Rural Clinical School Research Articles

In-Place Training: Optimizing Rural Health Workforce Outcomes through Rural-Based Education in Australia

The medical workforce shortfall in rural areas is a major issue influencing the nature of undergraduate medical education in Australia. Exposing undergraduates to rural life through rural clinical school (RCS) placements is seen as a key strategy to address workforce imbalances. We investigated the influence of an extended RCS placement and rural origin on the rural principal place of practice (PPP) of the first 3 graduate cohorts (2012–2014) from a Joint Medical Program offered by two universities based in northern New South Wales. Data was available for 426 eligible graduates. Participation in an extended RCS placement (odds ratio (OR), 6.075, 95% confidence interval (CI) 2.716–13.591), rural background (OR 3.613, 95% CI 1.752–7.450) and being 25 years or older at completion of a medical degree (OR 2.550, 95% CI 1.252–5.194) were all independently associated with rural PPP. Being bonded into a program to practice rurally was not associated with rural PPP. Participation in an extended RCS placement is strongly associated with rural practice in the first 3 to 5 years of practice for graduates from both rural and metropolitan backgrounds. This finding indicates that strategies to improve the rural workforce should focus on the promotion of rural placements, in addition to rural background.

Thoughtful questions in the history as new pedagogy for teaching patient centred care: A pilot study in an Australian Rural Clinical School (RCS).

Abstract Introduction: The taking of the patient medical history is at the heart of the doctor patient relationship. It is often critical for a diagnosis and also plays an important part in ongoing clinical care of the patient. However, with the move away from assessment by “long case” to the Objective Structured Clinical Examination (OSCE), medical students spend less time with patients and when they do take a history it is done in a didactic checklist manner. This learning is contrary to the needs of the now more health literate patient. Methods: By an iterative process we developed a program of teaching medical history at the bedside of real patients that focussed on listening to what the patient said as opposed to the traditional history checklist. By anonymous online survey we sought feedback from the students on this way of teaching. Results: Over the three years of this program (from 2013) 76 of the 85 students responded to the survey (89% response rate). Students were mostly receptive to the ideas of following up on clues and information that patients gave them and then presenting this information in a more interesting way to peers. However, there was less enthusiasm, for taking the history in a more casual but patient centred way Conclusion: This program was feasible and welcomed by the students. The major limitations were that students were frustrated by not being taught examinable OSCE cases and that the time commitment by the clinician was onerous.

Paediatric case mix in a rural clinical school is relevant to future practice

BackgroundExposure to a representative case mix is essential for clinical learning, with logbooks established as a way of demonstrating patient contacts. Few studies have reported the paediatric case mix available to geographically distributed students within the same medical school. Given international interest in expanding medical teaching locations to rural contexts, equitable case exposure in rural relative to urban settings is topical. The Rural Clinical School of Western Australia locates students up to 3500 km from the urban university for an academic year. There is particular need to examine paediatric case mix as a study reported Australian graduates felt unprepared for paediatric rotations.We asked:Does a rural clinical school provide a paediatric case mix relevant to future practice? How does the paediatric case mix as logged by rural students compare with that by urban students?MethodsThe 3745 logs of 76 urban and 76 rural consenting medical students were categorised by presenting symptoms and compared to the Australian Institute of Health and Welfare (AIHW) database Major Diagnostic Categories (MDCs).ResultsRural and urban students logged core paediatric cases, in similar order, despite the striking difference in geographic locations. The pattern of overall presenting problems closely corresponded to Australian paediatric hospital admissions. Rural students logged 91% of cases in secondary healthcare settings; urban students logged 90% of cases in tertiary settings. The top four presenting problems were ENT/respiratory, gastrointestinal/urogenital, neurodevelopmental and musculoskeletal; these made up 60% of all cases. Rural and urban students logged similar proportions of infants, children and adolescents, with a variety of case morbidity.ConclusionsRural clinical school students logged a mix of core paediatric cases relevant to illnesses of Australian children admitted to public hospitals, with similar order and pattern by age group to urban students, despite major differences in clinical settings. Logged cases met the curriculum learning outcomes of graduates. Minor variations were readily addressed via recommendations about logging. This paper provides evidence of the legitimacy of student logs as useful tools in affirming appropriate paediatric case mix. It validates the rural clinical school context as appropriate for medical students to prepare for future clinical paediatric practice.

Attitudes towards peer review of teaching in medical education

Introduction: Peer review of teaching is an important evaluation and development activity. Its use is well documented within US tertiary institutions but less common in the UK and Australia. While some research into prevalence, outcomes and opinions of peer review within medical education exists, documented implementation is uncommon. This topic is particularly underresearched within a rural and regional education context. This research sought opinions on peer review of teaching among medical educators and intended to ascertain levels of experience with, and ease of access to, peer review programmes across city, rural and international locations. Methods: A purposefully designed questionnaire, seeking views and experiences of peer review of teaching, was sent to medical educators at the University of Melbourne (metropolitan-based Melbourne Medical School educators at multiple metropolitan hospitals; educators based at multiple Rural Clinical School campuses in regional Victoria) and the University of Manchester (based at Manchester Royal Infirmary). Information regarding teaching experience and qualifications, as well as previous experience with peer review, was also sought. Results: Only 10.4% of respondents had a formal teaching qualification at postgraduate or masters level; 29.2% had previous experience of formal peer review. Respondents who reported teaching more hours per week were more likely to agree that formal peer review programmes would be beneficial to teaching development ( r = 0.12; p = 0.05) and were also more likely to have the time to take part ( r = 0.14; p = 0.02). The overall attitude towards peer review was favourable; 87.7% of respondents stated they would take part in a programme, and 90.6% were of the view that peer review improved teaching practice. There were no statistically-significant differences in opinions towards peer review across the three locations. Conclusions: This study shows there is a significant unmet interest among medical educators for peer review of teaching, and it suggests this is particularly prevalent among rural and regional-based medical educators. Further, data suggests a voluntary and informative form of peer review is more likely to be embraced as an opportunity for professional development.

Opting for rural practice: the influence of medical student origin, intention and immersion experience.

To compare the influence of rural background, rural intent at medical school entry, and Rural Clinical School (RCS) participation on the likelihood of later participation in rural practice. Analysis of linked data from the Medical School Outcomes Database Commencing Medical Students Questionnaire (CMSQ), routinely collected demographic information, and the Australian Health Practitioner Regulation Agency database on practice location. University of Western Australia medical students who completed the CMSQ during 2006-2010 and were practising medicine in 2016. Medical practice in rural areas (ASGC-RAs 2-5) during postgraduate years 2-5. Full data were available for 508 eligible medical graduates. Rural background (OR, 3.91; 95% CI, 2.12-7.21; P < 0.001) and experience in an RCS (OR, 1.93; 95% CI, 1.05-3.54; P = 0.034) were significant predictors of rural practice in the multivariate analysis of all potential factors. When interactions between intention, origin, and RCS experience were included, RCS participation significantly increased the likelihood of graduates with an initial rural intention practising in a rural location (OR, 3.57; 95% CI, 1.25-10.2; P = 0.017). The effect of RCS participation was not significant if there was no pre-existing intention to practise rurally (OR, 1.38; 95% CI, 0.61-3.16; P = 0.44). For students who entered medical school with the intention to later work in a rural location, RCS experience was the deciding factor for realising this intention. Background, intent and RCS participation should all be considered if medical schools are to increase the proportion of graduates working rurally.

The rural pipeline to longer-term rural practice: General practitioners and specialists

BackgroundRural medical workforce shortage contributes to health disadvantage experienced by rural communities worldwide. This study aimed to determine the regional results of an Australian Government sponsored national program to enhance the Australian rural medical workforce by recruiting rural background students and establishing rural clinical schools (RCS). In particular, we wished to determine predictors of graduates’ longer-term rural practice and whether the predictors differ between general practitioners (GPs) and specialists.MethodsA cross-sectional cohort study, conducted in 2012, of 729 medical graduates of The University of Queensland 2002–2011. The outcome of interest was primary place of graduates’ practice categorised as rural for at least 50% of time since graduation (‘Longer-term Rural Practice’, LTRP) among GPs and medical specialists. The main exposures were rural background (RB) or metropolitan background (MB), and attendance at a metropolitan clinical school (MCS) or the Rural Clinical School for one year (RCS-1) or two years (RCS-2).ResultsIndependent predictors of LTRP (odds ratio [95% confidence interval]) were RB (2.10 [1.37–3.20]), RCS-1 (2.85 [1.77–4.58]), RCS-2 (5.38 [3.15–9.20]), GP (3.40 [2.13–5.43]), and bonded scholarship (2.11 [1.19–3.76]). Compared to being single, having a metropolitan background partner was a negative predictor (0.34 [0.21–0.57]). The effects of RB and RCS were additive—compared to MB and MCS (Reference group): RB and RCS-1 (6.58[3.32–13.04]), RB and RCS-2 (10.36[4.89–21.93]). Although specialists were less likely than GPs to be in LTRP, the pattern of the effects of rural exposures was similar, although some significant differences in the effects of the duration of RCS attendance, bonded scholarships and partner’s background were apparent.ConclusionsAmong both specialists and GPs, rural background and rural clinical school attendance are independent, duration-dependent, and additive, predictors of longer-term rural practice. Metropolitan-based medical schools can enhance both specialist and GP rural medical workforce by enrolling rural background medical students and providing them with long-term rural undergraduate clinical training. Policy settings to achieve optimum rural workforce outcomes may differ between specialists and GPs.

What is an appropriate social scenario for staff and students at an Australian Rural Clinical School? A survey of fourth and fifth year medical student and #8217;s resident in rural Tasmania.

Introduction: The degree of comfort that medical students have in different social settings with staff and faculty has not been documented. Methods: We undertook in 2012 a survey of 53, 4th and 5th year medical students at the University of Tasmanian Rural Clinical School to determine the incidence of previous inappropriate social invitations/interactions and perceptions of comfort to five different hypothetical social scenarios of different appropriateness. Results: Two students had received what they considered to be an inappropriate invitation. Most students were comfortable with communal public social situations. However, in an overt date scenario eight students were either completely at ease with or comfortable. 18 students although uncomfortable with this scenario would still attend and only 14 students would decline the invitation. Conclusion: There needs to be increased awareness that certain social interactions between health professionals when there is significant difference in hierarchy may not always be appropriate.

Corrigendum to: It's more than money: policy options to secure medical specialist workforce for regional centres.

Objectives Regional centres and their rural hinterlands support significant populations of non-metropolitan Australians. Despite their importance in the settlement hierarchy and the key medical services provided from these centres, little research has focused on their issues of workforce supply and long-term service requirements. In addition, they are a critical component of the recent growth of 'regional' hub-and-spoke specialist models of service delivery.Methods The present study interviewed 62 resident specialists in four regional centres, seeking to explore recruitment and retention factors important to their location decision making. The findings were used to develop a framework of possible evidence-informed policies.Results This article identifies key professional, social and locational factors, several of which are modifiable and amenable to policy redesign, including work variety, workplace culture, sense of community and spousal employment; these factors that can be targeted through initiatives in selection, training and incentives.Conclusions Commonwealth, state and local governments in collaboration with communities and specialist colleges can work synergistically, with a multiplicity of interdigitating strategies, to ensure a positive approach to the maintenance of a critical mass of long-term rural specialists.What is known about the topic? Rural origin increases likelihood of long-term retention to rural locations, with rural clinical school training associated with increased rural intent. Recruitment and retention policy has been directed at general practitioners in rural communities, with little focus on regional centres or medical specialists.What does this study add? Rural origin is associated with regional centre recruitment. Professional, social and locational factors are all moderately important in both recruitment and retention. Specialist medical training for regional centres ideally requires both generalist and subspecialist skills sets. Workforce policy needs to address modifiable factors with four groups, namely commonwealth and state governments, specialist medical colleges and local communities, all needing to align their activities for achievement of long-term medical workforce outcomes.What are the implications for practitioners? Modifiable factors affecting recruitment and retention must be addressed to support specialist models of care in regional centres. Modifiable factors relate to maintenance of a critical mass of practitioners, training a fit-for-purpose workforce and coordinated effort between stakeholders. Although remuneration is important, the decision to stay relates primarily to non-financial factors.

Student academic performance in rural clinical schools: The impact of cohort size and competition

Objectives: The Deakin University School of Medicine commenced in 2008 as a rurally focused medical school in south-eastern Australia. This research was designed to examine the effectiveness of the school’s adoption of small regional clinical school settings.Methods: A retrospective cohort study of the first two cohorts of students was employed to assess academic performance at each of five geographically dispersed clinical training sites, with varying student cohort sizes. The Dundee Ready Education Environment Measure (DREEM) questionnaire provided quantitative data regarding the students’ perception of their educational environment. The data were analyzed using univariate and multivariate analyses.Results: The highest examination scores, and greatest satisfaction with educational environment, were associated with the clinical school that had a small-sized group of students and was not co-located with another medical school. These differences remained after adjusting for multiple potential confounding factors.Conclusion: The smaller sites appear to have provided superior support for student learning in this new medical school. This advantage diminishes when smaller cohorts are co-located with students from other medical schools. Cohort size and co-location of medical school curricula may be important independent variables for researchers to consider when comparing the results of clinical education innovations in different settings.

It’s more than money: policy options to secure medical specialist workforce for regional centres

Objectives Regional centres and their rural hinterlands support significant populations of non-metropolitan Australians. Despite their importance in the settlement hierarchy and the key medical services provided from these centres, little research has focused on their issues of workforce supply and long-term service requirements. In addition, they are a critical component of the recent growth of 'regional' hub-and-spoke specialist models of service delivery. Methods The present study interviewed 62 resident specialists in four regional centres, seeking to explore recruitment and retention factors important to their location decision making. The findings were used to develop a framework of possible evidence-informed policies. Results This article identifies key professional, social and locational factors, several of which are modifiable and amenable to policy redesign, including work variety, workplace culture, sense of community and spousal employment; these factors that can be targeted through initiatives in selection, training and incentives. Conclusions Commonwealth, state and local governments in collaboration with communities and specialist colleges can work synergistically, with a multiplicity of interdigitating strategies, to ensure a positive approach to the maintenance of a critical mass of long-term rural specialists. What is known about the topic? Rural origin increases likelihood of long-term retention to rural locations, with rural clinical school training associated with increased rural intent. Recruitment and retention policy has been directed at general practitioners in rural communities, with little focus on regional centres or medical specialists. What does this study add? Rural origin is associated with regional centre recruitment. Professional, social and locational factors are all moderately important in both recruitment and retention. Specialist medical training for regional centres ideally requires both generalist and subspecialist skills sets. Workforce policy needs to address modifiable factors with four groups, namely commonwealth and state governments, specialist medical colleges and local communities, all needing to align their activities for achievement of long-term medical workforce outcomes. What are the implications for practitioners? Modifiable factors affecting recruitment and retention must be addressed to support specialist models of care in regional centres. Modifiable factors relate to maintenance of a critical mass of practitioners, training a fit-for-purpose workforce and coordinated effort between stakeholders. Although remuneration is important, the decision to stay relates primarily to non-financial factors.

Effect of medical student preference on rural clinical school experience and rural career intentions

The key parameter for rural clinical schools (RCSs) is to provide at least 1 year of clinical training in rural areas for 25% of Australian Commonwealth supported medical students with the intent to influence future rural medical workforce outcomes. The objective of this study was to describe the association between a medical student's selection preference and their RCS experience and rural career intent. Medical students completing an RCS placement in 2012 and 2013 were encouraged to complete a survey regarding their experience and future career intent. Data were analysed to compare medical students for whom the RCS was their first choice with students who described the RCS as other than their first preference. Students for whom RCS was their first choice (724/1092) were significantly more likely to be female, come from a rural background and be from an undergraduate program. These students reported more positive experiences of all aspects of the RCS program (costs, access, support and networks, safety) and were 2.36 times more likely to report intentions to practice in a non-metropolitan area (odds ratio(OR)=2.36 (95% confidence interval(CI)=1.82-3.06), <i>p</i><0.001). This was true for students of rural (OR=3.11 (95%CI=1.93-5.02), <i>p</i><0.001) and metropolitan backgrounds (OR=2.07 (95%CI=1.48-2.89), <i>p</i><0.001). More students in the first-choice group (68.8%) intended to practice in a regional area (not a capital or major city), significantly higher than the 48.4% of participants in the other-preference group (&#967;2 (1) 42.79, <i>p</i><0.001). The decision to choose an RCS placement is a marker of rural career intention and a positive rural training experience for students of both rural and metropolitan backgrounds. It may be important to identify other-preference students and their specific social support needs to ensure a positive perception of a future rural career.

Interest in rural clinical school is not enough: Participation is necessary to predict an ultimate rural practice location.

Rural exposure during medical school is associated with increased rural work after graduation. How much of the increase in rural workforce by these graduates is due to pre-existing interest and plans to work rurally and how much is related to the extended clinical placement is not known. This cohort study compared the employment location of medical graduates who professed no rural interest as undergraduates (negative control), with those who applied but did not participate in Rural Clinical School of Western Australia (RCSWA) (positive control), and those who applied and participated in RCSWA (participants). All 1026 University of Western Australia students who had an opportunity to apply for a year-long rotation in RCSWA from 2004 to 2010, and who had subsequently graduated by the end of 2011, were included. Graduates' principal workplace location (AHPRA, Feb 2014). The three groups differed significantly in their graduate work locations (χ2 = 39.2, P < 0.001). In multivariate analysis, only being of older age at graduation (OR 2.28 (95% CI 1.40, 3.72), P = 0.001), being from a rural background (OR 2.99 (95% CI 1.85, 4.85), P < 0.001), being a recipient of a Medical Rural Bonded Scholarship (OR 3.36 (95% CI 1.68, 6.73, P = 0.001) and actually participating in the RCSWA remained significantly related to rural work (OR 3.10 (95% CI 1.95, 4.93), P < 0.001). After accounting for other factors relating to rural work, RCSWA graduates were three times more likely to work rurally than either control group. These data suggest that RCSWA has a significant independent effect on rural workforce.

Allied health professional rural education: Stellenbosch University learners’ experiences

Background. Rural clinical training is not widely established or documented for allied health sciences (AHS) learners. This article focuses on the experiences of AHS learners from Stellenbosch University’s uKwanda Rural Clinical School. Objective. To explore learners’ practices with regard to rural clinical training in the AHS. Methods. A total of 22 documented reflections and seven educator or learner semi-structured focus group discussions, using critical conversations, were analysed with methods such as textual and thematic analysis and qualitative research software (ATLAS.ti, Germany). Results. The perception of rural clinical training was reported as an overwhelmingly positive experience. Practices positioned ‘rural’ as a catalyst for developing learners’ emerging identities as policy brokers, and as best when delivered by team participation. Professional education curricula were reported as dependant on: (i) context; (ii) educators; and (iii) how time was managed. Conclusion. Rural-based learning is a humanising experience for health science learners.

Strengthening nursing and midwifery capacity in rural New South Wales, Australia

A small rural health service and two university schools of nursing joined forces to establish a rural clinical school to advance clinical education and research. The collaboration, while in its infancy, has given rise to outcomes that strength the capacity of nursing and midwifery services in the community.

The career preferences of students who choose longer duration rural clinical placements

BackgroundIn Australia, medical students usually undertake a series of 6–8 weeks long clinical specialty placements, and mainly in urban teaching hospitals. As part of a strategy to increase interest in rural careers, students at some medical schools may instead choose longer, more generalist clinical placements through either rural medical schools or rural clinical schools that are affiliated with urban medical schools. These placements involve varying combinations of rotations for periods up to a whole academic year in more generalist hospital and family practice settings. Models include rural longitudinal integrated clerkships (LICs), rural clinical schools, and rural medical schools. Little is known about the effect of these longer placements on career outcomes in Australia. MethodStudent category and placement data from the Medical Student Outcomes Database project was sourced for three categories of medical students commencing in 2008 and 2009: 276 students with at least 700h (about half an academic year) in rural clinical placements; 772 students at the same medical schools with less than 700h in rural clinical placements; and 5326 students at 16 medical schools that either did not offer longer rural placements or had very small numbers undertaking them. Data were compared from all three groups using the Chi Square statistic. ResultsThere were a total of 3483 students in commonwealth supported places without a rural obligation (CSP); 1375 students in CSPs with a rural obligation; 414 in domestic full fee (DFF) places; and 926 in international full fee (IFF) places. CSP students are more likely, and IFF students are less likely to choose an LRP (χ2 statistic 56.4, P<0.05). Students choosing a LRP are more likely to have a rural background (χ2 statistic 124.5, P<0.05) and a preference for careers outside metropolitan areas, particularly in smaller communities (χ2 statistic 182.2, P<0.05). Future specialty preferences of LRP students are similar to other students, except for emergency medicine and rural medicine, but not for family practice (chi-squared statistic 53.4, P<0.05). Discussion and conclusionsLonger rural placements appear to be associated with stronger preference at graduation for rural careers, and appear to be a valid strategy for enhancing rural workforce outcomes. More research is needed to determine the outcomes of all models of longer rural placements, including a comparison of the different models that include longer rural placements. The relevance to other education systems and national contexts also needs examining.

Factors related to doctors' choice of rural pathway in general practice specialty training.

To investigate the factors eligible applicants consider in electing for a rural pathway into specialty training. Cohort study. Australia. Applicants to the Australian General Practice Training program. Applicants' initial preference of either a general or rural pathway to undertake specialty training. Of the 2,221 applicants, 45% were Australian Medical Graduates (AMGs), 27% Foreign Graduates of Accredited Medical Schools (FGAMS) and 29% International Medical Graduates (IMGs). Through government regulation, two thirds (70%) were eligible to train on both general and rural pathways and a third (30%) were required to train rurally. For applicants eligible for general pathway (n=1552), those with rural background [Odds Ratio (OR)=3.7, 95% CI 2.7-5.2] and rural clinical school experience (OR=2.0, 95% CI 1.5-2.8) were more likely to choose the rural pathway. In addition, FGAMS who were eligible for the general pathway were less likely to choose a rural pathway when compared with IMGs (OR=0.33, 95%CI 0.1=0.7). In applicants who changed their training pathway from their initial to revised preference, lower Multiple-Mini-Interview (OR=0.54, 95% CI 0.43-0.66) and Situational Judgement Test z-scores (OR=0.68, 95% CI 0.56-0.83) were associated with a higher probability of changing from a general to rural pathway preference. For those eligible for a general or rural pathway, rural background and rural clinical school experience are associated with the decision to elect for rural training. Targeted support for international and foreign graduates of Australia/New Zealand schools may influence them to train rurally.

Supports for medical students during rural clinical placements: factors associated with intention to practise in rural locations

Through rural clinical schools (RCSs), medical students may undertake an extended block of clinical training in rural Australia. The premise of these placements is that meaningful rural exposure will facilitate rural career uptake. RCSs offer a range of supports to facilitate student engagement in the program. This study aims to analyse RCS students' perceptions of these supports and impact on intentions to work rurally. Between September 2012 and January 2013 RCS students were invited to complete questions regarding perceptions of student support, as a part of the annual Federation of Australian Medical Educators survey. Multivariable logistic regression was used to identify associations between supports and intentions for rural internship or career. There were 454 participants. A majority of students (n=349, 79.1%) felt well supported by their RCS. Students from a rural background (odds ratio (OR)=1.64 (95% confidence interval (CI):1.13-2.38)), or who indicated that their placement had a positive impact on their wellbeing (OR=1.38 (95%CI:1.07-1.80)), were more likely to intend to complete a rural internship. Those who felt socially isolated were less likely to elect this (OR=0.82 (0.70-0.97)). Outcomes were similar for those indicating a preference for rural or remote practice after completing training. Student perceptions of supports offered by RCSs were generally very positive. Perceptions of financial support were not predictive of rural career intent. Although this does not negate the importance of providing appropriate financial supports, it does demonstrate that student wellbeing is a more important recruitment factor for rural practice.

James Cook University's decentralised medical training model: an important part of the rural workforce pipeline in northern Australia

There has been much recent investment to improve the recruitment and retention of medical graduates in rural Australia. This paper describes the different outcomes of the strategies used at the James Cook University (JCU) medical school to improve the recruitment and retention of medical graduates in northern Australian towns: the decentralised model of four rural clinical schools, selecting students with a rural home town, enrolling students under the Bonded Medical Placements (BMP) scheme, and providing rurally orientated scholarships. Home town at application to medical school, clinical school location, scholarship, BMP and postgraduate practice location data for JCU medical graduates were retrieved from an ongoing longitudinal cohort study. Multivariate logistic regression analysis was used to identify independent predictors of intern practice location from 2006 to 2013, and current (2014) practice location for postgraduate year 4-9 graduates for each of the four rural clinical school sites of Townsville, Cairns, Darwin and Mackay. The strongest predictor of JCU Bachelor of Medicine, Bachelor of Surgery (MBBS) graduates undertaking their internship in Townsville, Cairns, Mackay or Darwin hospitals was attending the JCU clinical school in that location (p<0.001, prevalence odds ratios (POR)=7.1; p<0.001, POR=11.5; p<0.001, POR=19.4; p<0.001, POR=85.7; respectively). Attending the JCU clinical school in the main town was also a strong predictor of JCU MBBS graduates currently practising (2014) in the Townsville, Cairns and Mackay health service districts (p<0.001, POR=2.9; p<0.001, POR=3.8; p=0.033, POR=3.6; respectively). While this study supports the effectiveness of improving the rural medical workforce via the targeted selection of students with a rural background, the JCU medical school's decentralised medical education program also appears to be significantly associated with rural recruitment and retention, including in districts of workforce shortage and/or geographically remote locations. These findings support other evidence that decentralised medical training can assist recruitment to underserved regions, and have implications for other jurisdictions looking to invest in a decentralised training model.

A combination of traditional learning and e-learning can be more effective on radiological interpretation skills in medical students: a pre- and post-intervention study

BackgroundThe ability to interpret an X-Ray is a vital skill for graduating medical students which guides clinicians towards accurate diagnosis and treatment of the patient. However, research has suggested that radiological interpretation skills are less than satisfactory in not only medical students, but also in residents and consultants.MethodsThis study investigated the effectiveness of e-learning for the development of X-ray interpretation skills in pre-clinical medical students. Competencies in clinical X-Ray interpretation were assessed by comparison of pre- and post-intervention scores and one year follow up assessment, where the e-learning course was the ‘intervention’.ResultsOur results demonstrate improved knowledge and skills in X-ray interpretation in students. Assessment of the post training students showed significantly higher scores than the scores of control group of students undertaking the same assessment at the same time.ConclusionsThe development of the Internet and advances in multimedia technologies has paved the way for computer-assisted education. As more rural clinical schools are established the electronic delivery of radiology teaching through websites will become a necessity. The use of e-learning to deliver radiology tuition to medical students represents an exciting alternative and is an effective method of developing competency in radiological interpretation for medical students.

Association between self-efficacy, career interest and rural career intent in Australian medical students with rural clinical school experience

ObjectivesTo investigate medical student's self-efficacy at the time of finishing their rural clinical school (RCS) placement and factors associated with self-efficacy. Secondary aims are to explore whether interest levels or...