To the Editor: Recent reports have highlighted problems with our capacity to teach medical students.1,2 Others have described workforce problems, calling for innovative approaches.3 The Rural Internship program at the James Cook University (JCU) School of Medicine may contribute to such strategies.

The first regionally based medical program in Australia, the School was founded in 2000 and has recently graduated its first cohort.4 All final-year students undertake an 8-week rural internship, having previously completed 12 weeks of structured rural placements in their 2nd and 4th years, and a core 2nd-year subject — Rural, Remote, Indigenous and Tropical Health.

The rural internship allows students to develop and practise clinical skills in a rural context. All students in the first cohort completed the rotation in 2005 in hospitals across northern Queensland, usually in groups of two or three, providing full-time inpatient, outpatient and after-hours duties under supervision. Hospitals were in rural and remote communities (Rural, Remote and Metropolitan Area classifications 4–7; comprising rural areas with populations < 24 999 to remote areas with populations < 5000), with demonstrated capacity to supervise and teach. Most were 2–4-doctor hospitals, although one larger hospital (Mt Isa, 35 doctors) and one smaller hospital (Moranbah, one doctor) were used. Supervision was provided by experienced rural doctors (medical superintendents and senior medical officers) holding an FACRRM or equivalent.

Evaluation in the first year included student questionnaires, site visits, interviews and follow-up teleconferences with instructors. Early evaluation suggests that the rural internship provides senior students with valuable experience in the health care team. Students accept limited responsibility and further their abilities and confidence to undertake the role of the intern. Importantly, specific feedback from medical superintendents indicated that the rural interns made a net contribution to the system when teaching time and supervision were considered. The rotation appears to meet educational objectives without burdening (indeed, possibly bolstering) the local workforce. This is consistent with other reports of students undertaking extended rural experiences.5 It also addresses a common conundrum: rural instructors and communities are keen to teach students and appreciate the long-term workforce implications, but are constrained by resources, particularly time.

This model extends and enhances apprenticeship-style medical education through its rural focus, distributed delivery and involvement of the entire cohort of students. The contribution to patient care by senior students and junior doctors creates a consultant–registrar–resident model, in which experienced rural doctors function as consultants providing advice, support and tuition rather than predominantly face-to-face patient care. We feel that this innovative approach should be explored in other settings.