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ObjectiveTo capture and better understand patients’ experience during their healthcare journey from hospital admission to discharge, and to identify patient suggestions for improvement.DesignProspective, exploratory, qualitative study. Patients were asked to complete an unstructured written diary expressed in their own words, recording negative and positive experiences or anything else they considered noteworthy.Participants and settingPatients undergoing vascular surgery in a metropolitan hospital.Primary outcome measuresComplete diary transcripts underwent a general inductive thematic analysis, and opportunities to improve the experience of care were identified and collated.ResultsWe recruited 113 patients in order to collect 80 completed diaries from 78 participants (a participant response rate of 69%), recording patients’ experiences of their hospital-stay journey. Participating patients were a median (range) age of 69 (21–99) years and diaries contained a median (range) of 197 (26–1672) words each. Study participants with a tertiary education wrote more in their diaries than those without—a median (range) of 353.5 (48–1672) vs 163 (26–1599) words, respectively (Mann-Whitney U test, p=0.001). Three primary and eight secondary themes emerged from analysis of diary transcripts—primary themes being: (1) communication as central to care; (2) importance of feeling cared for and (3) environmental factors shaping experiences. In the great majority, participants reported positive experiences on the hospital ward. However, a set of 12 patient suggestions for improvement were identified, the majority of which could be addressed with little cost but result in substantial improvements in patient experience. Half of the 12 suggestions for improvement fell into primary theme 1, concerning opportunities to improve communication between healthcare providers and patients.ConclusionsUnstructured diaries completed in a patient’s own words appear to be an effective and simple approach to capture the hospital-stay experience from the patient’s own perspective, and to identify opportunities for improvement.

Introduction: In most countries it remains a challenge to sustain the rural medical workforce. Based on evidence that medical students with rural backgrounds are more likely than their urban peers to enter rural practice, medical schools may have rural entry pathways. It is less well established what happens to career intentions during medical school. This study assessed how rural intentions persist or change during medical school and sought factors associated with either persistence or change in rural intention. Methods: Students who participate in the Medical Schools Outcomes Database and Longitudinal Tracking project complete surveys at entry to and exit from medical school. They are asked about demographics, career intentions and influencing factors.

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Introduction: New Zealand (NZ) faces an ongoing shortage of rural medical professionals. In an effort to increase interest in rural practice, both of the medical schools in NZ offer rural immersion programs as well as rural entry pathways. The aim of this study was to compare the effect of long (>33-week) rural immersion with a short (5-week interprofessional) rural immersion or no rural immersion on the career location intentions of NZ medical students. Methods: This observational study used linked data from the Commencing Medical Students Questionnaire (CMSQ) and Exit Questionnaire (EQ), collected between 2011 and 2017 as part of the Medical Schools Outcomes Database project, along with information on whether or not a student undertook a rural immersion program. The main outcome measure was EQ career location intention (Rural (population <25 000), Regional (25 000-100 000) or Urban (>100 000)). The explanatory variables were rural immersion (long, short, none), age, ethnicity, background, CMSQ career location intention, gender, specialisation preferences and interest in rural medicine. In addition to univariate analysis, data were used to build a multinomial model to determine relative associations of these variables with the outcome. Results: Full data were available for 1367 NZ medical students (47% of all students during the time period). Of these, 17.4% had undertaken a long or short rural immersion program. In univariate analysis, age was the only variable that did not significantly predict EQ rural intention outcome. In the multivariate model, rural immersion was a significant independent predictor of EQ career location intention. Students taking a long rural immersion were 6.4 and 4.4 times more likely to select a Rural or Regional intention, respectively, than those with no rural immersion. This strong effect on rural intentions was seen regardless of background. CMSQ career location intention, background, ethnicity, rural club membership and preference for general practice were also significant predictors. While short rural immersion did not have an independent effect, this finding should be interpreted with caution given the smaller number of students and the response rate. Conclusions: Long rural immersion is highly beneficial for increasing interest in rural work, increasing the likelihood that medical students will intend to work outside an urban setting. Students who signal an early rural intention are strong candidates for such programs later in their course, regardless of their background. A three-category classification for geographic background and career location intention permitted a more detailed understanding of the interplay among demographic variables and rural immersion in influencing career intentions. Following cohorts into their postgraduate years is needed to ascertain if these career location intentions persist.