Rural Workforce Research Articles

An inverted U-shaped relationship between work-family conflict and job burnout among village clinic doctors: the moderating effect of information and communication technology use

BackgroundVillage clinic doctors are an integral part of the rural healthcare workforce. With the advancement of science and technology and the coronavirus disease 2019 (COVID-19) pandemic, the prevalence of remote work and the use of information and communication technologies (ICT) have increased significantly. However, these developments have also had an impact on the work family balance and mental well-being of village clinic doctors. The study aimed to explore how work-family conflict affected job burnout and what the role of ICT use was in this relationship.MethodsThis was a cross-sectional study. Data were collected collected through an anonymous self-administered questionnaire survey conducted in December 2021 in Shandong Province, China. A total of 1,093 village clinic doctors participated in the survey. The data were analyzed using multiple linear regression and the PROCESS macro in SPSS.ResultsThe results showed that an inverted U-shaped relationship between work-family conflict and job burnout among village clinic doctors. Specifically, the squared term of work-family conflict had a negative coefficient (-0.324). The slope was positive (SL=2.291) at the low end of the X-range and negative (SH=-0.379) at the high end. The turning point occurred at X = 1.227(-2.309 ≤ X ≤ 1.812). Additionally, ICT use positively moderated between work-family conflict and job burnout (β1β4-β2β3 = 0.217, β4 > 0).ConclusionsThe work-family conflict has an inverted U-shaped effect on job burnout, while the use of ICT positively moderates this relationship between work-family conflict and job burnout. Policymakers should pay attention to the effects of ICT use and work-family conflict on job burnout among village clinic doctors.

Improving rural and remote health workforce retention amid global workforce shortages: a scoping review of evaluated workforce interventions.

The aim of this study was to conduct a scoping review of a global body of scholarly and industry (grey) literature for evidence of implemented and evaluated interventions to identify best practice workforce retention strategies for organisations providing health services in rural and remote areas. A scoping review was conducted of the scholarly and grey literature by two independent researchers. This comprised a search of four scholarly databases, and a Google and website search for grey literature. Quality checks were conducted, and a total of 15 documents were included in the literature review. Using the World Health Organisation's categories of workforce intervention (regulatory, education, financial incentives, personal and professional support), the documents were analysed to identify effective workforce interventions. The literature review found evidence of regulatory impacts as well as organisation-level evaluated workforce interventions for education-to-employment pathways (education), remuneration programs (financial incentives) and working and living conditions (personal and professional support) but seldom provided insight into how successful interventions were implemented or evaluated at the organisational level. Further, there was an absence of scholarship contributing to the development of empirical evidence to inform organisations about designing, implementing and evaluating workforce strategies to improve health workforce retention in rural and remote communities. Few studies have focused on evidence-based organisation-level interventions to improve rural and remote workforce sustainability. This article offers insights to shape future intervention implementation and evaluation research for rural and remote health workforce sustainability.

Twelve Tips for Engaging Medical Students in Rural-Focused Research

Background The future of rural healthcare depends on training the future rural health workforce, and on rural health research that can guide clinical and policy decisions in rural spaces. Promotion of rural healthcare careers usually focuses on clinical aspects of care, and research may be seen as a lower priority. Supporting students to be involved in rural focused research offers the opportunity to broaden the pool of potentially rural interested students, and to develop research and scholarship skills and capacity in the future rural workforce. Aim and method We identify twelve tips that medical schools can adopt to foster medical student participation in research and promote student interest in rural healthcare and rural medical practice. These recommendations are based on a review of literature and our personal experience of conducting rural-focused research activities with medical students. Conclusion Through these twelve tips, we provide a practical framework for enhancing undergraduate medical student exposure to rural-focused research to foster research capacity. This has potential to inspire student interest in future rural medical practice and could contribute to alleviate workforce and research gaps in rural areas.

Growing the peer workforce in rural mental health and social and emotional well-being services: A scoping review of the literature.

Growing the mental health peer workforce holds promise for rural communities, but we currently lack an understanding of the guidance available to support the development, implementation and sustainability of this workforce in rural settings. Study aims are to: (1) determine the extent and nature of the literature that provides guidance for growing the peer workforce in rural mental health services; and (2) identify and explore any guidance relevant to rural peer work services dedicated to First Nations communities, including those promoting social and emotional well-being within this body of literature. A scoping review method was employed to identify relevant peer-reviewed and grey literature published between 2013 and 2022 across PsychInfo, Medline, Embase and CINAHL, Scopus and Informit HealthInfoNet databases, as well as targeted organisation websites and Google Advanced Search. A total of 26 unique studies/projects were included from the US, UK, Canada and Australia with public mental health, non-government/for purpose and private sector service settings represented in the literature. Grey literature, such as reports of evaluations and frameworks, formed the majority of included texts. While there is a lesser volume of rurally focused literature relative to the general peer work literature, this is a rich body of knowledge, which includes guidance concerning services dedicated to First Nations communities. Via synthesis critical considerations were identified for the development, implementation and sustainability of peer work in rural mental health services across six domains: 'Working with community members and stakeholders', 'Organisational culture and governance', Working with others and in teams, Professional expertise and experience, Being part of and working in the community and 'Local mental health services capacity'. While there are considerations relevant across a range of settings, the domains of: 'working with community members and stakeholders', 'being part of and working in the community' and 'local mental health services capacity', capture additional, distinct and nuanced challenges and opportunities for growing the peer work in rural services. The literature offers insights valuable for service planning, policy development and the allocation of resources to support rural peer workforce growth.

"Endogenous forces" and "exogenous forces": a study on the development of the rural teaching workforce in the context of rural revitalization

In the context of rural revitalization, the development of the rural teaching workforce relies on the synergistic promotion of endogenous forces and exogenous forces. endogenous forces mean internal driving forces that emphasize proactive and innovative personal motivation, while exogenous forces refer to external supports that focus on resource investment and policy guidance. However, an increasing emphasis on exogenous forces while neglecting endogenous forces has limited the sustainable development of China’s current rural teaching workforce. We believe that activating endogenous forces is a key and weak link in promoting the synergistic development of rural revitalization and the rural teaching workforce. Only when endogenous forces are activated by exogenous forces and achieve a "feedback" effect on exogenous forces can a positive cycle in the development of rural teachers be established. In summary, the collaborative development and mutual reinforcement of endogenous and exogenous forces will enhance the professional development of the rural teaching workforce.

It's more than just a rural GP shortage: challenging a dominant construction of the rural health workforce 'problem'.

It's more than just a rural GP shortage: challenging a dominant construction of the rural health workforce 'problem'.

Protesting the future: The evolution of the European farmer

Recent farmer protests across Europe demonstrate the complex challenges facing modern agriculture. This article examines the human story behind these protests. It explores how farmers’ roles have changed from respected innovators and providers to a group caught between environmental demands, economic pressures and shifting societal expectations. Neoliberal policies, green regulations and new workforce patterns have precipitated an identity crisis among European farmers. Their protests are not just about money but also about deep‐seated anxieties concerning their place in a rapidly changing world. Farmers struggle to balance traditions with new environmental imperatives, to maintain viable livelihoods in a global market and their unease with an increasingly diverse rural workforce. European farming is at a crossroads, pointing towards possible paths for a future.

Gender differences in factors associated with rural health care practice in Minnesota.

To understand gender differences in factors affecting rural health care workforce to inform the development of effective policies and recruitment strategies to address rural health care workforce shortages. A cross-sectional survey of health care professionals (including Advanced practice registered nurses (APRNs), physicians, physician assistants (PAs), and registered nurses (RNs)) in Minnesota was administered by the Minnesota Department of Health from October 18, 2021, to July 25, 2022, during their professional license renewal. The main outcome was whether or not the respondent was practicing in a rural area. The effects of factors associated with rural practice were estimated using binary logistic regression models, and subsequently subgroup analysis was conducted by gender across the four health care professions. Results show that although there were significant gender differences in some factors (growing up in a rural area and family considerations were more likely to influence women's decisions than men's, whereas men were more likely to be influenced by the prospect of having autonomy and broad scope of practice than women), these differences became insignificant when the four health care professionals were analyzed separately suggesting that overall gender differences observed were almost entirely explained by profession differences. Gender differences do not significantly influence the factors impacting rural practice. However, being raised in a rural environment emerges as the most influential predictor of rural practice underscoring the importance of involving rural residents of all genders in health care practice.

Training a rural oral health workforce: Effects of rural background on dentist practice choice

AbstractPurposeThe Regional Initiatives in Dental Education (RIDE) program is an educational track of the University of Washington School of Dentistry that aims to produce leaders who practice in rural areas of the Pacific Northwest. This study assesses outcomes of the first 10 years of the RIDE program. The hypothesis tested is that rural background is the most important predictor of long‐term rural dental practice.MethodsThis descriptive study assessed existing data including graduates' location of practice, demographics, rurality of origin, parental occupation, and practice type over time. Subjects are all graduates of the RIDE program from 2012 to 2021 (N = 80), and range in age from 25 to 50 years. Statistical analyses were utilized to explore associations.ResultsWithin the study sample 78% of graduates practiced in a rural and/or underserved area, 32.5% of graduates pursued post‐graduate dental training, 40% participated in Medicaid, and 78% practiced in the Pacific Northwest at the time of analysis (March 2023). Statistical analysis demonstrated a strong association and medium to large effect sizes between both rural upbringing and training sites and established dental practice in a rural region.ConclusionsGraduates of the RIDE program practice in rural areas in greater proportion compared to the general population of practicing dentists. RIDE graduates from the study period tended to be male, and white, and practice in a health professional shortage area or rural site. The rurality of origin analysis was confounded by the substantial number of graduates from Spokane, Washington, an urban area surrounded by extensive rural territory.

The right care in the right place: a scoping review of digital health education and training for rural healthcare workers

BackgroundDigital health offers unprecedented opportunities to enhance health service delivery across vast geographic regions. However, these benefits can only be realized with effective capabilities and clinical leadership of the rural healthcare workforce. Little is known about how rural healthcare workers acquire skills in digital health, how digital health education or training programs are evaluated and the barriers and enablers for high quality digital health education and training.ObjectiveTo conduct a scoping review to identify and synthesize existing evidence on digital health education and training of the rural healthcare workforce.Inclusion criteriaSources that reported digital health and education or training in the healthcare workforce in any healthcare setting outside metropolitan areas.MethodsWe searched for published and unpublished studies written in English in the last decade to August 2023. The databases searched were PubMed, Embase, Scopus, CINAHL and Education Resources Information Centre. We also searched the grey literature (Google, Google Scholar), conducted citation searching and stakeholder engagement. The JBI Scoping Review methodology and PRISMA guidelines for scoping reviews were used.ResultsFive articles met the eligibility criteria. Two case studies, one feasibility study, one micro-credential and one fellowship were described. The mode of delivery was commonly modular online learning. Only one article described an evaluation, and findings showed the train-the-trainer model was technically and pedagogically feasible and well received. A limited number of barriers and enablers for high quality education or training of the rural healthcare workforce were reported across macro (legal, regulatory, economic), meso (local health service and community) and micro (day-to-day practice) levels.ConclusionsUpskilling rural healthcare workers in digital health appears rare. Current best practice points to flexible, blended training programs that are suitably embedded with interdisciplinary and collaborative rural healthcare improvement initiatives. Future work to advance the field could define rural health informatician career pathways, address concurrent rural workforce issues, and conduct training implementation evaluations.Review registration numberOpen Science Framework: https://doi.org/10.17605/OSF.IO/N2RMX.

Rural healthcare workers' well-being: A systematic review of support interventions.

Although there is increased awareness about healthcare workers' (HCWs') stress and burnout after the COVID-19 pandemic, support interventions should be tailored according to the needs of HCWs. Given the unique challenges rural HCWs face, we sought to systematically identify the types of interventions specifically designed and utilized to support the well-being of HCWs practicing in rural settings. We conducted a comprehensive search of the existing literature through electronic databases to identify quantitative, qualitative, and mixed-methods studies describing supportive interventions for rural HCWs with well-being-related outcomes between January 1, 2023 and March 31, 2023. We used the Effective Public Health Practice Project, Mixed Methods Assessment Tool, and Joanna Briggs Institute Critical Appraisal Checklist to evaluate the study quality. Out of 1,583 identified records, 25 studies were included in the analysis. The studies described a wide range of supportive interventions and outcomes. The overall quality of the studies was weak to moderate. None of the studies were randomized and only six included controls. Included interventions were generally well- accepted. Quantitative and qualitative themes identified shared decision making, effective supervision, and proactive cultural change as promising interventions that warrant further exploration. Financial interventions alone were not effective. Most of the studies were either unfunded or were funded internally by the institutions. There is limited research in support interventions for rural HCWs. Larger, well-designed studies are needed to explore promising interventions to promote well-being of rural healthcare workforce. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Factors associated with early-career GPs' retention as independent specialists in former training practices.

Retention of general practice registrars in their training practices is important for addressing the GP workforce deficit and maldistribution of GPs. Given that rural and remote general practices are disproportionately affected by low retention, identifying the factors that promote retention may be as important as developing recruitment strategies in these areas. Quantifying the impact of relevant factors on registrar retention will enable a better understanding of how to incentivise retention and attenuate the loss of the rural workforce to other areas. We sought to establish the prevalence and associations of retention of general practice registrars in their training practices. This analysis was a component of the New alumni Experience of Training and independent Unsupervised Practice (NEXT-UP) study: a cross-sectional questionnaire-based study of early-career GPs in conjunction with evaluation of data contemporaneously recorded as part of vocational training. Participants were former registrars of three regional training organisations delivering general practice training in New South Wales, Tasmania, the Australian Capital Territory and Eastern Victoria, who had attained Fellowship of the Royal Australian College of General Practitioners or the Australian College of Rural and Remote Medicine between January 2016 and July 2018. The outcome measured was whether the registrar had previously worked at their current practice during vocational training. Multivariable logistic regression was used to estimate the association between relevant explanatory variables and the outcome. A total of 354 alumni responded (response rate 28%), of whom 322 provided data regarding previous training practice retention, with 190 (59%) having previously worked at their current practice as registrars. Among respondents who reported currently working in a regional-rural practice location (n=100), 69% reported having previously worked at their current practice during training. GPs were more likely to be retained by a practice they had trained at if it was of lower socioeconomic status (adjusted odds ratio (aOR) 0.82 (95% confidence interval (CI) 0.73-0.91), p<0.001 for each decile of socioeconomic status) and if the practice provided two or more of home visits, nursing home visits or after-hours services (aOR 4.29 (95%CI 2.10-8.75), p<0.001). They were less likely to be retained by the practice if training was completed in a regional-rural area (aOR 0.35 (95%CI 0.17-0.72), p=0.004). Regional-rural training location is associated with reduced odds of subsequent retention of general practice registrars. This is occurring despite significant government investment in expansion of general practice training in regional and rural areas. The practice factor most strongly associated with GP retention was the provision of out-of-practice and after-hours care. There may be altruistic, rather than monetary, reasons that explain this finding. Such training opportunities, if provided to all trainees, especially in regional and rural areas, would be a learning opportunity, a way of promoting holistic community-based care and an incentive for subsequent retention within the practice and community as an established GP.

Exploring learning characteristics and progression ofGPtrainees based in regional, rural and remote settings:Aqualitative study.

Globally, most doctors train and work in metropolitan areas but a key strategy for developing the rural health workforce is expanding rural training. The aim of this study was to describe the scope and quality of learning along with skill acquisition of GP trainees based in regional, rural, and remote settings. Regional, rural and remote settings in Queensland Australia excluding Brisbane. Thirty-seven general practice trainees who had undertaken their first community placement were recruited from regional, rural and remote learning settings within Queensland. Qualitative descriptive methodology based on constructionist epistemology was employed which allowed for the exploration of current GP trainees' experiences. Trainees were interviewed and data were thematically analysed as to the scope and quality of learning by the setting of training. Learning experiences were then mapped against the Dreyfus and Dreyfus model to explore skill acquisition. In terms of the scope and quality of learning, rural and remote trainees mainly focused on the diverse and unique (sometimes challenging) experiences their setting offered compared with regionally based trainees. Mapping of the trainee comments to the Dreyfus model of skill acquisition demonstrated that regardless of setting, equivalent learning occurred by GP trainees. This exploratory study provides evidence that rural and remote learning may provide a more diverse and challenging experience. It suggests an equivalence of quality of education and skill acquisition across settings rural, regional and remote. This suggests that the training distribution policies may not disadvantage GP trainees and the scope and quality of more remote learning may increase uptake of remote placements.

Practice outcomes for the first decade of Rural Pharmacy Education (RPHARM) Program graduates

BackgroundThe maldistribution of pharmacy services in underserved areas is a national issue. Analysis of data from the 2019 National Pharmacist Workforce Study indicated that 13.9% of pharmacists were working in a rural community. However, the percentage of people living in rural communities in the United States is 20.0%. Currently, there are 20 rural pharmacy programs in the United States, including the Rural Pharmacy Education (RPHARM) Program at University of Illinois Chicago (UIC) College of Pharmacy, which contain both didactic and experiential rural components. This research project examines the practice outcomes of the RPHARM Program graduates.MethodsDescriptive analysis was used to examine the practice outcome characteristics of RPHARM Program graduates between 2014 and 2023. The characteristics of the RPHARM graduates included the rurality of hometowns, practice locations and populations, and distance of practice locations to hometowns. Rural practice outcomes were described utilizing frequently used rural definitions. The practice locations of 54 of the 61 RPHARM graduates were used in the analysis.ResultsApproximately 41% of the practicing RPHARM graduates were from rural hometowns and two-thirds were female. RPHARM graduates mostly work in either a community setting (44.4%) or a hospital setting (37.0%). Approximately 11% worked in a federal government organization and 5.6% worked in a long-term care pharmacy. When examining job location, 42.6% were working in a rural location based on Rural–Urban Commuting Area Version 3.0 and 35.2% of RPHARM graduates had always worked in a rural location. Approximately 57% of practicing RPHARM graduates are working in a location < 50 miles from their hometown, and 13% are working 50 to 100 miles from their hometown. Approximately 74% of RPHARM graduates are practicing in Illinois.ConclusionsApproximately 40% of RPHARM graduates practice in rural locations. A significant portion (35.2%) of RPHARM graduates have always practiced in rural locations, and many (57.4%) are practicing near their hometowns. Results indicate that the RPHARM Program is making meaningful contributions to increasing the rural pharmacy workforce. Due to the lack of information on rural pharmacy practice outcomes, all programs with rural pharmacy content are encouraged to track graduates’ practice locations.

Developing a rural paediatrician workforce: Using social network analysis to examine influence on reasons to go rural.

This pilot study examines how rural and remote junior doctors' career decisions are influenced by collegial relationships within the discipline of general paediatrics. Social network analysis (SNA) was undertaken by structured interviews with 10 paediatricians working in regional towns in Western Australia. UNICET software was used to determine the interactions between individual networks to look for overlap and common influencers. Ten rural paediatricians were interviewed. An individual was found to have key measures of centrality at the core of the entire social network of rural general paediatricians. This included a high degree of 'betweenness' (connections within social networks), and a high broker index (connections between separate areas of a network or between networks) demonstrated by that person combining three disconnected networks into a single coherent network. This central individual was a recently appointed consultant with links to senior paediatricians, peers and junior trainees, and may be instrumental in recruitment and retention in the rural paediatric workforce. Improving understanding of the impact of social networks, and decision-making processes that influence rural career choices, can inform innovative solutions to develop sustainable strategies for recruiting and retaining the rural paediatric workforce. Applying this model on a larger scale may provide more data to support evidence-based programmes that enable this within the Australian context.

DEMOGRAPHIC, ECONOMIC AND PSYCHOLOGICAL DRIVERS OF WOMEN'S PARTICIPATION IN RURAL TOURISM IN DARJEELING DISTRICT, WEST BENGAL, INDIA

Rural tourism has gained global popularity, with varying characteristics across regions. This study explores the demographic, economic, and psychological factors influencing women's participation in rural tourism in Darjeeling, West Bengal, India. Despite its proximity to Sikkim, Darjeeling remains under-researched, particularly regarding women's motivations. Data from 200 women, including 50 in the hospitality sector, were collected via a pre-tested, interviewer-administered questionnaire to understand the push factors for their involvement. The analysis shows that middle-aged, married women with secondary or less education dominate the rural tourism workforce. Their primary motivations are economic need, improved educational opportunities for their children, and escaping socioeconomic challenges. Significant economic drivers include contributing to family businesses and achieving financial independence. Psychological factors, such as improving living conditions and securing future stability, also play a crucial role, though aspirations for leadership and decision-making are less prominent due to cultural norms. The findings highlight rural tourism's critical role in providing employment and empowerment opportunities for women in Darjeeling. Enhancing participation and empowerment requires addressing economic and psychological needs, improving income levels, supporting leadership roles, and fostering greater family decision-making power. These efforts can strengthen women's involvement in rural tourism, boosting their socioeconomic development and quality of life.

Location and access to health courses for rural students: an Australian audit

BackgroundThe undersupply of health professionals in rural areas impacts healthcare access for those living in rural Australia. A strategy to increase the rural health workforce is to recruit and educate rural people. However, long-standing inequities for rural Australians in accessing tertiary education persist. The aim of this study was to audit the 2023 offerings of Australian allied health, nursing, dental and medical university courses to identify geographical availability and those delivered online.MethodsA desktop audit of Australian allied health, nursing, dental and medical courses offered in 2023 was undertaken to identify the courses and delivery modes of those courses offered in regional, rural and remote locations. The audit involved searching lists of professionally accredited courses and university websites, which is publicly available information about health courses. Data were tabulated and descriptive statistics used for data analysis.ResultsThere were marked differences in online and rural course offerings across health professions in Modified Monash (MM) Model category 2–7 locations. Nursing/midwifery had the most courses while pharmacy, podiatry, dental and medicine had few offerings and optometry had none. Social work, nursing/midwifery and psychology also had the most online course offerings. Most courses were offered in MM2 and MM3 locations with few offerings in rural or remote areas. The availability of studying part-time was very limited and often this was only for the early years of the course. Inconsistencies relating to the course information on university websites existed relating to course delivery mode descriptions.ConclusionsThere is a lack of rural on-campus or online course offerings for some allied health disciplines, dentistry and medicine. Provision of end-to-end, flexible courses in rural areas or online is needed to reduce access barriers for rural students and to enable sustainable rural health workforce development.

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

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

Influence of a rural Longitudinal Integrated Clerkship on medical graduates’ geographic and specialty decisions: a constructivist grounded theory study

BackgroundLike many countries, Australia is suffering from a longstanding and persistent medical workforce maldistribution with fewer doctors per capita in rural locations and a trend towards sub-specialisation. Longitudinal Integrated Clerkships (LIC), a medical education model, are more likely than other clerkship models to produce graduates who work rurally, in communities of increasing remoteness and in primary care. While this quantitative data is essential, there has been a dearth of program-specific evidence explaining this phenomenon.MethodsTo address this knowledge gap, a constructivist qualitative grounded theory approach was employed to identify how the Deakin University comprehensive rural LIC influences graduates’ (2011–2020) career decisions in terms of both medical specialty and geographic practice location.ResultsThirty-nine graduates participated in qualitative interviews. The Rural LIC Career Decision Making Framework was developed, postulating that an alignment of personal and program factors under the central concept of ‘choosing to participate’ can influence graduates’ geographic and specialist career decisions, both individually and symbiotically. Once embedded in the clerkship, participation was augmented by the concepts of learning design affordance and learning in place, providing the participants with longitudinal opportunities to experience and compare medical disciplines in an integrated manner.ConclusionsThe developed framework presents contextual elements of the program that were deemed influential on graduates’ subsequent career decisions. The alignment of these elements with the program’s mission statement has the capacity to enhance the program’s rural workforce goals. Regardless of graduates’ willingness to participate in the program, a transformation occurred. Transformation occurs through reflection, either challenging or confirming the graduate’s pre-conceived ideas about career decisions and in turn influencing professional identity formation.

Towards a home-grown rural health workforce: Evidence from Tasmania, Australia.

To examine the association between place of origin and principal place of practice (PPP) of domestic Tasmanian health graduates who received end-to-end training with the University of Tasmania (UTAS). The 2022 PPP for all UTAS domestic Tasmanian graduates from medicine, nursing, pharmacy, psychology, medical radiation science and paramedicine between 2011 and 2020 was identified using the online Australian Health Practitioner Regulation Agency (Ahpra) registration database. The graduate's place of origin (home address at the time of course application), together with their 2022 PPP, was described using the Modified Monash Model (MM) classification system of remoteness. Data were analysed using STATA. Over the 10-year period, 4079 domestic Tasmanians graduated from health courses at UTAS, of which 3850 (94.4%) were matched to an Australian PPP. In all, 78.3% of graduates were working in Tasmania, while the remainder (21.7%) were employed interstate. Of those with a Tasmanian PPP, 81.4% were working in a regional setting (MM2), while 77.6% of interstate employed graduates recorded a metropolitan (MM1) PPP. Rural place of origin (MM3-7) was associated with rural employment (MM3-7) in both Tasmania (OR, 37.08; 95% CI 29.01-47.39, p < 0.001), and on the Australian mainland (OR, 21.4; 95% CI 17.4-26.3, p < 0.001). Most domestic Tasmanian origin UTAS health graduates contribute to the state's health workforce after qualifying. Further research is needed to explore PPP over time and to understand why some graduates are motivated to seek employment on the Australian mainland and in particular, metropolitan cities.