Influences on medical students' decisions to study at a rural clinical school.

OBJECTIVE: To identify factors that influenced medical students at Monash University to undertake their first year of clinical training (third year of the medical course) at a rural clinical school (RCS). DESIGN: Third-year Monash University medical students undertaking clinical placements at a RCS were surveyed in 2005. A semistructured questionnaire was used to ask students to rate the influence of a list of factors on their decision to undertake their year-long placement at a RCS. RESULTS: Under half (48%) of students studying at an RCS reported that they were of rural background. All surveyed items were identified as having had a positive influence. Greater clinical experience, learning opportunities and patient access were identified as having the greatest positive influence followed closely by free accommodation and other financial and supportive incentives. Future rural career intention was eight times more likely to be a positive influence in rural compared with urban background students. CONCLUSION: The most important positive influence on Monash third-year medical students' decision to study at an RCS is the perception of high-quality clinical experiences and education. This perception arises from rural exposure during pre-clinical years.

Where is the evidence that rural exposure increases uptake of rural medical practice?

Australian Government initiatives to address medical workforce shortages in rural Australia include increasing the intake of students of rural background and increasing exposure to rural medicine during training. Rural-orientated medical training programs in the USA that selectively admit students from rural backgrounds and who intend to practise as family practitioners have demonstrated success in increasing uptake of practice in rural/underserved areas. However, in examining the specific contribution of rural exposure towards increasing uptake of rural practice, the evidence is inconclusive, largely due to the failure to adjust for these critical independent predictors of rural practice. This paper identifies this evidence gap, examines the concept of rural exposure, and highlights the need to identify which aspects of rural exposure contribute to a positive attitude towards rural practice, thereby influencing students to return to rural areas. The cost of rural exposure through student placements is not insignificant, and there is a need to identify which aspects are most effective in increasing the uptake of rural practice, thereby helping to address the medical workforce shortage experienced in rural Australia.

The challenge of cross-cultural assessment--The Test of Ability To Explain for Zulu-speaking Children.

UNLABELLED: A culturally appropriate test, The Test of Ability To Explain for Zulu-speaking Children (TATE-ZC), was developed to measure verbal problem solving skills of rural, Zulu-speaking, primary school children. Principles of 'non-biased' assessment, as well as emic (culture specific) and etic (universal) aspects of intelligence formed the theoretical backdrop. In addition, specific principles relating to test translation; test content; culturally appropriate stimulus material; scoring procedures and test administration were applied. Five categories of abstract thinking skills formed the basis of the TATE-ZC. These were: (a) Explaining Inferences, (b) Determining Cause, (c) Negative Why Questions, (d) Determining Solutions and (e) Avoiding Problem. The process of test development underwent three pilot studies. Results indicate that the TATE-ZC is a reliable and valid test for the target population. A critical analysis of the efficacy of creating a test of verbal reasoning for children from the developing world concludes the article. LEARNING OUTCOMES: As a result of this activity (1) the participant will have a clearer understanding of the principles that need to be followed when developing culturally appropriate test material; (2) the participant will understand the process of developing culturally appropriate test material for non-mainstream cultures; (3) the participant will be able to apply the process and principles to other cross-cultural testing situations.