Rural Intentions Research Articles

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.

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.

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.

Predicting Rural Practice and Service to Indigent Patients: Survey of Dental Students Before and After Rural Community Rotations

Community-based clinical rotations in rural areas expose dental students to diverse patient populations, practice models, and career opportunities as well as rural culture. The aims of this study at West Virginia University were to determine the best predictors of rural practice, assess the predictive validity of students' intention to practice in a rural area before and after their rural rotations, and evaluate the relationship between students' intention to practice in a rural area and intention to provide care for indigent patients. Online survey data were submitted pre- and post-rural clinical rotation by 432 of 489 dental students over the study period 2001-12, yielding an 88% response rate. In 2013, practice addresses from the West Virginia Board of Dentistry were added to the student database. The results showed that significant predictors of rural practice site were intended rural practice choice, rural hometown, and projected greater practice accessibility for indigent patients. The likelihood of students' predicting they would choose a rural practice increased after completion of their rural rotations. After the rotations, students predicted providing greater accessibility to indigent patients; these changes occurred for those who changed their predictions to rural practice choice after the rotations and those who subsequently entered rural practice. The dental students with a rural background or a greater service orientation were also more likely to expect to enter a rural practice and actually to do so after graduation. These findings suggest that dental school curricula that include rural rotations may increase students' sensitivity to issues of indigent patients and increase students' likelihood of rural practice choice.

Interpreting rural career intention in medical workforce research

Rural medical educators have devised strategies based on research evidence to help shape a medical workforce that will choose to serve in rural and other under-served communities, where the health care needs are often high. Based on evidence that students from rural communities are more likely to work later in rural practice, many medical programmes now have targets for rural background students in addition to rural curriculum and placement initiatives. However, just how strong is the evidence that this is effective? Australian medical schools now have data for up to 20 years since the rural medical education initiatives were first introduced. Rural background still appears to be a strong predictor or rural practice outcomes, although combining multiple strategies appears strongest. There remain some methodological issues, such as defining both 'rural' and 'background', and determining how intention relates to ultimate location of practice. We may yet have to await longer follow-up periods before we can be confident about what works best in rural medical education.

Does a mandatory rural exposure change medical students’ rural practice intent?

While rural background has consistently been the strongest predictor of rural practice, the Australian medical schools have a vital role to play in changing rural intention. Research on rural exposure during medical training has to date resulted in inconsistent findings. The purpose of this paper is to examine what occurs during a short conscripted rural exposure. A post-test self-report questionnaire evaluating the University of Queensland Rural Medicine Rotation eight-week clinical rotation was completed by 1609 domestic medical students from 2007 to 2011. The most effective single learning outcome was students who strongly agree that the rural rotation experience had increased their appreciation of the greater depth of clinical responsibility inherent in rural practice. These students were more likely to indicate that their intention to practise rurally had been positively rather than negatively influenced and more like to indicate they were very encouraged by the experience rather than merely encouraged to practise rurally. The most powerful group of learning outcomes, in positively changing rural intention from a short mandated exposure were aligned with developing an understanding of the context of rural medical practise. These contribute to our understanding of the role rural exposure.

외국인 농촌관광 중요도속성에 따른 농촌관광 인지도 및 경험여부, 행동의도 판별분석

This study was to investigate if there are important variables of rural tourism destination for foreign tourists that discriminate rural tourism perception, experience, and intention to behavior. of the experience activity among the regions and the villages. From the literature review, the survey questionnaires was developed to measure important variables of rural tourism destination, rural tourism perception, experiences and intention to behavior. A total of 799 useful samples were collected and analyzed in SPSS. Factor analysis showed that there are four underlying dimensions (program, preparation to receive, service and regional products, and human service). the results of discriminate analysis showed that service and regional products are important variables in rural tourism perception and experiences. And also service and regional products and human service are important variables in intention to behavior. More detailed discussion and implications are provided in conclusion.

Medical student selection criteria as predictors of intended rural practice following graduation.

BackgroundRecruiting medical students from a rural background, together with offering them opportunities for prolonged immersion in rural clinical training environments, both lead to increased participation in the rural workforce after graduation. We have now assessed the extent to which medical students’ intentions to practice rurally may also be predicted by either medical school selection criteria and/or student socio-demographic profiles.MethodsThe study cohort included 538 secondary school-leaver entrants to The University of Western Australia Medical School from 2006 to 2011. On entry they completed a questionnaire indicating intention for either urban or rural practice following graduation. Selection factors (standardised interview score, percentile score from the Undergraduate Medicine and Health Sciences Admission Test (UMAT) and prior academic performance (Australian Tertiary Admissions Rank), together with socio-demographic factors (age, gender, decile for the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) and an index of rurality) were examined in relation to intended rural or urban destination of practice.ResultsIn multivariate logistic regression, students from a rural background had a nearly 8-fold increase in the odds of intention to practice rurally after graduation compared to those from urban backgrounds (OR 7.84, 95% CI 4.10, 14.99, P < 0.001). Those intending to be generalists rather than specialists had a more than 4-fold increase in the odds of intention to practice rurally (OR 4.36, 95% CI 1.69, 11.22, P < 0.001). After controlling for these 2 factors, those with rural intent had significantly lower academic entry scores (P = 0.002) and marginally lower interview scores (P = 0.045). UMAT percentile scores were no different. Those intending to work in a rural location were also more likely to be female (OR 1.93, 95% CI 1.08, 3.48, P = 0.027), to come from the lower eight IRSAD deciles (OR 2.52, 95% CI 1.47, 4.32, P = 0.001) and to come from Government vs independent schools (OR 2.02, 95% CI 1.15, 3.55, P = 0.015).ConclusionsVery high academic scores generally required for medical school entry may have the unintended consequence of selecting fewer graduates interested in a rural practice destination. Increased efforts to recruit students from lower socioeconomic backgrounds may be beneficial in terms of an ultimate intended rural practice destination.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6920-14-218) contains supplementary material, which is available to authorized users.

Are rural placements positively associated with rural intentions in medical graduates?

Medical school curricula remain one of the key levers in increasing the future supply of rural doctors. Data from Australia and overseas have suggested exposure to rural practice via rural placements during basic medical training is positively associated with graduates becoming rural doctors. However, previous studies have suffered from serious methodological limitations. This study sought to determine whether rural clinical placements are associated with a higher proportion of graduating students planning rural careers and to explore associations with timing, duration and location of placements. Data were obtained from the Medical Schools Outcomes Database and Longitudinal Tracking Project, which is a longitudinal study with a high response rate that prospectively collects data, including practice location intention, from all Australian medical schools. Using logistic regression analysis, the association between placements and rural career intention was assessed, controlling for a number of demographic and contextual variables. The association between rural/remote placements later in the programme and rural practice intention was strongly positive whether viewed as simple occurrence or as duration, in contrast to later urban placements, which were strongly negative. A longer duration of placement enhanced the associations reported. Non-metropolitan medical schools were also associated with higher odds of intention to take up rural practice. However, the association with rural placements was overshadowed by the strong positive associations with rural background of students and their stated intention to become a rural doctor at the start of their studies. Exposure to rural practice during basic medical training, and the location and curriculum focus of a medical school are confirmed as factors that are positively associated with students' intention to become rural doctors after graduation. However, rural origin and the early intentions at the start of their medical training are better predictors of expressed intention to take up rural practice than rural clinical placements.

Rural intentions: Sexuality in Danish homeland cinema

Abstract This article focuses on the central importance of issues of sexuality, gender and the body in Danish homeland cinema. It demonstrates how the characters’ physical and emotional bond with the land and the livestock has a significant physical component which, considered in connection with a libidinal crisis of the films’ young couples, may be taken to harbour a sexual potential. Many of the films illustrate crises of procreative heterosexuality that threaten the rural heritage. The article posits marked sexual overtones in the aesthetic interdependence of virtue and villainy and the way moral encounters are staged. Sexually aggressive characters who threaten a passive couple may function as necessary sexual activators. Likewise, natural forces that provoke intense physical and emotional reactions are examined for their sexual associations. Apart from dangerous forces and characters, homeland cinema features many positively portrayed queer characters and relationships, which include male homoerotic relationships involving the hero.

Attracting psychologists to practice in rural Australia: The role of work values and perceptions of the rural work environment

To investigate whether psychologists' career/work values and perceptions of the rural work environment influence their intentions or choice to practise in a rural location beyond the effect of rural background. Online, cross-sectional survey assessed rural background, work values and perceptions of the reinforcers available in rural and urban work environments. One hundred and eighty-nine first year psychology students (78.8% women) and 124 registered psychologists (84.7% women). Students' intention to practise in a rural location and psychologists' choice of practice location. Rural environments were seen as offering psychologists less opportunity than urban environments to fulfil their need for lifestyle, prestige, management and scholarly pursuits, but more opportunity for service and autonomy. Practitioners and students who placed less value on prestige were more likely to have worked in a rural area or be intending to do so. High value of service was also a predictor of rural intentions. Perceptions that rural work environments offered opportunities for scholarly pursuits increased the odds that a psychologist had spent time practising in a rural area. Person-environment fit was not significant. Recruitment and retention strategies to address the shortage of mental health professionals in rural areas need to consider perceptions of the work environment and how to fulfil practitioners' work values.

Faculty staff and rural placement supervisors' pre‐ and post‐placement perceptions of a clinical rural placement programme in NSW Australia

Staff views on a rural clinical placement involving 4th year dental undergraduates from the University of Sydney (Australia) were collected in order to monitor whether the programme was feasible and acceptable to the academic Faculty Staff and the rural clinical supervisors. An evaluation of the rural placement programme was undertaken in 2009 at three rural sites in New South Wales (Australia). Semi-structured pre- and post-placement in person interviews recorded the views of three University Faculty Staff whilst similar data were collected by telephone interviews for three supervising clinicians at the rural clinical sites. Interviews gathered opinions on the organisation, implementation and outcomes of the rural placement programme. Eight qualitative analysis identified themes were specified and included communication, programme duration, effect on students and staff, benefits of the programme, rural intentions, programme sustainability and the success of the programme. Positive pre-placement aspects were potentially good clinical experience, new environment, sharing of knowledge and interaction with a rural community. Negative issues were anxieties about students' clinical ability to offer a service, missing lectures and maintaining clinical training quotas. The post-placement themes were generally positive; staff reported that the students enjoyed the rural community experience, their communication and clinical skills improved. According to the staff, the placement programme was feasible and provided acceptable positive clinical and personal development for the students. This research will help educators planning to incorporate a rural clinical programme into a University curriculum.

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.

The SOMERS Index: A simple instrument designed to predict the likelihood of rural career choice

The World Health Organization has drawn up a set of strategies to encourage health workers to live and work in remote and rural areas. A comprehensive instrument designed to evaluate the effectiveness of such programs has not yet been tested. Factors such as Stated rural intention, Optional rural training, Medical sub-specialization, Ease (or self-efficacy) and Rural Status have been used individually or in limited combinations. This paper examines the development, validity, structure and reliability of the easily-administered SOMERS Index. Limited literature review and cross-sectional cohort study. Australian medical school. A total of 345 Australian undergraduate-entry medical students in years 1 to 4 of the 5-year course. Validity of the factors as predictors of rural career choice was sought in the international literature. Structure of the index was investigated through Principal Components Analysis and regression modelling. Cronbach's alpha was the test for reliability. The international literature strongly supported the validity of the components of the index. Factor analysis revealed a single, strong factor (eigenvalue: 2.78) explaining 56% of the variance. Multiple regression modelling revealed that each of the other variables contributed independently and strongly to Stated Rural Intent (semi-partial correlation coefficients range: 0.20-0.25). Cronbach's alpha was high at 0.78. This paper presents the reliability and validity of an index, which seeks to estimate the likelihood of rural career choice. The index might be useful in student selection, the allocation of rural undergraduate and postgraduate resources and the evaluation of programs designed to increase rural career choice.

What does it take? The influence of rural upbringing and sense of rural background on medical students' intention to work in a rural environment

There is abundant evidence that rural origin is an influence on rural career choice. Rural origin is widely used to select students to be supported into programs designed to address the rural medical workforce shortage. What is not as clear is how many years of rural upbringing are required to have a maximal effect on rural career choice. Neither is the place of having a sense of rural background well understood. A cross-sectional self-completed paper-based survey of all students in years one through four of the Monash University medical course was undertaken in 2003. The survey included a scale to measure stated rural career intention as well as questions about the number of years of rural upbringing and whether students had a sense of rural background. The Rural Intention score was divided into three categories: strong urban intent, strong rural intent, and an intermediate, less certain intent. There was an 88% (n = 399) response rate from students holding Commonwealth Supported Places. Approximately 30% of these claimed a sense of rural background, and 28% had more than 8 years of rural upbringing. Twenty-five percent stated a strong intention to choose a rural career and 34.5% had strong urban intent. The remaining 40.5% were in the intermediate group. Almost all students (97.5%) with over 5 years of rural upbringing had developed a sense of rural background, and almost all (97.5%) with less than 5 years' rural upbringing denied a sense of rural background. Rural intent was high for those with a sense of rural background and those with more than 8 years of rural upbringing, but the students who had had from 4 to 8 years of rural upbringing mainly fell into the 'uncertain' category. In this cohort of almost 400 Australian medical students, a sense of rural background developed at a clear point, around 5 years of rural upbringing. Students with a sense of rural background were likely to develop a strong rural intent several years before similar students who had failed to make this connection with a rural community. This latter group displayed uncertainty toward a rural career choice, possibly due to unfamiliarity. Unlike those with strong urban intent, these students have not excluded a rural career and should be supported. The inclusion of a measure of the intention of students to work in a rural environment is likely to increase the reliability and validity of selection procedures.

Contextual Analysis of Rural Migration Intention: A Comparison of Taiwanese and Pennsylvania Data

This paper uses the interactional community approach to examine the effects of community attachment and quality of life on migration intention in rural Pennsylvania and Taiwanese communities. Both quality of life and community attachment were found to have positive effects on reducing migration intention. Similar patterns were found in both data sets, although the hypothesis that quality of life mediates the effect of community attachment on migration intention was not supported in the Taiwanese data. Separate models that include additional measures of community attachment and quality of life are needed to further elaborate the mediating effect of quality of life on the relationship between community attachment and migration intention.

Contextual Analysis of Rural Migration Intention: A Comparison of Taiwanese and Pennsylvania Data

Contextual Analysis of Rural Migration Intention: A Comparison of Taiwanese and Pennsylvania Data