Reporting rural workforce outcomes of rural-based postgraduate vocational training

To the Editor: Following calls to bridge the evidence gap regarding rural exposure and uptake into rural medical practice,1 Rural Clinical Schools (RCS) regularly report graduate rural career outcomes. This permits comparison of approaches and quality improvement of the program.

Comparatively little is reported from the postgraduate rural-based vocational training programs. Just as the evidence gap for RCS required bridging, a similar approach should be adopted as standing key performance outcome indicators of regional training providers.

Ministerial review of general practice training previously identified a chronic undersupply of rural doctors as a “pressing concern” for government.2 Rural vocational training needs were determined as a priority in establishing the regionalised Australian General Practice Training (AGPT) program in 2002. The program requires 50% of vocational training to be conducted in rural areas to improve distribution of general practitioners into rural and regional areas.3 Yet, unlike RCS, in the AGPT program, training providers are not required to routinely report their rural workforce outcomes.

Two key performance outcome indicators are proposed: rural retention rate (RRR) and advanced rural skills proportion (ARSP). RRR reflects the number of registrars in rural practice 1 or more years after completing training. Advanced rural skill training acquisition is not available to RCS, but has been identified as increasing rural retention,4 and is intimately related to rural retention and workforce outcomes. ARSP is the proportion of all completing registrars who achieved Fellowship in Australian College of Rural and Remote Medicine or Fellowship in Advanced Rural General Practice.

These are both reasonable and appropriate measures of rural workforce contribution. Such sentinel measures would permit comparison between programs, leading to further improvement of vocational rural medical education.

In one dedicated rural medical vocational training program in Queensland, the RRR is 75% (38/51 registrars since the exclusive rural pathway was delivered) and the ARSP is 49% (25/51).

Dedicated rural medicine training contributes to the short- and intermediate-term rural medical workforce. This contribution should be measured using key sentinel measures in addition to detailed multivariate analyses.