions: The present study suggests that medical schools might recruit medical students with higher rural self-efficacy score and have to foster their rural-oriented attitudes in order to provide physicians to rural areas.

Positive placement experience and future rural practice intentions: findings from a repeated cross-sectional study

ObjectiveTo identify the constituents of positive placement experience and explore the association between positive placement experiences and rural and remote practice intentions.MethodsA repeated cross-sectional study was conducted between January 2014 and December 2017. Medical, nursing, dentistry, and allied health students who completed a rural/remote placement were invited to complete a survey questionnaire on placement experience. Information on students’ sociodemographic factors, discipline, placement experience, placement satisfaction, and rural/remote practice intentions was collected. Modified Poisson regression was performed to determine the relationships between placement satisfaction and future rural practice intentions. Qualitative data were analyzed by thematic analysis.ResultsA total of 873 students responded. The majority of the survey respondents were females (70.06%), with a median age of 22 years (IQR 21–25 years), and 44.46% of respondents were medical students. Students satisfied with their placement were 2.10 times more likely to have rural/remote practice intention than their counterparts. Of all components of rural/remote placement experience, satisfaction with the placement supervision had the highest impact on changing students’ rural/remote practice intentions from negative to positive. The major themes from qualitative analysis were as follows: “wide variety of experience and hands-on learning opportunities,” “multidisciplinary exposure at home and workplace,” “support from the local University Department of Rural Health (UDRH),” “learning of indigenous culture,” and “experiencing challenges of rural health care services.”ConclusionThere is a strong association between positive placement experience and future rural/remote practice intentions. Therefore, facilitation of positive placement experiences in remote and rural locations could be a key strategy in addressing rural health workforce maldistribution.

Ruralization of students' horizons: insights into Australian health professional students' rural and remote placements.

IntroductionHealth workforce shortages have driven the Australian and other Western governments to invest in engaging more health professional students in rural and remote placements. The aim of this qualitative study was to provide an understanding of the lived experiences of students undertaking placements in various nonmetropolitan locations across Australia. In addition to providing their suggestions to improve rural placements, the study provides insight into factors contributing to positive and negative experiences that influence students’ future rural practice intentions.MethodsResponses to open-ended survey questions from 3,204 students from multiple health professions and universities were analyzed using two independent methods applied concurrently: manual thematic analysis and computerized content analysis using Leximancer software.ResultsThe core concept identified from the thematic analysis was “ruralization of students’ horizons,” a construct representing the importance of preparing health professional students for practice in nonmetropolitan locations. Ruralization embodies three interrelated themes, “preparation and support,” “rural or remote health experience,” and “rural lifestyle and socialization,” each of which includes multiple subthemes. From the content analysis, factors that promoted students’ rural practice intentions were having a “positive” practice experience, interactions with “supportive staff,” and interactions with the “community” in general. It was apparent that “difficulties,” eg, with “accommodation,” “Internet” access, “transport,” and “financial” support, negatively impacted students’ placement experience and rural practice intentions.ConclusionsThe study findings have policy and practice implications for continuing to support students undertaking regional, rural, and remote placements and preparing them for future practice in nonmetropolitan locations. This study may, therefore, further inform ongoing strategies for improving rural placement experiences and enhancing rural health workforce recruitment, retention, and capacity building.

Influence of student debt on health career location and specialty.

INTRODUCTION In New Zealand (NZ), there are shortages of health professionals in rural areas and in primary care. AIM This study aims to examine the association of student debt levels of medical, nursing, pharmacy and optometry students with: (1) preferred geographical location of practice, specifically preference to work in urban vs. rural areas; and (2) preferred career specialties, specifically interest in primary health care. METHODS Medical, nursing, pharmacy and optometry students completed a questionnaire at graduation that included questions about levels of New Zealand Government Student Loan debt and preferences regarding location of practice and career specialty. In an additional survey, medical students were asked to self-rate the effect of financial factors on their career choices. RESULTS Debt patterns varied across programmes. Medical and pharmacy students with high debt were significantly more likely than students with low debt to prefer rural over urban practice (P = 0.003). There was no difference in level of interest in a primary care specialty by debt level for any programme. Medical students reported little influence of debt on career choice, although students with high debt levels were less concerned over career financial prospects than students with lower levels of debt. DISCUSSION Current levels of student debt do not deter students from planning a career in rural or primary care settings. Somewhat surprisingly, higher levels of debt are associated with greater rural practice intentions for medical and pharmacy students, although the underlying reasons are uncertain.

Health professional students' rural placement satisfaction and rural practice intentions: A national cross-sectional survey.

The aim of this study was to profile students undertaking placements at University Departments of Rural Health (UDRHs) and investigate factors affecting students' satisfaction and intention to enter rural practice. Cross-sectional survey comprising 21 core questions used by all UDRHs. Eleven UDRHs across Australia that support students' placements in regional, rural and remote locations. Medical, nursing and allied health students who participated in UDRH placements between July 2014 and November 2015 and completed the questionnaire. Key dependent variables were placement satisfaction and rural practice intention. Descriptive variables were age, gender, Aboriginal or Torres Strait Islander (ATSI) background, location of placement, healthcare discipline, year of study and type and length of placement. A total of 3328 students responded. The sample was predominantly female (79%), the mean age was 26.0 years and 1.8% identified as ATSI. Most placements (69%) were >2 but ≤12 weeks, 80% were in Modified Monash 3, 4 or 5 geographical locations. Public hospitals and community health made up 63% of placements. Students satisfied with their placement had 2.33 higher odds of rural practice intention. Those satisfied with Indigenous cultural training, workplace supervision, access to education resources and accommodation had higher odds of overall satisfaction and post-placement rural practice intention. The majority of students were highly satisfied with their placement and the support provided by rural clinicians and the UDRHs. UDRHs are well placed to provide health professional students with highly satisfactory placements that foster rural practice intention.