Rural Clinical School Research Articles

Factors associated with satisfaction of the australian rural resident medical officer cadetship program: results from a cross-sectional study

BackgroundAustralian Rural Resident Medical Officer Cadetships are awarded to medical students interested in a rural medical career. The Rural Residential Medical Officer Cadetship Program (Cadetship Program) is administered by the Rural Doctors Network on behalf of the NSW Ministry of Health. This study aimed to assess the overall experience of medical students and key factors that contributed to their satisfaction with the Cadetship Program.MethodsA quantitative cross-sectional study was conducted among 107 former cadets who had completed the Cadetship Program. Data on medical students’ experience with the Cadetship Program (outcome variable) and potential explanatory variables were collected using a structured self-administered questionnaire. Explanatory variables included gender, geographical location, rural health club membership, rural clinical school attendance, financial support, mentorship benefits, networking opportunities, influence on career decisions, opportunity for preferential placements, and relocation. Both bivariate (Pearson’s chi-squared test) and multiple logistic regression analysis were employed to identify the factors associated with medical students’ overall experience with the Cadetship Program. The non-linear analysis was weighted to represent the rural/remote health workforce, in Stata/SE 14.1.ResultsOur results indicate that 91% of medical students were satisfied with the Cadetship Program. The logistic regression model identified two significant predictors of a positive experience with the Cadetship Program. Medical students who perceived financial support as beneficial were significantly more likely to report a satisfactory program experience (aOR = 6.22, 95% CI: 1.36–28.44, p = 0.019) than those who perceived financial support as not beneficial. Similarly, those who valued networking opportunities were more likely to have a positive view of their cadetship experience (aOR = 10.06, 95% CI: 1.11–91.06, p = 0.040) than their counterparts.ConclusionOur study found that students who valued financial support and networking opportunities had the most positive views of the Cadetship Program. These findings demonstrate that the Cadetship Program may be most helpful for those who need financial support and for students who seek networking opportunities. These findings increase our knowledge about the characteristics of medical students who have the most positive experiences with the Cadetship Program. They help us to understand the mechanisms of influence of such programs on individuals’ decisions to be part of the future rural health workforce.

Describing a medical school's rural activity footprint: setting selection and workforce distribution priorities.

There is growing evidence supporting a shift towards 'grow your own' approaches to recruiting, training and retaining health professionals from and for rural communities. To achieve this, there is a need for sound methodologies by which universities can describe their area of geographic focus in a precise way that can be utilised to recruit students from their region and evaluate workforce outcomes for partner communities. In Australia, Deakin University operates a Rural Health Multidisciplinary Training (RHMT) program funded Rural Clinical School and University Department of Rural Health, with the purpose of producing a graduate health workforce through the provision of rural clinical placements in western and south-western Victoria. The desire to establish a dedicated Rural Training Stream within Deakin's Doctor of Medicine course acted as a catalyst for us to describe our 'rural footprint' in a way that could be used to prioritise local student recruitment as well as evaluate graduate workforce outcomes specifically for this region. In Australia, selection of rural students has relied on the Australian Statistical Geography Standard Remoteness Areas (ASGS-RA) or Modified Monash Model (MMM) to assign rural background status to medical course applicants, based on a standard definition provided by the RHMT program. Applicants meeting rural background criteria may be preferentially admitted to any medical school according to admission quotas or dedicated rural streams across the country. Until recently, evaluations of graduate workforce outcomes have also used these rurality classifications, but often without reference to particular geographic areas. Growing international evidence supports the importance of place-based connection and training, with medical graduates more likely to work in a region that they are from or in which they have trained. For universities to align rural student recruitment more strategically with training in specific geographic areas, there is a need to develop precise geographical definitions of areas of rural focus that can be applied during admissions processes. As we strived to describe our rural activity area precisely, we modelled the application of several geographical and other frameworks, including the MMM, ASGS-RA, Primary Healthcare Networks (PHN), Local Government Areas (LGAs), postcodes and Statistical Areas. It became evident that there was no single geographical or rural framework that (1) accurately described our area of activity, (2) accurately described our desired workforce focus, (3) was practical to apply during the admissions process. We ultimately settled on a bespoke approach using a combination of the PHN and MMM to achieve the specificity required. This report provides an example of how a rural activity footprint can be accurately described and successfully employed to prioritise students from a geographical area for course admission. Lessons learned about the strengths and limitations of available geographical measures are shared. Applications of a precise footprint definition are described including student recruitment, evaluation of workforce outcomes for a geographic region, benefits to stakeholder relationships and an opportunity for more nuanced RHMT reporting.

How the training pathways and capacity of rural physicians inform their scope of practice: A qualitative study examining the experiences of Australian and international medical graduates in South-East New South Wales, Australia.

Current strategies to address shortages of rural doctors focus on developing a pipeline for rural generalist practice. Limited research has explored how doctors' professional journey engenders the skills required to practice rurally. This paper analyses how rural general practitioners' clinical pathway informs their scope of practice and future retention. Qualitative thematic analysis using semi-structured telephone interviews. Twenty-one general practitioners appointed in their local health district of Murrumbidgee and Southern New South Wales, Australia, within the past 10 years. Participants comprised 10 Australian medical graduates (AMG) and 11 international medical graduates (IMG). AMGs and IMGs contrasted how their pathway into rural practice, and capacity to work rurally, informed their scope of practice. Australian medical graduates' familiarity with rural areas was consolidated through congruous experiences, including at rural clinical schools. Paradoxically, the fluency of their training limited the amount of unsupervised experience and confidence AMGs gained. Together with a focus on work-life balance, this limited many to providing mainstream general practice, precluding extending their scope of practice. International medical graduates described disseminated experiences, often unsupervised in high-volume contexts. However, a lack of professional opportunities prevented them from extending their scope of practice. IMG and AMG motivation and pathway for working rurally differ. Respective cohorts have concerns regarding requisite skills and knowledge for rural practice, which incorporates opportunity and recognition. Entry points for training should be variable to allow consideration of life stage, prior skill development and extension of scope of practice. Doctors' scope of practice is informed by their pathways into rural practice. Australian medical graduates may not gain adequate competence during expedited training programs to confidently undertake extended clinical activities. International medical graduates, however lacked the opportunities and support, to utilise their expertise in rural practice. Complementarily utilising the expertise and commitment of both AMGs and IMGs may synergistically address workforce shortages.

Developing a digital anatomy lab for rural medical students

This paper follows the genesis and development of a digital anatomy lab for geographically isolated students in a postgraduate Doctor of Medicine programme in rural New South Wales and represents a work in progress. Students studying their degree at the rural clinical school do so without an in-situ cadaver-centred anatomy laboratory. This represents a pivotal shift away from the fundamental learning pedagogies implicit in academic Medicine, and therefore a challenge for situating the digital anatomy lab; its contents and explicit pedagogical needs, inside an already saturated curriculum. The Digital Anatomy space under development represents an intersection of scholarship on whether nascent digital tools (VR/AR) can develop fast enough to provide haptic and spatial feedback, how such digital spaces sit pedagogically amidst the accepted didactic teaching frameworks of Medicine, and whether creating virtual spaces improves student learning of Anatomy. This work-in-progress reflects the conference themes of people, partnerships and pedagogies.

Australian rural medical students' perceived readiness for work as a junior doctor: A cross-sectional national survey.

To report self-perceived readiness for work as a junior doctor in a national cohort of rural clinical school students. Cross-sectional study using a self-report questionnaire. Independent variables included 14 individual readiness items related to clinical and professional tasks, sociodemographic data and reported experience of rural clinical school (RCS) training. Participants were 668 medical students (55.3% females) completing a full academic year in rural Australia. Multivariable analysis explored factors associated with overall readiness for work as a junior doctor. 86% agreed that RCS experience prepared them to undertake the roles and responsibilities of a junior doctor. Self-ratings for specific clinical and professional tasks varied from a mean score of 5.9-8.0 out of 10, and 13 of the 14 items were associated with the outcome (p-value <0.001, except for performing spirometry). Lowest readiness scores were seen for some aspects including raising concerns about a colleague (mean score 6.1) or responding to workplace bullying (mean score 6.0). Aspects of the RCS experience that were strongly associated with overall readiness included: feeling a valued team-member (OR 9.28, 95%CI 2.43-35.39), feeling well-supported academically (OR 6.64, 95%CI 3.39-13.00), having opportunity for unsupervised but supported clinical practice (OR 4.67, 95%CI 1.45-15.00), having a rural mentor (OR 3.38, 95%CI 1.89-6.06) and having a previous health professional qualification (OR 2.7, 95%CI 1.32-5.54). Most RCS students felt ready for work as a junior doctor. Important aspects of RCS experience are likely to include students feeling integrated within the clinical team and having opportunities for authentic clinical roles. There remains a significant challenge for medical school curricula to address professional areas where graduates felt less prepared.

Assessing medical student satisfaction with rural placement: The Australian Rural Clinical School Support Survey.

Australia has a doctor shortage in rural settings, and rural placements for medical students have an important role in increasing the likelihood of students staying in rural settings throughout their careers. However, to date there is limited research regarding medical student perceptions of rural placement quality. We aimed to determine factors that impact the overall medical student experience during rural placements. Cross-sectional survey. Rural/remote clinical schools across Australia. Medical students on rural/remote clinical placements for at least 6 months. To assess factors impacting student experience on rural placements, we conducted a cross-sectional survey, known as the Australian Rural Clinical School Support Survey (ARCSSS) which was completed online by medical students across Australia. Demographic data were collected in addition to responses regarding academic teaching, extracurricular activities, and support services. Multiple choice and Likert scale questions were utilised. A total of 107 responses to our survey were analysed. The majority of participants were female (66.4%), and in their middle years of clinical education (55.1%). Overall, respondents showed high levels of satisfaction with clinical school supervisors, and clinical education. A high proportion of respondents indicated minimal accessibility of health and other support services. While a large proportion of participants indicated satisfaction with the rural placements, it was demonstrated that students were generally dissatisfied with school wellness activities and extracurricular activities. Financial insecurity was noted. The findings from our survey indicate there are numerous areas in which rural placements have been effective for medical students, and others in which improvement is needed. Furthermore, more research is required to better develop well-being initiatives that are effective in improving overall experience.

Reviewing academic coordination on the rural distributed training platform in South Africa.

Distributed training of students from a variety of health professions is increasing in South Africa because of the type of learning it offers and that it caters for the increasing number of students being accepted into health sciences programs. Challenges and facilitators to distributed training are well documented in the literature, and include increased distance from the academic home, human resources for health challenges, student access to support systems, and identifying learning environments to match learning outcomes. In the case of the Rural Clinical School in the Western Cape, South Africa, 'academic coordinators' were employed on site to fulfil the role of coordinating and supervising student learning and community engagement. This article explores their experiences. A large-scale qualitative study was conducted in 2017 exploring the history and development of the Ukwanda Centre for Rural Health and the Rural Clinical School. Part of this study included semi-structured individual and focus group interviews with consenting academic coordinators exploring their experiences of developing and working on a rural distributed training platform in South Africa. Data were inductively analysed. Ethical approval and institutional permission were obtained for this study, and all participants provided consent. In addition to previously published challenges that clinical supervisors who are employed by the health system face, the academic coordinators reported facing challenges related to professional isolation, boundary blurring between providing student support versus acting as clinical educator, juggling multiple line managers and administrative responsibilities, navigating the new field of academia, and not having the potential for career progression. Reflecting on the needs of academic coordinators expressed in this article, we identified four conditions that may promote sustained and continuous academic coordination at rural or remote distributed training sites. These conditions are (1) living and working local; (2) having a dual role in academia and the health system; (3) having access to academic support; and (4) regular engagement with the academic home, the value of which is detailed in this article. These recommendations can be adopted to optimise and sustain academic engagement on the distributed training platform, especially in light of the current expansion of health professions training and subsequent need to attract and retain clinician-academics in remote locations.

The impact of facilitators and rural immersion on medical student engagement during a child and adolescent mental health videoconference workshop.

Child and adolescent mental health (CAMH) disorders are a major public health problem in Australia, especially outside metropolitan areas. The issue is compounded by a shortage of child and adolescent psychiatrists (CAPs). CAMH receives minimal coverage in health professional training, training opportunities are scarce, and support for generalist health professionals, who treat most cases, is lacking. Novel approaches to early medical education and teaching are required to strengthen the available skilled workforce in rural and remote settings. This qualitative study explored the factors influencing medical student engagement in a CAMH videoconferencing workshop as part of the Rural Clinical School of WA. Our results confirm the priority of personal characteristics of medical educators, over clinical and subject matter expertise, on student learning. This research affirms that general practitioners are well-placed to facilitate recognition of learning experiences, especially given that students may not readily recognise exposure to CAMH cases. Our findings support the effectiveness, efficiencies, and benefits of utilising general medical educators in supporting child and adolescent psychiatry expertise in delivering subspecialty training within medical school curricula.

Evaluating the impact of the Adelaide Rural Clinical School longitudinal clinical placement on the rural medical workforce: A retrospective cohort study of graduates, 2004-2019.

To evaluate the contribution of the Adelaide Rural Clinical School (ARCS) longitudinal integrated clerkship to the rural medical workforce. Design: Retrospective cohort study. Practice location data were sourced from the Australian Health Practitioner Regulation Agency (AHPRA, January 2021) and matched using university records. University of Adelaide medical school alumni graduating between 2004 and 2019 (ARCS alumni who completed a full year of rural training [n = 423], metropolitan-trained peers [n = 1655]). The proportions of medical graduates working in a rural location (Modified Monash Model [MMM3-7] or Australian Statistical Geography Standard [ASGS-RA2-5] classifications). Logistic regression was used to examine the association between ARCS training and working rurally, and the influence of rural background and sociodemographic factors. Working in a rural location was almost three times more frequent among ARCS alumni than their metropolitan-trained peers, using the MMM3-7 (14.7% vs. 5.3%) classification; forASGS-RA2-5 classification (21.3% vs. 8.9%). In adjusted analysis, working rurally (MMM3-7) was associated with having a rural/remote residence on enrolment (OR 8.29, 95% CI 4.22-16.26) and was 3.1 times more likely for ARCS alumni (OR 3.06, 95% CI 2.06-4.53) than their peers. The magnitude of the effects of ARCS training on whether they are working rurally was similar among those with metropolitan or rural background (p-value for interaction 0.873). Similar associations were observed using ASGS-RA2-5 classifications. Extended rural placements through the Adelaide Rural Clinical School increased the rural medical workforce, with a similar impact among those with a rural or metropolitan background.

Undergraduate rural medical training experiences and uptake of rural practice: a retrospective cohort study in South Australia

BackgroundRural medical training experiences provided by Rural Clinical Schools (RCS) can encourage future practice in rural locations. However, the factors influencing students’ career choices are not well understood. This study explores the influence of undergraduate rural training experiences on graduates’ subsequent practice location.MethodsThis retrospective cohort study included all medical students who completed a full academic year at the University of Adelaide RCS training program between 2013–2018. Details of student characteristics, experiences, and preferences were extracted from the Federation of Rural Australian Medical Educators (FRAME, 2013–2018) survey and linked to graduates’ recorded practice location obtained from the Australian Health Practitioner Regulation Agency (AHPRA, January 2021). The rurality of the practice location was defined based on the Modified Monash Model (MMM 3–7) or Australian Statistical Geography Standard (ASGS 2–5). Logistic regression was used to examine associations between student rural training experiences and rural practice location.ResultsA total of 241 medical students (60.1% females; mean age 23.2 ± 1.8 years) completed the FRAME survey (response rate 93.2%). Of these, 91.7% felt well supported, 76.3% had a rural-based clinician mentor, 90.4% reported increased interest in a rural career, and 43.6% preferred a rural practice location after graduation. Practice locations were identified for 234 alumni, and 11.5% were working rurally in 2020 (MMM 3–7; 16.7% according to ASGS 2–5). In adjusted analysis, the odds of working rurally were 3–4 times more likely among those with a rural background or lived the longest in a rural location, 4–12 times more likely among those preferring a rural practice location after graduation, and increased with the student’s rural practice self-efficacy score (p-value < 0.05 in all cases). Neither the perceived support, having a rural-based mentor, or the increased interest in a rural career were associated with the practice location.ConclusionsThese RCS students consistently reported positive experiences and increased interest in rural practice after their rural training. Student reported preference for a rural career and rural practice self-efficacy score were significant predictors of subsequent rural medical practice. Other RCS could use these variables as indirect indicators of the impact of RCS training on the rural health workforce.

What have the Romans ever done for us?

The only privilege of being the Editor in Chief of a journal is that I get the opportunity to write an editorial for every edition. I can say, within reason, what I like, without peer review, censor or editing by anyone else. This being my last editorial for the journal that is probably even more true. So, as I sat contemplating the blank screen to write this editorial, my tongue decided it was once again time to explore the tooth that was causing me some discomfort, where a chip had come off making it extremely sensitive. My experience of managing this dental problem brought my mind to the RHMT funding for rural health workforce training and that is when the title of this paper came to the front of my mind. Yes, for those of you from my generation, I am referencing the classic scene from Monty Python's, Life of Brian. As John Cleese, playing the part of Reg goes on to say “apart from sanitation, the medicine, education, wine, public order, irrigation, roads, a fresh water system and public health, what have the Romans ever done for us?” What has that got to with the Australian rural health care. Well at times I feel like I am Reg in the Life of Brian. I struggle to see what the Romans, in the form of the RHMT funded Rural Clinical Schools, University Departments of Rural Health and Dental Training Expanding Rural Placement Programs have done for us. If I go back to my tooth. I live in a regional city, Bendigo, with both a Rural Clinical School (Monash), a University Department of Rural Health (La Trobe University) and a Dental School, solely based in Bendigo. Yet, when I saw the dentist and it was determined that I need my tooth assessed for suitability of a crown (it might need root canal work), my options were to wait a long time for an appointment with the Endodontist who comes to Bendigo from Melbourne, or travel to Melbourne to see them at their practice. In the latter case, I could get an appointment within a week, in the former, more than a month wait with ongoing pain. So, despite all the RHMT funding and rural health workforce training here in Bendigo, if I wanted a reasonably quick resolution of my tooth pain, I needed to go to Melbourne. Fortunately, I have the advantage of a good income and flexible employment, which allowed me to do that, with no financial penalty. Unfortunately, the vast majority of our rural communities do not have that privilege. So, at an individual level, I feel like Reg. Apart from “on average, graduates who had the most rural clinical placement experience are now working more in regional, rural and remote Australia” (1 p213) and “the RHMT program, has a direct economic benefit to the communities and regions with economic analyses demonstrating a positive multiplier effect of around 2 i.e. for every spent under the RHMT program another dollar is generated in the local economy” (1 p 236), I wonder what has the RHMT programme done for us. Despite these assertions, we do not have any good quality evidence anywhere that the approach we are taking is actually addressing the problems of recruiting and retaining a rural and remote health workforce. Where are the data that the workforce shortage in a city or town is less after an RCS or UDRH was established than before, or that towns without RCS's and UDRHs have more workforce shortages and worse health outcomes than communities with them. In the most recent review, that I am aware of,2 identified that 34 papers focused on health workforce retention interventions for rural and remote areas. They conclude that most of the studies were of low quality, that about only one-third applied appropriate statistical analysis to the date, less than half adjusted for key potential confounders, and many had no comparator groups.2 In no other contexts of health care would that be considered a solid literature base to make any conclusions on, yet it does not deter the authors from asserting “Policy makers seeking rural retention in the medium and longer term would be prudent to strengthen rural training pathways and limit the use of strongly coercive interventions.”2 So, my plea to the few people who read these editorials is can we please stop pretending that the RHMT programme has had a major impact on the health and health workforce of rural and remote Australia and spent the time and intellectual effort to actually determine if this approach is working because I am not seeing what the RHMT programme has done for my tooth.

The ties that bind: Social network analysis describes the social element of medical workforce recruitment to rural/remote Australia

We present the argument that medical recruitment to a previously under-recruited remote town was effected through what Social Network Analysis (SNA) measures as “brokerage” which operates amidst “structural holes”. We proposed that medical graduates being generated by the national Rural Health School movement in Australia were particularly affected by the combined effect of workforce lacks (structural holes) and strong social commitments (brokerage) – all key SNA concepts. We therefore chose SNA to assess whether the characteristics of RCS-related rural recruitment had feature that SNA might be able to identify, as operantly measured using the industry-standard UCINET's suite of statistical and graphical tools. The result was clear. Graphical output from the UCINET editor showed one individual as being central to all recently recruited doctors to one rural town with recruitment issues like all the others. The statistical outputs from UCINET characterised this person as the single point of most connections. The real-world engagements of this central doctor were in accord with the description of brokerage, a core SNA construct, relationship with reported the reason for these new graduates both coming and staying in town. SNA thus proved fruitful in this first quantification of the role of social networks in drawing new medical recruits to particular rural towns. It allowed description at the level of individual actors with a potent influence on recruitment to rural Australia. We propose these measures could be helpful as key performance indicators for the national Rural Clinical School programme that is generating and distributing a large workforce in Australia, which appears from this work to have a strong social basis. This redistribution of medical workforce from urban to rural is needed internationally.

Medical student interest and participation in research at one rural clinical school: Insights from the last six years.

Limited evidence is currently available relating to research acitivity of medical students training in regional or rural areas. To describe medical student interest and participation in research at The University of Queensland Rural Clinical School (UQRCS). Annual student expression of interest surveys were collated with records of student research participation maintained at UQRCS from 2017-2022. Additionally, a systematic search was conducted to identify student outputs not captured in internal records. Frequencies and proportions were calculated for all descriptive data along with proportions of students who engaged with a project, and projects that led to a peer-reviewed publication. At UQRCS commencement, 55% of research-interested students reported having basic research skills. Thirty-nine percent of research-interested students engaged with a project, most commonly literature reviews (47%) or audits (29%). Thirty-three percent of completed projects led to a peer-reviewed manuscript. Students who engage with a project are unlikely to receive a project in their preferred clinical area and should be informed about the transferrability of research skills. Most students have basic research skills when commencing a project and therefore require ongoing support and mentorship from staff/supervisors. Publication rates of medical students in regional/rural areas are comparable to those reported by metropolitan medical schools (~30%).

Impact of the COVID-19 pandemic on student experiences during rural placements in Australia: findings from a national multi-centre survey

The aim of this national study was to explore the learning experiences of Australia's medical students who trained rurally during the COVID-19 pandemic in 2020. A cross-sectional, national multi-centre survey was conducted in 2020, through the Federation of Rural Australian Medical Educators (FRAME). Participants were medical students who had completed an extended Rural Clinical School (RCS) training placement (≥ 12months). A bespoke set of COVID-19 impact questions were incorporated into the annual FRAME survey, to capture COVID-19-related student experiences in 2020. Pre-pandemic (2019 FRAME survey data) comparisons were also explored. FRAME survey data were obtained from 464 students in 2020 (51.7% response rate), compared with available data from 668 students in 2019 (75.6% response rate). Most students expressed concern regarding the pandemic's impact on the quality of their learning (80%) or missed clinical learning (58%); however, students reported being well-supported by the various learning and support strategies implemented by the RCSs across Australia. Notably, comparisons to pre-pandemic (2019) participants of the general RCS experience found higher levels of student support (strongly agree 58.9% vs 42.4%, p < 0.001) and wellbeing (strongly agree 49.6% vs 42.4%, p = 0.008) amongst the 2020 participants. Students with more than one year of RCS experience compared to one RCS year felt better supported with clinical skills learning opportunities (p = 0.015) and less affected by COVID-19 in their exam performance (p = 0.009). This study has provided evidence of both the level of concern relating to learning quality as well as the positive impact of the various learning and support strategies implemented by the RCSs during the pandemic in 2020. RCSs should further evaluate the strategies implemented to identify those that are worth sustaining into the post-pandemic period.

Factors predicting rural location employment intent and choice among medical students and graduates.

Workforce shortage is a contributing cause of health inequality in rural Australia. There is inconclusive evidence demonstrating which factors cause doctors to choose rural practice. This study's objective is to determine predictive factors for medical students' intent to work rurally and for graduates' current rural employment location choice. This prospective cohort study, utilized data gathered from the University of New South Wales about students and graduates who had spent one or more years in a Rural Clinical School. Participants were final year students and graduates already working in Australia. Stepwise logistic regression was used to determine predictive factors for the two outcomes. Predictors for student intent to work rurally are rural background (odds ratio [OR], 7.16; 95% confidence interval [CI], 2.59-19.53), choosing to study at the Rural Clinical School (OR, 8.72; 95% CI, 1.32-57.63), and perceiving rural areas as opportunistic for career advancement (OR, 1.69; 95% CI, 1.15-2.49). Predictors for graduates currently working in a rural location are Bonded Medical Program participation (OR, 6.40; 95% CI, 1.15-35.59) and personal altruism (OR, 1.91; 95% CI, 1.02-3.57). While intent is predicted by having a rural background, choosing to study at the Rural Clinical School and perception of rural areas as having positive career opportunities, a current rural workplace location among graduates is predicted by holding a bonded medical position and a desire to serve an under-resourced population. Maintaining the Bonded Medical Program and clear communication regarding training pathways may increase numbers of rural doctors.

Competition or collaboration in regional Australia? A cross-border and multi-university approach to maximising rural health investments, community health and health workforce outcomes.

To describe the establishment of a cross-border and multi-university collaboration in rural Australia to mitigate potential competition, maximise Rural Health Multidisciplinary Training (RHMT) Programme investments and regional health workforce outcomes. Rural Health Multidisciplinary Training programme investments have enabled the establishment of 19 Australian University Departments of Rural Health (UDRH) and 17 Rural Clinical Schools. The importance of these investments is acknowledged. However, in regional settings, due to limited clinical placement and training opportunities, there is potential for heightened competition between universities who are operating within shared geographical footprints. Competition between universities risks focusing RHMT programme activity on individual reporting requirements and activities, in preference to: regional needs; existing community-university relationships; and place-based approaches to health workforce development. A rural New South Wales and Victorian RHMT-funded departments, collectively known as the Sunraysia Collaboration. Strategic and operational processes, structures and actions underpinning collaboration formation and relationship consolidation will be described. Co-design methodologies employed to collectively define collaboration vision and aims, governance framework and guiding principles, reporting structures and co-contributions to teaching, research and service will be discussed. Collaboration sensitivity to the social, cultural, relationship and economic connectedness within the region and existing health workforce flows will also be explored. The Sunraysia collaboration demonstrates one approach towards mitigating potential competition between RHMT Programme funded universities within rural and remote Australia. The collaboration is an exemplar of co-design in action providing an alternative approach to address RHMT Programme parameters and regional needs whilst supporting rural-remote health workforce training and education innovations.

Beyond rural clinical schools to “by rural, in rural, for rural”: immersive community engaged rural education and training pathways

Beyond rural clinical schools to “by rural, in rural, for rural”: immersive community engaged rural education and training pathways

Contemporary Australian socio-cultural factors and their influence on medical student rural career intent.

ObjectiveTo understand how contemporary socio‐cultural factors may impact medical students' rural career intent.DesignCross‐sectional study using data from the national Federation of Rural Australian Medical Educators survey.Participants/settingMedical students across 18 Australian universities who completed a full academic year of clinical training in rural areas in 2019.Main outcome measure(s)Preferred location of practice post‐training reported to be either: (i) a major city; (ii) a regional area or large town; or (iii) a small rural location.ResultsIn total, 626 students completed the survey (70.1% response rate). A small rural location was the most preferred location of practice after graduation for 28.3% of the students (95% CI 21.6–36.0). Four socio‐cultural factors were positively associated with a preference for a rural career location: poor health status of rural people, motor vehicle traffic congestion in cities, rural generalist training opportunities in the state and the Royal Flying Doctor Service. Other socio‐cultural factors, including specialists’ under‐employment, Medicare freeze effect on doctors' income, bullying/sexual harassment in hospitals, climate change/natural disasters or recognised rural health personalities did not influence the investigated outcome.ConclusionsOur findings indicate a novel association between contemporary socio‐cultural factors and rural career intention in a cohort of Australian rural clinical school students. These findings advocate for further consideration of research exploring socio‐cultural factors shaping rural career intent and workforce outcomes.

Influence of rural clinical school experience and rural origin on practising in rural communities five and eight years after graduation.

ObjectiveTo examine associations between extended medical graduates’ rural clinical school (RCS) experience and geographic origins with practising in rural communities five and eight years after graduation.Design, participantsCohort study of 2011 domestic medical graduates from ten Australian medical schools with rural clinical or regional medical schools.Main outcome measuresPractice location types eight years after graduation (2019/2020) as recorded by the Australian Health Practitioner Regulation Agency, classified as rural or metropolitan according to the 2015 Modified Monash Model; changes in practice location type between postgraduate years 5 (2016/2017) and 8 (2019/2020).ResultsData were available for 1321 graduates from ten universities; 696 were women (52.7%), 259 had rural backgrounds (19.6%), and 413 had extended RCS experience (31.3%). Eight years after graduation, rural origin graduates with extended RCS experience were more likely than metropolitan origin graduates without this experience to practise in regional (relative risk [RR], 3.6; 95% CI, 1.8–7.1) or rural communities (RR, 4.8; 95% CI, 3.1–7.5). Concordance of location type five and eight years after graduation was 92.6% for metropolitan practice (84 of 1136 graduates had moved to regional/rural practice, 7.4%), 26% for regional practice (56 of 95 had moved to metropolitan practice, 59%), and 73% for rural practice (20 of 100 had moved to metropolitan practice, 20%). Metropolitan origin graduates with extended RCS experience were more likely than those without it to remain in rural practice (RR, 2.0; 95% CI, 1.3–2.9) or to move to rural practice (RR, 1.9; 95% CI, 1.2–3.1).ConclusionThe distribution of graduates by practice location type was similar five and eight years after graduation. Recruitment to and retention in rural practice were higher among graduates with extended RCS experience. Our findings reinforce the importance of longitudinal rural and regional training pathways, and the role of RCSs, regional training hubs, and the rural generalist training program in coordinating these initiatives.

Impact of the COVID-19 pandemic on medical student placements in rural Queensland: A survey study.

ObjectiveThe COVID‐19 pandemic has adversely impacted medical students' learning experiences. Students in one Australian Rural Clinical School were surveyed to investigate the impact of disruptions to clinical placements and satisfaction with educational changes implemented as a result of the pandemic.DesignCross‐sectional survey.SettingThe University of Queensland Rural Clinical School.MethodsStudents undertaking one or two years of study at the participating Rural Clinical School in November 2020.Main outcome measureA 20‐item anonymised survey with questions on personal health and safety, quality of clinical training experience, response to changes in learning and student environment, and progression to completion of the medical degree.ResultsThe survey was completed by 124 students (76% response rate). Students were satisfied with the changes made to their learning to accommodate the disruptions to health service delivery and placements. Final year students were more satisfied with their learning experiences compared to their third‐year counterparts.ConclusionsThe Rural Clinical School implemented a range of academic and psychological support strategies which appear to have helped with mitigating mental health concerns experienced by students completing rural placements, who are already prone to experiencing social isolation. Strengthening communication between the academic and health service sectors can improve the quality of learning for medical students on placements.