Longitudinal rural clerkships: increased likelihood of more remote rural medical practice following graduation

Abstract

BackgroundExtended rural clerkships clearly increase the likelihood of rural practice post-graduation. What has not been determined is whether such rural interventions increase the likelihood of graduates practicing in more remote, versus inner regional, locations.MethodsThe Australian Health Practitioner Regulation Agency database was used to identify the current workplace of every graduate of the Medical School of Western Australia, 1980 to 2011. There were 324 graduates working in a primary practice location defined by the Australian Standard Geographical Classification as inner regional to very remote. They were divided into 3 groups - 200 graduates who entered medical school before commencement of the Rural Clinical School of Western Australia (RCSWA), 63 who entered after the RCSWA had started, but not participated in RCSWA, and 61 who participated in the RCSWA. The RCSWA offers a longitudinal rural clinical clerkship throughout level 5 of the MBBS course.ResultsThe two groups not participating in the RCSWA had 45.5% and 52.4% of subjects in outer regional/very remote locations, respectively. In comparison, 78.7% of those who had participated in the RCSWA were currently practicing in outer regional/very remote locations. When the 3 groups were compared, the significant predictors of working in a more remote practice compared to working in an inner regional area were being female (OR 1.75 95% CI 1.13, 2.72, P = 0.013) and participating in the RCSWA (OR 4.42, 95% CI 2.26, 8.67, P < 0.001). In multivariate logistic regression that corrected for gender and remoteness of rural address before entry to medical school, participation in the RCSWA still predicted a more than 4-fold increase in the odds of practicing in a more remote area (OR 4.11, 95% CI 2.04, 8.30, P < 0.001).ConclusionExtended rural clinical clerkship during an undergraduate MBBS course is related to a much greater likelihood of practicing in more remote, under-serviced rural locations.

Preparing Graduates to Meet the Allied Health Workforce Needs in Rural Australia: Short-Term Outcomes from a Longitudinal Study

“…As in the medical literature [9][10][11][12], this study found that students with a rural or remote background were more likely to be located in a rural or remote workplace, 2.350 times more likely than graduates from a metropolitan background, (95% CI 1.056-5.229). This is similar to findings from other rural training programs which have found that graduates from a rural background were more likely to enter rural practice (OR 2.30, 95% CI = 1.57-3.36).…”

“…Of the graduates from a metropolitan background who were influenced by their rural placement, 79% had chosen a rural or remote location when deciding to take up their current employment. This highlights an important finding, that even though rural background has been strongly linked to future rural employment [9][10][11][12], the impact of rural-based education on those from a metropolitan background should not be overlooked as an important source for the future rural workforce, particularly if longer-term outcomes are tracked. We found that 52% of graduates were working in rural or remote locations after one year, which compares favorably with previous data from the Australian Graduate Survey.…”

Predictors of remote practice location in the first seven cohorts of James Cook University MBBS graduates

“…This work is significant as a number of studies have evaluated the impact of rurally oriented programs at universities like JCU, the University of Queensland and the University of Western Australia 13,14,[16][17][18] . While it is clear that some of these programs are meeting their aims of producing increasing numbers of graduates who are working in rural and remote locations, with concomitant growth in the rural workforce, it is important to consider whether all communities are benefiting from these initiatives.…”

What does 'rural return' mean? Rural-origin medical graduates do not 'go home'

“…There is early evidence that medical students placed for an undergraduate year in rural and remote locations go on to return to more remote locations than those not so placed 4,5 . Those placed remotely for postgraduate training appear also to remain more remote 6 .…”