National study of the impact of rural immersion programs on intended location of medical practice in New Zealand

Abstract

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.

Influence of a rural interprofessional education placement on the rural health workforce: working in primary care, rural settings, and with Māori

“…This is consistent with medical student research findings that long, but not short, rural immersion programmes increased rural practice intentions. 4 Three years' post-graduation may be too early; however, to determine whether short rural immersion placements ultimately help to meet rural health workforce needs. Many early-career clinicians are still undertaking prescribed training programmes (eg medical pre-vocational training) or moving around to gain wide experience around the country or world.…”

“…1 Clinical placements can influence attitudes towards rural careers and decisions to work rurally. 2,3 Year-long rural immersion placements increased Australian allied health graduates' rural practice participation after 1 year 2 and Aotearoa New Zealand (NZ) medical graduates' rural/ regional practice intentions; 4 however, less is known about the impact of shorter rural placements. It is also unknown whether rural intentions translate to actual rural workforce participation, and whether early increased participation is maintained over time.…”

National cross-sectional study of the sociodemographic characteristics of Aotearoa New Zealand’s regulated health workforce pre-registration students: a mirror on society?

“…From equity and needs-based perspectives, there are arguments that health professionals from diverse backgrounds contribute to health equity through the impact their careers have on the education of others, they are more likely to focus their research on the communities they serve and engage with, and their leadership has the potential to benefit the entire system. [16][17][18][19] With these responsibilities in mind, NZ has recently implemented health reforms, with the creation of two new national agencies, Te Aka Whai Ora (Māori Health Authority) and Te Whatu Ora (Health New Zealand). These two agencies sit alongside the Ministry of Health (MoH), and all three are responsible for ensuring the production of a fit-for-purpose, sustainable health workforce.…”

Effects of a regional–rural immersion program in Northland, New Zealand, on returning to work in that region

“…Rural exposure during medical training might be for the entirety of the program in rurally based schools, 10 or through rural immersion of varying duration and structure (3 weeks to a year or more) in urban-based programs (immersion programs). [11][12][13][14] The latter positively impacts rural work intentions 11 and the likelihood of rural practice, independent of rural origin. 15,16 Research that has assessed the impact of immersion programs on the workforce outcomes of medical students has often focused on whether graduates return to areas broadly similar to the rural immersion context in terms of population size or degree of remoteness.…”

“…Medical schools often institute curriculum‐based strategies in addition to selection‐based initiatives to foster rural workforce outcomes in medical graduates. Rural exposure during medical training might be for the entirety of the program in rurally based schools, 10 or through rural immersion of varying duration and structure (3 weeks to a year or more) in urban‐based programs (immersion programs) 11–14 . The latter positively impacts rural work intentions 11 and the likelihood of rural practice, independent of rural origin 15,16 …”