Rural clinical school outcomes: what is success and how long do we wait for it?

To the Editor: The main criterion for the success of any rural clinical school (RCS) should be a substantial proportion of graduates in the rural health workforce after completing postgraduate training. As RCS graduates comprise only 25% of all Commonwealth-supported medical school places, RCSs on their own will never meet the needs of the 32% of the Australian population in rural areas;1 and it is impossible to compel, and unreasonable to expect, all RCS graduates to enter rural practice. A target of 50% of RCS graduates in rural practice would seem ambitious but not inappropriate, given the level of financial support for the RCS program. However, targeted and actual outcomes may differ, depending on the location of RCS training and future regional employment options. For example, the demographics and locations of RCS training are very different in rural Western Australia (substantially outer regional and remote) compared with rural Victoria (substantially inner regional).

Assessing outcomes takes time. The minimum time from graduation to completion of training ranges from 4 years (for general practice) to 6–10 years (for other specialties), but is often longer because of delays occasioned by indecision, lack of access to training positions, and delays during training (eg, parental leave). The question then is how long after graduation should we wait before assessing the workplace location of RCS graduates.

We compared January 2013 and January 2014 practice location data for graduates from the Melbourne Medical School RCS.2 For the 47 graduates from 2006, there was an encouraging 58% increase in those practising in a in rural location (Australian Standard Geographical Classification – Remoteness Areas 2–5).3 In graduating years 2007–2013, the proportion in rural practice varied from 13% to 33% and showed either no change or a decrease in rural location of practice over the 12-month period.

The recent increased numbers in rural practice of the 2006 graduates is encouraging in terms of desired RCS outcomes, and is consistent with the predicted time delay (> 7 years) required before assessing the success of the RCS program.