Rural Clinical School Research Articles

Medical graduates becoming rural doctors: rural background versus extended rural placement

To determine whether recruitment of rural students and uptake of extended rural placements are associated with students' expressed intentions to undertake rural internships and students' acceptance of rural internships after finishing medical school, and to compare any associations. Longitudinal study of three successive cohorts (commencing 2005, 2006, 2007) of medical students in the Sydney Medical Program (SMP), University of Sydney, New South Wales, using responses to self-administered questionnaires upon entry to and exit from the Sydney Medical School and data recorded in rolls. Students' expressed intentions to undertake rural internships, and their acceptance of rural internships after finishing medical school. Data from 448 students were included. The proportion of students preferring a rural career dropped from 20.7% (79/382) to 12.5% (54/433) between entry into and exit from the SMP. A total of 98 students took extended rural placements. Ultimately, 8.1% (35/434) accepted a rural internship, although 14.5% (60/415) had indicated a first preference for a rural post. Students who had undertaken an extended rural placement were more than three times as likely as those with rural backgrounds to express a first preference for a rural internship (23.9% v 7.7%; χ(2) = 7.04; P = 0.008) and more than twice as likely to accept a rural internship (21.3% v 9.9%; χ(2) = 3.85; P = 0.05). For the three cohorts studied, rural clinical training through extended placements in rural clinical schools had a stronger association than rural background with a preference for, and acceptance of, rural internship.

Is the National Registration website (Australian Health Practitioner Regulation Agency) effective in tracking Australian medical graduates’ rural work?

This study compared rural location identified through the National Registration (AHPRA) registry with location obtained through labour-intensive personal contact. Longitudinal cohort study with two methods to identify the work locations of medical graduates from The Rural Clinical School of Western Australia (RCSWA). Consenting alumni from the University of Western Australia and the University of Notre Dame Fremantle participating in RCSWA between 2002 and 2009 inclusive and available to contact in 2011. Percentage location matches between two contact methods. There was 80% agreement for principal suburb, 92% agreement for principal city and 94% agreement for principal state between RCSWA personal contact and the AHPRA registry. AHPRA identified nearly two times as many graduate locations. However, there was only 31% agreement for a rural placement location (of any length). In more detail, for year-long rural placement, personal contact was 88% concordant with AHPRA; work six months or more were less concordant (44% agreement); work less than six months were not concordant (4% agreement). AHPRA data matched RCSWA alumni data only for graduates in full-time rural work. Since medical alumni spend up to 10 years in pre-vocational and vocational training, which includes many rural options, personal contact was able to pick up the myriad of rural choices, whereas the AHPRA database was not sensitive enough to identify them. Until graduates have stably finished training, the optimal method to identify rural work is through personal contact but statistical correction for missing data needs to be considered.

What is the evidence for clinical placements in underserved areas?

What is the evidence for clinical placements in underserved areas?

Building Research Capacity of Medical Students and Health Professionals in Rural Communities: Leveraging a Rural Clinical School's Resources to Conduct Research Skills Workshops

The paper reports on a project where the objective was for the Rural Clinical School, The University of Queensland, Australia, to design an acceptable model of research skills workshops for medical students and rural health professionals. Eight, interactive research skills workshops focused on skill development were conducted in rural Queensland, and attended by 62 undergraduate medical students and rural health professionals. The workshop learning objectives were to: provide an understanding of research methods and practise some basic research skills; and develop a greater understanding of the research process. Of the 53 participants who provided evaluations, more than two-thirds agreed that the learning objectives were met, and although health professionals evaluated the workshops most highly, two-thirds of the medical students also agreed. Consistent with the positive quantitative evaluations, participants reported valuing the knowledge acquired in the workshops, combined with the teaching methods. The study demonstrated that an interactive, skills-based workshop was an acceptable model for the medical students and rural health professionals who participated, and that better health outcomes for rural Australians could ultimately result from leveraging a Rural Clinical School's resources to increase research capacity through this approach.

Women in the rural medical academic workforce

This study assessed the role of women as fractional full-time equivalent (FTE) rural academics in the context of significant workforce shortage and increasing academic demand. The design was a cross-sectional cohort study conducted from June 2002 to June 2012. All Rural Clinical School teaching sites in Western Australia were included, numbering from 3 (at inception in 2002) to 13 in 2012. Participants were all clinicians employed as academic staff of The University of Western Australia since its inception. Teaching staff employed elsewhere were not included. Main outcome measures were the proportion of women employed in the Rural Clinical School and work characteristics including appointment fraction, duration and site leadership. Relative to the workforce at large, female academics were disproportionately employed in the Rural Clinical School with a relative risk of 1.28 (CI 1.0-1.64), χ²=2.0 p=0.46. Their likelihood of being Australian trained was 1.62 (CI 1.3-2.0), χ²=19.3, p=0.000 relative to the rural female GP workforce. Their FTE (t=1.0 p=0.295), time of tenure (t=1.19, p=0.24) and site leadership was indistinguishable from male Rural Clinical School academics. Female doctors who are willing to take on part-time work are supporting the rural medical teaching workforce.

Better rural health through research?

Better rural health through research?

Additional years of Australian Rural Clinical School undergraduate training is associated with rural practice

BackgroundTo understand the influence of the number of years spent at an Australian rural clinical school (RCS) on graduate current, preferred current and intended location for rural workforce practice.MethodsRetrospective online survey of medical graduates who spent 1–3 years of their undergraduate training in the University of New South Wales (UNSW) Rural Clinical School. Associations with factors (gender, rural versus non-rural entry, conscription versus non-conscript and number of years of RCS attendance) influencing current, preferred current and intended locations were assessed using χ2 test. Factors that were considered significant at P < 0.1 were entered into a logistic regression model for further analysis.Results214 graduates responded to the online survey. Graduates with three years of previous RCS training were more likely to indicate rural areas as their preferred current work location, than their colleagues who spent one year at an RCS campus (OR = 3.0, 95% CI = 1.2-7.4, P = 0.015). Also RCS graduates that spent three years at an RCS were more likely to intend to take up rural medical practice after completion of training compared to the graduates with one year of rural placement (OR = 5.1, 95% CI = 1.8-14.2, P = 0.002). Non-rural medicine entry graduates who spent three years at rural campuses were more likely to take up rural practice compared to those who spent just one year at a rural campus (OR = 8.4, 95% CI = 2.1-33.5, P = 0.002).ConclusionsIncreasing the length of time beyond a year at an Australian RCS campus for undergraduate medical students is associated with current work location, preferred current work location and intended work location in a rural area. Spending three years in a RCS significantly increases the likelihood of rural career intentions of non-rural students.

Reply to Comment on: Medical students on long-term regional and rural placements: what is the financial cost to supervisors?

It was difficult to consider every cost to the practice given the complexities of each practice and within the limits of our study, income proved the most effective way to look at the student impact. All the practices participating in the study received a one-off capital grant as part of Rural Clinical School funding from the Commonwealth Government, in return for a commitment to the project for several years. Capacity to provide a room for independent student consulting is essential to give students access to 'undifferentiated patients' and develop student competency for an authentic contribution to patient care. At least infrastructure funding allows the practice to use the consulting room for other doctors or health professionals when the student is doing other community, hospital or academic work (2-3 days per week).

Clinical ethics ward rounds: building on the core curriculum

The clinical years of medical student education are an ideal time for students to practise and refine ethical thinking and behaviour. We piloted a new clinical ethics teaching activity this...

A decade of Australian Rural Clinical School graduates - where are they and why?

The Australian Rural Clinical School (RCS) initiative has been addressing the rural medical workforce shortage at the medical education level for over a decade. A major expectation of this initiative is that it will improve rural medical workforce recruitment and subsequent retention through a rurally based undergraduate clinical training experience. The longitudinal nature of these workforce initiatives means that definitive evidence of its impact on the shortage of rural doctors is yet to be provided; however, to date cross-sectional studies are accumulating a measure of efficacy for these initiatives by monitoring early career factors such as internship location choice and speciality choice of RCS graduates. This article reports on a study in one RCS that is monitoring the impact of rural undergraduate clinical training on trends in workforce participation patterns of its graduates as long as 9 years in the workforce. Career location and speciality choice are reported as well as perspectives on early career intentions and the reality of making career and life decisions as a doctor in the medical workforce. A longitudinal mixed methods sequential explanatory design employed a quantitative data collection phase followed by a qualitative phase with the merging of data sources during the interpretation and analysis. In 2007 a database was established that maintained the contact details of all former graduates since 2002. Every 2 years graduates are invited to participate in a survey and provide an update on the influences on their current career intentions/decisions. The qualitative sample was recruited through a survey question asking for interest in participating in an interview. The whole-sample survey results showed that out of a 64% (N = 115) response rate, 40% of respondents were currently working in non-urban locations. The majority (<n = 51, 53%) had been out in the workforce for 5 to 7 years and general practice was the most frequent speciality choice. Out of 29 interviewees, just over half (n = 16, 55%) were currently working in non-urban locations and primarily in general practice. The majority (n = 17, 58%) had been out in the workforce for 5 to 6 years. Overall they perceived that the primary drivers influencing their early career/life decisions were personal/family reasons and speciality training requirements. The study highlighted what is obvious but often overlooked in recruitment strategies for medical students and prevocational doctors: the significance of the inevitable life decisions that frequently take precedence over career intentions. A decade on there is strong endorsement for the positive influence that rural undergraduate clinical training has on promoting rural career intentions. However the fulfilment of these intentions is at risk when competing with concurrent personal/life choices and while based in an urban training environment. Provision of a continuum of postgraduate training opportunities in rural and regional settings that include a rural focus for specialties such as surgery, anaesthetics and obstetrics could: (1) satisfy speciality training requirements; (2) focus life decisions in a rural environment; and (3) keep rural career intentions viable and congruent with other life goals. The overriding message is: the longer the exposure to training in the rural context, the greater the impact on interest in future rural practice and, particularly, the greater the likelihood that important life decisions will also be made in the rural context.

Rural origin plus a rural clinical school placement is a significant predictor of medical students' intentions to practice rurally: a multi-university study

Health workforce shortages are a major problem in rural areas. Australian medical schools have implemented a number of rural education and training interventions aimed at increasing medical graduates' willingness to work in rural areas. These initiatives include recruiting students from rural backgrounds, delivering training in rural areas, and providing all students with some rural exposure during their medical training. However there is little evidence regarding the impact of rural exposure versus rural origin on workforce outcomes. The aim of this study is to identify and assess factors affecting preference for future rural practice among medical students participating in the Australian Rural Clinical Schools (RCS) Program. Questionnaires were distributed to 166 medical students who had completed their RCS term in 2006; 125 (75%) responded. Medical students were asked about their preferred location and specialty for future practice, their beliefs about rural work and life, and the impact of the RCS experience on their future rural training and practice preferences. Almost half the students (47%; n=58) self-reported a 'rural background'. Significantly, students from rural backgrounds were 10 times more likely to prefer to work in rural areas when compared with other students (p<0.001). For those preferring general practice, 80% (n=24) wished to do so rurally. Eighty-five per cent (n=105) of students agreed that their RCS experience increased their interest in rural training and practice with 62% (n=75) of students indicating a preference for rural internship/basic training after their RCS experience. A substantial percentage (86%; n=108) agreed they would consider rural practice after their RCS experience. This baseline study provides significant evidence to support rural medical recruitment and retention through education and training, with important insights into the factors affecting preference for future rural practice. By far the most significant predictor of rural practice intention is recruitment of students with a rural background who also undertake an RCS placement. This research also demonstrates significant demand for post-graduate rural training places, including specialty places, as RCS graduates become junior doctors and vocational trainees.

Rural Undergraduate Support and Coordination, Rural Clinical School, and Rural Australian Medical Undergraduate Scholarship: rural undergraduate initiatives and subsequent rural medical workforce

This study examined postgraduate work after an undergraduate clinical year spent in the Rural Clinical School of Western Australia (RCSWA), compared with 6 weeks Rural Undergraduate Support and Coordination (RUSC)-funded rural experience in a 6-year undergraduate medical course. Rural background, sex and Rural Australian Medical Undergraduate Scholarship (RAMUS)-holding were taken into account. Methods. University of Western Australia undergraduate data were linked by hand with postgraduate placements to provide a comprehensive dataset on the rural exposure history of junior medical practitioners working in Western Australia between 2004 and 2007. Participation in the RCSWA program was associated with significantly more postgraduate year one rural work than RUSC placement alone (OR=1.5, CI 0.97-2.38). The RCSWA workforce effect increased at postgraduate year two (OR=3.0, CI 1.6484 to 5.5935 relative to RUSC). Rural-origin practitioners who chose the RCSWA program were more likely than other rural-origin practitioners to take rural rotations in both postgraduate years. RAMUS holders' choice in relation to the RCSWA program predicted later rural work. There were no effects of sex. Rural initiatives, in particular the Rural Clinical School program, are associated with postgraduate rural choices. The real impact of these data rely on the translation of early postgraduate choices into long-term work commitments.

The Cradle Coast personally controlled electronic health record evaluation research.

In 2010 the Federal Government announced funding over two years to create a Personally Controlled Electronic Health Record (PCEHR) for Australians. One of the wave 2 implementation sites is the Cradle Coast in Tasmania. A PCEHR Program Benefits and Evaluation Partner (BEP) has been appointed to undertake evaluation activities with the e-health lead implementation sites. In addition to this implementation a comprehensive research plan has been developed and commenced through the Rural Clinical School at the University of Tasmania. The overarching aim of the research agenda is to evaluate the outcomes of various elements of the 4C project as it evolves and is implemented, from multiple perspectives. The research agenda is important as it expands upon the NEHTA mandated evaluation and provides an holistic overview of the PCEHR implementation process and outcomes for clinicians, patients and family members. This paper will detail the planned evaluation and its progress to date.

Assessment in rural health professional education

[Extract] Well may we say that Australia is a world leader in rural health professional education, but what about rurally focused assessment? Educating students in rural areas is well established in Australia, with a wide network of Rural Clinical Schools and University Departments of Rural Health offering opportunities for students across many disciplines to undertake substantial rural experience as an integral part of their course. This rural emphasis has been accompanied by an increased rural focus in curricula and selection processes, increased recruitment of rural-origin students, and investment in infrastructure and academic and administrative appointments in rural areas to support the increased rural teaching.

Implications of increased student intake on rural rotations in Australian medical schools

There has been significant growth in the intake of medical students in Australia in recent years, particularly between 2003 and 2007, where the intake increased by an average of 12.3% each year 2 . Reports indicate that despite the substantial annual growth of medical student intake, the supply of clinical teachers and patients for teaching has remained static. This raises the question as to whether or not there will be sufficient rural preceptors to give all students an adequate experience in rural medicine. As a student-initiated research project at the Rural Clinical School of the University of Queensland, we surveyed each of the Australian medical schools to collect information on the type of rural training they offer and, where applicable, data on student placements at RUSC sites during 2008 and 2009 at the participating medical schools. Of the 14 medical schools that were providing RUSC placements for their students in those years, 10 medical schools responded with analysable data. The rural sites that hosted students in both years of the study were analysed as a subset, and the number of students in 2008 was subtracted from the number of students in 2009 for each site, in order to determine whether or not individual rural sites are hosting more students in 2009 than in the previous year.

Compulsory medical rural placements: Senior student opinions of early-year experiential learning

The aim of this study was to determine senior medical student (year 3-5) opinions of their early-year (year 1-2) rural placement. We assessed the impact of MBBS early-year rural placements through a follow up of this cohort in their later years using a cross-sectional questionnaire. The questionnaire was administered to year 3-5 medical students at their clinical school. There were 97 participants (49% response rate) in the study. Twenty-nine per cent were male and 71% were female; 44% were from a rural background and 56% were from a metropolitan background; 48% were year 3 students, 32% were year 4 students and 20% were year 5 students; and 59% of the students were, at the time, situated at a rural clinical school and 41% were at a metropolitan clinical school. Closed-ended questions were quantified and statistically analysed. Open-ended responses were thematically analysed to determine what their experience of early-year rural placements were like. Seventy-nine per cent of students considered the year 1 placement length as 'about right'. Overall, most students found year 1 rural placements positive and grasped the placement aims and objectives. Most students were also pleased with year 2 rural placements, mainly due to the clinical aspects. Medical students appear to prefer shorter early-year rural placements and understand the benefits and importance of such placements. They also have a desire for greater clinical exposure during these early-year placements.

Academics appeal to State: 'help us train where the needs are'

With many medical schools boldly piloting on-site clinical training in vastly underserved rural areas, the top generalist educators among South Africa’s eight medical campuses last month agreed to urgently petition government for expanded rural teaching platforms. Over 46% of the country’s population lives in rural areas where just 2.9% of local medical graduates end up annually, the massive unmet service delivery crying out for government intervention – and the academics want to suggest pragmatic solutions. The group, consisting of top rural health training advocates at the universities of the Witwatersrand, Pretoria, Western Cape, Stellenbosch, Cape Town and Walter Sisulu University (Mthatha), held a rural clinical schools workshop at UCT’s Sports Science Academy on 23 June this year. Facilitated by Benguela Health, it followed an Atlantic Philanthropies-funded tour to South Eastern Australia (Gippsland and Victoria) by several participants to observe best practice in expanding rural health training facilities. The timing of the workshop petition, to be presented to the South African Committee of Deans this October, after which a compelling best-evidence set of recommendations for increased rural clinical schools support will go to the Health and Higher Education ministries, could not be better. Health Minister Dr Aaron Motsoaledi is diligently setting up new district maternal and child health care teams, having publicly vowed to triple the country’s 1 200 annual MB ChB graduate output in order to make some dent in the apparently intractable human resource (HR) crisis.

Social accountability in medical education – An Australian rural and remote perspective

Australia's medical education system is undergoing a socially motivated transformation focused on improving access to medical care for rural and remote communities. A rural and remote backbone of Rural Clinical Schools (RCS), University Departments of Rural Health, regional medical schools, and the postgraduate college, ACRRM, have enabled community responsive innovation and partnerships with rural health services that once would have been difficult to imagine. This article argues that this transformation is succeeding because of the passionate leadership of rural medical and community leaders, government seed funding to encourage rural medicine as an academic discipline, rigorous research and consultation that underpinned each step of the innovation pathway, and a political campaign to invest in rural medical education as a form of rural social capital.

Vertical integration of teaching in Australian general practice — a survey of regional training providers

To examine vertical integration of teaching and clinical training in general practice and describe practical examples being undertaken by Australian general practice regional training providers (RTPs). A qualitative study of all RTPs in Australia, mid 2010. All 17RTPs in Australia responded. Eleven had developed some vertical integration initiatives. Several encouraged registrars to teach junior doctors and medical students, others encouraged general practitioner supervisors to run multilevel educational sessions, a few coordinated placements, linkages and support across their region. Three RTPs provided case studies of vertical integration. Many RTPs in Australia use vertical integration of teaching in their training programs. RTPs with close associations with universities and rural clinical schools seem to be leading these initiatives.

Initial evaluation of rural programs at the Australian National University: understanding the effects of rural programs on intentions for rural and remote medical practice

Rural health workforce issues are a priority area for the Australian Government and substantial funding has been provided for rural education programs to address health workforce disparities across Australia's rural and remote communities. The Australian Government established a Rural Health Strategy in 2001 and as a result there are now 14 rural clinical schools in Australia. The 2008 Urbis Report highlighted the lack of research on rural programs and workforce outcomes, essential to ensuring that educational efforts, resources and funding are being concentrated appropriately. This study examined the Australian National University (ANU) Medical School's 4 year rural program to identify the impact of elective and compulsory program components on student intentions to practice in a rural and remote location post-graduation. The study also explores factors that affect student decisions to apply for year-long rural placements. METHODS; ANU Medical School's graduating cohort of 2008 fourth year medical students completed an anonymous and voluntary online survey questionnaire. Survey sections included student demographics, compulsory and elective components of the ANU rural program, and an overall evaluation of the ANU rural curriculum. The survey contained a mixture of forced-answer questions and open-ended commentary. Quantitative data were analyzed for descriptive and frequency statistics using EpiInfo V3.5.1 (<a href='http://wwwn.cdc.gov/epiinfo/' target='_blank'>http://wwwn.cdc.gov/epiinfo/). Qualitative data were reviewed and consistent themes among responses extracted. In total, 40 students from a cohort of 88 (45%) responded, with 26 respondents (65%) indicating that at medical school commencement they considered working in a rural or remote area. At the end of their medical education, 33 respondents (82%) indicated their intention to spend some time in their careers working in a rural or remote area. Students from non-rural backgrounds had greater positive change in their intentions to practice rurally as a direct effect of ANU rural programs when compared with students from rural backgrounds. More than 70% of students believed the amount of rural focus in the curriculum was correct, 75% believed that they will be better medical practitioners because of the program, and 85% found the curriculum was delivered effectively. Students who undertook elective rural programs such as a year-long rural placement were more likely to have future rural career intentions when compared with students undertaking compulsory rural components. Compulsory components, however, had a strong influence on students applying for elective programs. Regarding application for the year-long rural placement, students reported clinical exposure was the most encouraging factor, and time away from family and friends, and lack of spousal and family support were the most discouraging factors. Rural programs at the ANU, and medical school exposure to rural health experiences is important in influencing students' perceptions of a career in rural and remote health. This study provides evidence that both compulsory and elective components contribute to a successful holistic rural program which nurtures the rural interest of all students. Overall, students at the ANU medical school were satisfied with the rural curriculum. The results confirm that there is difficulty in recruiting students with family commitments into year-long rural placement programs, despite incentives. Those students who select long-term rural study for reasons other than an interest in a career in rural health end the program with positive rural intentions.