Objective: To use short-term indicators (hospital internship choice, and interest in a future rural career) to assess how the University of Queensland rural clinical school is meeting its program objectives.
Results: Most students were from an urban background. Over the year, interest in a future rural medical career increased measurably across the cohort. The most important factors in choosing to study at the UQRCS were the quality of teaching, level of student contact with clinical teachers, increased patient access, and accommodation facilities. Comparison of graduates’ choice of internship location for 2006 compared with 2005 showed a trend away from urban or metropolitan toward regional or rural hospitals.
Conclusions: Our results suggest that the primary attraction of UQRCS is the quality of education, and rural undergraduate training is a popular choice for urban students. Although the long-term effect on rural medical workforce remains to be determined, the trend at UQRCS of new graduates choosing non-urban internships is encouraging.
Rural clinical schools are now established through federal funding in most medical schools in Australia,1 and are required to provide 25% of medical students with at least 50% of their clinical training. A major expectation is that this will encourage rural medical workforce recruitment and retention.1
The rural clinical school at the University of Queensland (UQRCS), established in 2002, is part of the School of Medicine’s 4-year graduate MB BS program. Year 4 students may elect to train in the Central or Southern (capital city) Divisions, or the Rural Division, comprising teaching sites throughout regional and rural central and south-west Queensland. This report presents an update on how the UQRCS is addressing the need to prepare and encourage its students to enter rural medical practice.
University of Queensland Year 4 MB BS students undertook their entire fourth year (2006) of clinical training in the UQRCS. Two questionnaires, the entry survey (administered at the start of Year 4) and exit survey (end of Year 4) were developed or modified (2003–2005) to capture the most important variables related to choosing rural medicine as a career.2
Analysis revealed no significant differences in responses by sex, age or UQRCS location. Results are presented in aggregate as the 2006 UQRCS cohort (n = 28). Surveys were administered on the first (entry) and last (exit) day of their clinical year, but, because of absences, 17 and 27 students completed the surveys, respectively. Most students were male (18), aged 25–29 years (17), and single (19). Eight students reported a rural background.
The entry survey asked students to rank their degree of interest in pursuing a rural medicine career on an 11-point scale of − 5 to − 1 (no interest) to +1 to +5 (strong interest), with a midpoint of neutral. Fifteen of the 17 students rated their degree of interest in the positive, with two reporting neutral interest.
Likewise, the exit survey asked, How did your year at the UQRCS alter your interest in pursuing a rural medicine career? Using a similar 11-point scale of − 5 to − 1 (discouraged my interest) to +1 to +5 (encouraged my interest) with a midpoint of no change, only two students registered discouragement. Twenty-two were encouraged and three reported no change. Box 1 shows the trend toward a positive effect of the UQRCS on interest in a future rural medicine career.
On exit, the most important factors related to choosing to study at the UQRCS were the quality of teaching, level of student–teacher contact, and high patient access (Box 2). Availability of free accommodation also ranked highly, as did rurality (location) of the UQRCS.
We measured the effect of the UQRCS on students’ desire to pursue a rural career and found a positive effect on interest from the start to the end of their final year. Furthermore, more than half of the 2006 cohort chose internships in large rural centres rather than in other urban or metropolitan centres.
Our study is limited by its cross-sectional design, using a small cohort of rural clinical school students from one university. It emphasises the need for longitudinal tracking of medical graduates’ careers, in particular from rural clinical schools, to provide evidence for any effect of rural clinical schools on the shortage of rural doctors.
Evidence is mounting in support of a strong relationship between rural educational exposure and an increased interest in pursuing a rural career or selecting a rural internship.4 Students’ choice of internship location (urban hospital versus regional or rural hospital) is an important indication of their desire to pursue rural medicine.
Our cohort reported that rural location was not of the highest importance in their decision to train at the UQRCS. Given the importance of rurality to the rationale underpinning the rural clinical schools program, this may appear disappointing. However, a quality educational program would be expected to attract students, and if clinical training within the UQRCS encourages rural career intentions, the aim of workforce recruitment through rural clinical school placement appears satisfactorily managed.
Most of our cohort was of urban origin, a feature noted in other rural clinical schools or programs with a rural focus.2 There is strong evidence for a relationship between geographical background and predictors of practice locality,5,6 but studies have identified that up to 74% of rural doctors have an urban background.6 This illustrates the important role that rural clinical schools play in developing and encouraging an interest in rural medicine among students of both urban and rural backgrounds.
1 Effect of the University of Queensland rural clinical school over the year on Year 4 students’ interest in pursuing a career in rural medicine
2 Important factors in choosing to study at the University of Queensland rural clinical school (UQRCS)
Student responses, means and standard deviations are represented as ratings of each statement on a Likert scale of 1 (not at all important), 2 (somewhat important), 3 (important), 4 (very important) and 5 (extremely important).
3 Intern location choice for Year 4 University of Queensland rural clinical school (UQRCS) graduates in 2005 and 2006
- 1. Australian Government Department of Health and Ageing. Rural clinical schools program. http://health.gov.au/clinicalschools (accessed Jun 2007).
- 2. Eley D, Baker P. Does recruitment lead to retention? Rural clinical school training experiences and subsequent intern choices. Rural Remote Health [Internet] 2006; 6: 511. http://www.rrh.org.au/articles/defaultnew.asp?Issue No=6x (accessed Jun 2007).
- 3. Australian Rural and Remote Workforce Agencies Group. Review of the Rural and Remote Metropolitan Areas Classification System. A submission to the Department of Health and Ageing. Melbourne: ARRWAG, 2005. http://www.arrwag.com.au/client_images/84169.pdf (accessed Mar 2007).
- 4. Tolhurst HM, Adams J, Stewart SM. An exploration of when urban background medical students become interested in rural practice. Rural Remote Health [Internet] 2006; 6: 452. http://www.rrh.org.au/articles/defaultnew.asp?Issue No=6x (accessed Jun 2007).
- 5. Laven G, Wilkinson D. Rural doctors and rural backgrounds: how strong is the evidence? A systematic review. Aust J Rural Health 2003; 11: 277-284.
- 6. Wilkinson D, Laven G, Pratt N, Beilby J. Impact of undergraduate and postgraduate rural training, and medical school entry criteria on rural practice among Australian general practitioners: a national study of 2414 doctors. Med Educ 2003; 37: 809-814.
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